Δευτέρα, 8 Φεβρουαρίου 2016

Glucose control in critically ill diabetic: Not so sweet

SK Todi

Indian Journal of Critical Care Medicine 2016 20(2):65-66



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Impact of clinical pharmacist in an Indian Intensive Care Unit

Mohamed Hisham, Mudalipalayam N Sivakumar, Ganesh Veerasekar

Indian Journal of Critical Care Medicine 2016 20(2):78-83

Background and Objectives: A critically ill patient is treated and reviewed by physicians from different specialties; hence, polypharmacy is a very common. This study was conducted to assess the impact and effectiveness of having a clinical pharmacist in an Indian Intensive Care Unit (ICU). It also evaluates the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety. Materials and Methods: The prospective, observational study was carried out in medical and surgical/trauma ICU over a period of 1 year. All detected drug-related problems and interventions were categorized based on the Pharmaceutical Care Network Europe system. Results: During the study period, average monthly census of 1032 patients got treated in the ICUs. A total of 986 pharmaceutical interventions due to drug-related problems were documented, whereof medication errors accounted for 42.6% (n = 420), drug of choice problem 15.4% (n = 152), drug-drug interactions were 15.1% (n = 149), Y-site drug incompatibility was 13.7% (n = 135), drug dosing problems were 4.8% (n = 47), drug duplications reported were 4.6% (n = 45), and adverse drug reactions documented were 3.8% (n = 38). Drug dosing adjustment done by the clinical pharmacist included 140 (11.9%) renal dose, 62 (5.2%) hepatic dose, 17 (1.4%) pediatric dose, and 104 (8.8%) insulin dosing modifications. A total of 577 drug and poison information queries were answered by the clinical pharmacist. Conclusion: Clinical pharmacist as a part of multidisciplinary team in our study was associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.

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Correlation of measurement of optic nerve sheath diameter with ultrasound and magnetic resonance imaging

Munta Kartik, Manimala S Rao

Indian Journal of Critical Care Medicine 2016 20(2):126-126



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Physiotherapy practice patterns in Intensive Care Units of Nepal: A multicenter survey

Sumana Baidya, Ranjeeta S Acharya, Michel W Coppieters

Indian Journal of Critical Care Medicine 2016 20(2):84-90

Context: As physiotherapy (PT) is a young profession in Nepal, there is a dearth of insight into the common practices of physiotherapists in critical care. Aims: To identify the availability of PT services in Intensive Care Units (ICUs) and articulate the common practices by physiotherapists in ICUs of Nepal. Settings and Design: All tertiary care hospitals across Nepal with ICU facility via an exploratory cross-sectional survey. Subjects and Methods: An existing questionnaire was distributed to all the physiotherapists currently working in ICUs of Nepal with 2 years of experience. The survey was sent via E-mail or given in person to 86 physiotherapists. Statistical Analysis Used: Descriptive and inferential statistics according to nature of data. Results: The response rate was 60% (n = 52). In the majority of hospitals (68%), PT service was provided only after a physician consultation, and few hospitals (13%) had established hospital criteria for PT in ICUs. Private hospitals (57.1%) were providing PT service in weekends compared to government hospitals (32.1%) (P = 0.17). The likelihood of routine PT involvement varied significantly with the clinical scenarios (highest 71.2% status cerebrovascular accident, lowest 3.8% myocardial infarction, P < 0.001). The most preferred PT treatment was chest PT (53.8%) and positioning (21.2%) while least preferred was therapeutic exercise (3.8%) irrespective of clinical scenarios. Conclusions: There is a lack of regular PT service during weekends in ICUs of Nepal. Most of the cases are treated by physiotherapists only after physician's referral. The preferred intervention seems to be limited only to chest PT and physiotherapists are not practicing therapeutic exercise and functional mobility training to a great extent.

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Unusual manufacturing defect of the endotracheal tube: Problem revisited

Subrata Kumar Singha, Smita Kujur

Indian Journal of Critical Care Medicine 2016 20(2):130-131



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Airway accidents in critical care unit: A 3-year retrospective study in a Public Teaching Hospital of Eastern India

Sugata Dasgupta, Shipti Shradha Singh, Arunima Chaudhuri, Dipasri Bhattacharya, Sourav Das Choudhury

Indian Journal of Critical Care Medicine 2016 20(2):91-96

Background: Although tracheal tubes are essential devices to control and protect airway in a critical care unit (CCU), they are not free from complications. Aims: To document the incidence and nature of airway accidents in the CCU of a government teaching hospital in Eastern India. Methods: Retrospective analysis of all airway accidents in a 5-bedded (medical and surgical) CCU. The number, types, timing, and severity of airway accidents were analyzed. Results: The total accident rate was 19 in 233 intubated and/or tracheostomized patients over 1657 tube days (TDs) during 3 years. Fourteen occurred in 232 endotracheally intubated patients over 1075 endotracheal tube (ETT) days, and five occurred in 44 tracheostomized patients over 580 tracheostomy TDs. Fifteen accidents were due to blocked tubes. Rest four were unplanned extubations (UEs), all being accidental extubations. All blockages occurred during night shifts and all UEs during day shifts. Five accidents were mild, the rest moderate. No major accident led to cardiorespiratory arrest or death. All blockages occurred after 7th day of intubation. The outcome of accidents were more favorable in tracheostomy group compared to ETT group (P = 0.001). Conclusions: The prevalence of airway accidents was 8.2 accidents per 100 patients. Blockages were the most common accidents followed by UEs. Ten out of the 15 blockages and all 4 UEs were in endotracheally intubated patients. Tracheostomized patients had 5 blockages and no UEs.

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Cerebral venous thrombosis presenting with intracerebral hemorrhage in a patient with paroxysmal nocturnal hemoglobinuria

Gentle Sunder Shrestha, Bishesh Sharma Poudyal, Gopal Sedain, Khandokar Imran Mahmud, Niranja Acharya

Indian Journal of Critical Care Medicine 2016 20(2):117-119

Cerebral venous thrombosis (CVT) is an uncommon cause of stroke. Paroxysmal nocturnal hemoglobinuria (PNH) is a rare type of hemolytic anemia, frequently associated with thrombophilia. PNH may rarely present with CVT. Approximately, one-third of the patients with CVT develop cerebral hemorrhage. Here, we present a rare combination of CVT presenting with intracerebral hemorrhage in a patient with PNH. High index of suspicion is needed to avoid misdiagnosis. Patient was successfully managed with anticoagulation therapy.

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Author response to Dr Wises letter

We welcome the opportunity to respond to the concerns of Dr Wise1 from the American Chemistry Council, regarding our report on the association between childhood infections and use of bleach at home.2

Dr Wise expresses disappointment with ‘design flaws’ and ‘the speculative nature of our conclusions’. We do not agree that our study was badly designed, and the limitations have been carefully considered and discussed in our original paper. We relied on questionnaires for both exposure and outcome, but this does not imply flawed results or bad study design. Obviously, future studies are needed with better exposure and outcome assessment to further address the causal nature of the associations, as we acknowledge in the discussion.

Dr Wise is particularly concerned about the reliability of self-reported illnesses. Indeed, no further description of the targeted infections was given to the parents, nor were these illnesses confirmed by medical diagnosis. The...



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Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi's sarcoma in five countries across sub-Saharan Africa.

Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi's sarcoma in five countries across sub-Saharan Africa.

BMC Cancer. 2016;16(1):65

Authors: Freeman E, Semeere A, Wenger M, Bwana M, Asirwa FC, Busakhala N, Oga E, Jedy-Agba E, Kwaghe V, Iregbu K, Jaquet A, Dabis F, Yumo HA, Dusingize JC, Bangsberg D, Anastos K, Phiri S, Bohlius J, Egger M, Yiannoutsos C, Wools-Kaloustian K, Martin J

Abstract
BACKGROUND: Survival after diagnosis is a fundamental concern in cancer epidemiology. In resource-rich settings, ambient clinical databases, municipal data and cancer registries make survival estimation in real-world populations relatively straightforward. In resource-poor settings, given the deficiencies in a variety of health-related data systems, it is less clear how well we can determine cancer survival from ambient data.
METHODS: We addressed this issue in sub-Saharan Africa for Kaposi's sarcoma (KS), a cancer for which incidence has exploded with the HIV epidemic but for which survival in the region may be changing with the recent advent of antiretroviral therapy (ART). From 33 primary care HIV Clinics in Kenya, Uganda, Malawi, Nigeria and Cameroon participating in the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortia in 2009-2012, we identified 1328 adults with newly diagnosed KS. Patients were evaluated from KS diagnosis until death, transfer to another facility or database closure.
RESULTS: Nominally, 22 % of patients were estimated to be dead by 2 years, but this estimate was clouded by 45 % cumulative lost to follow-up with unknown vital status by 2 years. After adjustment for site and CD4 count, age <30 years and male sex were independently associated with becoming lost.
CONCLUSIONS: In this community-based sample of patients diagnosed with KS in sub-Saharan Africa, almost half became lost to follow-up by 2 years. This precluded accurate estimation of survival. Until we either generally strengthen data systems or implement cancer-specific enhancements (e.g., tracking of the lost) in the region, insights from cancer epidemiology will be limited.

PMID: 26852390 [PubMed - as supplied by publisher]



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Are mental health services getting better at responding to abuse, assault and neglect?

Are mental health services getting better at responding to abuse, assault and neglect?

Acta Psychiatr Scand. 2016 Feb 7;

Authors: Read J, Sampson M, Critchley C

Abstract
OBJECTIVE: To determine whether staff responses to abuse disclosures had improved since the introduction of a trauma policy and training programme.
METHOD: The files of 250 clients attending four New Zealand mental health centres were audited.
RESULTS: There was a significant improvement, compared to an audit prior to the introduction of the policy and training, in the proportion of abuse cases included in formulations, and, to a lesser extent, in treatment plans. There was no significant improvement in the proportion referred for relevant treatment, which remained at less than 25% across abuse categories. The proportion of neglect disclosures responded to was significantly lower than for abuse cases. Fifty percent of the files in which abuse/neglect was recorded noted whether the client had been asked about previous disclosure, and 22% noted whether the client thought there was any connection between the abuse/neglect and their current problems. Less than 1% of cases were reported to legal authorities. People diagnosed with a psychotic disorder were significantly less likely to be responded to appropriately.
CONCLUSION: Future training may need to focus on responding well to neglect and people diagnosed with psychosis, on making treatment referrals, and on initiating discussions about reporting to authorities.

PMID: 26852371 [PubMed - as supplied by publisher]



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The adsorption of tetracycline and vancomycin onto nanodiamond with controlled release.

The adsorption of tetracycline and vancomycin onto nanodiamond with controlled release.

J Colloid Interface Sci. 2016 Jan 28;468:253-261

Authors: Giammarco J, Mochalin VN, Haeckel J, Gogotsi Y

Abstract
The unique properties and tailorable surface of detonation nanodiamonds have given rise to an abundance of potential biomedical applications. Very little is known about the details of adsorption/desorption equilibria of drugs on/from nanodiamonds with different purity, surface chemistry, and agglomeration state. The studies presented here delve into the details of adsorption and desorption of tetracycline (TET) and vancomycin (VAN) on nanodiamond, which are critically important for the rational design of the nanodiamond drug delivery systems. The nanodiamonds studied in these experiments were as-received (ND), purified and carboxyl terminated (ND-COOH), and aminated (ND-NH2). The monolayer capacities of the drugs loaded onto the nanodiamonds are reported herein using Langmuir and Freundlich isotherm models. The results from the desorption studies demonstrate that, by changing the pH environment of drug loaded nanodiamond using buffers of pH 4.09, 7.45, 8.02, and a phosphate buffered saline (PBS) solution, the drug release can effectively be triggered.

PMID: 26852349 [PubMed - as supplied by publisher]



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The Effectiveness of SMS Reminders on Appointment Attendance: a Meta-Analysis.

The Effectiveness of SMS Reminders on Appointment Attendance: a Meta-Analysis.

J Med Syst. 2016 Apr;40(4):90

Authors: Boksmati N, Butler-Henderson K, Anderson K, Sahama T

Abstract
To identify the efficacy of short message service (SMS) reminders in health care appointment attendance. A systematic review was undertaken to identify studies published between 2005 and 2015 that compared the attendance rates of patients receiving SMS reminders compared to patients not receiving a reminder. Each article was examined for information regarding the study design, sample size, population demographics and intervention methods. A meta-analysis was used to calculate a pooled estimate odds ratio. Twenty-eight (28) studies were included in the review, including 13 (46 %) randomized controlled trials. The pooled odds ratio of the randomized control trials was 1.62 (1.35-1.94). Half of the studies reviewed sent the reminder within 48 h prior to the appointment time, yet no significant subgroups differences with respect to participant age, SMS timing, rate or type, setting or specialty was detectable. All studies, except one with a small sample size, demonstrated a positive OR, indicating SMS reminders were an effective means of improving appointment attendance. There was no significant difference in OR when controlling for when the SMS was sent, the frequency of the reminders or the content of the reminder. SMS appointment reminders are an effective and operative method in improving appointment attendance in a health care setting and this effectiveness has improved over the past 5 years. Further research is required to identify the optimal SMS reminder timing and frequency, specifically in relation to the length of time since the appointment.

PMID: 26852337 [PubMed - as supplied by publisher]



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Recently diagnosed rheumatoid arthritis patients benefit from a treat-to-target strategy: results from the DREAM registry.

Recently diagnosed rheumatoid arthritis patients benefit from a treat-to-target strategy: results from the DREAM registry.

Clin Rheumatol. 2016 Feb 6;

Authors: Steunebrink LM, Vonkeman HE, Ten Klooster PM, Hoekstra M, van Riel PL, van de Laar MA

Abstract
Despite considerable evidence on the efficacy and safety of early aggressive treat-to-target (T2T) strategies in early rheumatoid arthritis (RA), a proportion of patients still fail to reach remission. The goal of this study is to examine remission rates and predictors of remission in a real life T2T cohort of consecutive patients with a recent diagnosis of RA. Baseline demographics, clinical, laboratory and patient-reported variables and 1-year follow-up disease activity data were used from patients with early RA included in the DREAM remission induction cohort II study. Survival analyses and simple and multivariable logistic regression analyses were used to examine remission rates and significant predictors of achieving remission. A total of 137 recently diagnosed consecutive RA patients were available for this study. During the first year after inclusion, DAS28 remission was achieved at least once in 77.2 % of the patients and the median time to first remission was 17 weeks. None of the examined baseline variables were robustly associated with achieving remission within 1 year and in the multivariable analysis only lower ESR (p = 0.005) remained significantly associated with achieving fast remission within 17 weeks. During the first year of their disease a high proportion of recently diagnosed RA patient achieved remission, with only a small percentage of patients needing bDMARD therapy. Combined with the absence of baseline predictors of remission, this suggests that clinicians in daily clinical practice may focus on DAS28 scores only, without needing to take other patients characteristics into account.

PMID: 26852313 [PubMed - as supplied by publisher]



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Four complement factor H gene polymorphisms in association with AMD: A meta-analysis.

Four complement factor H gene polymorphisms in association with AMD: A meta-analysis.

Arch Gerontol Geriatr. 2016 Jan 28;64:123-129

Authors: Liao X, Lan CJ, Cheuk IW, Tan QQ

Abstract
AIM: To investigate the possible association between CFH gene polymorphisms -543G>A (rs1410996), A473A (rs2274700), -257C>T (rs3753394), IVS15 (rs1329428) and AMD risk.
METHODS: We searched the published literature in the Medline and Scopus from inception to May 2015. A meta-analysis was performed by the programs RevMan 5.1 and Stata 12.0, and the Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated in fixed or random effect model based on heterogeneity test among studies.
RESULTS: Nineteen studies with a total of 10,676 subjects were included in the present meta-analysis. A statistical significant association was observed between AMD risk and CFH -543G>A polymorphism with OR of 1.77 (95% CI, 1.47-2.12), 2.24 (95% CI, 1.71-2.94), 0.49 (95% CI, 0.38-0.62) and 0.25 (95% CI, 0.18-0.37) in additive, dominant, recessive and codominant models, respectively. Similar results were obtained in polymorphisms A473A, -257C>T, IVS15. Furthermore, stratified analysis for ethnicity showed a significantly strong association between -543G>A, A473A polymorphisms and AMD risk.
CONCLUSION: The present meta-analysis suggested that CFH -543G>A, A473A, -257C>T, and IVS15 polymorphisms might be moderately associated with AMD risk. This conclusion warrants confirmation by further studies.

PMID: 26852301 [PubMed - as supplied by publisher]



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Differentiation of myocardial ischemia and infarction assessed by dynamic computed tomography perfusion imaging and comparison with cardiac magnetic resonance and single-photon emission computed tomography.

Differentiation of myocardial ischemia and infarction assessed by dynamic computed tomography perfusion imaging and comparison with cardiac magnetic resonance and single-photon emission computed tomography.

Eur Radiol. 2016 Feb 6;

Authors: Tanabe Y, Kido T, Uetani T, Kurata A, Kono T, Ogimoto A, Miyagawa M, Soma T, Murase K, Iwaki H, Mochizuki T

Abstract
OBJECTIVES: To evaluate the feasibility of myocardial blood flow (MBF) by computed tomography from dynamic CT perfusion (CTP) for detecting myocardial ischemia and infarction assessed by cardiac magnetic resonance (CMR) or single-photon emission computed tomography (SPECT).
METHODS: Fifty-three patients who underwent stress dynamic CTP and either SPECT (n = 25) or CMR (n = 28) were retrospectively selected. Normal and abnormal perfused myocardium (ischemia/infarction) were assessed by SPECT/CMR using 16-segment model. Sensitivity and specificity of CT-MBF (mL/g/min) for detecting the ischemic/infarction and severe infarction were assessed.
RESULTS: The abnormal perfused myocardium and severe infarction were seen in SPECT (n = 90 and n = 19 of 400 segments) and CMR (n = 223 and n = 36 of 448 segments). For detecting the abnormal perfused myocardium, sensitivity and specificity were 80 % (95 %CI, 71-90) and 86 % (95 %CI, 76-91) in SPECT (cut-off MBF, 1.23), and 82 % (95 %CI, 76-88) and 87 % (95 %CI, 80-92) in CMR (cut-off MBF, 1.25). For detecting severe infarction, sensitivity and specificity were 95 % (95 %CI, 52-100) and 72 % (95 %CI, 53-91) in SPECT (cut-off MBF, 0.92), and 78 % (95 %CI, 67-97) and 80 % (95 %CI, 58-86) in CMR (cut-off MBF, 0.98), respectively.
CONCLUSIONS: Dynamic CTP has a potential to detect abnormal perfused myocardium and severe infarction assessed by SPECT/CMR using comparable cut-off MBF.
KEY POINTS: • CT-MBF accurately reflects the severity of myocardial perfusion abnormality. • CT-MBF provides good diagnostic accuracy for detecting myocardial perfusion abnormalities. • CT-MBF may assist in stratifying severe myocardial infarction in abnormal perfusion myocardium.

PMID: 26852220 [PubMed - as supplied by publisher]



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Assessment of conjunctival goblet cell density using laser scanning confocal microscopy versus impression cytology.

Assessment of conjunctival goblet cell density using laser scanning confocal microscopy versus impression cytology.

Cont Lens Anterior Eye. 2016 Feb 3;

Authors: Colorado LH, Alzahrani Y, Pritchard N, Efron N

Abstract
PURPOSE: To determine the association between conjunctival goblet cell density (GCD) assessed using in vivo laser scanning confocal microscopy and conjunctival impression cytology in a healthy population.
METHODS: Ninety (90) healthy participants undertook a validated 5-item dry eye questionnaire, non-invasive tear film break-up time measurement, ocular surface fluorescein staining and phenol red thread test. These tests where undertaken to diagnose and exclude participants with dry eye. The nasal bulbar conjunctiva was imaged using laser scanning confocal microscopy (LSCM). Conjunctival impression cytology (CIC) was performed in the same region a few minutes later. Conjunctival goblet cell density was calculated as cells/mm(2).
RESULTS: There was a strong positive correlation of conjunctival GCD between LSCM and CIC (ρ=0.66). Conjunctival goblet cell density was 475±41 cells/mm(2) and 466±51 cells/mm(2) measured by LSCM and CIC, respectively.
CONCLUSIONS: The strong association between in vivo and in vitro cellular analysis for measuring conjunctival GCD suggests that the more invasive CIC can be replaced by the less invasive LSCM in research and clinical practice.

PMID: 26852166 [PubMed - as supplied by publisher]



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Bridging the gap between science and policy: an international survey of scientists and policy makers in China and Canada.

Bridging the gap between science and policy: an international survey of scientists and policy makers in China and Canada.

Implement Sci. 2016;11(1):16

Authors: Choi BC, Li L, Lu Y, Zhang LR, Zhu Y, Pak AW, Chen Y, Little J

Abstract
BACKGROUND: Bridging the gap between science and policy is an important task in evidence-informed policy making. The objective of this study is to prioritize ways to bridge the gap.
METHODS: The study was based on an online survey of high-ranking scientists and policy makers who have a senior position in universities and governments in the health sector in China and Canada. The sampling frame comprised of universities with schools of public health and medicine and various levels of government in health and public health. Participants included university presidents and professors, and government deputy ministers, directors general and directors working in the health field. Fourteen strategies were presented to the participants for ranking as current ways and ideal ways in the future to bridge the gap between science and policy.
RESULTS: Over a 3-month survey period, there were 121 participants in China and 86 in Canada with response rates of 30.0 and 15.9 %, respectively. The top strategies selected by respondents included focus on policy (conducting research that focuses on policy questions), science-policy forums, and policy briefs, both as current ways and ideal ways to bridge the gap between science and policy. Conferences were considered a priority strategy as a current way, but not an ideal way in the future. Canadian participants were more in favor of using information technology (web-based portals and email updates) than their Chinese counterparts. Among Canadian participants, two strategies that were ranked low as current ways (collaboration in study design and collaboration in analysis) became a priority as ideal ways. This could signal a change in thinking in shifting the focus from the "back end" or "downstream" (knowledge dissemination) of the knowledge transfer process to the "front end" or "upstream" (knowledge generation).
CONCLUSIONS: Our international study has confirmed a number of previously reported priority strategies to bridge the gap between science and policy. More importantly, our study has contributed to the future work on evidence-based policy making by comparing the responses from China and Canada and the current and ideal way for the future. Our study shows that the concept and strategies of bridging the gap between science and policy are not static but varying in space and evolving over time.

PMID: 26852131 [PubMed - as supplied by publisher]



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Silver nanoparticles synthesized from Adenium obesum leaf extract induced DNA damage, apoptosis and autophagy via generation of reactive oxygen species.

Silver nanoparticles synthesized from Adenium obesum leaf extract induced DNA damage, apoptosis and autophagy via generation of reactive oxygen species.

Colloids Surf B Biointerfaces. 2016 Jan 18;141:158-169

Authors: Farah MA, Ali MA, Chen SM, Li Y, Al-Hemaid FM, Abou-Tarboush FM, Al-Anazi KM, Lee J

Abstract
Silver nanoparticles (AgNPs) are an important class of nanomaterial used for a wide range of industrial and biomedical applications. Adenium obesum is a plant of the family Apocynaceae that is rich in toxic cardiac glycosides; however, there is scarce information on the anticancer potential of its AgNPs. We herein report the novel biosynthesis of AgNPs using aqueous leaf extract of A. obesum (AOAgNPs). The synthesis of AOAgNPs was monitored by color change and ultraviolet-visible spectroscopy (425nm). It was further characterized by Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD) and transmission electron microscopy (TEM). The FTIR spectra for the AOAgNPs indicated the presence of terpenoids, long chain fatty acids, secondary amide derivatives and proteins that could be responsible for the reduction and capping of the formed AOAgNPs. X-ray diffraction confirmed the crystallinity of the AgNPs. The TEM images revealed mostly spherical particles in the size range of 10-30nm. The biological properties of novel AOAgNPs were investigated on MCF-7 breast cancer cells. Cell viability was determined by the MTT assay. Generation of reactive oxygen species (ROS), DNA damage, induction of apoptosis and autophagy were assessed. A dose-dependent decrease in the cell viability was observed. The IC50 value was calculated as 217μg/ml. Both qualitative and quantitative evaluation confirmed about a 2.5 fold increase in the generation of ROS at the highest concentration of 150μg/ml. A significant (p<0.05) increase in the DNA damage evaluated by comet assay was evident. Flow cytometry revealed an increase in the apoptotic cells (24%) in the AOAgNPs treated group compared to the control. Acridine orange staining of acidic vesicles in exposed cells confirmed the induction of autophagy. These findings suggest that AOAgNPs increased the level of ROS resulting in heightened the DNA damage, apoptosis and autophagy in MCF-7 cells.

PMID: 26852099 [PubMed - as supplied by publisher]



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[Experimentation of an e-platform to detect situations at risk of cardiac impairment (platform E-care) in an internal medicine unit].

[Experimentation of an e-platform to detect situations at risk of cardiac impairment (platform E-care) in an internal medicine unit].

Rev Med Interne. 2016 Feb 3;

Authors: Andrès E, Talha S, Benyahia A, Keller O, Hajjam M, Moukadem A, Dieterlen A, Hajjam J, Ervé S, Hajjam A

Abstract
INTRODUCTION: Monitoring patients with heart failure by telemedicine systems is a potential means susceptible to optimize the management of these patients and avoid life-threatening emergencies. In this context, we experimented in internal medicine unit an e-platform E-care dedicated to automated, intelligent detection of situations at risk of heart failure.
METHODS: The E-care platform based on medical sensors (blood pressure, heart rate, O2, weight), communicating (Bluetooth), to go up, in real time, to an intelligent physiological information and an analysis of the ontology medical, leading ultimately to the generation of alerts. After a development phase (proof of concept), the E-care platform has been deployed and tested by health professionals and patients in an internal medicine unit with 20 beds, opened on emergencies to the Strasbourg University Hospitals.
RESULTS: One hundred and eighty patients were included and 1500 measurements were obtained. The patient profile included in this experiment was an elderly patient, with comorbidity in 90% of cases, with a loss of autonomy in 25%. Health professionals were using E-care platform every day to their great satisfaction. This experiment made it possible to validate the technology choices, to consolidate the system, and to test the robustness of the platform E-care. The collection continuously allowed us to have the critical number of patients for more detailed analysis of the relevance of alerts related to heart impairment. A preliminary analysis showed the relevance of the generated alerts.
CONCLUSION: Preliminary results following the deployment of E-care platform in hospitals appear to show the relevance of technological choices, tools and solutions developed and adopted. This telemedicine system allows automatic, non-intrusive, generate alerts related to the detection of situations at risk for heart failure. Ultimately, E-care was capable of preventing hospitalization. A home deployment is currently underway.

PMID: 26852082 [PubMed - as supplied by publisher]



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A qualitative study of hospital pharmacists and antibiotic governance: negotiating interprofessional responsibilities, expertise and resource constraints.

A qualitative study of hospital pharmacists and antibiotic governance: negotiating interprofessional responsibilities, expertise and resource constraints.

BMC Health Serv Res. 2016;16(1):43

Authors: Broom A, Plage S, Broom J, Kirby E, Adams J

Abstract
BACKGROUND: Antibiotic treatment options for common infections are diminishing due to the proliferation of antimicrobial resistance (AMR). The impact of Antimicrobial Stewardship (AMS) programs seeking to preserve viable antibiotic drugs by governing their use in hospitals has hitherto been limited. Pharmacists have been delegated a critical role in antibiotic governance in AMS teams within hospitals but the experience of pharmacists in influencing antibiotic use has received limited attention. In this study we explore the experiences of pharmacists in antibiotic decision-making in two Australian hospitals.
METHODS: We conducted 19 semi-structured interviews to explore hospital-based pharmacists' perceptions and experiences of antibiotic use and governance. The analysis was conducted with NVivo10 software, utilising the framework approach.
RESULTS: Three major themes emerged in the pharmacist interviews including (1) the responsibilities of pharmacy in optimising antibiotic use and the interprofessional challenges therein; (2) the importance of antibiotic streamlining and the constraints placed on pharmacists in achieving this; and (3) the potential, but often under-utilised expertise, pharmacists bring to antibiotic optimisation.
CONCLUSIONS: Pharmacists have a critical role in AMS teams but their capacity to enact change is limited by entrenched interprofessional dynamics. Identifying how hospital pharmacy's antibiotic gatekeeping is embedded in the interprofessional nature of clinical decision-making and limited by organisational environment has important implications for the implementation of hospital policies seeking to streamline antibiotic use. Resource constraints (i.e. time limitation and task prioritisation) in particular limit the capacity of pharmacists to overcome the interprofessional barriers through development of stronger collaborative relationships. The results of this study suggest that to enact change in antibiotic use in hospitals, pharmacists must be supported in their negotiations with doctors, have increased presence on hospital wards, and must be given opportunities to pass on specialist knowledge within multidisciplinary clinical teams.

PMID: 26852016 [PubMed - as supplied by publisher]



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A new proposal for priority setting in Norway: Open and fair.

A new proposal for priority setting in Norway: Open and fair.

Health Policy. 2016 Jan 18;

Authors: Ottersen T, Førde R, Kakad M, Kjellevold A, Melberg HO, Moen A, Ringard Å, Norheim OF

Abstract
Health systems worldwide struggle to meet increasing demands for health care, and Norway is no exception. This paper discusses the new, comprehensive framework for priority setting recently laid out by the third Norwegian Committee on Priority Setting in the Health Sector. The framework posits that priority setting should pursue the goal of "the greatest number of healthy life years for all, fairly distributed" and centres on three criteria: 1) The health-benefit criterion: The priority of an intervention increases with the expected health benefit (and other relevant welfare benefits) from the intervention; 2) The resource criterion: The priority of an intervention increases, the less resources it requires; and 3) The health-loss criterion: The priority of an intervention increases with the expected lifetime health loss of the beneficiary in the absence of such an intervention. Cost-effectiveness plays a central role in this framework, but only alongside the health-loss criterion which incorporates a special concern for the worse off and promotes fairness. In line with this, cost-effectiveness thresholds are differentiated according to health loss. Concrete implementation tools and open processes with user participation complement the three criteria. Informed by the proposal, the Ministry of Health and Care Services is preparing a report to the Parliament, with the aim of reaching political consensus on a new priority-setting framework for Norway.

PMID: 26851991 [PubMed - as supplied by publisher]



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Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

Eur Spine J. 2016 Feb 6;

Authors: Varatharajan S, Ferguson B, Chrobak K, Shergill Y, Côté P, Wong JJ, Yu H, Shearer HM, Southerst D, Sutton D, Randhawa K, Jacobs C, Abdulla S, Woitzik E, Marchand AA, van der Velde G, Carroll LJ, Nordin M, Ammendolia C, Mior S, Ameis A, Stupar M, Taylor-Vaisey A

Abstract
PURPOSE: To update findings of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and evaluate the effectiveness of non-invasive and non-pharmacological interventions for the management of patients with headaches associated with neck pain (i.e., tension-type, cervicogenic, or whiplash-related headaches).
METHODS: We searched five databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case-control studies comparing non-invasive interventions with other interventions, placebo/sham, or no interventions. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria to determine scientific admissibility. Studies with a low risk of bias were synthesized following best evidence synthesis principles.
RESULTS: We screened 17,236 citations, 15 studies were relevant, and 10 had a low risk of bias. The evidence suggests that episodic tension-type headaches should be managed with low load endurance craniocervical and cervicoscapular exercises. Patients with chronic tension-type headaches may also benefit from low load endurance craniocervical and cervicoscapular exercises; relaxation training with stress coping therapy; or multimodal care that includes spinal mobilization, craniocervical exercises, and postural correction. For cervicogenic headaches, low load endurance craniocervical and cervicoscapular exercises; or manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine may also be helpful.
CONCLUSIONS: The management of headaches associated with neck pain should include exercise. Patients who suffer from chronic tension-type headaches may also benefit from relaxation training with stress coping therapy or multimodal care. Patients with cervicogenic headache may also benefit from a course of manual therapy.

PMID: 26851953 [PubMed - as supplied by publisher]



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Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems.

Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems.

BMC Med Inform Decis Mak. 2016;16(1):16

Authors: Garg SK, Lyles CR, Ackerman S, Handley MA, Schillinger D, Gourley G, Aulakh V, Sarkar U

Abstract
BACKGROUND: Text messaging is an affordable, ubiquitous, and expanding mobile communication technology. However, safety net health systems in the United States that provide more care to uninsured and low-income patients may face additional financial and infrastructural challenges in utilizing this technology. Formative evaluations of texting implementation experiences are limited. We interviewed safety net health systems piloting texting initiatives to study facilitators and barriers to real-world implementation.
METHODS: We conducted telephone interviews with various stakeholders who volunteered from each of the eight California-based safety net systems that received external funding to pilot a texting-based program of their choosing to serve a primary care need. We developed a semi-structured interview guide based partly on the Consolidated Framework for Implementation Research (CFIR), which encompasses several domains: the intervention, individuals involved, contextual factors, and implementation process. We inductively and deductively (using CFIR) coded transcripts, and categorized themes into facilitators and barriers.
RESULTS: We performed eight interviews (one interview per pilot site). Five sites had no prior texting experience. Sites applied texting for programs related to medication adherence and monitoring, appointment reminders, care coordination, and health education and promotion. No site texted patient-identifying health information, and most sites manually obtained informed consent from each participating patient. Facilitators of implementation included perceived enthusiasm from patients, staff and management belief that texting is patient-centered, and the early identification of potential barriers through peer collaboration among grantees. Navigating government regulations that protect patient privacy and guide the handling of protected health information emerged as a crucial barrier. A related technical challenge in five sites was the labor-intensive tracking and documenting of texting communications due to an inability to integrate texting platforms with electronic health records.
CONCLUSIONS: Despite enthusiasm for the texting programs from the involved individuals and organizations, inadequate data management capabilities and unclear privacy and security regulations for mobile health technology slowed the initial implementation and limited the clinical use of texting in the safety net and scope of pilots. Future implementation work and research should investigate how different texting platform and intervention designs affect efficacy, as well as explore issues that may affect sustainability and the scalability.

PMID: 26851941 [PubMed - as supplied by publisher]



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Scenario drafting for early technology assessment of next generation sequencing in clinical oncology.

Scenario drafting for early technology assessment of next generation sequencing in clinical oncology.

BMC Cancer. 2016;16(1):66

Authors: Joosten SE, Retèl VP, Coupé VM, van den Heuvel MM, van Harten WH

Abstract
BACKGROUND: Next Generation Sequencing (NGS) is expected to lift molecular diagnostics in clinical oncology to the next level. It enables simultaneous identification of mutations in a patient tumor, after which targeted therapy may be assigned. This approach could improve patient survival and/or assist in controlling healthcare costs by offering expensive treatment to only those likely to benefit. However, NGS has yet to make its way into the clinic. Health Technology Assessment can support the adoption and implementation of a novel technology, but at this early stage many of the required variables are still unknown.
METHODS: Scenario drafting and expert elicitation via a questionnaire were used to identify factors that may act as a barrier or facilitate adoption of NGS-based molecular diagnostics. Attention was paid to predominantly elicit quantitative answers, allowing their use in future modelling of cost-effectiveness.
RESULTS: Adequately informing patients and physicians, the latters' opinion on clinical utility and underlying evidence as well as presenting sequencing results within a relevant timeframe may act as pivotal facilitators. Reimbursement for NGS-based testing and accompanying therapies (both general and in case of off-label prescription) was found to be a potential barrier. Competition on the market and demonstrating clinical utility may also be challenging. Importantly, numerous quantitative values for variables related to each of these potential barriers/facilitators, such as such as desired panel characteristics, willingness to pay or the expected number of targets identified per person, were also elicited.
CONCLUSIONS: We have identified several factors that may either pose a barrier or facilitate the adoption of NGS in the clinic. We believe acting upon these findings, for instance by organizing educational events, advocating new ways of evidence generation and steering towards the most cost-effective solution, will accelerate the route from bench-to-bedside. Moreover, due to the methodology of expert elicitation, this study provides parameters that can be incorporated in future cost-effectiveness modeling to steer the development of NGS gene panels towards the most optimal direction.

PMID: 26851938 [PubMed - as supplied by publisher]



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The effect of bergamot on dyslipidemia.

The effect of bergamot on dyslipidemia.

Phytomedicine. 2015 Dec 30;

Authors: Giglio RV, Patti AM, Nikolic D, Li Volti G, Al-Rasadi K, Katsiki N, Mikhailidis DP, Montalto G, Ivanova E, Orekhov AN, Rizzo M

Abstract
BACKGROUND: Statins are the most common used lipid lowering drugs but they may cause adverse effects and despite their well-established therapeutic benefits residual cardiovascular (CV) risk remains. The use of other lipid lowering drugs and nutraceuticals alone or as add-on lipid-modifying therapy can be an option in such cases. Several studies have reported health-related properties of the Citrus fruits, among which bergamot (Citrus bergamia Risso) differs from others by particularly high content of certain compounds.
PURPOSE: This narrative review summarizes the current evidence on the effects of bergamot on lipid parameters based on studies involving animals and humans.
MAIN EVIDENCE: This natural supplement may lead to effective lipid-lowering treatment. Its lipid-lowering activity is attributed to different flavonoids. However, the exact mechanisms involved remain unclear.
CONCLUSION: It is expected that ongoing and future studies will confirm the benefit of bergamot in dyslipidemic and other cardiometabolic disorders, potentially leading to reduced overall CV risk.

PMID: 26851838 [PubMed - as supplied by publisher]



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Responsiveness of PROMIS® Pediatric Measures to Hospitalizations for Sickle Pain and Subsequent Recovery

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Background

The Patient-Reported Outcomes Measurement Information System® (PROMIS®) created pediatric self-report scales measuring a variety of health attributes (domains), but their responsiveness to changes in health status has not yet been determined in children with sickle cell disease (SCD).

Procedure

A convenience cohort of symptomatic SCD children, aged 8–17 years, was asked to complete PROMIS pediatric scales at an initial clinic visit, at the end of a subsequent hospitalization for sickle pain, at a subsequent clinic visit or at home 2–3 weeks after hospitalization, and at a clinic visit 1–2 years after their initial assessment.

Results

A total of 121 participants (mean age 12.5 ± 3.1 years, 56.2% female) participated in the study. Pain interference and fatigue domain scores were elevated at baseline, increased substantially during hospitalization, and largely returned to baseline by the recovery period, whereas the depressive symptoms, anger, and anxiety domain scores displayed a less pronounced elevation during hospitalizations and a slower return to baseline levels. The two physical functioning scales showed a substantial decline in response to hospitalization, but only modest improvements at the recovery assessment, likely representing incomplete recovery.

Conclusions

Several PROMIS pediatric measures were responsive to changes in health status associated with occurrence and resolution of acute vaso-occlusive pain requiring hospitalization. The substantial differences in these domains during SCD-related pain exacerbations support their potential usefulness in clinical research or in clinical practice. Further studies to characterize variations in symptom patterns over time may provide insights into strategies for more effective management of sickle pain.



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Lipid emulsion for intoxication by local anaesthetic: sunken sink?



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The Impact of Relationship-Specific Support and Strain on Depressive Symptoms Across the Life Course

Objective: This study integrates stress process theory into a life course framework to examine how support and strain from particular relationship types (spouse/partner, children, mother, and friends/relatives) influence trajectories of depressive symptoms among different age groups, net of support and strain from other relationship types. Method: Latent growth curve models were used on nationally representative panel data (N = 3,617) from the Americans’ Changing Lives survey (1986, 1989, 1994, and 2001/2002). Results: Net of support and strain from other relationships, support from a spouse was related to fewer depressive symptoms among each age group. Friendships were important for depressive symptoms among younger and older adults, whereas only support/strain from family relationships influenced depressive symptoms among adults in midlife. Discussion: Findings demonstrate the importance of support and strain in multiple types of network members for the mental health of adults across the life course.



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Psychometric Properties of the Itch Numeric Rating Scale in Patients with Moderate-to-Severe Plaque Psoriasis

Summary

Background

Itching is a profoundly distressing symptom for many patients with psoriasis but has not been rigorously studied using validated tools for this condition.

Objectives

This study investigated the psychometric properties of the Itch Numeric Rating Scale (Itch NRS), a single-item patient-reported outcome (PRO) measuring worst itching severity due to psoriasis in the past 24 hours.

Methods

Using disease-specific clinician-rated and PRO data from one phase 2 and three phase 3 randomised clinical studies of subjects with moderate-to-severe plaque psoriasis, the Itch NRS was evaluated for test-retest reliability, construct validity, and responsiveness. A responder definition was explored using anchor- and distribution-based methods.

Results

Test-retest reliability analyses supported the reproducibility of the measure (intraclass correlation coefficient range: 0.71-0.74). To support construct validity of the Itch NRS, large cross-sectional correlations with the Dermatology Quality of Life (DLQI) Symptoms and Feelings domain (r ≥ 0.60 at baseline and r ≥ 0.80 at week 12) supported a priori hypotheses, while large correlations (r ≥ 0.71) between changes in Itch NRS scores and changes in DLQI Symptoms and Feelings domain scores from baseline to week 12 established responsiveness. A 4-point change was optimal for demonstrating a level of clinically meaningful improvement in itch severity after 12 weeks of treatment that corresponds with marked clinical improvements in plaque psoriasis.

Conclusions

The Itch NRS demonstrated sufficient reliability, validity, and responsiveness, and appropriate interpretation standards for evaluating change over time in itch severity among patients with moderate-to-severe plaque psoriasis when validated using clinical trial data for this condition.

This article is protected by copyright. All rights reserved.



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How to convey a diagnosis of skin cancer - patient preferences

Telling a patient that they have cancer is conventionally undertaken face-to-face1,2,3 and there are several government publications which stress that ‘how’ the patient is informed of their diagnosis is a crucial area4,5,6,, there are however no official guidelines. Headlines such as “Staff at NHS Trust rebuked for breaking bad news to patients over the phone” 7 suggest that many people would not support using the telephone or letter as a communication tool. We see approximately 1500 patients annually where skin cancer is a possible diagnosis. Bringing back every patient after biopsy is unworkable and for those with benign or low grade pathology, unnecessary.

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Delayed oral toxicity from long term Vemurafenib therapy

We read with interest the article by Vigarios et al.1 describing eight patients treated with a variety of BRAF inhibitors who developed asymptomatic hyperkeratotic oral mucosal lesions. These were frequently multifocal and presented following a mean onset of three months of treatment with a BRAF inhibitor. In one patient, one such lesion rapidly developed into oral squamous cell carcinoma requiring excision. We would like to highlight delayed oral toxicity in a long-term responder to a BRAF inhibitor.

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Pulse photodynamic therapy reduces inflammation without compromising efficacy in the treatment of multiple mild actinic keratoses of the face and scalp – a randomized clinical trial

Abstract

Background

The main side effects of PDT for actinic keratoses (AK) are post-treatment erythema and oedema, and pain during illumination. Severe erythema after PDT enhances the down-time associated with the treatment.

Objectives

To evaluate in a randomized intraindividual study if pulse-PDT and corticosteroid pulse-PDT would reduce treatment induced erythema compared to conventional PDT.

Methods

Twenty-two patients with multiple mild AK in the face and scalp were treated with methyl aminolevulinate (MAL)-PDT in three similar areas. Two areas were incubated with MAL for 30 minutes (pulse-PDT) and one area was incubated with MAL for 3 hours (c-PDT). All areas were illuminated with red light after 3 hours. In one of the pulse-PDT areas a super potent corticosteroid was applied before and just after PDT (S-pulse-PDT).

Results

Pulse-PDT significantly reduced PDT-induced erythema (p=0.020) and erythema was even further reduced by S-pulse-PDT (p<0.0001). The complete lesion response rate 3 months after PDT did not differ significantly between the three treated areas.

Conclusions

Pulse-PDT and S-pulse-PDT reduced erythema 24h after treatment of multiple mild AK in the face and scalp.

The use of short MAL application time and topical corticosteroid did not affect the efficacy of PDT and may be an easy way to make PDT treatment of large visible areas more acceptable.

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Short-contact low-dose MAL-PDT for acne vulgaris

We read with great interest the study by Pariser et al1 presenting a PDT regimen with methyl aminolaevulinate (MAL) 80 mg/g, with short-contact application (1.5 hour) for the treatment of severe acne vulgaris. With reference to their report, we would like to share our experience on the use of a low-dose MAL PDT regimen 40 mg/g with short-contact application (1 hour) for facial acne.2

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Common and rare CARD14 gene variants affect the anti-TNF response among Psoriasis patients

Abstract

Background

The CARD14 gene encodes a protein that enhances nuclear factor-kappa B (NF-kB) activation and the upregulation of proinflammatory pathway genes. CARD14 was upregulated in Psoriasis (Psor) vs normal skin, and rare and common CARD14 variants have been associated with the risk of developing Psor. Our hypothesis was that CARD14 variants could also influence the response to anti-TNF therapies among Psor-patients.

Objectives

To determine whether CARD14 gene variants were related with a significant anti-TNF positive response in Psor-patients.

Results

A reduction of at least 75% in the Psoriasis area and severity index (PASI 75) at week 24 was considered as a positive response to treatment. A total of 116 patients (79 responders and 37 non-responders) were next generation sequenced, and we identified five nucleotide variants that would result in missense amino acid changes. These variants were determined in all the patients, and allele and genotype frequencies were compared between the two groups. We found a significantly higher frequency of rs11652075 CC (p.Arg820Trp) among the group with a positive response (p=0.01; OR=3.71, 95%CI= 1.30-10.51). Furthermore, among responders six patients were heterozygous carriers of the rare p.Glu422Lys and two patients heterozygous for p.Arg682Trp variants (p=0.04).

Conclusions

The common CARD14 p.Arg820Trp variant might have a significant effect on the response to anti-TNF therapies among Psor-patients. In addition, rare CARD14 missense variants could also predispose to a better response.

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Is a punch biopsy reliable in subtyping basal cell carcinoma? A systematic review

Basal cell carcinoma (BCC) is the most prevalent type of skin cancer. Numerous studies have reported on the rising incidence of BCC causing a major burden on current health care systems 1. Current management relies on the histopathological subtype of a punch biopsy and this becomes more and more relevant due to the increasing use of non-surgical treatments. However the reliability of a punch biopsy in subtyping BCC has been questioned. The aim of this systematic review was to judge the reliability of a punch biopsy in accurately subtyping primary BCC.

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IgE and FcεRI are highly expressed on innate cells in psoriasis

Abstract

Background

Although elevated serum IgE levels have been reported in psoriasis, the role of IgE in psoriasis still needs to be clarified.

Objective

To analyze serum total IgE levels as well as the presence and distributionof IgE and FcεRI in psoriatic lesions, and investigate alteration of IgE and FcεRI after successful systemic treatment.

Methods

Total serum IgE levels was determined using ELISA. The expression and localization of IgE and FcεRI was investigated using immunohistochemistry and double-immunofluorescence.

Results

Elevated total serum IgE levels were found in 39% patients with psoriasis. The levels of total serum IgE were significantly higher in male patients compared to females. Furthermore, total serum IgE levels decreased after successful systemic treatment. A positive correlation between IgE+ and FcεRI + cells and a significant increase of these cells was found in psoriatic lesions as compared to normal skin. Interestingly, IgE+ and FcƐRI + cells decreased significantly after successful therapy with ustekinumab. IgE and FcεRI were co-expressed on mast cells, epidermal Langerhans cells, dermal DCs, macrophages and a few neutrophils.

Conclusions

IgE might participate in the development of psoriasis by activating FcεRI-bearing cells.

This article is protected by copyright. All rights reserved.



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Perioperative management of novel oral anticoagulants in skin surgery: a national survey

A recent study has shown that as many as 38% of patients who undergo skin surgery are on an antiplatelet or anticoagulant agent. 1 With the recent publication of the National Institute for Health and Care Excellence (NICE) guidelines on the use of novel oral anticoagulants (NOACs) for atrial fibrillation2, deep vein thrombosis and pulmonary embolism3-5, we are likely to see an increasing number of patients on these agents (i.e. dabigatran, rivaroxaban and apixaban) undergoing skin surgery. NICE has recently recommended that small skin excisions (procedures that have ‘no clinically important bleeding risk’) can be performed just before the next dose is due, or approximately 18-24 hours after the last dose (i.e. one dose may be missed).6 However, there is no recommendation on more complex dermatological procedures (i.e. Mohs surgery, flaps and/or grafts).

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Comparative anatomy of the extraocular muscles in four Myliobatoidei rays (Batoidea, Myliobatiformes)

Abstract

Extraocular muscles are classically grouped as four rectus and two oblique muscles. However, their description and potential associations with species behavior are limited. The objective was to characterize extraocular muscles in four Myliobatoidei rays from diverse habitats with divergent behaviors. Heads (10 per species) of Dasyatis hypostigma, Gymnura altavela, Mobula thurstoni and Pteroplatytrygon violacea were decalcified and dissected to characterize and describe extraocular muscles. Principal component analysis (PCA) was used to evaluate relationships between muscle length and species; for P. violacea, D. hypostigma and G. altavela, these were qualitatively and quantitatively consistent with the general pattern of extraocular muscles in vertebrates. In contrast, for M. thurstoni, the two oblique muscles were completely fused and there was a seventh extraocular muscle, named m. lateral rectus β (both were apparently novel findings in this species). There were also significant differences in eye disposition in the chondrocranium. The PCA axis 1 (rectus muscles) and PCA axis 2 (oblique muscles) accounted for 98.47% of data variability. Extraocular muscles had significant differences in length and important anatomical differences among sampled species that facilitated grouping species according to their life history. In conclusion, extraocular muscles are not uniform in all vertebrate species, thereby providing another basis for comparative studies.



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Thyroid and breast cancer survivors at risk of the other malignancy - Medical News Today


Medical News Today

Thyroid and breast cancer survivors at risk of the other malignancy
Medical News Today
There are four types of thyroid cancer: papillary, follicular, medullary, and anaplastic. Papillary is the most common type of thyroid cancer. Anaplastic is the most difficult to treat, but the other three can normally be cured, according to the ...

and more »


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Study compares effectiveness of phone-based and web-based smoking cessation programs in four states

An analysis indicates that states’ Web-based and phone-based tobacco cessation programmes can help people quit smoking, but certain personal characteristics may lead individuals to prefer one type of programmes over the other. Published early online in...

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Synthesis, Structural Characterization, and Thermal Properties of the Poly(methylmethacrylate)/δ-FeOOH Hybrid Material: An Experimental and Theoretical Study

The δ-FeOOH/PMMA nanocomposites with 0.5 and 2.5 wt.% of δ-FeOOH were prepared by grafting 3-(trimethoxysilyl)propyl methacrylate on the surface of the iron oxyhydroxide particles. The FTIR spectra of the δ-FeOOH/PMMA nanocomposites showed that the silane monomers were covalently attached to the δ-FeOOH particles. Because of the strong interaction between the PMMA and δ-FeOOH nanoparticles, the thermal stability of the δ-FeOOH/PMMA nanocomposites was improved compared to the pure PMMA. The SEM analysis conferred the size agglomerate of particles regarding the morphology of samples. The theoretical study enabled a better understanding of the interaction of the polymer with the iron oxyhydroxide. The DFT-based calculations reinforce the radical trapping mechanism of stabilization of nanocomposites; that is, Fe3+ species might be able to accept electrons coming from the organic phase that decomposes via radical unzipping. The radical scavenge effect delays the weight loss of polymer.

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Simulation of Sediment Discharges during an Outfall Dredging Operation

CORMIX-GTS simulations are carried out to study suspended muddy sediment plumes following the discharge of the spoils taken from the seabed during a marine outfall pipeline dredging operation. Single port discharges are considered at three different locations at 400 m, 800 m, and 1200 m from the shoreline with water depths ranging from 3.5 m to 10.5 m. For discharges in the shallow near-shore region at 400 m offshore, most of the dredge materials are deposited at the seabed and the simulated suspended sediment plumes are found to be carrying a concentration of less than 1 kg/m3 of mainly fine silt and clay. For discharges in the deeper far-shore region at 1200 m offshore, the sediment plumes are more elongated and carrying a concentration of more than 3 kg/m3. Iterative simulations are also conducted to analyse the inherent uncertainty in the input data by varying the ambient velocity and the port’s horizontal angle of discharge.

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Hematospermia and Cloacogenic Transitional Cell Carcinoma: A Twist on Significance and Meaning

A 52-year-old gentleman presented with recurrent hematospermia. Further history revealed recent onset of constipation and difficulty voiding. Rectal examination revealed a firm, polypoid mass and colonoscopy showed suspicious, ulcerated lesions of the rectal mucosa with narrowing of the rectal vault. Pathology demonstrated transitional cell carcinoma of the rectum. While transitional cell carcinoma is a common genitourinary cancer, its presence in the anus and rectum is exceedingly rare. Furthermore, hematospermia is generally not associated with malignancy. This case is a remarkable example of two pathologic processes presenting in rare form and underscores the value of a thorough investigation of hematospermia when associated with other clinical symptoms.

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Numerical Study of Mixed Convection of the Nanofluids in Two-Sided Lid-Driven Square Cavity with a Pair of Triangular Heating Cylinders

A numerical study is carried out concerning mixed convection of the nanofluid in two-sided lid-driven square cavity with a pair of triangular heat sources. The upper and bottom moving walls are thermally insulated while the left and right walls are cooled at constant temperature. Two-dimensional Navier-Stokes and energy equations are solved using the finite volume discretization method with SIMPLE algorithm. The method used is validated against previous works. Two cases were considered depending on the direction of moving walls. Effects of various design parameters such as Richardson number , nanoparticle volume fraction , and size and type of nanoparticles on the heat transfer rate are investigated. The results of this investigation illustrate that, by reducing the diameter of the nanoparticles and , the heat transfer rate increases. Moreover, it is found that by changing horizontal direction of the moving walls the heat transfer rate variation is negligible.

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Comorbidity Factors and Brain Mechanisms Linking Chronic Stress and Systemic Illness

Neuropsychiatric symptoms and mental illness are commonly present in patients with chronic systemic diseases. Mood disorders, such as depression, are present in up to 50% of these patients, resulting in impaired physical recovery and more intricate treatment regimen. Stress associated with both physical and emotional aspects of systemic illness is thought to elicit detrimental effects to initiate comorbid mental disorders. However, clinical reports also indicate that the relationship between systemic and psychiatric illnesses is bidirectional, further increasing the complexity of the underlying pathophysiological processes. In this review, we discuss the recent evidence linking chronic stress and systemic illness, such as activation of the immune response system and release of common proinflammatory mediators. Altogether, discovery of new targets is needed for development of better treatments for stress-related psychiatric illnesses as well as improvement of mental health aspects of different systemic diseases.

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Orofacial Pain during Mastication in People with Dementia: Reliability Testing of the Orofacial Pain Scale for Non-Verbal Individuals

Objectives. The aim of this study was to establish the reliability of the “chewing” subscale of the OPS-NVI, a novel tool designed to estimate presence and severity of orofacial pain in nonverbal patients. Methods. The OPS-NVI consists of 16 items for observed behavior, classified into four categories and a subjective estimate of pain. Two observers used the OPS-NVI for 237 video clips of people with dementia in Dutch nursing homes during their meal to observe their behavior and to estimate the intensity of orofacial pain. Six weeks later, the same observers rated the video clips a second time. Results. Bottom and ceiling effects for some items were found. This resulted in exclusion of these items from the statistical analyses. The categories which included the remaining items () showed reliability varying between fair-to-good and excellent (interobserver reliability, ICC: 0.40–0.47; intraobserver reliability, ICC: 0.40–0.92). Conclusions. The “chewing” subscale of the OPS-NVI showed a fair-to-good to excellent interobserver and intraobserver reliability in this dementia population. This study contributes to the validation process of the OPS-NVI as a whole and stresses the need for further assessment of the reliability of the OPS-NVI with subjects that might already show signs of orofacial pain.

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Growth Performance and Nutrient Uptake of Oil Palm Seedling in Prenursery Stage as Influenced by Oil Palm Waste Compost in Growing Media

The use of composted oil palm wastes in the oil palm nursery as an organic component of growing medium for oil palm seedlings seems promising in sustainable oil palm seedling production. This study was conducted to investigate the effects of six oil palm waste compost rates (0, 20, 40, 60, 80, and 100%) on the growth performance of oil palm seedling and nutrient uptake in the prenursery stage (0–3 months). The addition of oil palm compost reduced the soil bulk density (1.32 to 0.53 g cm−3) and increased soil pH (4.7 to 5.1) of growth media. Oil palm waste compost treatment produced positive growth performance up to 70%. A regression analysis indicated in 72% of compost and topsoil mixture as a polybag growth medium was optimum in producing best growth performance of oil palm seedling in the prenursery stage. Foliar analysis implied highest nutrients uptake (N, P, K, Mg, Ca, Fe, Zn, and Cu) for seedlings grown in 60 to 100% compost media.

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Aging Thermal Treatment in the Inconel 725 Brazed Incorporating Tungsten Nanoparticles

Fractures in blade sections of Inconel 725 were impregnated with tungsten nanoparticles and jointed by the brazing process. In order to evaluate their effect over the microstructure, aging thermal treatments at 750°C for 2, 6, 10, and 14 h were done. BNi-9 was selected as brazing filler metal and was characterized by scanning electron microscopy and X-ray fluorescence. Before brazing, the fractures were impregnated with a mixture of tungsten NPs in ethanol. Measurements of Vickers microhardness showed an increase in the melting zone of samples with aging thermal treatment for 14 h, which is attributed to the precipitation of the γ′ phase with a typical size of ca. 100 nm. Likewise, the tungsten NPs modified the size and morphology of Cr-Ni eutectics into finer and uniformly distributed microstructures.

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Sleep mediates the link between resiliency and behavioural problems in children at high and low risk for alcoholism

Summary

Children of alcoholic parents are at greater risk for developing substance use problems. Having a parent with any mental illness increases the risk for sleep disorders in children. Using actigraphy, this study characterized sleep in children of alcoholics and community controls over a period of 1 week. This study further examined whether sleep characteristics of the children mediated the relationship between self-regulation indices (i.e. undercontrol and resiliency) and outcome measures of function (e.g. problem behaviours and perceived conflict at home). Eighty-two children (53 boys, 29 girls, 7.2–13.0 years old) were recruited from the ongoing Michigan Longitudinal Study. Seventeen participants had no parental history of alcohol abuse or dependence (FH−), 43 had at least one parent who was a recovered alcoholic, and 22 had at least one parent who met diagnostic criteria within the past 3 years. Sleep was assessed with actigraphy and sleep diaries for 1 week, and combined with secondary analysis of data collected for the longitudinal study. FH− children had more objectively measured total sleep time. More total sleep time was associated with greater resiliency and behavioural control, fewer teacher-reported behavioural problems, and less child-reported conflict at home. Further, total sleep time partially mediated the relationship between resiliency and perceived conflict, and between resiliency and externalizing problems. These findings suggest that in high-risk homes, the opportunity to obtain sufficient sleep is reduced, and that insufficient sleep further exacerbates the effects of impaired dispositional self-regulatory capacity on behavioural and emotional regulation.



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Laryngeal (larynx) cancer - Recovery - The Observer Star


The Observer Star

Laryngeal (larynx) cancer - Recovery
The Observer Star
If you've had all of your larynx removed (total laryngectomy), you won't be able to speak normally, because you will no longer have vocal cords. A number of techniques can be used to replicate the functions of your vocal cords (see below), although ...



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