Investigation of erectile dysfunction.

PubMed

Patel, D V; Halls, J; Patel, U

2012-11-01

Erectile dysfunction (ED) represents a common and debilitating condition with a wide range of organic and non-organic causes. Physical aetiologies can be divided into disorders affecting arterial inflow, the venous occlusion mechanism or the penile structure itself. Various imaging modalities can be utilised to investigate the physical causes of ED, but penile Doppler sonography (PDS) is the most informative technique, indicated in those patients with ED who do not respond to oral pharmacological agents (e.g. phosphodiesterase type 5 inhibitors). This review will examine the anatomical and physiological basis of penile erection, the method for performing PDS and features of specific causes of ED, and will also consider the alternative imaging modalities available.

Lightning can strike twice: an unlucky patient of neurological interest

PubMed Central

Gilbee, Ebony S

2013-01-01

Poliomyelitis, once a worldwide epidemic, is becoming increasingly rare owing to the introduction of the polio vaccine in the 1950s. It is estimated that the number of cases of polio has reduced by 99% since the Global Polio Eradication Initiative (GPEI) started in 1988. Amyotrophic lateral sclerosis (ALS) is another relatively uncommon condition which also affects anterior horn cells with debilitating neurological, and deadly, consequences. An unusual case of an aggressive form of ALS developing in a 72-year-old patient with paralytic poliomyelitis in childhood is presented. Her initial presentation was puzzling, and our approach to the diagnostic dilemma is discussed. PMID:23814000

Shoe allergic contact dermatitis.

PubMed

Matthys, Erin; Zahir, Amir; Ehrlich, Alison

2014-01-01

Foot dermatitis is a widespread condition, affecting men and women of all ages. Because of the location, this condition may present as a debilitating problem to those who have it. Allergic contact dermatitis involving the feet is frequently due to shoes or socks. The allergens that cause shoe dermatitis can be found in any constituent of footwear, including rubber, adhesives, leather, dyes, metals, and medicaments. The goal of treatment is to identify and minimize contact with the offending allergen(s). The lack of product information released from shoe manufacturers and the continually changing trends in footwear present a challenge in treating this condition. The aim of this study is to review the current literature on allergic contact shoe dermatitis; clinical presentation, allergens, patch testing, and management will be discussed. PubMed and MEDLINE databases were used for the search, with a focus on literature updates from the last 15 years.

Arthritis of the hand - Rheumatoid

MedlinePlus

... Therapist? Media Find a Hand Surgeon Home Anatomy Rheumatoid Arthritis Email to a friend * required fields From * To * ... debilitating when it affects the hands and fingers. Rheumatoid arthritis is one of the most common forms of ...

Global efforts for effective training in fistula surgery.

PubMed

Elneil, Sohier

2015-10-01

Obstetric fistulas continue to be a problem in low- and middle-income nations, affecting women of childbearing age during pregnancy and labor and resulting in debilitating urinary and/or fecal incontinence. Historically, this predicament also affected women in high-income nations until the middle of the last century. This is not a "new world" crisis therefore, but simply one of economic and health development. In the last two decades, new global initiatives have been instituted to improve training and education in preventative and curative fistula treatment by developing a unified and competency-based learning tool by surgeons in the field in partnership with FIGO and its global partners. This modern approach to the management of a devastating condition can only serve to achieve the WHO objective of health security for women throughout their life span. Copyright © 2015. Published by Elsevier Ireland Ltd.

Gaucher disease: the role of the specialist on metabolic bone diseases

PubMed Central

Masi, Laura; Brandi, Maria Luisa

2015-01-01

Summary According to European legislation, a disease can be considered rare or “orphan” when it affects less than 1 subject of 2000 (1). Often these diseases affecting the pediatric age, are complex diseases and chronically debilitating and for this motive need the intervention of multidisciplinary skills specific. Among the rare disease as affecting the skeleton more than 400 are characterized by dysplastic changes of the skeleton (2). Alongside the disorders affecting the skeleton primitively, many systemic diseases can have a bone involvement. Among these, the Gaucher disease (GD), an heterogeneous lysosomal storage determined by hereditary enzyme deficiency of β-glucosidase. Patients with this disease have skeletal disorders of varying severity (Erlenmeyer flask deformity, lytic lesions and osteonecrosis, pathological fractures) that affects both the bone marrow, both mineralized bone with progressive damage of the tissue. The bone disease is the most debilitating of GD and can have a significant impact on the quality of life of patients. Thorough evaluations by monitoring biochemical markers of bone turnover and instrumental, with a quantitative and qualitative evaluation of the bone, are of fundamental importance to intervene early so they can prevent complications irreversible. PMID:26604943

Cerebro-rhino orbital mucormycosis: an update.

PubMed

Wali, Upender; Balkhair, Abdullah; Al-Mujaini, Abdullah

2012-04-01

Mucormycosis is an uncommon fungal infection which can lead to fulminant necrotizing infection under optimal host condition. Fungi have the ability to invade blood vessels and can affect different parts of the body. The most common, though the most aggressive, form is cerebro-rhino-orbital mucormycosis that occurs in debilitated patients, in conjunction with sinus or para-sinus involvement. Due to increased number of newly diagnosed cases of mucormycosis world-wide resulting from uncontrolled metabolic conditions, this paper intends to widen the reader's scope and knowledge about the nature of the disease and its multicomplexity that require a collaborative effort for careful management. Patients who are at risks both at the onset of the disease and during its management have been identified in the paper. Copyright © 2012 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Dry eye disease: an immune-mediated ocular surface disorder

PubMed Central

Stevenson, William; Chauhan, Sunil K.; Dana, Reza

2013-01-01

Dry eye disease is a multifactorial disorder of the tears and ocular surface characterized by symptoms of dryness and irritation. Although the pathogenesis of dry eye disease is not fully understood, it is recognized that inflammation has a prominent role in the development and propagation of this debilitating condition. Factors that adversely affect tear film stability and osmolarity can induce ocular surface damage and initiate an inflammatory cascade that generates innate and adaptive immune responses. These immunoinflammatory responses lead to further ocular surface damage and the development of a self-perpetuating inflammatory cycle. Herein, we review the fundamental links between inflammation and dry eye disease and discuss the clinical implications of inflammation in disease management. PMID:22232476

Understanding the dark and bright sides of anxiety: A theory of workplace anxiety.

PubMed

Cheng, Bonnie Hayden; McCarthy, Julie M

2018-05-01

Researchers have uncovered inconsistent relations between anxiety and performance. Although the prominent view is a "dark side," where anxiety has a negative relation with performance, a "bright side" of anxiety has also been suggested. We reconcile past findings by presenting a comprehensive multilevel, multiprocess model of workplace anxiety called the theory of workplace anxiety (TWA). This model highlights the processes and conditions through which workplace anxiety may lead to debilitative and facilitative job performance and includes 19 theoretical propositions. Drawing on past theories of anxiety, resource depletion, cognitive-motivational processing, and performance, we uncover the debilitative and facilitative nature of dispositional and situational workplace anxiety by positioning emotional exhaustion, self-regulatory processing, and cognitive interference as distinct contrasting processes underlying the relationship between workplace anxiety and job performance. Extending our theoretical model, we pinpoint motivation, ability, and emotional intelligence as critical conditions that shape when workplace anxiety will debilitate and facilitate job performance. We also identify the unique employee, job, and situational characteristics that serve as antecedents of dispositional and situational workplace anxiety. The TWA offers a nuanced perspective on workplace anxiety and serves as a foundation for future work. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Evaluation of Therapeutics for Advanced-Stage Heart Failure and Other Severely-Debilitating or Life-Threatening Diseases.

PubMed

Prescott, J S; Andrews, P A; Baker, R W; Bogdanffy, M S; Fields, F O; Keller, D A; Lapadula, D M; Mahoney, N M; Paul, D E; Platz, S J; Reese, D M; Stoch, S A; DeGeorge, J J

2017-08-01

Severely-debilitating or life-threatening (SDLT) diseases include conditions in which life expectancy is short or quality of life is greatly diminished despite available therapies. As such, the medical context for SDLT diseases is comparable to advanced cancer and the benefit vs. risk assessment and development of SDLT disease therapeutics should be similar to that of advanced cancer therapeutics. A streamlined development approach would allow patients with SDLT conditions earlier access to therapeutics and increase the speed of progression through development. In addition, this will likely increase the SDLT disease therapeutic pipeline, directly benefiting patients and reducing the economic and societal burden of SDLT conditions. Using advanced-stage heart failure (HF) as an example that illustrates the concepts applicable to other SDLT indications, this article proposes a streamlined development paradigm for SDLT disease therapeutics and recommends development of aligned global regulatory guidance. © 2017 American Society for Clinical Pharmacology and Therapeutics.

Chondrogenesis and cartilage tissue engineering: the longer road to technology development.

PubMed

Mahmoudifar, Nastaran; Doran, Pauline M

2012-03-01

Joint injury and disease are painful and debilitating conditions affecting a substantial proportion of the population. The idea that damaged cartilage in articulating joints might be replaced seamlessly with tissue-engineered cartilage is of obvious commercial interest because the market for such treatments is large. Recently, a wealth of new information about the complex biology of chondrogenesis and cartilage has emerged from stem cell research, including increasing evidence of the role of physical stimuli in directing differentiation. The challenge for the next generation of tissue engineers is to identify the key elements in this new body of knowledge that can be applied to overcome current limitations affecting cartilage synthesis in vitro. Here we review the status of cartilage tissue engineering and examine the contribution of stem cell research to technology development for cartilage production. Copyright © 2011 Elsevier Ltd. All rights reserved.

Successful closure of chronic BPF by thoracoscopy after failure of endoscopic fibrin glue application and thoracoplasty.

PubMed

Tschopp, J M; Evéquoz, D; Karrer, W; Aymon, E; Naef, A P

1990-03-01

We report a case of chronic debilitating BPF following right upper lobe resection. Despite several endobronchial applications of fibrin glue, we could not close it. Since the patient was extremely debilitated by symptoms due to the BPF, a thoracoplasty was attempted but was not successful. Finally, the BPF was definitely closed by instillation of talc into the pleura through thoracoscopy. To our knowledge, this is the first reported case of chemical closure of a recalcitrant BPF by the route of thoracoscopy. It also shows the failure of endoscopic fibrin glue application in such a condition.

Shortness of Breath

MedlinePlus

... with blood clots in the legs or pelvis (deep venous thrombosis), debilitating medical conditions, immobility, or inherited ... it hard for a person to take a deep breath, which usually results in retention of carbon ...

Comparative Effectiveness of Smoking Prevention Programs.

ERIC Educational Resources Information Center

Jason, Leonard A.; Mollica, Mark

Given the documented link between smoking and later debilitating health conditions, a need exists to investigate educational programs aimed at reducing rates of smoking among school-age children. An entire class of ninth graders was involved in a treatment condition featuring either role-playing and discussion or discussion only. While both…

Conditions Presenting with Symptoms of Peripheral Arterial Disease

PubMed Central

Sharma, Aditya M.; Norton, Patrick T.; Zhu, Daisy

2014-01-01

Peripheral artery disease (PAD) is estimated to affect more than 20% of people older than 65 years. The vast majority of patients with symptoms suggestive of PAD have atherosclerosis often associated with conventional vascular risk factors such as smoking, diabetes, dyslipidemia, and inflammation. A minority of people presenting with symptoms suggesting PAD have an alternative etiology. These groups of disorders are often underdiagnosed, and if diagnosed correctly the diagnosis may be delayed. Understanding these pathologies well is important, as they can be very debilitating and optimal treatment may vary significantly. Inappropriate treatment of these disorders can lead to worsening morbidity and mortality. This article discusses the underlying causes of nonatherosclerotic PAD, including the diagnosis and treatment of these disorders. PMID:25435652

Anti-Seizure Medications: Relief from Nerve Pain

MedlinePlus

... be debilitating and difficult to control. Nerve damage (neuropathy) can be caused by many conditions, including: Diabetes. ... and pain in your hands and feet (diabetic neuropathy). Shingles. Anyone who has had chickenpox is at ...

Alleviating debilitating, chronic constipation with colostomy after appendicostomy: a case study.

PubMed

Baig, Mirza K; Boyer, Mary Lou; Marquez, Helen; Wexner, Steven D

2005-12-01

Severe chronic constipation is a debilitating condition. Patients not only experience infrequent bowel movements, but also are often frustrated by the sensation of incomplete evacuation; pain; straining; daily use of enemas; and continual concerns regarding diet, fluids, and medications. Diagnostic tests are performed to rule out organic causes of the condition. Common treatment options consist of dietary fiber supplementation, dietary instruction, adequate fluid intake, enemas, and laxatives; additional noninvasive management includes biofeedback training and botulinum toxin type A injections. Surgery is rarely recommended, although a select group of patients may benefit from antegrade continence enema procedure. A female patient presented with a history of long-standing constipation. When antegrade continence enema offered no improvement and other treatment measures failed, she underwent successful laparoscopic-assisted sigmoid resection and end colostomy. This approach may provide options for patients in similar circumstances.

Lionfish envenomation.

PubMed

Kasdan, M L; Kasdan, A S; Hamilton, D L

1987-10-01

Correct and immediate care can significantly reduce the debilitating effects of Scorpaenidae evenomation. The lack of immediate heat application to the wound in our case report may have contributed to the complications and eventual loss of motion in the affected area, since the toxic ingredient, a nondialyzable protein, remained active.

Burning mouth syndrome

PubMed Central

Gurvits, Grigoriy E; Tan, Amy

2013-01-01

Burning mouth syndrome is a debilitating medical condition affecting nearly 1.3 million of Americans. Its common features include a burning painful sensation in the mouth, often associated with dysgeusia and xerostomia, despite normal salivation. Classically, symptoms are better in the morning, worsen during the day and typically subside at night. Its etiology is largely multifactorial, and associated medical conditions may include gastrointestinal, urogenital, psychiatric, neurologic and metabolic disorders, as well as drug reactions. BMS has clear predisposition to peri-/post menopausal females. Its pathophysiology has not been fully elucidated and involves peripheral and central neuropathic pathways. Clinical diagnosis relies on careful history taking, physical examination and laboratory analysis. Treatment is often tedious and is aimed at correction of underlying medical conditions, supportive therapy, and behavioral feedback. Drug therapy with alpha lipoic acid, clonazepam, capsaicin, and antidepressants may provide symptom relief. Psychotherapy may be helpful. Short term follow up data is promising, however, long term prognosis with treatment is lacking. BMS remains an important medical condition which often places a recognizable burden on the patient and health care system and requires appropriate recognition and treatment. PMID:23429751

Burning mouth syndrome.

PubMed

Gurvits, Grigoriy E; Tan, Amy

2013-02-07

Burning mouth syndrome is a debilitating medical condition affecting nearly 1.3 million of Americans. Its common features include a burning painful sensation in the mouth, often associated with dysgeusia and xerostomia, despite normal salivation. Classically, symptoms are better in the morning, worsen during the day and typically subside at night. Its etiology is largely multifactorial, and associated medical conditions may include gastrointestinal, urogenital, psychiatric, neurologic and metabolic disorders, as well as drug reactions. BMS has clear predisposition to peri-/post menopausal females. Its pathophysiology has not been fully elucidated and involves peripheral and central neuropathic pathways. Clinical diagnosis relies on careful history taking, physical examination and laboratory analysis. Treatment is often tedious and is aimed at correction of underlying medical conditions, supportive therapy, and behavioral feedback. Drug therapy with alpha lipoic acid, clonazepam, capsaicin, and antidepressants may provide symptom relief. Psychotherapy may be helpful. Short term follow up data is promising, however, long term prognosis with treatment is lacking. BMS remains an important medical condition which often places a recognizable burden on the patient and health care system and requires appropriate recognition and treatment.

Denying Sanctuary

DTIC Science & Technology

2009-04-01

the socio-economic conditions, the most debilitating of which was “economic maladjustment ,” 34 were pathetic. The Algerian economy was primarily...representation, economic maladjustment and poor standards of living caused by lack of essential services disenfranchised the native Algerian populace. In

Defining sarcopenia

USDA-ARS?s Scientific Manuscript database

Currently there is no standardized definition of sarcopenia. This hampers the clinical management of sarcopenia and retards the development and regulatory approval of interventions to reduce the progression of this common and debilitating condition in the elderly. Nine definitions of sarcopenia have...

Chronic Fatigue Syndrome: How Vulnerable Are Athletes?

ERIC Educational Resources Information Center

Eichner, Edward R.

1989-01-01

Discusses chronic fatigue syndrome as it affects elite athletes, noting that overtraining may mimic it. In some cases, athletes who have it perform exceedingly well in the face of debilitating fatigue. Among athletes and nonathletes, the cause and the mind-body connection are areas of controversy and research. (Author/SM)

The effects of a documentary film about schizophrenia on cognitive, affective and behavioural aspects of stigmatisation.

PubMed

Thonon, Bénédicte; Pletinx, Amandine; Grandjean, Allison; Billieux, Joël; Larøi, Frank

2016-03-01

Stereotypes about schizophrenia may lead to prejudicial attitudes and discrimination with debilitating effects on people diagnosed with schizophrenia. There is thus a need to develop interventions aiming to prevent, reduce or eliminate such stereotypes. The aim of this study was to evaluate the effects of a documentary film on schizophrenia on cognitive, affective and behavioural aspects of stigmatisation. Forty-nine participants were assessed on measures of stereotypes and social distance, and on the Model of Stereotype Content, which includes measures of stereotypes, emotional reactions and behavioural tendencies. Participants were randomly assigned into either a condition in which they viewed the documentary film (Film group), or into a control condition in which no intervention was conducted (Control group). Only participants in the Film group revealed a significant decrease of negative stereotypes (Dangerousness and Unpredictability) and desired Social distance, and a significant increase in the perception of sociability in persons with schizophrenia. Small sample size and its reduced generalizability are the main limitations in this study. These findings suggest that a documentary film promoting indirect contact with people diagnosed with schizophrenia is a promising tool to prevent and reduce stigmatisation regarding schizophrenia.. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prosopagnosia as a Type of Conversion Disorder.

PubMed

Power, Clodagh; Hannigan, Oisin; Coen, Robert; Bruce, Irene; Gibb, Matthew; McCarthy, Marie; Robinson, David; Lawlor, Brian A

2018-01-01

Conversion disorder is a common and debilitating condition that remains poorly understood. We present a previously undescribed form of conversion disorder to highlight the complexity of the condition and consider the interplay of factors that produce conversion symptoms. A 50-year-old male presented with acquired prosopagnosia and language impairment. Neuropsychological testing indicated right temporal lobe dysfunction. Extensive work-up outruled an organic aetiology. Reactivation of childhood trauma coincided with the onset of his symptoms. Childhood trauma is known to have adverse effects on the developing brain which may affect an individual's emotional behaviour and coping style. Functional neuroimaging techniques suggest that conversion symptoms may be linked to the disruption of higher order neural circuitry involved in the integration of emotional processing and cortical functioning. We propose that our patient's adverse childhood experiences led to the development of a particular personality and coping style that "primed" him for a later abnormal emotional and behavioural response when confronted with reminders of his traumatic background. Further interdisciplinary studies are required to further elucidate the neurobiological basis for this condition.

Determining the Debilitative Impact of Test Anxiety.

ERIC Educational Resources Information Center

Madsen, Harold S.

The detrimental effects of anxiety in English as a second language/foreign language (ESL/FL) are investigated. Although empirical research on the subject of ESL/FL test affect is limited, helpful insights on test anxiety exist in the psychological literature. Two constructs in the anxiety literature are considered relevant for this study: trait…

3 CFR 8494 - Proclamation 8494 of April 8, 2010. National D.A.R.E. Day, 2010

Code of Federal Regulations, 2011 CFR

2011-01-01

... substance abuse. Drug dependence affects individuals from all backgrounds, and its debilitating effects... to chemical inhalants, many substances can be harmful if abused, and preventing our children from... drug use with the young people in their lives. Community-based prevention and treatment programs can...

A Water Workout Is Fun! Give It a Try!

ERIC Educational Resources Information Center

Waters, Liz

2008-01-01

When a family faces the particular challenge of a debilitating illness, disorder, or other disability that is affecting a child, life becomes complicated. Suddenly the need for medications and therapies takes center stage, and things like summer swimming lessons and lazy days poolside can get lost in the shuffle. In this article, the author…

Temporomandibular joint dislocation

PubMed Central

Sharma, Naresh Kumar; Singh, Akhilesh Kumar; Pandey, Arun; Verma, Vishal; Singh, Shreya

2015-01-01

Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic. Acute TMJ dislocation is common in clinical practice and can be managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage. In this article, we discuss the comprehensive review of the different treatment modalities in managing TMJ dislocation. PMID:26668447

Compensatory deficits following rejection: the role of social anxiety in disrupting affiliative behavior.

PubMed

Mallott, Michael A; Maner, Jon K; DeWall, Nathan; Schmidt, Norman B

2009-01-01

Managing perceived or actual social rejection is an important facet of meeting basic needs for affiliation. Social anxiety disorder (SAD) is characterized by significant distress and debilitation relating to affiliation and recent work suggests higher levels of social anxiety symptoms may adversely affect responses to social rejection. This study examined emotional and behavioral responding to a social rejection stressor to explore whether social anxiety moderates the effects of social rejection on prosocial compensatory behaviors. Individuals (N=37) evaluated on social anxiety symptoms were assigned to either a social rejection condition or control condition. Consistent with expectation, rejection promoted renewed interest in connecting with sources of positive social interaction among participants low in social anxiety. Participants with higher levels of social anxiety, however, failed to react to rejection in a positive or prosocial manner and exhibited some evidence of negative social responses. Such differential compensatory responding could have important implications for the genesis, maintenance, and treatment of SAD.

78 FR 26221 - National Mental Health Awareness Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... conditions like depression and anxiety, post-traumatic stress and bipolar disorder--debilitating illnesses...-662-HELP. The National Suicide Prevention Lifeline offers immediate assistance for all Americans... depression screening and behavioral assessments for children at no extra cost to patients. My Administration...

Surgical treatment of Peyronie's disease.

PubMed

Carson, Culley C

2006-02-01

Peyronie's disease is a sexually debilitating disease causing significant penile deformity and erectile dysfunction as well as psychological stress for many men. The incidence of Peyronie's disease appears to be increasing and urologists are being called upon more frequently to treat this debilitating condition. Urologists have an opportunity to help men suffering from Peyronie's disease to improve their lives and the lives of their partners. Appropriate treatment should be individualized and tailored to the patient's expectations, disease history, physical exam findings, and coital function. After medical therapy is considered and the Peyronie's disease has stabilized, surgical correction is an excellent option for patients with functional impairment from their Peyronie's disease. Surgical outcomes are excellent with expected return to normal sexual function following Peyronie's disease treatment.

ASTHMA AND MENTAL HEALTH SYMPTOMS AMONG ADULT ARAB AMERICANS IN THE DETROIT AREA

EPA Science Inventory

The burden of managing chronic health problems such as asthma is often compounded by psychological distress and debilitating mental health problems associated with these conditions. In this study we assessed the relationship between asthma and self-reported mental health symptom...

Natriuretic Peptides, 6-Min Walk Test, and Quality-of-Life Questionnaires as Clinically Meaningful Endpoints in HF Trials.

PubMed

Ferreira, João Pedro; Duarte, Kevin; Graves, Todd L; Zile, Michael R; Abraham, William T; Weaver, Fred A; Lindenfeld, JoAnn; Zannad, Faiez

2016-12-20

The Expedited Access for Premarket Approval and De Novo Medical Devices Intended for Unmet Medical Need for Life Threatening or Irreversibly Debilitating Diseases or Conditions document was issued as a guidance for industry and for the Food and Drug Administration. The Expedited Access Pathway was designed as a new program for medical devices that demonstrated the potential to address unmet medical needs for life threatening or irreversibly debilitating conditions. The Food and Drug Administration would consider assessments of a device's effect on intermediate endpoints that, when improving in a congruent fashion, are reasonably likely to predict clinical benefit. The purpose of this review is to provide evidence to support the use of 3 such intermediate endpoints: natriuretic peptides, such as N-terminal pro-B-type natriuretic peptide/B-type natriuretic peptide, the 6-min walk test distance, and health-related quality of life in heart failure. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Medical implications of obesity in horses--lessons for human obesity.

PubMed

Johnson, Philip J; Wiedmeyer, Charles E; Messer, Nat T; Ganjam, Venkataseshu K

2009-01-01

There is growing recognition that obesity is common and represents a significant detriment to the health of companion animals in a manner similar to that by which it is affecting the human population. As is the case for other species, obesity appears to promote insulin resistance in horses and it is through this pathophysiological process that many of the adverse medical consequences of obesity are being characterized. Equine medical conditions that have been described in the context of obesity and insulin resistance differ from those in humans. Chronic human conditions that have been attributed to obesity and insulin resistance, such as atherosclerosis and diabetes mellitus, are rarely described in obese horses. Significant current interest is centered on the recognition that insulin resistance plays a role in the pathogenesis of laminitis, a potentially severe and debilitating cause of lameness in the equine species. Other equine medical conditions that are more likely in obese, insulin-resistant individuals include hyperlipemia (hepatic lipidosis) and developmental orthopedic disease (osteochondrosis). Pituitary pars intermedia dysfunction (equine Cushing's syndrome) represents another common endocrinopathic condition of older horses associated with insulin resistance. This review presents an introductory overview of the present understanding of obesity and insulin resistance and how these conditions may be associated with disease conditions in horses. © Diabetes Technology Society

Medical Implications of Obesity in Horses—Lessons for Human Obesity

PubMed Central

Johnson, Philip J.; Wiedmeyer, Charles E.; Messer, Nat T.; Ganjam, Venkataseshu K.

2009-01-01

There is growing recognition that obesity is common and represents a significant detriment to the health of companion animals in a manner similar to that by which it is affecting the human population. As is the case for other species, obesity appears to promote insulin resistance in horses and it is through this pathophysiological process that many of the adverse medical consequences of obesity are being characterized. Equine medical conditions that have been described in the context of obesity and insulin resistance differ from those in humans. Chronic human conditions that have been attributed to obesity and insulin resistance, such as atherosclerosis and diabetes mellitus, are rarely described in obese horses. Significant current interest is centered on the recognition that insulin resistance plays a role in the pathogenesis of laminitis, a potentially severe and debilitating cause of lameness in the equine species. Other equine medical conditions that are more likely in obese, insulin-resistant individuals include hyperlipemia (hepatic lipidosis) and developmental orthopedic disease (osteochondrosis). Pituitary pars intermedia dysfunction (equine Cushing's syndrome) represents another common endocrinopathic condition of older horses associated with insulin resistance. This review presents an introductory overview of the present understanding of obesity and insulin resistance and how these conditions may be associated with disease conditions in horses. PMID:20046661

Mechanisms of Acupuncture-Electroacupuncture on Persistent Pain

PubMed Central

Zhang, Ruixin; Lao, Lixing; Ren, Ke; Berman, Brian M.

2014-01-01

In the last decade, preclinical investigations of electroacupuncture mechanisms on persistent tissue-injury (inflammatory), nerve-injury (neuropathic), cancer, and visceral pain have increased. These studies show that electroacupuncture activates the nervous system differently in health than in pain conditions, alleviates both sensory and affective inflammatory pain, and inhibits inflammatory and neuropathic pain more effectively at 2–10 Hz than at 100 Hz. Electroacupuncture blocks pain by activating a variety of bioactive chemicals through peripheral, spinal, and supraspinal mechanisms. These include opioids, which desensitize peripheral nociceptors and reduce pro-inflammatory cytokines peripherally and in the spinal cord, and serotonin and norepinephrine, which decrease spinal n-methyl-d-aspartate receptor subunit GluN1 phosphorylation. Additional studies suggest that electroacupuncture, when combined with low dosages of conventional analgesics, provides effective pain management that can forestall the side effects of often-debilitating pharmaceuticals. PMID:24322588

Sarcoptic mange in raccoons in Michigan.

PubMed

Fitzgerald, Scott D; Cooley, Thomas M; Murphy, Alice; Cosgrove, Melinda K; King, Betty A

2004-04-01

Sarcoptic mange is a cause of pruritic skin disease in domestic dogs and a wide range of wildlife species. We describe sarcoptic mange in free-ranging raccoons (Procyon lotor). Three adult raccoons from upper Wayne County, Michigan (USA), were captured, killed, and submitted for diagnostic evaluation. The animals were intensely pruritic, and two had advanced alopecic and crusting lesions over their dorsum and hind limbs. Skin scrapings and skin biopsies revealed crusting and hyperkeratotic dermatitis with high numbers of Sarcoptes scabiei adults, larvae, nymphs, and eggs. These raccoons were not otherwise debilitated, with minimal internal parasites, good body condition, and no evidence of infectious bacterial or viral diseases. Because sarcoptic mange is highly contagious and affects many species, including humans, transiently, it is important that wildlife biologists and rehabilitators include sarcoptic mange in their differential list for raccoons exhibiting pruritus and alopecia.

"You Ain't Going to Say...I've Got a Problem down There": Workplace-Based Prostate Health Promotion with Men

ERIC Educational Resources Information Center

Dolan, Alan; Staples, Victoria; Summer, Sylvie; Hundt, Gillian Lewando

2005-01-01

Prostate health has emerged as a key health issue for men. Nearly 10000 men die from prostate cancer each year and many more live with non-cancerous, but debilitating, prostate conditions. Despite the widespread prevalence, evidence suggests that men lack knowledge about male cancers and conditions, and are more likely to ignore signs and delay…

Hematology and serum biochemistry in debilitated, free-ranging raccoon dogs (Nyctereutes procyonoides) infested with sarcoptic mange.

PubMed

Kido, Nobuhide; Kamegaya, Chihiro; Omiya, Tomoko; Wada, Yuko; Takahashi, Maya; Yamamoto, Yasuhiko

2011-12-01

Frequent outbreaks of Sarcoptes scabiei infestation in raccoon dogs (Nyctereutes procyonoides) have been reported in Japan. Although many raccoon dogs are brought to Kanazawa Zoological Garden (Yokohama, Kanagawa, Japan) because of S. scabiei infestation and debilitation, some of them die of asthenia. The clinical status of severely debilitated raccoon dogs must be determined to save their lives. In this study, we compared hematological and serum biochemical values between severely debilitated and nondebilitated raccoon dogs infested with S. scabiei. The total protein, albumin, glucose, and calcium values of debilitated raccoon dogs were significantly lower than those of nondebilitated raccoon dogs. On the other hand, debilitated raccoon dogs had significantly higher aspartate aminotransferase, total bilirubin, blood urea nitrogen, sodium, chloride, and phosphorus values than did nondebilitated raccoon dogs. The increase in the blood urea nitrogen value was particularly dramatic. The present study revealed that debilitated raccoon dogs infested with S. scabiei exhibited abnormal hematological values compared with nondebilitated raccoon dogs infested with S. scabiei. Clinically, the raccoon dogs developed malnutrition and sepsis if the mange infestation was untreated. Moreover, dehydration associated with appetite loss may have resulted in insufficient renal perfusion. These findings suggest that chronic S. scabiei infestations debilitated the raccoon dogs and resulted in physiological changes that were detected with hematological and serum biochemical tests. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Fatigue in Adolescents With Cancer Compared to Healthy Adolescents

PubMed Central

Daniel, Lauren C.; Brumley, Lauren D.; Schwartz, Lisa A.

2015-01-01

Background Cancer-related fatigue is one of the most pervasive and debilitating side-effects of cancer treatment and adolescents consistently rate cancer-related fatigue as one of the most distressing aspects of treatment. Because fatigue is also high in adolescents without cancer, the current study aims to describe fatigue in adolescents with cancer relative to a control group and to identify associates of such fatigue. Knowing this is important for understanding the extent of the problem in adolescents with cancer relative to healthy adolescents and for understanding who is most at risk for fatigue and related distress. Procedure Adolescents with cancer and their caregivers (n =102) and adolescents without a history of chronic health conditions and their caregivers (n =97) completed the Multidimensional Fatigue Scale and measures of depression, quality of life (QoL), affect, coping, and family functioning. Results Adolescents with cancer and their caregivers reported significantly more adolescent fatigue across all domains (with the exception of adolescent reports of cognitive fatigue) relative to adolescents without chronic health conditions. Higher fatigue was significantly related to adolescent report of more symptoms of depression, poorer QoL, higher negative affect, less positive affect, and behavioral disengagement coping style. Fatigue was not related to active coping or family functioning. Conclusions Adolescents with cancer experience significantly more fatigue than peers without chronic health conditions. Reports of fatigue are closely related to multiple indicators of psychosocial well-being, suggesting that fatigue may be an important cancer-related symptom to assess and manage to improve adolescent QoL. PMID:23897651

Multidisciplinary disease management in rheumatology.

PubMed

Oliver, Susan

2003-11-01

With an increasingly ageing population, the number of patients with osteoarthritis and rheumatoid arthritis is expected to rise. High-quality patient education and self-management are essential in these chronic debilitating conditions. A multidisciplinary team has produced a template to guide the assessment, treatment and holistic care of patients in primary care.

Case report: Emergency department diagnosis of melorheostosis in the upper extremity: a rare disease with an unusual presentation.

PubMed

Murano, Tiffany; Egarian, Michele

2012-10-01

Melorheostosis is a rare disease that affects fewer than 1:1,000,000 persons worldwide and most typically affects the lower extremities. It is a non-hereditary disease that may be debilitating due to chronic pain, contractures of the soft tissue, and even shortening of the affected limbs. Although it most commonly occurs in the lower extremities, melorheostosis has been reported in various locations throughout the body. This case report describes a patient who presented to the Emergency Department (ED) with this rare disease in an uncommonly affected bone. The patient was a 21-year-old man who presented to the ED with pain in his left upper extremity that he attributed to playing sports 3 days before presentation. Plain films revealed periosteal hyperostosis typical of melorheostosis in several of his carpals, metacarpals, and phalanges, as well as the humerus and ulna. The patient was discharged with orthopedic follow-up and pain medication. Melorheostosis is a rare disease that has characteristic radiographic findings likened to the appearance of melting wax flowing down the side of a candle. In certain cases, the disease can be debilitating and may require chronic pain management and even operative intervention. If this diagnosis is made in the ED, the emergency physician should provide adequate pain management and refer the patient to an orthopedic specialist for a work-up to rule out other sclerosing bone dysplasias. Copyright © 2012 Elsevier Inc. All rights reserved.

Relational Schemas and the Developing Self: Perceptions of Mother and of Self as Joint Predictors of Early Adolescents' Self-Esteem

ERIC Educational Resources Information Center

Ojanen, Tiina; Perry, David G.

2007-01-01

This 1-year longitudinal study examined early adolescents' (N=278, age 11-13 years) perceptions of their mother's behavior (affection, knowledge of child's activities, and psychological control) and of how they react to their mother (trust in mother, defiance, and debilitation) as predictors of self-esteem among peers. Perceived maternal affection…

[Psychological care of patients with head and neck cancer].

PubMed

Moya, Mélanie

2015-09-01

Treatments for head and neck cancers are generally complex and debilitating. Surgery, often mutilating, profoundly affects the relationship between oneself and others and causes verbal communication, breathing and swallowing difficulties. The functional and aesthetic sequelae are a constant reminder to the patient of the disease and make them conscious of their appearance. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

In Search of Dignity: One Family Caring for Their Child's Incontinence

ERIC Educational Resources Information Center

Coelho, Amy

2009-01-01

This article shares a story of a family with a child who has a spastic quadriplegia cerebral palsy, a form of cerebral palsy (CP) that affects all four limbs and torso with debilitating muscle dysfunction. It describes how the family cares for their child's incontinence. It also shares the experience of the child's mother, Kathy, who attributes…

Revisiting the Corticomotor Plasticity in Low Back Pain: Challenges and Perspectives

PubMed Central

Massé-Alarie, Hugo; Schneider, Cyril

2016-01-01

Chronic low back pain (CLBP) is a recurrent debilitating condition that costs billions to society. Refractoriness to conventional treatment, lack of improvement, and associated movement disorders could be related to the extensive brain plasticity present in this condition, especially in the sensorimotor cortices. This narrative review on corticomotor plasticity in CLBP will try to delineate how interventions such as training and neuromodulation can improve the condition. The review recommends subgrouping classification in CLBP owing to brain plasticity markers with a view of better understanding and treating this complex condition. PMID:27618123

High Times for Painful Blues: The Endocannabinoid System in Pain-Depression Comorbidity

PubMed Central

Fitzgibbon, Marie; Finn, David P.

2016-01-01

Depression and pain are two of the most debilitating disorders worldwide and have an estimated cooccurrence of up to 80%. Comorbidity of these disorders is more difficult to treat, associated with significant disability and impaired health-related quality of life than either condition alone, resulting in enormous social and economic cost. Several neural substrates have been identified as potential mediators in the association between depression and pain, including neuroanatomical reorganization, monoamine and neurotrophin depletion, dysregulation of the hypothalamo-pituitary-adrenal axis, and neuroinflammation. However, the past decade has seen mounting evidence supporting a role for the endogenous cannabinoid (endocannabinoid) system in affective and nociceptive processing, and thus, alterations in this system may play a key role in reciprocal interactions between depression and pain. This review will provide an overview of the preclinical evidence supporting an interaction between depression and pain and the evidence supporting a role for the endocannabinoid system in this interaction. PMID:26342110

Pathogenesis of Endometriosis: Roles of Retinoids and Inflammatory Pathways

PubMed Central

Taylor, Robert N.; Kane, Maureen A.; Sidell, Neil

2016-01-01

Endometriosis is a nonmalignant, but potentially metastatic, gynecological condition manifested by the extrauterine growth of inflammatory endometrial implants. Ten percent of reproductive-age women are affected and commonly suffer pelvic pain and/ or infertility. The theories of endometriosis histogenesis remain controversial, but retrograde menstruation and metaplasia each infer mechanisms that explain the immune cell responses observed around the ectopic lesions. Recent findings from our laboratories and others suggest that retinoic acid metabolism and action are fundamentally flawed in endometriotic tissues and even generically in women with endometriosis. The focus of our ongoing research is to develop medical therapies as adjuvants or alternatives to the surgical excision of these lesions. On the basis of concepts put forward in this review, we predict that the pharmacological actions and anticipated low side-effect profiles of retinoid supplementation might provide a new treatment option for the long-term management of this chronic and debilitating gynecological disease. PMID:26132929

Emerging therapies for mitochondrial disorders

PubMed Central

Nightingale, Helen; Pfeffer, Gerald; Bargiela, David; Horvath, Rita

2016-01-01

Abstract Mitochondrial disorders are a diverse group of debilitating conditions resulting from nuclear and mitochondrial DNA mutations that affect multiple organs, often including the central and peripheral nervous system. Despite major advances in our understanding of the molecular mechanisms, effective treatments have not been forthcoming. For over five decades patients have been treated with different vitamins, co-factors and nutritional supplements, but with no proven benefit. There is therefore a clear need for a new approach. Several new strategies have been proposed acting at the molecular or cellular level. Whilst many show promise in vitro, the clinical potential of some is questionable. Here we critically appraise the most promising preclinical developments, placing the greatest emphasis on diseases caused by mitochondrial DNA mutations. With new animal and cellular models, longitudinal deep phenotyping in large patient cohorts, and growing interest from the pharmaceutical industry, the field is poised to make a breakthrough. PMID:27190030

The Ion Channel TRPA1 Is Required for Chronic Itch

PubMed Central

Wilson, Sarah R.; Nelson, Aislyn M.; Batia, Lyn; Morita, Takeshi; Estandian, Daniel; Owens, David M.; Lumpkin, Ellen A.; Bautista, Diana M.

2013-01-01

Chronic itch is a debilitating condition that affects one in 10 people. Little is known about the molecules that mediate chronic itch in primary sensory neurons and skin. We demonstrate that the ion channel TRPA1 is required for chronic itch. Using a mouse model of chronic itch, we show that scratching evoked by impaired skin barrier is abolished in TRPA1-deficient animals. This model recapitulates many of the pathophysiological hallmarks of chronic itch that are observed in prevalent human diseases such as atopic dermatitis and psoriasis, including robust scratching, extensive epidermal hyperplasia, and dramatic changes in gene expression in sensory neurons and skin. Remarkably, TRPA1 is required for both transduction of chronic itch signals to the CNS and for the dramatic skin changes triggered by dry-skin-evoked itch and scratching. These data suggest that TRPA1 regulates both itch transduction and pathophysiological changes in the skin that promote chronic itch. PMID:23719797

Migraine surgery: a plastic surgery solution for refractory migraine headache.

PubMed

Kung, Theodore A; Guyuron, Bahman; Cederna, Paul S

2011-01-01

Migraine headache can be a debilitating condition that confers a substantial burden to the affected individual and to society. Despite significant advancements in the medical management of this challenging disorder, clinical data have revealed a proportion of patients who do not adequately respond to pharmacologic intervention and remain symptomatic. Recent insights into the pathogenesis of migraine headache argue against a central vasogenic cause and substantiate a peripheral mechanism involving compressed craniofacial nerves that contribute to the generation of migraine headache. Botulinum toxin injection is a relatively new treatment approach with demonstrated efficacy and supports a peripheral mechanism. Patients who fail optimal medical management and experience amelioration of headache pain after injection at specific anatomical locations can be considered for subsequent surgery to decompress the entrapped peripheral nerves. Migraine surgery is an exciting prospect for appropriately selected patients suffering from migraine headache and will continue to be a burgeoning field that is replete with investigative opportunities.

Current and emerging strategies for treatment of childhood dystonia

PubMed Central

Bertucco, Matteo; Sanger, Terence D.

2014-01-01

Childhood dystonia is a movement disorder characterized by involuntary sustained or intermittent muscle contractions causing twisting and repetitive movements, abnormal postures, or both (Sanger et al. 2003). Dystonia is a devastating neurological condition that prevents the acquisition of normal motor skills during critical periods of development in children. Moreover, it is particularly debilitating in children when dystonia affects the upper extremities such that learning and consolidation of common daily motor actions are impeded. Thus, the treatment and rehabilitation of dystonia is a challenge that continuously requires exploration of novel interventions. This review will initially describe the underlying neurophysiological mechanisms of the motor impairments found in childhood dystonia followed by the clinical measurement tools that are available to document the presence and severity of symptoms. Finally, we will discuss the state-of-the-art of therapeutic options for childhood dystonia, with particular emphasis on emergent and innovative strategies. PMID:25835254

Factors involved in the etiology of temporomandibular disorders - a literature review

PubMed Central

CHISNOIU, ANDREA MARIA; PICOS, ALINA MONICA; POPA, SEVER; CHISNOIU, PETRE DANIEL; LASCU, LIANA; PICOS, ANDREI; CHISNOIU, RADU

2015-01-01

Background and aim This review aims at presenting a current view on the most frequent factors involved in the mechanisms causing temporomandibular disorders (TMD). Method We conducted a critical review of the literature for the period January 2000 to December 2014 to identify factors related to TMD development and persistence. Results The etiology of TMD is multidimensional: biomechanical, neuromuscular, bio-psychosocial and biological factors may contribute to the disorder. Occlusal overloading and parafunctions (bruxism) are frequently involved as biomechanical factors; increased levels of estrogen hormones are considered biological factors affecting the temporo-mandibular-joint. Among bio-psychosocial factors, stress, anxiety or depression, were frequently encountered. Conclusions The etiopathogenesis of this condition is poorly understood, therefore TMDs are difficult to diagnose and manage. Early and correct identification of the possible etiologic factors will enable the appropriate treatment scheme application in order to reduce or eliminate TMDs debilitating signs and symptoms. PMID:26732121

Somatoform Pain: A developmental theory and translational research review

PubMed Central

Landa, Alla; Peterson, Bradley S.; Fallon, Brian A.

2013-01-01

Somatoform pain is a highly prevalent, debilitating condition and a tremendous public health problem. Effective treatments for somatoform pain are urgently needed. The etiology of this condition is, however, still unknown. On the basis of a review of recent basic and clinical research, we propose one potential mechanisms of symptom formation in somatoform pain and a developmental theory of its pathogenesis. The emerging evidence from animal and human studies in developmental neurobiology, cognitive-affective neuroscience, psychoneuroimmunology, genetics, epigenetics, and clinical and treatment studies of somatoform pain all point to the existence of a shared physical and social pain neural system. Research findings also show that non-optimal early experiences interact with genetic predispositions to influence the development of this shared system and ability to regulate it in an effective way. Interpersonal affect regulation between infant and caregiver is crucial for the optimal development of these brain circuits. The aberrant development of this shared neural system during infancy, childhood and adolescence, therefore, may ultimately lead to an increased sensitivity to physical and social pain and to problems with their regulation in adulthood. The authors critically review translational research findings that support this theory and discuss its clinical and research implications. Specifically, the proposed theory and reviewed research suggest that psychotherapeutic and/or pharmacologic interventions that foster the development of affect regulation capacities in an interpersonal context will also serve to more effectively modulate aberrantly activated neural pain circuits and thus be of particular benefit in the treatment of somatoform pain. PMID:22929064

A Neolithic case of fibrous dysplasia from Çatalhöyük (Turkey).

PubMed

Milella, Marco; Knüsel, Christopher J; Haddow, Scott D

2016-12-01

The vast majority of primary burials at Neolithic Çatalhöyük (Central Anatolia, Turkey, 7100-6000cal BC) are recovered from beneath house floors, with burials in external spaces extremely rare. Excavations at Çatalhöyük in 1998 brought to light a young adult male buried in a midden (a burial location observed so far for only 4 out of 440 individuals), showing a suite of pathological features affecting the entire skeleton. The observed pathological changes include perimortem and antemortem fractures, proliferative and resorptive areas, thinning of the bone cortex, and localized areas of disorganized spongy bone invaded by fibrous tissue. We propose a differential diagnosis by considering a set of conditions: Paget's disease, osteomyelitis, hyperparathyrhoidism, Ollier's disease, fibrosarcoma, and fibrous dysplasia. The severity and distribution of the observed skeletal changes are consistent with a diagnosis of polyostotic fibrous dysplasia, a possibly debilitating and disfiguring condition. This, together with an unusual depositional context, may suggest a socially-mediated reaction to this individual's infirmity. Copyright © 2016 Elsevier Inc. All rights reserved.

Women Confronting the Reality of Multiple Sclerosis: A Qualitative Model of Self-Healing

ERIC Educational Resources Information Center

Romagosa, Carol J.

2010-01-01

Multiple sclerosis (MS) is a chronic debilitating disease that has an uncertain course. Although uncertainty is a universal experience in chronic illness, uncertainty in MS is especially threatening to psychological well-being. Chronic illness, including conditions of disability, is one of our greatest health care problems as society ages. Never…

COMPLICATED GRIEF AND RELATED BEREAVEMENT ISSUES FOR DSM-5

PubMed Central

Shear, M. Katherine; Simon, Naomi; Wall, Melanie; Zisook, Sidney; Neimeyer, Robert; Duan, Naihua; Reynolds, Charles; Lebowitz, Barry; Sung, Sharon; Ghesquiere, Angela; Gorscak, Bonnie; Clayton, Paula; Ito, Masaya; Nakajima, Satomi; Konishi, Takako; Melhem, Nadine; Meert, Kathleen; Schiff, Miriam; O’Connor, Mary-Frances; First, Michael; Sareen, Jitender; Bolton, James; Skritskaya, Natalia; Mancini, Anthony D.; Keshaviah, Aparna

2010-01-01

Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This paper focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders. PMID:21284063

CIRSE Guidelines on Percutaneous Vertebral Augmentation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tsoumakidou, Georgia, E-mail: gtsoumakidou@yahoo.com; Too, Chow Wei, E-mail: spyder55@gmail.com; Koch, Guillaume, E-mail: guillaume.koch@gmail.com

Vertebral compression fracture (VCF) is an important cause of severe debilitating back pain, adversely affecting quality of life, physical function, psychosocial performance, mental health and survival. Different vertebral augmentation procedures (VAPs) are used in order to consolidate the VCFs, relief pain,and whenever posible achieve vertebral body height restoration. In the present review we give the indications, contraindications, safety profile and outcomes of the existing percutaneous VAPs.

Epidemiology and social costs of hip fracture.

PubMed

Veronese, Nicola; Maggi, Stefania

2018-04-20

Hip fracture is an important and debilitating condition in older people, particularly in women. The epidemiological data varies between countries, but it is globally estimated that hip fractures will affect around 18% of women and 6% of men. Although the age-standardised incidence is gradually falling in many countries, this is far outweighed by the ageing of the population. Thus, the global number of hip fractures is expected to increase from 1.26 million in 1990 to 4.5 million by the year 2050. The direct costs associated with this condition are enormous since it requires a long period of hospitalisation and subsequent rehabilitation. Furthermore, hip fracture is associated with the development of other negative consequences, such as disability, depression, and cardiovascular diseases, with additional costs for society. In this review, we show the most recent epidemiological data regarding hip fracture, indicating the well-known risk factors and conditions that seem relevant for determining this condition. A specific part is dedicated to the social costs due to hip fracture. Although the costs of hip fracture are probably comparable to other common diseases with a high hospitalisation rate (e.g. cardiovascular disease), the other social costs (due to onset of new co-morbidities, sarcopenia, poor quality of life, disability and mortality) are probably greater. Copyright © 2018 Elsevier Ltd. All rights reserved.

STREPTOCOCCUS PHOCAE IN MARINE MAMMALS OF NORTHEASTERN PACIFIC AND ARCTIC CANADA: A RETROSPECTIVE ANALYSIS OF 85 POSTMORTEM INVESTIGATIONS.

PubMed

Taurisano, Nicole D; Butler, Brian P; Stone, Diana; Hariharan, Harry; Fields, Paul J; Ferguson, Hugh W; Haulena, Martin; Cotrell, Paul; Nielsen, Ole; Raverty, Stephen

2018-01-01

:  Streptococcus phocae is a pathogen of marine mammals, although its pathogenicity remains poorly understood. Recovery of this bacterium from asymptomatic carriers suggests that it is an opportunistic pathogen. We investigated the role of S. phocae in naturally occurring disease and its significance as a pathogen based on postmortem investigations. Between 2007 and 2012, 1,696 whole carcasses, tissue samples, or both were submitted from the northeastern Pacific and Arctic Canada for diagnostic testing. Streptococcus phocae was cultured from phocids ( n=66), otariids ( n=12), harbor porpoises ( Phocoena phocoena; n=5), and sea otters ( Enhydra lutris; n=2). Pathologic manifestations of S. phocae-associated disease included localized, as well as systemic, inflammatory lesions with common findings of suppurative bronchopneumonia ( n=17) and bacteremia ( n=27). Lung lesions were frequently culture-positive for S. phocae, suggesting commensal colonization of the oropharynx with subsequent opportunistic infection of the respiratory tract during tissue injury, coinfection, immunosuppression, or other debilitating conditions. The presence of a positive spleen culture, and interpretations at necropsy and histopathology, were used to determine the presence of S. phocae bacteremia. Less frequent lesions that were culture positive for S. phocae included abscesses ( n=9), meningitis ( n=7), and cellulitis ( n=1). The majority of cases with S. phocae lesions featured pre-existing conditions that presumably contributed to some degree of debilitation or immunosuppression, including emaciation ( n=29), liver mercury accumulation ( n=29), trauma ( n=22), severe pulmonary or cardiovascular nematodiasis ( n=9), concurrent bacterial or viral infections ( n=8), or sarcocystosis ( n=6). These findings suggest that S. phocae could be characterized as an opportunistic pathogen, associated with debilitating conditions in stranded and rehabilitating marine mammals. Wildlife investigators can use these results to draw more definitive conclusions regarding positive S. phocae cultures during postmortem studies in marine mammals.

21 CFR 312.84 - Risk-benefit analysis in review of marketing applications for drugs to treat life-threatening and...

Code of Federal Regulations, 2013 CFR

2013-04-01

... applications for drugs to treat life-threatening and severely-debilitating illnesses. 312.84 Section 312.84... Severely-debilitating Illnesses § 312.84 Risk-benefit analysis in review of marketing applications for drugs to treat life-threatening and severely-debilitating illnesses. (a) FDA's application of the...

21 CFR 312.84 - Risk-benefit analysis in review of marketing applications for drugs to treat life-threatening and...

Code of Federal Regulations, 2014 CFR

2014-04-01

... applications for drugs to treat life-threatening and severely-debilitating illnesses. 312.84 Section 312.84... Severely-debilitating Illnesses § 312.84 Risk-benefit analysis in review of marketing applications for drugs to treat life-threatening and severely-debilitating illnesses. (a) FDA's application of the...

21 CFR 312.84 - Risk-benefit analysis in review of marketing applications for drugs to treat life-threatening and...

Code of Federal Regulations, 2011 CFR

2011-04-01

... applications for drugs to treat life-threatening and severely-debilitating illnesses. 312.84 Section 312.84... Severely-debilitating Illnesses § 312.84 Risk-benefit analysis in review of marketing applications for drugs to treat life-threatening and severely-debilitating illnesses. (a) FDA's application of the...

21 CFR 312.84 - Risk-benefit analysis in review of marketing applications for drugs to treat life-threatening and...

Code of Federal Regulations, 2012 CFR

2012-04-01

... applications for drugs to treat life-threatening and severely-debilitating illnesses. 312.84 Section 312.84... Severely-debilitating Illnesses § 312.84 Risk-benefit analysis in review of marketing applications for drugs to treat life-threatening and severely-debilitating illnesses. (a) FDA's application of the...

Treating Selective Mutism Using Modular CBT for Child Anxiety: A Case Study

ERIC Educational Resources Information Center

Reuther, Erin T.; Davis, Thompson E., III; Moree, Brittany N.; Matson, Johnny L.

2011-01-01

Selective mutism is a rare, debilitating condition usually seen in children. Unfortunately, there is little research examining effective treatments for this disorder, and designing an evidence-based treatment plan can be difficult. This case study presents the evidence-based treatment of an 8-year-old Caucasian boy with selective mutism using an…

"Headache Tools to Stay in School": Assessment, Development, and Implementation of an Educational Guide for School Nurses

ERIC Educational Resources Information Center

Lazdowsky, Lori; Rabner, Jonathan; Caruso, Alessandra; Kaczynski, Karen; Gottlieb, Sarah; Mahoney, Elyse; LeBel, Alyssa

2016-01-01

Background: Headache is the most common type of pain reported in the pediatric population, and chronic headache is an increasingly prevalent and debilitating pain condition in children and adolescents. With large numbers of students experiencing acute headaches and more students with chronic headache reentering typical school settings, greater…

Reshaping Child Welfare's Response to Trauma: Assessment, Evidence-Based Intervention, and New Research Perspectives

ERIC Educational Resources Information Center

Ai, Amy L.; Jackson Foster, Lovie J.; Pecora, Peter J.; Delaney, Nancy; Rodriguez, Wenceslao

2013-01-01

Growing evidence has linked early trauma with severe psychiatric consequences. Posttraumatic stress disorder (PTSD) is a potentially debilitating mental health condition found among some youth in foster care and foster care alumni. However, the current child welfare practice response has not met the demands in both assessment and intervention.…

Emergency care of raptors.

PubMed

Graham, Jennifer E; Heatley, J Jill

2007-05-01

Raptors may present with a variety of conditions, such as trauma, debilitation, and disease, that necessitate emergency care. Emergency treatment should prioritize stabilization of the patient. Diagnostic testing should be delayed until feasible based on patient status. This article reviews emergency medicine in raptors, including appropriate handling and restraint, hospitalization, triage and patient assessment, sample collection, supportive care, and common emergency presentations.

Service-Learning with the Mentally Ill: Softening the Stigma

ERIC Educational Resources Information Center

Barney, Steve T.; Corser, Grant C.; White, Lynn H.

2010-01-01

Stigmas toward those who have mental illnesses are wide-spread and detrimental to the health and well-being of those suffering from these debilitating conditions, and to society as a whole. Stigma-reducing programs are plentiful but many are only marginally effective. In this paper we describe and evaluate a course in Psychopathology that included…

Long-term effectiveness of a comprehensive pain management program: strengthening the case for interdisciplinary care

PubMed Central

Oslund, Sarah; Clark, Timothy C.; Garofalo, John P.; Behnk, Pamela; Walker, Becky; Walker, Katherine E.; Gatchel, Robert J.; Mahaney, Micah; Noe, Carl E.

2009-01-01

Chronic pain, a debilitating medical condition affecting approximately 15% of the US population, leads to individual suffering and costs to society in terms of health care dollars and lost productivity. To examine the effectiveness of a comprehensive pain management program, data from 108 program participants were evaluated. Preprogram, postprogram, and 6-month follow-up data were collected from 80 participants, and preprogram, postprogram, and 1-year data were collected from 46 participants. Outcomes data from several domains were assessed: pain severity, emotional distress, interference of pain on function, perceived control of pain, treatment helpfulness, and number of hours resting. Within-subject repeated-measure analyses of variance found statistically significant findings on the six outcome measures utilized in this study for both the 6-month and 1-year samples. Examination of 95% confidence intervals revealed no overlap in pretreatment scores with 6-month and 1-year outcomes in five of the six domains studied. Mean scores on emotional distress did not maintain statistical significance in the 6-month or 1-year review. Overall, this study strengthens the case for interdisciplinary care for chronic pain management and provides evidence for the long-term effectiveness of this therapy. Furthermore, this study lends support to the notion that interdisciplinary treatments are effective in targeting multiple domains affected by the pain condition. PMID:19633738

The effect of badminton-specific exercise on badminton short-serve performance in competition and practice climates.

PubMed

Duncan, Michael J; Chan, Cheryl K Y; Clarke, Neil D; Cox, Martin; Smith, Mike

2017-03-01

This study examined the effects of changes in physiological and psychological arousal on badminton short-serve performance in competitive and practice climates. Twenty competitive badminton players (10 males and 10 females) volunteered to participate in the study following ethics approval. After familiarisation, badminton short-serve performance was measured at rest, mid-way through and at the end of a badminton-specific exercise protocol in two conditions; competition vs. practice. Ratings of cognitive and somatic anxiety were assessed at three time points prior to badminton short-serve performance using the Mental Readiness Form 3. Heart rate and rating of perceived exertion (RPE) were assessed during the exercise protocol. Results indicated that better short-serve performance was evident in practice compared to competition (P = .034). RPE values were significantly higher in the competition condition compared to practice (P = .007). Cognitive anxiety intensity was significantly lower post-exercise in the practice condition compared to competition (P = .001). Cognitive anxiety direction showed greater debilitation post-exercise in the competition condition compared to practice (P = .01). Somatic anxiety intensity increased from pre-, to mid- to post-exercise (P = .001) irrespective of condition. This study suggests that badminton serve performance is negatively affected when physiological arousal, via badminton-specific exercise, and cognitive anxiety, via perceived competition, are high.

Diagnosis and Management of Distal Clavicle Osteolysis.

PubMed

DeFroda, Steven F; Nacca, Christopher; Waryasz, Gregory R; Owens, Brett D

2017-03-01

Distal clavicle osteolysis is an uncommon condition that most commonly affects weight lifters and other athletes who perform repetitive overhead activity. Although this condition most commonly presents in young active men, it is becoming increasing more common in women with the rise in popularity of body building and extreme athletics. Distal clavicle osteolysis can be debilitating, especially in those with rigorous training regimens, preventing exercise because of pain with activities such as bench presses and chest flies. Aside from a careful history and physical examination, radiographic evaluation is essential in distinguishing isolated distal clavicle osteolysis from acromioclavicular joint pathology, despite a potentially similar presentation of the 2 conditions. Nonoperative therapy that includes activity modification, nonsteroidal anti-inflammatory drugs, and cortisone injections is the first-line management for this condition. Patients whose conditions are refractory to nonoperative modalities may benefit from distal clavicle resection via either open or arthroscopic techniques. Arthroscopic techniques typically are favored because of improved cosmesis and the added benefit of the ability to assess the glenohumeral joint during surgery to rule out concomitant pathology. There are varying operative techniques even within arthroscopic management, with pros and cons of a direct and an indirect surgical approach. Patients often do well after such procedures and are able to return to their preinjury level of participation in a relatively short period. [Orthopedics. 2017; 40(2):119-124.]. Copyright 2016, SLACK Incorporated.

Group Trauma-Focused Cognitive-Behavioural Therapy with Former Child Soldiers and Other War-Affected Boys in the DR Congo: A Randomised Controlled Trial

ERIC Educational Resources Information Center

McMullen, John; O'Callaghan, Paul; Shannon, Ciaran; Black, Alastair; Eakin, John

2013-01-01

Background: The Democratic Republic of Congo (DRC) has been home to the world's deadliest conflict since World War II and is reported to have the largest number of child soldiers in the world. Despite evidence of the debilitating impact of war, no group-based mental health or psychosocial intervention has been evaluated in a randomised controlled…

Enhancing Osteoclastic Resorption for the Prevention and Treatment of Heterotopic Ossification

DTIC Science & Technology

2015-03-01

two thirds of these patients developing painful and debilitating HO. There are currently no effective treatments for HO other than surgical...prevention and treatment of HO, to relieve this painful and debilitating orthopaedic complication. American Society for Bone and Mineral Research, Houston...developing painful and debilitating HO. There are currently no effective treatments for HO other than surgical excision of the ossified tissue which

Personal, interpersonal, and situational influences on behavioral self-handicapping.

PubMed

Brown, Christina M; Kimble, Charles E

2009-12-01

This study explored the combined effects of personal factors (participant sex), interpersonal factors (experimenter sex), and situational factors (performance feedback) on two forms of behavioral self-handicapping. Participants received non-contingent success or failure feedback concerning their performance on a novel ability and were given the opportunity to self-handicap before performing again. Behavioral self-handicapping took the form of (a) exerting less practice effort (practice) or (b) choosing a performance-debilitating tape (choice). Men practiced least after failure feedback and chose a debilitating tape if they were interacting with a female experimenter. Generally, across all participants in both choice and practice conditions, high performance concern and the presence of a male experimenter led to the most self-handicapping. Results are interpreted in terms of self-presentational concerns that emphasize a desire to impress or an awareness of the female or male experimenter's acceptance of self-handicappers.

Ovarian function's role during cancer cachexia progression in the female mouse.

PubMed

Hetzler, Kimbell L; Hardee, Justin P; LaVoie, Holly A; Murphy, E Angela; Carson, James A

2017-05-01

Cachexia is a debilitating condition that occurs with chronic disease, including cancer; our research has shown that some regulation of cancer cachexia progression is affected by sex differences. The Apc Min/+ mouse is genetically predisposed to develop intestinal tumors; IL-6 signaling and hypogonadism are associated with cachexia severity in the male. This relationship in the female warrants further investigation, as we have shown that the ability of IL-6 to induce cachexia differs between the sexes. Since ovarian reproductive function relies on a complex system of endocrine signaling to affect whole body homeostasis, we examined the relationship between ovarian reproductive function and progression of cancer cachexia in the female Apc Min/+ mouse. Our study of ovarian reproductive function in female Apc Min/+ mice showed disease-related cessation of estrous cycling (acyclicity) in 38% of mice. Acyclicity, including morphological and functional losses and enhanced muscle inflammatory gene expression, was associated with severe cachexia. Interestingly, ovariectomy rescued body weight and muscle mass and function but increased muscle sensitivity to systemic IL-6 overexpression. In conclusion, our results provide evidence for a relationship between ovarian reproductive function and cachexia progression in female Apc Min/+ mice. Copyright © 2017 the American Physiological Society.

Ovarian function’s role during cancer cachexia progression in the female mouse

PubMed Central

Hetzler, Kimbell L.; Hardee, Justin P.; LaVoie, Holly A.; Murphy, E. Angela

2017-01-01

Cachexia is a debilitating condition that occurs with chronic disease, including cancer; our research has shown that some regulation of cancer cachexia progression is affected by sex differences. The ApcMin/+ mouse is genetically predisposed to develop intestinal tumors; IL-6 signaling and hypogonadism are associated with cachexia severity in the male. This relationship in the female warrants further investigation, as we have shown that the ability of IL-6 to induce cachexia differs between the sexes. Since ovarian reproductive function relies on a complex system of endocrine signaling to affect whole body homeostasis, we examined the relationship between ovarian reproductive function and progression of cancer cachexia in the female ApcMin/+ mouse. Our study of ovarian reproductive function in female ApcMin/+ mice showed disease-related cessation of estrous cycling (acyclicity) in 38% of mice. Acyclicity, including morphological and functional losses and enhanced muscle inflammatory gene expression, was associated with severe cachexia. Interestingly, ovariectomy rescued body weight and muscle mass and function but increased muscle sensitivity to systemic IL-6 overexpression. In conclusion, our results provide evidence for a relationship between ovarian reproductive function and cachexia progression in female ApcMin/+ mice. PMID:28292759

Pathophysiology of wound healing and alterations in venous leg ulcers-review.

PubMed

Raffetto, Joseph D

2016-03-01

Venous leg ulcer (VLU) is one of the most common lower extremity ulcerated wound, and is a significant healthcare problem with implications that affect social, economic, and the well-being of a patient. VLU can have debilitating related problems which require weekly medical care and may take months to years to heal. The pathophysiology of VLU is complex, and healing is delayed in many patients due to a persistent inflammatory condition. Patient genetic and environmental factors predispose individuals to chronic venous diseases including VLU. Changes in shear stress affecting the glycocalyx are likely initiating events, leading to activation of adhesion molecules on endothelial cells, and leukocyte activation with attachment and migration into vein wall, microcirculation, and in the interstitial space. Multiple chemokines, cytokines, growth factors, proteases and matrix metalloproteinases are produced. The pathology of VLU involves an imbalance of inflammation, inflammatory modulators, oxidative stress, and proteinase activity. Understanding the cellular and biochemical events that lead to the progression of VLU is critical. With further understanding of inflammatory pathways and potential mechanisms, certain biomarkers could be revealed and studied as both involvement in the pathophysiology of VLU but also as therapeutic targets for VLU healing. © The Author(s) 2016.

Gene and Chromosomal Copy Number Variations as an Adaptive Mechanism Towards a Parasitic Lifestyle in Trypanosomatids.

PubMed

Reis-Cunha, João Luís; Valdivia, Hugo O; Bartholomeu, Daniella Castanheira

2018-02-01

Trypanosomatids are a group of kinetoplastid parasites including some of great public health importance, causing debilitating and life-long lasting diseases that affect more than 24 million people worldwide. Among the trypanosomatids, Trypanosoma cruzi, Trypanosoma brucei and species from the Leishmania genus are the most well studied parasites, due to their high prevalence in human infections. These parasites have an extreme genomic and phenotypic variability, with a massive expansion in the copy number of species-specific multigene families enrolled in host-parasite interactions that mediate cellular invasion and immune evasion processes. As most trypanosomatids are heteroxenous, and therefore their lifecycles involve the transition between different hosts, these parasites have developed several strategies to ensure a rapid adaptation to changing environments. Among these strategies, a rapid shift in the repertoire of expressed genes, genetic variability and genome plasticity are key mechanisms. Trypanosomatid genomes are organized into large directional gene clusters that are transcribed polycistronically, where genes derived from the same polycistron may have very distinct mRNA levels. This particular mode of transcription implies that the control of gene expression operates mainly at post-transcriptional level. In this sense, gene duplications/losses were already associated with changes in mRNA levels in these parasites. Gene duplications also allow the generation of sequence variability, as the newly formed copy can diverge without loss of function of the original copy. Recently, aneuploidies have been shown to occur in several Leishmania species and T. cruzi strains. Although aneuploidies are usually associated with debilitating phenotypes in superior eukaryotes, recent data shows that it could also provide increased fitness in stress conditions and generate drug resistance in unicellular eukaryotes. In this review, we will focus on gene and chromosomal copy number variations and their relevance to the evolution of trypanosomatid parasites.

The benefits of switching to nurse-led management of patients with psoriasis.

PubMed

Riddoch, Caroline

2005-01-01

Genetic in origin, this skin condition can be extremely debilitating, both in terms of physical discomfort and the stress it brings. This paper describes the main types of psoriasis and their treatments, the main aim of which is to control and minimise the symptoms and patient discomfort, focusing on the development of a nurse-led service

Meditation for Posttraumatic Stress Disorder: A Systematic Review

DTIC Science & Technology

2017-01-01

Meditation for Posttraumatic Stress Disorder A Systematic Review Lara Hilton, Alicia Ruelaz Maher, Benjamin Colaiaco, Eric Apaydin, Melony E...interventions for posttraumatic stress disorder. The review will be of interest to military health policymakers and practitioners, civilian health care...is provided on the web page). v Abstract Posttraumatic stress disorder (PTSD) is a debilitating condition that emerges after exposure to a

Anterior capsulotomy for refractory OCD: First case as per the core group guidelines.

PubMed

Doshi, Paresh K

2011-07-01

Obsessive-compulsive disorder (OCD) is a psychiatric disease characterized by anxiety-provoking thoughts (obsessions) leading to repeated, time-consuming behaviors (compulsions) that may or may not provide temporary relief. With an approximate prevalence of 2-3% of the general population and 0.6% in the Indian population, OCD is a debilitating disorder that can significantly affect nearly every aspect of a patient's life, and in some cases, lead to suicide.

A phenomenological study of fatigue in patients with primary biliary cirrhosis.

PubMed

Jorgensen, Roberta

2006-09-01

This paper reports the findings of research on the lived experience of fatigue in patients with primary biliary cirrhosis - a type of chronic liver disease. Fatigue is a universal phenomenon, commonly associated with both acute and chronic illness, but also seen in healthy individuals. However, it is not often addressed in healthcare encounters despite its disabling nature, perhaps because of the multitude of contributing factors and the lack of effective treatments. It is a common and debilitating symptom in patients with primary biliary cirrhosis. Despite the prevalence of fatigue in this condition, patients' experiences of this symptom have not been researched. An interpretive-phenomenological approach developed by van Manen was chosen and this combines features of descriptive and interpretive phenomenology. Eight participants were interviewed during 2005 about their fatigue experience. Thematic analysis was conducted. Five themes were identified: an unreliable body, fatigue as always present yet insidious, planning a life to conserve energy, struggling to maintain normality and emotional consequences. These themes reflected the unrelenting, intrusive nature of fatigue into the lives of those affected. This research will provide empathic insight into the fatigue experience in this condition and generate communication about coping strategies. It will add to the body of research on fatigue in chronic conditions and may generate ideas for intervention research.

Melorheostosis: a Rare Sclerosing Bone Dysplasia.

PubMed

Kotwal, Anupam; Clarke, Bart L

2017-08-01

Melorheostosis is a rare sclerosing bone dysplasia that affects both cortical bone and adjacent soft tissue structures in a sclerotomal distribution. In this review, we describe the natural history, radiological features, proposed pathogenesis, and management options for this debilitating condition. Since its first description in 1922, about 400 cases of melorheostosis have been reported, either as single reports or in small case series. Melorheostosis affects the appendicular skeleton more commonly than the axial skeleton and usually presents with lower limb deformity. Diagnosis is based on a combination of clinical and radiological features that help differentiate this condition from other sclerosing bone dysplasias. LEM domain-containing protein 3 (LEMD3) gene mutations have been demonstrated in several familial cases, but these have been more strongly correlated with other hereditary dysplasias, such as osteopoikilosis, and are not thought to be the causative gene for melorheostosis. The exact etiology of classic sporadically occurring melorheostosis remains unknown, with possible causes being somatic LEMD3 mutations, somatic mutations in the bone morphogenetic protein/transforming growth factor-beta pathway, mutations in multiple genes, or other non-genetic causes. Management in recent years has involved nitrogen-containing bisphosphonates in addition to traditional orthopedic surgical approaches and physical therapy. Melorheostosis may present as mixed or atypical osseous involvement in addition to the classically described "dripping candle wax" appearance of hyperostosis. Some patients may have overlap with osteopoikilosis or Buschke-Ollendorff syndrome. In the future, better characterization of genetic and developmental factors predisposing to melorheostosis may lead to the development of targeted therapy for this condition, as well as for more commonly encountered skeletal abnormalities.

Turning the tide: a history and review of hyperhidrosis treatment

PubMed Central

Levell, Nick J

2014-01-01

Summary Hyperhidrosis is a potential cause of severe physical and psychological distress, interfering in activities of daily living. Over the past 100 years, advances have been made regarding the treatment of this debilitating condition with some success. Surgical treatment with sympathectomy was successfully performed for hyperhidrosis in the early part of the 20th century, with various modifications of the technique over the past 100 years. Topical aluminium salt antiperspirants, anticholinergic medications, iontophoresis and botulinum toxin introduced less invasive ways to manage this condition. This historical review will enable dermatologists and non-dermatologists to manage this distressing condition. PMID:25057361

Variables affecting learning in a simulation experience: a mixed methods study.

PubMed

Beischel, Kelly P

2013-02-01

The primary purpose of this study was to test a hypothesized model describing the direct effects of learning variables on anxiety and cognitive learning outcomes in a high-fidelity simulation (HFS) experience. The secondary purpose was to explain and explore student perceptions concerning the qualities and context of HFS affecting anxiety and learning. This study used a mixed methods quantitative-dominant explanatory design with concurrent qualitative data collection to examine variables affecting learning in undergraduate, beginning nursing students (N = 124). Being ready to learn, having a strong auditory-verbal learning style, and being prepared for simulation directly affected anxiety, whereas learning outcomes were directly affected by having strong auditory-verbal and hands-on learning styles. Anxiety did not quantitatively mediate cognitive learning outcomes as theorized, although students qualitatively reported debilitating levels of anxiety. This study advances nursing education science by providing evidence concerning variables affecting learning outcomes in HFS.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williams, Petra L., E-mail: Petra.Williams@phnt.swest.nhs.uk; Coote, Jacky M.; Watkinson, Anthony F.

Uterine leiomyomata, or fibroids, although benign, cause debilitating symptoms in many women. Symptoms are often nonspecific and may be the presenting complaint in a number of other conditions. Furthermore, because the presence of fibroids may be coincident with other symptomatic conditions that result in similar complaints, there may be diagnostic difficulty and consequent difficulty in planning therapeutic strategy. Uterine artery embolization (UAE) is a safe and effective treatment for symptomatic fibroids and is increasingly being performed. Magnetic resonance imaging (MRI) evaluation before and after treatment is routine practice with the potential to significantly alter management in up to a fifthmore » of patients. It is well recognized that significant incidental findings may be demonstrated during imaging investigations, and in particular that abnormalities that are not directly related to the clinical question may be overlooked. Radiologists evaluating pre-UAE MRI studies must be aware of the MRI appearances of gynecological pathologies that may cause similar symptoms or that may affect the success or complication rates of UAE, and they must also be wary of 'satisfaction of search,' reviewing imaging thoroughly so that relevant other pathologies are not missed. We demonstrate the appearances of coincidental pathologies found on pre-UAE MRI, with the potential to change patient management.« less

Major Depressive Disorder and Measures of Cellular Aging: An Integrative Review

PubMed Central

Kinser, Patricia Anne; Lyon, Debra E.

2013-01-01

Major depressive disorder (MDD) affects millions of individuals and causes significant suffering worldwide. It has been speculated that MDD is associated with accelerated aging-related biological and functional decline. To examine the accelerated aging hypothesis, one of the biomarkers under study is leukocyte telomeres, and specifically the measure of telomere length and telomerase activity. This review integrates findings from eleven human studies which evaluated telomere length and telomerase activity, in order to synthesize the state of the current science and to inform the development of new knowledge and enhance nursing research of depression using appropriate biobehavioral measures. Although preliminary, the findings from this integrated review suggest that there is evidence to support a conceptualization of depression as a stress-related condition in which telomeres shorten over time in relation to cumulative exposure to the chronic stress of depression. For the purposes of testing in future nursing research, visual representations of the theoretical connection between stress vulnerabilities, depression, and health outcomes and key moderators and mediators involved in this conceptualization are provided. The findings from this review and the conceptual framework provided may be a useful step towards advancing therapeutic nursing interventions for this debilitating chronic condition. PMID:23691300

Spondylodiscitis.

PubMed

Márquez Sánchez, P

2016-04-01

Spondylodiscitis is an infection of the spine that has been known since ancient times. Its incidence is rising, due to the increases in life expectancy and debilitating conditions. Its age distribution is bimodal, affecting persons younger than 20 years of age or persons aged 50-70 years. According to its origin, it is classified as pyogenic, granulomatous or parasitic, though the first form is the most common, usually caused by Staphylococcus aureus or Escherichia coli. The clinical presentation is insidious, resulting in a delayed diagnosis, particularly in tuberculous spondylodiscitis. The initial onset usually involves inflammatory back pain, though the disease may course with fever, asthenia and neurological deficit, these being the most severe complications. Diagnosis is based on clinical, radiological, laboratory, microbiological and histopathological data. Magnetic resonance imaging is the technique of choice for the diagnosis of spondylodiscitis. The differential diagnosis involves, among other conditions, intervertebral erosive osteochondrosis, tumour, axial spondyloarthropathy, haemodialysis spondyloarthropathy, Modic type 1 endplate changes and Charcot's axial neuroarthropathy. Treatment is based on eliminating the infection with antibiotics, preventing spinal instability with vertebral fixation, and ample debridement of infected tissue to obtain samples for analysis. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

TGF-β Blockade Reduces Mortality and Metabolic Changes in a Validated Murine Model of Pancreatic Cancer Cachexia.

PubMed

Greco, Stephanie H; Tomkötter, Lena; Vahle, Anne-Kristin; Rokosh, Rae; Avanzi, Antonina; Mahmood, Syed Kashif; Deutsch, Michael; Alothman, Sara; Alqunaibit, Dalia; Ochi, Atsuo; Zambirinis, Constantinos; Mohaimin, Tasnima; Rendon, Mauricio; Levie, Elliot; Pansari, Mridul; Torres-Hernandez, Alejandro; Daley, Donnele; Barilla, Rocky; Pachter, H Leon; Tippens, Daniel; Malik, Hassan; Boutajangout, Allal; Wisniewski, Thomas; Miller, George

2015-01-01

Cancer cachexia is a debilitating condition characterized by a combination of anorexia, muscle wasting, weight loss, and malnutrition. This condition affects an overwhelming majority of patients with pancreatic cancer and is a primary cause of cancer-related death. However, few, if any, effective therapies exist for both treatment and prevention of this syndrome. In order to develop novel therapeutic strategies for pancreatic cancer cachexia, appropriate animal models are necessary. In this study, we developed and validated a syngeneic, metastatic, murine model of pancreatic cancer cachexia. Using our model, we investigated the ability of transforming growth factor beta (TGF-β) blockade to mitigate the metabolic changes associated with cachexia. We found that TGF-β inhibition using the anti-TGF-β antibody 1D11.16.8 significantly improved overall mortality, weight loss, fat mass, lean body mass, bone mineral density, and skeletal muscle proteolysis in mice harboring advanced pancreatic cancer. Other immunotherapeutic strategies we employed were not effective. Collectively, we validated a simplified but useful model of pancreatic cancer cachexia to investigate immunologic treatment strategies. In addition, we showed that TGF-β inhibition can decrease the metabolic changes associated with cancer cachexia and improve overall survival.

Interplay between Cartilage and Subchondral Bone Contributing to Pathogenesis of Osteoarthritis

PubMed Central

Sharma, Ashish R.; Jagga, Supriya; Lee, Sang-Soo; Nam, Ju-Suk

2013-01-01

Osteoarthritis (OA) is a common debilitating joint disorder, affecting large sections of the population with significant disability and impaired quality of life. During OA, functional units of joints comprising cartilage and subchondral bone undergo uncontrolled catabolic and anabolic remodeling processes to adapt to local biochemical and biological signals. Changes in cartilage and subchondral bone are not merely secondary manifestations of OA but are active components of the disease, contributing to its severity. Increased vascularization and formation of microcracks in joints during OA have suggested the facilitation of molecules from cartilage to bone and vice versa. Observations from recent studies support the view that both cartilage and subchondral bone can communicate with each other through regulation of signaling pathways for joint homeostasis under pathological conditions. In this review we have tried to summarize the current knowledge on the major signaling pathways that could control the cartilage-bone biochemical unit in joints and participate in intercellular communication between cartilage and subchondral bone during the process of OA. An understanding of molecular communication that regulates the functional behavior of chondrocytes and osteoblasts in both physiological and pathological conditions may lead to development of more effective strategies for treating OA patients. PMID:24084727

Legionnaires' disease.

PubMed

Cunha, Burke A; Burillo, Almudena; Bouza, Emilio

2016-01-23

Since first identified in early 1977, bacteria of the genus Legionella are recognised as a common cause of community-acquired pneumonia and a rare cause of hospital-acquired pneumonia. Legionella bacteria multisystem manifestations mainly affect susceptible patients as a result of age, underlying debilitating conditions, or immunosuppression. Water is the major natural reservoir for Legionella, and the pathogen is found in many different natural and artificial aquatic environments such as cooling towers or water systems in buildings, including hospitals. The term given to the severe pneumonia and systemic infection caused by Legionella bacteria is Legionnaires' disease. Over time, the prevalence of legionellosis or Legionnaires' disease has risen, which might indicate a greater awareness and reporting of the disease. Advances in microbiology have led to a better understanding of the ecological niches and pathogenesis of the condition. Legionnaires' disease is not always suspected because of its non-specific symptoms, and the diagnostic tests routinely available do not offer the desired sensitivity. However, effective antibiotics are available. Disease notification systems provide the basis for initiating investigations and limiting the scale and recurrence of outbreaks. This report reviews our current understanding of this disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

TGF-β Blockade Reduces Mortality and Metabolic Changes in a Validated Murine Model of Pancreatic Cancer Cachexia

PubMed Central

Rokosh, Rae; Avanzi, Antonina; Mahmood, Syed Kashif; Deutsch, Michael; Alothman, Sara; Alqunaibit, Dalia; Ochi, Atsuo; Zambirinis, Constantinos; Mohaimin, Tasnima; Rendon, Mauricio; Levie, Elliot; Pansari, Mridul; Torres-Hernandez, Alejandro; Daley, Donnele; Barilla, Rocky; Pachter, H. Leon; Tippens, Daniel; Malik, Hassan; Boutajangout, Allal; Wisniewski, Thomas; Miller, George

2015-01-01

Cancer cachexia is a debilitating condition characterized by a combination of anorexia, muscle wasting, weight loss, and malnutrition. This condition affects an overwhelming majority of patients with pancreatic cancer and is a primary cause of cancer-related death. However, few, if any, effective therapies exist for both treatment and prevention of this syndrome. In order to develop novel therapeutic strategies for pancreatic cancer cachexia, appropriate animal models are necessary. In this study, we developed and validated a syngeneic, metastatic, murine model of pancreatic cancer cachexia. Using our model, we investigated the ability of transforming growth factor beta (TGF-β) blockade to mitigate the metabolic changes associated with cachexia. We found that TGF-β inhibition using the anti-TGF-β antibody 1D11.16.8 significantly improved overall mortality, weight loss, fat mass, lean body mass, bone mineral density, and skeletal muscle proteolysis in mice harboring advanced pancreatic cancer. Other immunotherapeutic strategies we employed were not effective. Collectively, we validated a simplified but useful model of pancreatic cancer cachexia to investigate immunologic treatment strategies. In addition, we showed that TGF-β inhibition can decrease the metabolic changes associated with cancer cachexia and improve overall survival. PMID:26172047

Formative Investigation of Acceptability of Typhoid Vaccine during a Typhoid Fever Outbreak in Neno District, Malawi

PubMed Central

Blum, Lauren S.; Dentz, Holly; Chingoli, Felix; Chilima, Benson; Warne, Thomas; Lee, Carla; Hyde, Terri; Gindler, Jacqueline; Sejvar, James; Mintz, Eric D.

2014-01-01

Typhoid fever affects an estimated 22 million people annually and causes 216,000 deaths worldwide. We conducted an investigation in August and September 2010 to examine the acceptability of typhoid vaccine in Neno District, Malawi where a typhoid outbreak was ongoing. We used qualitative methods, including freelisting exercises, key informant and in-depth interviews, and group discussions. Respondents associated illness with exposure to “bad wind,” and transmission was believed to be airborne. Typhoid was considered extremely dangerous because of its rapid spread, the debilitating conditions it produced, the number of related fatalities, and the perception that it was highly contagious. Respondents were skeptical about the effectiveness of water, sanitation, and hygiene (WaSH) interventions. The perceived severity of typhoid and fear of exposure, uncertainty about the effectiveness of WaSH measures, and widespread belief in the efficacy of vaccines in preventing disease resulted in an overwhelming interest in receiving typhoid vaccine during an outbreak. PMID:25002303

Formative investigation of acceptability of typhoid vaccine during a typhoid fever outbreak in Neno District, Malawi.

PubMed

Blum, Lauren S; Dentz, Holly; Chingoli, Felix; Chilima, Benson; Warne, Thomas; Lee, Carla; Hyde, Terri; Gindler, Jacqueline; Sejvar, James; Mintz, Eric D

2014-10-01

Typhoid fever affects an estimated 22 million people annually and causes 216,000 deaths worldwide. We conducted an investigation in August and September 2010 to examine the acceptability of typhoid vaccine in Neno District, Malawi where a typhoid outbreak was ongoing. We used qualitative methods, including freelisting exercises, key informant and in-depth interviews, and group discussions. Respondents associated illness with exposure to "bad wind," and transmission was believed to be airborne. Typhoid was considered extremely dangerous because of its rapid spread, the debilitating conditions it produced, the number of related fatalities, and the perception that it was highly contagious. Respondents were skeptical about the effectiveness of water, sanitation, and hygiene (WaSH) interventions. The perceived severity of typhoid and fear of exposure, uncertainty about the effectiveness of WaSH measures, and widespread belief in the efficacy of vaccines in preventing disease resulted in an overwhelming interest in receiving typhoid vaccine during an outbreak. © The American Society of Tropical Medicine and Hygiene.

Recurrent phosphaturic mesenchymal tumour of the temporal bone causing deafness and facial nerve palsy.

PubMed

Syed, M I; Chatzimichalis, M; Rössle, M; Huber, A M

2012-07-01

We describe the first reported case of a phosphaturic mesenchymal tumour, mixed connective tissue variant, invading the temporal bone. A female patient presented with increasing deafness. On examination there appeared to be a mass behind an intact tympanic membrane. Further radiological investigation showed a vascular mass occupying the middle ear, mastoid and internal auditory meatus. This was surgically resected and revealed to be a benign phosphaturic mesenchymal tumour, mixed connective tissue variant. The tumour recurred a year later, presenting as facial nerve palsy. A revision procedure was carried out; the tumour was excised with the sacrifice of a segment of the facial nerve, and a facial-hypoglossal nerve anastomosis was performed. This case report highlights the occurrence of this benign but sometimes aggressive tumour, of which both clinicians and pathologists should be aware. Early recognition of the condition remains of utmost importance to minimise the debilitating consequences of long-term osteomalacia in affected patients, and to prevent extracranial and intracranial complications caused by the tumour.

The Challenges of Treating Sciatica Pain in Older Adults.

PubMed

Ferreira, Manuela L; McLachlan, Andrew

2016-11-01

Sciatica is a debilitating condition affecting approximately 25 % of the population. Typically, the patient will complain of lower limb pain that is more severe than pain in the lower back, usually accompanied by numbness and motor weakness. Most international guidelines recommend pharmacological management for the pain relief of sciatica, including paracetamol, non-steroidal anti-inflammatory drugs, opioid analgesics, anticonvulsants, and corticosteroids, among others. However, the evidence for most of these pharmacological options is scarce, and the majority of clinical trials exclude older patients. There is overall very limited information on the efficacy, safety, and tolerability of these medicines in older patients with sciatica. This review presents a critical appraisal of the existing evidence for the pharmacological treatment of sciatica, with a special focus on the older adult. The age-related changes in the health of older patients, as well as their impact on the response to pharmacological treatment, including polypharmacy, drug interactions, and drug-disease interactions, is also discussed.

Quality indicators in inflammatory bowel disease.

PubMed

Berry, Sameer K; Melmed, Gil Y

2018-01-01

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic, debilitating, and expensive condition affecting millions of people globally. There is significant variation in the quality of care for patients with IBD across North America, Europe, and Asia; this variation suggests poor quality of care due to overuse, underuse, or misuse of health services and disparity of outcomes. Several initiatives have been developed to reduce variation in care delivery and improve processes of care, patient outcomes, and reduced healthcare costs. These initiatives include the development of quality indicator sets to standardize care across organizations, and learning health systems to enable data sharing between doctors and patients, and sharing of best practices among providers. These programs have been variably successful in improving patient outcomes and reducing healthcare utilization. Further studies are needed to demonstrate the long-term impact and applicability of these efforts in different geographic areas around the world, as regional variations in patient populations, societal preferences, and costs should inform local quality improvement efforts.

Children's Emotion Regulation Difficulties Mediate the Association Between Maternal Borderline and Antisocial Symptoms and Youth Behavior Problems Over 1 Year.

PubMed

Kaufman, Erin A; Puzia, Megan E; Mead, Hilary K; Crowell, Sheila E; McEachern, Amber; Beauchaine, Theodore P

2017-04-01

Borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are among the most debilitating psychiatric conditions. Behaviors and traits associated with these disorders can have profound influences on those surrounding the affected individual. Accordingly, researchers have begun to examine effects of these symptoms on parent-child relationships. Theoretical and empirical work suggests that one mechanism linking maternal psychopathology to child symptoms is familial transmission of emotion dysregulation. The authors examined children's emotion regulation difficulties as a mediator between maternal BPD/ASPD symptoms and child behavior problems 1 year later. Analyses revealed that a composite of maternal BPD/ASPD symptoms had a direct effect on child internalizing, externalizing, and total symptoms. Associations between maternal BPD/ASPD symptoms and youth problems were partially mediated by child emotion regulation difficulties, even with maternal depression and other relevant covariates included in the models. Thus, maternal BPD/ASPD symptoms and child emotion regulation difficulties represent potential targets for prevention of psychopathology among youth.

Dry Eye Syndrome in Menopause and Perimenopausal Age Group.

PubMed

Peck, Travis; Olsakovsky, Leslie; Aggarwal, Shruti

2017-01-01

Dry eye disease (DED) is a multifactorial ocular surface disease that causes symptoms of ocular pain, discomfort, and decreased visual acuity. It significantly affects quality of life of patients. It is more prevalent in the females and is being specifically in the menopausal and postmenopausal age group. This is believed to be due to the changes in balance of sex hormones. Sex hormones - estrogens and androgens - influence production of all components of the tear film including aqueous layer, lipid, and mucin. Various mechanisms such as decrease in hormonal levels, shift in feedback mechanisms, and changes in receptor receptivity interplay to alter the ocular surface homeostasis and subsequently result in DED. Several studies have suggested potential role of hormone replacement therapy in menopause-associated dry eye symptoms. The purpose of this review is to help the non ophthalmic physicians about DED encountered commonly in menopausal age group. It is important for primary care physicians to understand DED due to its high prevalence, often debilitating symptoms and the potentially preventable and treatable nature of the condition.

Practical Management of Pressure Sores

PubMed Central

Jordan, John M.

1992-01-01

Pressure sores are common in the debilitated elderly. Causal factors are unrelieved pressure, shearing forces, friction, and moisture. Preventive measures should be used for all high-risk patients, defined by general condition, mental status, degree of incontinence, amount of activity, and mobility. Principles of treating ulcers include pressure relief, reducing bacterial counts, debriding necrotic tissue, and providing a moist, clean environment. Imagesp2385-ap2389-ap2392-a PMID:21221298

Depression in the classroom: considerations and strategies.

PubMed

Calear, Alison L

2012-01-01

Depression is a prevalent and debilitating disorder that can severely affect a young person’s social, emotional, and academic functioning. Identifying depression early is essential to reducing the impact of this disorder. Depression is treatable. However, there are a number of classroom and school supports that can be put in place to assist a young person experiencing or recovering from depression. Preventing the development of depression through effective classroom programs should be encouraged and supported within the school environment.

Assessment of anorexia nervosa in children and adolescents.

PubMed

Weaver, Laurel; Liebman, Ronald

2011-04-01

Anorexia nervosa is a debilitating illness that affects mostly females and their families. Multiple physiologic disturbances are present and can be life-threatening. Nutritional rehabilitation is the foremost initial treatment goal. Assessment skills include understanding the physiologic, developmental, and psychiatric status of the individual as well as engagement of the family system. A comprehensive assessment that stimulates patient and family to successfully engage in treatment is the cornerstone of good clinical care for this highly disabling disorder.

Ageing and muscular dystrophy differentially affect murine pharyngeal muscles in a region-dependent manner

PubMed Central

Randolph, Matthew E; Luo, Qingwei; Ho, Justin; Vest, Katherine E; Sokoloff, Alan J; Pavlath, Grace K

2014-01-01

The inability to swallow, or dysphagia, is a debilitating and life-threatening condition that arises with ageing or disease. Dysphagia results from neurological or muscular impairment of one or more pharyngeal muscles, which function together to ensure proper swallowing and prevent the aspiration of food or liquid into the lungs. Little is known about the effects of age or disease on pharyngeal muscles as a group. Here we show ageing affected pharyngeal muscle growth and atrophy in wild-type mice depending on the particular muscle analysed. Furthermore, wild-type mice also developed dysphagia with ageing. Additionally, we studied pharyngeal muscles in a mouse model for oculopharyngeal muscular dystrophy, a dysphagic disease caused by a polyalanine expansion in the RNA binding protein, PABPN1. We examined pharyngeal muscles of mice overexpressing either wild-type A10 or mutant A17 PABPN1. Overexpression of mutant A17 PABPN1 differentially affected growth of the palatopharyngeus muscle dependent on its location within the pharynx. Interestingly, overexpression of wild-type A10 PABPN1 was protective against age-related muscle atrophy in the laryngopharynx and prevented the development of age-related dysphagia. These results demonstrate that pharyngeal muscles are differentially affected by both ageing and muscular dystrophy in a region-dependent manner. These studies lay important groundwork for understanding the molecular and cellular mechanisms that regulate pharyngeal muscle growth and atrophy, which may lead to novel therapies for individuals with dysphagia. PMID:25326455

A case report highlighting the growing trend of Internet-based self-diagnosis of "Morgellon's disease".

PubMed

Mortillaro, Gino; Rodgman, Christopher; Kinzie, Erik; Ryals, Sarah

2013-01-01

"Morgellon's Disease" is a term used to describe a bizarre condition characterized by the belief that strange sensations in the skin are due to filaments called "Morgellon's Bodies."' The focus of this case report is to inform readers of the growing incidence of this psychosomatic condition. Unfortunately, self-diagnosis has become increasingly common because of the widespread coverage on the Internet. While the validity of the diagnosis is in question, the impact on patient's lives is real, often debilitating, and bears more examination.

Prevalence and treatment of depression in Parkinson's disease.

PubMed

Veazey, Connie; Aki, Sahinde Ozlem Erden; Cook, Karon F; Lai, Eugene C; Kunik, Mark E

2005-01-01

Parkinson's disease (PD) is a progressive neurological condition with debilitating symptoms, and depression is a common comorbid condition of this disease. The authors review existing literature on the prevalence and treatment of depression in PD. Prevalence estimates of depression vary widely, ranging from 7%-76%. This variation is due to inconsistent methodology. Treatment options for depression in PD include medication therapy, electroconvulsive therapy (ECT), and psychotherapy. There are few randomized controlled trials of these treatment options. The authors argue for more systematic and controlled research examining both the prevalence and treatment of depression in PD.

A candidate gene for choanal atresia in alpaca.

PubMed

Reed, Kent M; Bauer, Miranda M; Mendoza, Kristelle M; Armién, Aníbal G

2010-03-01

Choanal atresia (CA) is a common nasal craniofacial malformation in New World domestic camelids (alpaca and llama). CA results from abnormal development of the nasal passages and is especially debilitating to newborn crias. CA in camelids shares many of the clinical manifestations of a similar condition in humans (CHARGE syndrome). Herein we report on the regulatory gene CHD7 of alpaca, whose homologue in humans is most frequently associated with CHARGE. Sequence of the CHD7 coding region was obtained from a non-affected cria. The complete coding region was 9003 bp, corresponding to a translated amino acid sequence of 3000 aa. Additional genomic sequences corresponding to a significant portion of the CHD7 gene were identified and assembled from the 2x alpaca whole genome sequence, providing confirmatory sequence for much of the CHD7 coding region. The alpaca CHD7 mRNA sequence was 97.9% similar to the human sequence, with the greatest sequence difference being an insertion in exon 38 that results in a polyalanine repeat (A12). Polymorphism in this repeat was tested for association with CA in alpaca by cloning and sequencing the repeat from both affected and non-affected individuals. Variation in length of the poly-A repeat was not associated with CA. Complete sequencing of the CHD7 gene will be necessary to determine whether other mutations in CHD7 are the cause of CA in camelids.

Wernicke-Korsakoff syndrome: recognition and treatment.

PubMed

Donnelly, Alexander

2017-03-29

Wernicke-Korsakoff syndrome is a potentially debilitating and fatal condition that is caused by thiamine (vitamin B1) deficiency in the brain. It can be treated effectively or prevented completely; however, the condition is often undiagnosed and inadequately managed. Wernicke-Korsakoff syndrome is commonly considered to be specific to individuals who misuse alcohol; however, there are many other predisposing factors and causes associated with the condition. This article aims to raise awareness of Wernicke-Korsakoff syndrome, to enable nurses in all practice settings to recognise the signs, symptoms and risk factors associated with the condition and be informed about available treatments. Increased awareness aims to improve early diagnosis of the condition, enabling effective treatment and improving patients' symptoms, such as cognitive impairment.

Intra-Articular Therapeutic Delivery for Post Traumatic Osteoarthritis

DTIC Science & Technology

2015-10-01

AWARD NUMBER: W81XWH-14-2-0188 TITLE: Intra-Articular Therapeutic Delivery for Post-Traumatic Osteoarthritis PRINCIPAL INVESTIGATOR: Robert...Intra-Articular Therapeutic Delivery for Post-Traumatic Osteoarthritis 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-14-2-0188 5c. PROGRAM ELEMENT...are to test the ability of a novel therapeutic to hinder the progression of post-traumatic osteoarthritis . This debilitating joint condition more

Comparison of Anxiety Management Training and Self-Control Desensitization.

ERIC Educational Resources Information Center

Deffenbacher, Jerry L.; And Others

1980-01-01

Anxiety management training and self-control desensitization effectively reduced debilitating test anxiety and increased facilitating test anxiety. Follow-up demonstrated maintenance of debilitating test anxiety reduction. Subjects receiving treatment had significantly higher psychology grades. (Author)

Pseudobulbar affect: burden of illness in the USA.

PubMed

Colamonico, Jennifer; Formella, Andrea; Bradley, Walter

2012-09-01

Pseudobulbar affect (PBA) is characterized by involuntary and uncontrollable laughing and/or crying episodes, occurring secondary to neurological disease or injury. The impact of PBA on social and occupational function, health status, quality of life (QOL), and quality of relationships (QOR) is not well studied. This US survey conducted by Harris Interactive compared health status and daily function of patients with and without PBA. Eligible respondents were Harris Panel Online registrants previously diagnosed with stroke, multiple sclerosis, Parkinson's disease, Alzheimer's disease, traumatic brain injury, or amyotrophic lateral sclerosis, or primary, nonpaid caregivers for such patients who were too debilitated to participate. PBA was identified by a Center for Neurologic Study lability scale score of 13 or greater. Measures included the 36-item short form health survey (SF-36), the work productivity and impairment (WPAI) questionnaire, visual analog scales (VAS) for impact of PBA symptoms on QOL and QOR, and customized questions related to burden and impact of involuntary laughing/crying episodes on patients' lives. Survey responses were weighted to adjust for the relative proportion of the primary neurological conditions in the overall population and between group differences in patient age and gender. PBA and non-PBA group responses were compared using two-tailed t tests adjusted for severity of the primary neurological conditions. The 1,052 respondents included 399 PBA group participants and 653 controls. The PBA group showed significantly worse scores versus non-PBA controls on component and summary SF-36 scores (P<0.05 for all), VAS scores (P<0.05 for both), and WPAI scores (P<0.05). Among PBA group respondents, PBA contributed a great deal to or was the main cause of patients becoming housebound for 24% and being moved to supervised living placement for 9% of respondents. PBA is associated with considerable burden incremental to that of the underlying neurological conditions, affecting QOL, QOR, health status, and social and occupational functioning.

A Novel Approach to Treating CFS and Co-morbid Health Anxiety: A Case Study.

PubMed

Daniels, Jo; Loades, Maria E

2017-05-01

Chronic Fatigue Syndrome (CFS) is a debilitating condition that affects 0.2-0.4% of the population. First-line treatments are Cognitive Behaviour Therapy or graded exercise therapy; however, these treatments yield only moderate effect sizes. Emerging research suggests that anxiety about health may be common in CFS. Health anxiety treatment models demonstrate good therapeutic outcomes; however, these models have yet to be applied to CFS. This paper describes the application of a novel cognitive behavioural approach to the treatment of both physical and anxiety related symptoms in a patient with CFS and, furthermore, presents a conceptual hypothesis regarding the mutually maintaining relationship between these two co-occurring conditions. A single-case design was used, with pre-data, post-data and follow-up data. The cognitive behavioural model of health anxiety was adapted and delivered as an eight-session intervention. The intervention was driven by an individualized formulation developed collaboratively with the patient. The application of this approach generated reliable and clinically significant reductions in physical and psychological symptoms, which were maintained at 12-month follow-up. The participant no longer fulfilled the criteria for CFS or health anxiety following eight treatment sessions. The treatment approach was found to be agreeable to the patient. All treatment hypotheses were supported. An adapted cognitive behavioural approach to treating CFS and health anxiety yields positive results and shows promise for application to the broader CFS population. Copyright © 2016 John Wiley & Sons, Ltd. Chronic Fatigue Syndrome (CFS) is a debilitating condition that is difficult to treat successfully; first-line recommended treatments achieve only moderate effect sizes. Anxiety, particularly about health, is reported to be common in CFS. However, anxiety is not specifically targeted within treatment and may negatively influence outcome due to the potentially mutually maintaining nature of these complex conditions. The present study demonstrates that an integrated treatment approach designed to encompass physical and psychological symptoms yields reliable and clinically significant outcomes in 50% of time recommend for first line treatments. Results reflected non-case level status for both CFS and health anxiety at end of treatment, in addition to reductions across all clinical measures. This study demonstrates the fundamental importance of an individualized, rather than generic, treatment approach to complex cases; the 'meaning' of experience is a central tenet within a cognitive approach that should be reflected in treatment. Copyright © 2016 John Wiley & Sons, Ltd.

Chronic low back pain: a mini-review on pharmacological management and pathophysiological insights from clinical and pre-clinical data.

PubMed

Park, Thomas S W; Kuo, Andy; Smith, Maree T

2018-05-12

Globally, low back pain (LBP) is one of the most common health problems affecting humans. The lifetime prevalence of non-specific LBP is approximately 84%, with the chronic prevalence at about 23%. Chronic LBP in humans is defined as LBP that persists for more than 12 weeks without a significant pain improvement. Although there are numerous evidence-based guidelines on the management of acute LBP, this is not the case for chronic LBP, which is regarded as particularly difficult to treat. Research aimed at discovering new drug treatments for alleviation of chronic mechanical LBP is lacking due to the paucity of knowledge on the pathobiology of this condition, despite its high morbidity in the affected adult population. For a debilitating condition such as chronic LBP, it is necessary to assess the sustained effects of pharmacotherapy of various agents spanning months to years. Although many rodent models of mechanical LBP have been developed to mimic the human condition, some of the major shortcomings of many of these models are (1) the presence of a concurrent neuropathic component that develops secondary to posterior intervertebral disc puncture, (2) severe model phenotype, and/or (3) use of behavioural endpoints that have yet to be validated for pain. Hence, there is a great, unmet need for research aimed at discovering new biological targets in rodent models of chronic mechanical LBP for use in drug discovery programs as a means to potentially produce new highly effective and well-tolerated analgesic agents to improve relief of chronic LBP. On a cautionary note, it must be borne in mind that because humans and rats display orthograde and pronograde postures, respectively, the different mechanical forces on their spines add to the difficulty in translation of promising rodent data to humans.

Elite Athletes’ In-event Competitive Anxiety Responses and Psychological Skills Usage under Differing Conditions

PubMed Central

Hagan, John E.; Pollmann, Dietmar; Schack, Thomas

2017-01-01

Background and Purpose: Even though the assessment of competitive anxiety responses (intensity, interpretation, and frequency) using the time-to-event paradigm has gained much attention, literature on the account of these same experiences in-event and their corresponding psychological skills adopted under differing conditions is limited. This is a follow up investigation to establish the extent to which associated anxiety responses are stable or dynamic and whether this pattern could be related to reported psychological skills under low or high stressful conditions across gender. Methods: Twenty-three high level (N = 13 males and 10 females) Ghanaian Table Tennis players provided data through completion of modified versions of Competitive State Anxiety Inventory-2, incorporated with directional and frequency of intrusion scales and the Test of Performance Strategies inventory during breaks within competitive fixtures. Results: MANCOVAs (gender × stress condition) with follow-up analyses revealed no significant interactions and no main effect for gender but significant main effects were realized for all anxiety dimensions and psychological skills for only the second factor. Specifically, the intensity and frequency of cognitive and somatic state anxiety symptoms increased and were interpreted as debilitative under the high stress condition, although self-confidence and other array of psychological skills were highly displayed under the same stressful condition. Conclusion: Findings highlight the dynamic characteristics of in-event associated anxiety responses and ineffectiveness of deployed psychological skills regardless of gender. These perhaps show the exceptionality of affective experiences in an African setting, suggesting a culturally diversified approach to psychological skills application, if desirable effects are to be attained. PMID:29312103

The use of the United States FDA programs as a strategy to advance the development of drug products for neglected tropical diseases.

PubMed

Sachs-Barrable, Kristina; Conway, Jocelyn; Gershkovich, Pavel; Ibrahim, Fady; Wasan, Kishor M

2014-11-01

Neglected tropical diseases (NTDs) are infections which are endemic in poor populations in lower- and middle-income countries (LMIC). Approximately one billion people have now or are at risk of getting an NTD and yet less than 5% of research dollars are focused on providing treatments and prevention of these highly debilitating and deadly conditions. The United States Food and Drug Administration (FDA) Orphan Drug Designation program (ODDP) provides orphan status to drugs and biologics, defined as those intended for the safe and effective treatment, diagnosis or prevention of rare diseases and/or disorders that affect fewer than 200 000 people in the United States, or that affect more than 200 000 persons but are not expected to recover the costs of developing and marketing a treatment drug. These regulations have led to the translation of rare disease knowledge into innovative rare disease therapies. The FDA Guidance for Industry on developing drugs for the treatment and prevention of NTDs describes the following regulatory strategies: Orphan Product Designation, Fast Track Designation, Priority Review Designation, Accelerated Approval and Tropical Disease Priority Review Voucher. This paper will discuss how these regulations and especially the ODDP can improve the clinical development and accessibility of drug products for NTDs.

Nutritional interventions for the adjunctive treatment of schizophrenia: a brief review.

PubMed

Arroll, Megan Anne; Wilder, Lorraine; Neil, James

2014-09-16

Schizophrenia is a chronic condition that impacts significantly not only on the individual and family, but the disorder also has wider consequences for society in terms of significant costs to the economy. This highly prevalent condition affects approximately 1% of the worldwide population, yet there are few therapeutic options. The predominant treatment strategy for schizophrenia is anti-psychotic medication (with or without additional talking therapy) even though this approach lacks efficacy in managing the negative symptoms of the condition, is not effective in one-third of the patient group and the side effects of the medication can be severe and debilitating. In recent years, a number of pathophysiological processes have been identified in groups of people with schizophrenia including oxidative stress, one-carbon metabolism and immune-mediated responses. A number of studies have shown that these altered physiological mechanisms can be ameliorated by nutritional interventions in some individuals with schizophrenia. This review briefly describes the aforementioned processes and outlines research that has investigated the utility of nutritional approaches as an adjunct to anti-psychotic medication including antioxidant and vitamin B supplementation, neuroprotective and anti-inflammatory nutrients and exclusion diets. Whilst none of these interventions provides a 'one-size-fits-all' therapeutic solution, we suggest that a personalised approach warrants research attention as there is growing agreement that schizophrenia is a spectrum disorder that develops from the interplay between environmental and genetic factors.

A novel mutation in IL36RN underpins childhood pustular dermatosis.

PubMed

Ellingford, J M; Black, G C M; Clayton, T H; Judge, M; Griffiths, C E M; Warren, R B

2016-02-01

Chronic pustular dermatoses are severe and debilitating autoinflammatory conditions that can have a monogenic basis. Their clinical features are, however, complex with considerable overlap. Null and missense mutations in the genes encoding interleukin (IL)-1 family (IL-1 and IL-36) anti-inflammatory receptor antagonist (Ra) cytokines can underlie the development of severe pustular dermatoses. We present a clinical and genetic study of four children of Pakistani descent with similar clinical presentations and treatment course, each of whom suffers from a severe pustular dermatosis, initially described as a pustular variant of psoriasis. We use DNA sequencing to refine the diagnosis of two of the children studied. Bidirectional Sanger sequencing was performed on the coding regions of the IL-1Ra and IL-36Ra genes (IL1RN and IL36RN, respectively), for the four affected children and their parents. We identified a novel homozygous missense mutation in IL36RN in two siblings, and showed the molecular basis of the condition to be both distinct from psoriasis and distinct between the two families studied. We describe a novel mutation which underpins the diagnosis of childhood pustular dermatosis. Molecular diagnostics can be used to aid the clinical diagnosis and potential treatment of autoinflammatory conditions. © 2015 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.

Advances in Proximal Interphalangeal Joint Arthroplasty: Biomechanics and Biomaterials.

PubMed

Zhu, Andy F; Rahgozar, Paymon; Chung, Kevin C

2018-05-01

Proximal interphalangeal (PIP) joint arthritis is a debilitating condition. The complexity of the joint makes management particularly challenging. Treatment of PIP arthritis requires an understanding of the biomechanics of the joint. PIP joint arthroplasty is one treatment option that has evolved over time. Advances in biomaterials have improved and expanded arthroplasty design. This article reviews biomechanics and arthroplasty design of the PIP joint. Copyright © 2018 Elsevier Inc. All rights reserved.

A Regional Prototype for Obtaining and Evaluating Disease-Specific, Community-Level Data

DTIC Science & Technology

2000-04-24

TEXAS Outlying Area GREGG TX TEXARKANA TX/ AR /OK HOUSTON TX TEXOMA TX/OK** JONESBORO AR TULSA OK KILLEEN TX ** VERNON LA** LAFAYETTE LA VICTORIA TX Next...appropriate setting and incur fewer costs for treatment (Litaker, 1996). The following questions may now be asked. How well are the communities within...and at times debilitating condition that tends to afflict young people who are otherwise healthy and productive. Migraine sufferers, who are

Elephantiasis nostras verrucosa.

PubMed

Yoho, Robert M; Budny, Adam M; Pea, Anisa S

2006-01-01

Swelling of the leg is a frequent finding in podiatric medicine. Unless the patient draws notice to the condition or the physician is diligent in asking questions and examining the extremity, the condition may be viewed as minor and given little attention. Swelling of the leg can be a clinical sign of certain systemic diseases, lymphatic and venous disorders, or other miscellaneous causes. Dermatologic consequences linked to many of these causes of swelling are well documented. What is not as well chronicled is a dramatic skin alteration associated with chronic lymphedema. This article provides an overview and a case presentation of the unusual and debilitating skin condition related to chronic lymphedema of the lower extremity known as elephantiasis nostras verrucosa.

MK-801 treatment affects glycolysis in oligodendrocytes more than in astrocytes and neuronal cells: insights for schizophrenia

PubMed Central

Guest, Paul C.; Iwata, Keiko; Kato, Takahiro A.; Steiner, Johann; Schmitt, Andrea; Turck, Christoph W.; Martins-de-Souza, Daniel

2015-01-01

Schizophrenia is a debilitating mental disorder, affecting more than 30 million people worldwide. As a multifactorial disease, the underlying causes of schizophrenia require analysis by multiplex methods such as proteomics to allow identification of whole protein networks. Previous post-mortem proteomic studies on brain tissues from schizophrenia patients have demonstrated changes in activation of glycolytic and energy metabolism pathways. However, it is not known whether these changes occur in neurons or in glial cells. To address this question, we treated neuronal, astrocyte, and oligodendrocyte cell lines with the NMDA receptor antagonist MK-801 and measured the levels of six glycolytic enzymes by Western blot analysis. MK-801 acts on the glutamatergic system and has been proposed as a pharmacological means of modeling schizophrenia. Treatment with MK-801 resulted in significant changes in the levels of glycolytic enzymes in all cell types. Most of the differences were found in oligodendrocytes, which had altered levels of hexokinase 1 (HK1), enolase 2 (ENO2), phosphoglycerate kinase (PGK), and phosphoglycerate mutase 1 after acute MK-801 treatment (8 h), and HK1, ENO2, PGK, and triosephosphate isomerase (TPI) following long term treatment (72 h). Addition of the antipsychotic clozapine to the cultures resulted in counter-regulatory effects to the MK-801 treatment by normalizing the levels of ENO2 and PGK in both the acute and long term cultures. In astrocytes, MK-801 affected only aldolase C (ALDOC) under both acute conditions and HK1 and ALDOC following long term treatment, and TPI was the only enzyme affected under long term conditions in the neuronal cells. In conclusion, MK-801 affects glycolysis in oligodendrocytes to a larger extent than neuronal cells and this may be modulated by antipsychotic treatment. Although cell culture studies do not necessarily reflect the in vivo pathophysiology and drug effects within the brain, these results suggest that neurons, astrocytes, and oligodendrocytes are affected differently in schizophrenia. Employing in vitro models using neurotransmitter agonists and antagonists may provide new insights about the pathophysiology of schizophrenia which could lead to a novel system for drug discovery. PMID:26029051

Meditation and Yoga for Posttraumatic Stress Disorder: A Meta-Analytic Review of Randomized Controlled Trials

PubMed Central

Gallegos, Autumn M.; Crean, Hugh F.; Pigeon, Wilfred R.; Heffner, Kathi L.

2018-01-01

Posttraumatic stress disorder (PTSD) is a chronic and debilitating disorder that affects the lives of 7-8% of adults in the U.S. Although several interventions demonstrate clinical effectiveness for treating PTSD, many patients continue to have residual symptoms and ask for a variety of treatment options. Complementary health approaches, such as meditation and yoga, hold promise for treating symptoms of PTSD. This meta-analysis evaluates the effect size (ES) of yoga and meditation on PTSD outcomes in adult patients. We also examined whether the intervention type, PTSD outcome measure, study population, sample size, or control condition moderated the effects of complementary approaches on PTSD outcomes. The studies included were 19 randomized control trials with data on 1,173 participants. A random effects model yielded a statistically significant ES in the small to medium range (ES = −.39, p < .001, 95% CI [−.57, −.22]). There were no appreciable differences between intervention types, study population, outcome measures, or control condition. There was, however, a marginally significant higher ES for sample size ≤ 30 (ES = −.78, k = 5). These findings suggest that meditation and yoga are promising complementary approaches in the treatment of PTSD among adults and warrant further study. PMID:29100863

Worldwide trends in the socioeconomic impact and long-term prognosis of rheumatoid arthritis.

PubMed

Markenson, J A

1991-10-01

Rheumatoid arthritis (RA), once considered a benign and nonprogressive disease, is a debilitating condition with serious physical, emotional, and economic consequences. It afflicts approximately 1% of the adult population worldwide; prevalence increases with age, with twice as many women as men affected. In the United States, age, lack of formal education, and lower socioeconomic class correlate with both the incidence and poor prognosis of RA. The patient with RA faces increasing functional disability, the likelihood of work disability within 10 years after the onset of the disease, and a drastic reduction in earnings. Compared with individuals without the disease, patients with RA incur higher medical care costs, increased hospitalization, and a greater number of physician visits. As in the general population, the leading cause of death among patients with RA is cardiovascular disease, and deaths due to malignancy occur at a comparable incidence; however, patients with RA are at greater risk of mortality due to infection, renal disease, respiratory conditions, and gastrointestinal disease. Life expectancy is shorter among patients with RA than in the general population, and survival rates are comparable to those for Hodgkin's disease, diabetes mellitus, stroke, and three-vessel coronary artery disease. Efforts must be made to develop improved therapeutic strategies and rehabilitative programs to improve the quality of life of patients with RA.

Evaluation of task shifting in community-based DOTS program as an effective control strategy for tuberculosis.

PubMed

Gabriel, André P; Mercado, Charles P

2011-01-01

Tuberculosis (TB) remains to be the most prevalent and debilitating pulmonary (PTB) infection in the world today, affecting about one-third of the world's population. TB is an endemic disease in many developing countries, and efforts at eliminating the disease remain futile. While the course of the disease is indolent with years of latency, the reactivation of the disease can pose serious pulmonary and systemic infections that compromise multiple organ functions which lead to respiratory failure or end-organ damage. Despite attempts to control and eradicate the mycobacterium, the prevalence of the disease remains high due to increasing population rate, persistence of poverty and poor health care, treatment failure, increasing multidrug resistance as a consequence of treatment failure and poor compliance, and existence of comorbid conditions that compromise immune response. Limited government resources to screen and monitor disease progression of TB in third world countries hamper the eradication of the disease. In response, we have evaluated the efficiency and effectivity of a Community-Based Directly Observed Treatment, Short-Course (CB-DOTS), which is an equally effective alternative strategy to health center DOTS.

Austerity and its implications for immigrant health in France.

PubMed

Sargent, Carolyn; Kotobi, Laurence

2017-08-01

The ongoing economic crisis in France increasingly has affected immigrant rights, including access to health care. Consistent with a 2014 League Against Cancer survey, we identify the ways in which sickness produces a "double penalty" for immigrants with serious illness. Immigrants with chronic illnesses such as cancer, diabetes, and other debilitating conditions divert vital funds from daily needs to deal with sickness and loss of work while at the same time national austerity measures shred the state's traditional safety net of social services and support. We examine how immigrants strategize to manage financial exigencies, therapeutic itineraries and social relations in the face of these converging pressures. We base our findings on two studies related by this theme: an investigation of health inequalities in the Médoc region, in which 88 women, 44 of North African and Eastern European origin, were interviewed over a three-year period (2010-2013); and a three-year study (2014-2017) of West African immigrant women with breast cancer seeking treatment in the greater Paris region, 70 members of immigrant associations, and clinical personnel in three hospitals. Copyright © 2017 Elsevier Ltd. All rights reserved.

Attempted experimental reproduction of porcine periweaning-failure-to-thrive syndrome using tissue homogenates.

PubMed

Huang, Yanyun; Harding, John C S

2014-01-01

Porcine periweaning failure-to-thrive syndrome (PFTS) is characterized by anorexia and progressive debilitation of newly weaned pigs, of which some also demonstrate repetitive oral behaviour. Although no relevant porcine pathogens have been shown to be causally associated, inoculation of susceptible pigs using tissue homogenates is needed to rule out infectious etiologies. Eight snatched-farrowed porcine-colostrum-deprived (SF-pCD) pigs were inoculated with tissue homogenates made from PFTS-affected pigs orally, or combined orally, intraperitoneally (i.p.) and intramuscularly (i.m.) at day (D) 14 of age (INOC). On D21, i.p. and i.m. inoculation were repeated. Four sham-inoculated pigs served as control (CTRL). Three INOC pigs developed mixed bacterial septicemia between the first and second inoculation. All other pigs survived until termination on D49. Average daily gain (ADG) and the frequencies of diarrhea did not differ between INOC and CTRL pigs D14 and D29. Additionally, the progressive debilitation characteristic of PFTS was not observed in any pig, and repetitive oral behaviour was observed in both groups. In conclusion, PFTS was not experimentally reproduced by the current experimental approach providing evidence that PFTS may not have an infectious etiology.

Cognitive changes associated with cancer and cancer treatment: state of the science.

PubMed

Von Ah, Diane

2015-02-01

Cognitive impairment is a distressing, disruptive, and potentially debilitating symptom that can occur as a direct result of cancer or its treatment. National organizations have identified cognitive impairment as a challenge many survivors face and call for research to address this problem. Despite the priority, research is still relatively limited and questions remain unanswered about prevalence and impact on survivors, as well as coping strategies and effective treatment options available to address this potentially debilitating problem. The purpose of this article is to (a) analyze the prevalence and types of cognitive impairment that commonly affect survivors; (b) delineate the impact that cognitive impairment after cancer and cancer treatment has on self-esteem, social relationships, work ability, and overall quality of life among survivors; and (c) synthesize and appraise commonly used coping strategies used by survivors to address cognitive impairment and evidence-based interventions that may be incorporated into clinical practice. A comprehensive review and synthesis of the literature was conducted. Evidence-based interventions to address cognitive changes after cancer and cancer treatment are limited. However, emerging research has demonstrated that nonpharmacologic treatments, such as cognitive training, are likely to be effective.

Physician-assisted suicide and euthanasia: disproportionate prevalence of women among Kevorkian's patients.

PubMed

Solomon, Louis M; Noll, Rebekka C

2008-06-01

End-of-life decisions are among the most difficult to make or study. When we examined these decisions made under the auspices and protection of stringent state laws, we found no gender bias among patients who chose to end their lives in the face of documented debilitating and terminal diseases. However, in the case of euthanasia as practiced by Jack Kevorkian, we found significant statistical bias against women. Moreover, other data have questioned whether all of Kevorkian's patients did, in fact, have debilitating and terminal illnesses. In this article, we explore why a gender disparity exists in end-of-life decision making. We conclude that if physician-assisted suicide and euthanasia are to be integrated into any end-of-life medical care policy, stringent legal and medical safeguards will be required. Institution of these safeguards should prevent selection bias in a vulnerable population hastening death for reasons other than medically justifiable conditions or issues of individual autonomy, and should ensure that end-of-life decisions are truly reflective of competent personal choice, free from economic considerations or societal pressure.

Clinical Manifestations of Human Brucellosis: A Systematic Review and Meta-Analysis

PubMed Central

Dean, Anna S.; Crump, Lisa; Greter, Helena; Hattendorf, Jan; Schelling, Esther; Zinsstag, Jakob

2012-01-01

Background The objectives of this systematic review, commissioned by WHO, were to assess the frequency and severity of clinical manifestations of human brucellosis, in view of specifying a disability weight for a DALY calculation. Methods/Principal Findings Thirty three databases were searched, with 2,385 articles published between January 1990–June 2010 identified as relating to human brucellosis. Fifty-seven studies were of sufficient quality for data extraction. Pooled proportions of cases with specific clinical manifestations were stratified by age category and sex and analysed using generalized linear mixed models. Data relating to duration of illness and risk factors were also extracted. Severe complications of brucellosis infection were not rare, with 1 case of endocarditis and 4 neurological cases per 100 patients. One in 10 men suffered from epididymo-orchitis. Debilitating conditions such as arthralgia, myalgia and back pain affected around half of the patients (65%, 47% and 45%, respectively). Given that 78% patients had fever, brucellosis poses a diagnostic challenge in malaria-endemic areas. Significant delays in appropriate diagnosis and treatment were the result of health service inadequacies and socioeconomic factors. Based on disability weights from the 2004 Global Burden of Disease Study, a disability weight of 0.150 is proposed as the first informed estimate for chronic, localised brucellosis and 0.190 for acute brucellosis. Conclusions This systematic review adds to the understanding of the global burden of brucellosis, one of the most common zoonoses worldwide. The severe, debilitating, and chronic impact of brucellosis is highlighted. Well designed epidemiological studies from regions lacking in data would allow a more complete understanding of the clinical manifestations of disease and exposure risks, and provide further evidence for policy-makers. As this is the first informed estimate of a disability weight for brucellosis, there is a need for further debate amongst brucellosis experts and a consensus to be reached. PMID:23236528

[Podoconiosis, a society and medical community neglected disease].

PubMed

Prieto-Pérez, Laura; Soriano Cea, Juan José; Górgolas Hernández-Mora, Miguel

2015-11-20

Podoconiosis, mossy foot or endemic non-filarial elephantiasis, is a geochemical disease that causes lower limb lymphedema; it is directly related to walking barefoot over soils of volcanic origin, in areas with a high pluviometric annual index. It has a specific geographical distribution, affecting around 5% population in areas where it is endemic. It is debilitating and disfiguring disease, which frequently leads to social margination. Podoconiosis is totally preventable and, once a diagnosis is established, it may improve with simple therapeutic measures. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Stroke from Vasospasm due to Marijuana Use: Can Cannabis Synergistically with Other Medications Trigger Cerebral Vasospasm?

PubMed

Jamil, Marium; Zafar, Atif; Adeel Faizi, Syed; Zawar, Ifrah

2016-01-01

We present a case of imaging proven cerebral vasospasm causing ischemic stroke in a young patient chronically on buprenorphine-naloxone for heroin remission who started smoking cannabis on a daily basis. With cannabis legalization spreading across the states in the USA, it is important for physicians not only to be aware of cannabis reported association with cerebral vasospasm in some patients but also to be on the lookout for possible interacting medications that can synergistically affect cerebral vessels causing debilitating strokes.

Perceived Fear Appeals and Examination Performance: Facilitating or Debilitating Outcomes?

ERIC Educational Resources Information Center

Putwain, Dave; Symes, Wendy

2011-01-01

This study examines whether students' perception of classroom fear appeals concerning a forthcoming high-stakes examination are associated with facilitating or debilitating performance outcomes. Self-report data were collected for perceived fear appeals, test anxiety and achievement goals from a sample of 273 students in their final year of…

Anxiety Evokes Hypofrontality and Disrupts Rule-Relevant Encoding by Dorsomedial Prefrontal Cortex Neurons.

PubMed

Park, Junchol; Wood, Jesse; Bondi, Corina; Del Arco, Alberto; Moghaddam, Bita

2016-03-16

Anxiety is a debilitating symptom of most psychiatric disorders, including major depression, post-traumatic stress disorder, schizophrenia, and addiction. A detrimental aspect of anxiety is disruption of prefrontal cortex (PFC)-mediated executive functions, such as flexible decision making. Here we sought to understand how anxiety modulates PFC neuronal encoding of flexible shifting between behavioral strategies. We used a clinically substantiated anxiogenic treatment to induce sustained anxiety in rats and recorded from dorsomedial PFC (dmPFC) and orbitofrontal cortex (OFC) neurons while they were freely moving in a home cage and while they performed a PFC-dependent task that required flexible switches between rules in two distinct perceptual dimensions. Anxiety elicited a sustained background "hypofrontality" in dmPFC and OFC by reducing the firing rate of spontaneously active neuronal subpopulations. During task performance, the impact of anxiety was subtle, but, consistent with human data, behavior was selectively impaired when previously correct conditions were presented as conflicting choices. This impairment was associated with reduced recruitment of dmPFC neurons that selectively represented task rules at the time of action. OFC rule representation was not affected by anxiety. These data indicate that a neural substrate of the decision-making deficits in anxiety is diminished dmPFC neuronal encoding of task rules during conflict-related actions. Given the translational relevance of the model used here, the data provide a neuronal encoding mechanism for how anxiety biases decision making when the choice involves overcoming a conflict. They also demonstrate that PFC encoding of actions, as opposed to cues or outcome, is especially vulnerable to anxiety. A debilitating aspect of anxiety is its impact on decision making and flexible control of behavior. These cognitive constructs depend on proper functioning of the prefrontal cortex (PFC). Understanding how anxiety affects PFC encoding of cognitive events is of great clinical and evolutionary significance. Using a clinically valid experimental model, we find that, under anxiety, decision making may be skewed by salient and conflicting environmental stimuli at the expense of flexible top-down guided choices. We also find that anxiety suppresses spontaneous activity of PFC neurons, and weakens encoding of task rules by dorsomedial PFC neurons. These data provide a neuronal encoding scheme for how anxiety disengages PFC during decision making. Copyright © 2016 the authors 0270-6474/16/363322-14$15.00/0.

[The diabetic hand].

PubMed

Schiavon, F; Circhetta, C; Dani, L

2004-01-01

Diabetes mellitus is a chronic metabolic condition characterized by persistent hyperglycaemia with resultant morbidity and mortality related to its microvascular and macrovascular complications. In addition diabetes is also associated with several musculoskeletal disorders of the hand, that can be debilitating. There is increased incidence of these abnormalities in patients with type 1 and type 2 diabetes compared with the general population, related to disease duration but not to the age or sex. Typical diabetes associated hand condition include the palmar flexor tenosynovitis, Dupuytren's contracture, syndrome of limited joint mobility, carpal tunnel syndrome, Charcot arthropathy and reflex sympathetic dystrophy. Maintaining good glycaemic control by exercise, diet and drugs improves or prevents the development of these hand rheumatic condition. In this brief report we review the rational therapeutic approach to these disorders.

Neurological Diseases, Disorders and Injuries in Canada: Highlights of a National Study.

PubMed

Bray, Garth M; Huggett, Deanna L

2016-01-01

The National Population Health Study of Neurological Conditions, a partnership between Neurological Health Charities Canada and the Government of Canada, was the largest study of neurological diseases, disorders, and injuries ever conducted in Canada. Undertaken between 2009 and 2013, the expansive program of research addressed the epidemiology, impacts, health services, and risk factors of 18 neurological conditions and estimated the health outcomes and costs of these conditions in Canada through 2031. This review summarizes highlights from the component projects of the study as presented in the synthesis report, Mapping Connections: An Understanding of Neurological Conditions in Canada. The key findings included new prevalence and incidence estimates, documentation of the diverse and often debilitating effects of neurological conditions, and identification of the utilization, economic costs, and current limitations of related health services. The study findings will support health charities, governments, and other stakeholders to reduce the impact of neurological conditions in Canada.

Diagnosis and treatment of patients with prostatic abscess in the post-antibiotic era.

PubMed

Ackerman, Anne Lenore; Parameshwar, Pooja S; Anger, Jennifer T

2018-02-01

We reviewed the pathogenesis, clinical presentation, treatment options and outcomes of prostatic abscess in the post-antibiotic era, focusing on how patient risk factors and the emergence of multidrug-resistant organisms influence management of the condition. A MEDLINE search for "prostate abscess" or "prostatic abscess" was carried out. Prostate abscess is no longer considered a consequence of untreated urinary infection; now, men with prostatic abscess are typically debilitated or immunologically compromised, with >50% of patients having diabetes. In younger men, prostatic abscess can be the initial presentation of such chronic conditions. In older men, prostatic abscess is increasingly a complication of benign prostatic hyperplasia or prostate biopsy. Diagnosis is based on a physical examination, leukocytosis, leukocyturia and transrectal ultrasound, with magnetic resonance imaging serving as the preferred confirmatory imaging modality. Treatment of prostatic abscess is changing as a result of the emergence of atypical and drug-resistant organisms, such as extended-spectrum β-lactamase-producing enterobacteriaceae and methicillin-resistant Staphylococcus aureus. As many as 75% of infections are resistant to first-generation antibiotics, necessitating aggressive therapy with broad-spectrum parenteral antibiotics, such as third-generation cephalosporins, aztreonam or antibiotic combinations. A total of 80% of patients require early surgical drainage, frequently through a transurethral approach. In the post-antibiotic era, prostatic abscess is evolving from an uncommon complication of urinary infection to a consequence of immunodeficiency, growing antibiotic resistance and urological manipulation. This condition, primarily affecting patients with chronic medical conditions rendering them susceptible to atypical, drug-resistant organisms, requires prompt aggressive intervention with contemporary antibiotic therapy and surgical drainage. © 2017 The Japanese Urological Association.

The occupational and quality of life consequences of chronic fatigue syndrome/myalgic encephalomyelitis in young people

PubMed Central

Taylor, Renee R; O’Brien, Jane; Kielhofner, Gary; Lee, Sun-Wook; Katz, Ben; Mears, Cynthia

2011-01-01

Introduction Chronic fatigue syndrome, termed myalgic encephalomyelitis in the United Kingdom (CFS/ME), is a debilitating condition involving severe exhaustion, cognitive difficulties, educational and vocational losses, and disruption of social activities and relationships. CFS/ME may affect volition (that is, value, interest and sense of competence). Purpose To test Model of Human Occupation (MOHO) concepts by comparing young people with and without CFS/ME in terms of occupational participation, volition and health-related quality of life during infection and over time. Method Three hundred and one people (12–18 years old) diagnosed with glandular fever were evaluated at the time of acute infection (baseline). Six months following diagnosis, 39 of them met the criteria for CFS/ME. A further 39 who recovered were randomly selected and matched to CFS/ME participants. Both groups were re-evaluated at 12 months and 24 months. The Occupational Self Assessment and the Child General Health Questionnaire were used to compare occupational participation. Results Those with CFS/ME reported lower levels of perceived competency, more difficulties with physical functioning and poorer general health status than those who recovered. Conclusion Those with CFS/ME report lower perceived competency, and compromises in physical functioning, school performance, social activities, emotional functioning and general health. This supports the MOHO assertion that impairments affect volition and quality of life. PMID:22102767

Facilitating and Debilitating Test Anxiety Among College Students and Volunteers for Desensitization Workshops

ERIC Educational Resources Information Center

Hudesman, John; Wiesner, Ezra

1978-01-01

Examines whether the degree of facilitating and debilitating test anxiety is different for students who volunteer for test anxiety desensitization workshops than it is for the general college population, whether test anxiety in urban community college students is correlated, and whether either or both of the AAT scales are predictive of student…

Alzheimer disease: focus on computed tomography.

PubMed

Reynolds, April

2013-01-01

Alzheimer disease is the most common type of dementia, affecting approximately 5.3 million Americans. This debilitating disease is marked by memory loss, confusion, and loss of cognitive ability. The exact cause of Alzheimer disease is unknown although research suggests that it might result from a combination of factors. The hallmarks of Alzheimer disease are the presence of beta-amyloid plaques and neurofibrillary tangles in the brain. Radiologic imaging can help physicians detect these structural characteristics and monitor disease progression and brain function. Computed tomography and magnetic resonance imaging are considered first-line imaging modalities for the routine evaluation of Alzheimer disease.

Multiple sclerosis.

PubMed

Files, Daniel Kane; Jausurawong, Tani; Katrajian, Ruba; Danoff, Robert

2015-06-01

Multiple sclerosis (MS) is a chronic, debilitating disease that can have devastating effects. Presentation varies widely in symptoms, pace, and progression. In addition to a thorough history and physical examination, diagnostic tools required to diagnose MS and exclude other diagnoses include MRI, evoked potential testing, and cerebrospinal fluid analysis. Although the disease is not curable presently, quality of life can be improved by minimizing the frequency and severity of disease burden. Disease modification, symptom management, preservation of function, and treatment of psychosocial issues are paramount to enhance the quality of life for the patient affected with MS. Copyright © 2015 Elsevier Inc. All rights reserved.

Establishment of reference values for various coagulation tests in healthy Florida manatees (Trichechus manatus latirostris) and evaluation of coagulation in debilitated manatees during rehabilitation.

PubMed

Gerlach, Trevor J; Bandt, Carsten; Conner, Bobbi; Ball, Ray L

2015-11-01

To establish reference ranges for coagulation parameters in healthy Florida manatees (Trichechus manatus latirostris) and compare results with those for debilitated manatees undergoing treatment at a rehabilitation facility. Prospective study. 29 healthy manatees and 45 debilitated manatees with various diseases. Manatees considered healthy on the basis of results of physical examination, CBC, and serum biochemical analysis underwent coagulation testing including measurement of prothrombin time, partial thromboplastin time, D-dimer concentration, platelet count, and fibrinogen concentration to establish reference ranges. For comparison, a group of manatees undergoing rehabilitation was also tested, and the results were compared. Thromboelastography was also performed on some animals. Values for D-dimer concentration were significantly higher in debilitated versus healthy animals. There was no significant difference for prothrombin time, partial thromboplastin time, platelet count, or fibrinogen concentration between groups. Thromboelastography was performed on 8 healthy animals. Reference ranges were established for various tests of coagulation that may assist clinicians during the initial evaluation and rehabilitation of Florida manatees. Future research to evaluate the effect of specific disease processes on the coagulation cascade is recommended.

What lessons can history teach us about the Charcot foot?

PubMed

Sanders, Lee J

2008-01-01

Regrettably, physicians today receive very little instruction in the history of medicine. Most health care providers have a very limited, contemporary knowledge of the condition that we know of as the Charcot foot. Yet, historical concepts of the pathogenesis and natural history of this condition provide us with important lessons that enhance our understanding, recognition, and management of this rare but debilitating neurogenic arthropathy. It is my belief that knowledge of the history of medicine provides us with a better understanding of present-day issues and clearer vision as we look to the future. This article describes some of the important lessons learned from the history of the Charcot foot.

Current protocols in the management of oral submucous fibrosis: An update.

PubMed

Arakeri, Gururaj; Rai, Kirthi Kumar; Boraks, George; Patil, Shekar Gowda; Aljabab, Abdulsalam S; Merkx, M A W; Carrozzo, Marco; Brennan, Peter A

2017-07-01

Oral submucous fibrosis (OSMF) is a debilitating condition of oral cavity which has significant potential for malignant transformation. In spite of over 20 years of research, the pathogenesis of the condition is still obscure and no single management modality is effective. Many OSMF treatment protocols have been proposed to alleviate the signs and symptoms of the disorder and there is overwhelming evidence that as areca nut is primary cause, stopping its use may have a considerable effect on symptoms rather than reversing pre-existing fibrosis. We present a review of the current protocols for managing OSMF. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Phenotypic Correction of Hemophilia A in Sheep by Postnatal Intraperitoneal Transplantation of FVIII-Expressing MSC

PubMed Central

Porada, Christopher D.; Sanada, Chad; Kuo, Chung-Jung; Colletti, Evan; Mandeville, Walter; Hasenau, John; Zanjani, Esmail D.; Moot, Robert; Doering, Christopher; Spencer, H. Trent; Almeida-Porada, Graça

2011-01-01

We recently re-established a line of sheep that accurately mimics the clinical symptoms and genetics of severe hemophilia A (HA). Herein, we tested a novel, non-ablative transplant therapy in 2 pediatric HA animals. Paternal mesenchymal stem cells (MSC) were transduced with a porcine FVIII-encoding lentivector, and transplanted via the intraperitoneal route, without preconditioning. At the time of transplantation, these animals had received multiple hFVIII treatments for various spontaneous bleeds, and had developed debilitating hemarthroses which produced severe defects in posture and gait. Transplantation of transduced MSC resolved all existent hemarthroses, and spontaneous bleeds ceased. Damaged joints recovered fully; the animals regained normal posture and gait and resumed normal activity. Despite achieving factor-independence, a sharp rise in pre-existent Bethesda titers occurred following transplantation, decreasing the effectiveness and duration of therapy. Post-mortem examination revealed widespread engraftment, with MSC present within the lung, liver, intestine, and thymus, but particularly within joints affected at the time of transplantation, suggesting MSC homed to sites of ongoing injury/inflammation to release FVIII, explaining the dramatic improvement in hemarthrotic joints. In summary, this novel, non-ablative MSC transplantation was straightforward, safe, and converted life-threatening, debilitating HA to a moderate phenotype in a large animal model. PMID:21906573

Cause of vocal fold scar.

PubMed

Allen, Jacqui

2010-12-01

The prolonged debilitation, loss of income, and decrement in quality of life caused by vocal fold scar is exacerbated by our inability to successfully treat this difficult problem. As technology focuses on developing innovative treatments, we need to fully appreciate and understand the mechanisms giving rise to glottal scar, on both a macroscopic and microscopic level. This review examines recent literature pertaining to the gross and molecular mechanisms which give rise to vocal fold scar. Mechanisms of vocal fold scar production have been examined in both macroscopic and microscopic detail. Trauma and injury involving any aspect of the lamina propria, particularly the deeper layers, may result in epithelial tethering and scar formation. At the molecular level, early inflammatory cytokines activate and recruit fibroblasts which then drive the fibrotic cascade. Transforming growth factor-β enhances fibrosis and is balanced by tissue matrix metalloproteinases and hepatocyte growth factor activity. Molecular signaling offers novel opportunities to intervene in scar formation. New work investigating the cause of vocal fold scar identifies complex molecular processes leading to fibrosis in the lamina propria. Improved mechanistic understanding offers insight into prevention strategies and possible targets for antifibrotic therapies that may help prevent or treat this debilitating condition.

Developing Gene Silencing for the Study and Treatment of Dystonia

DTIC Science & Technology

2015-11-01

cause abnormal twisting postures. DYT1 dystonia is an autosomal dominant disease with onset of dystonia during childhood . The most common early onset...SUPPLEMENTARY NOTES 14. ABSTRACT Dystonia is a debilitating neurological disease with no cure. In dystonia, there are involuntary muscle contractions that...is a debilitating neurological disease with no cure that is characterized by involuntary muscle contractions that cause abnormal twisting postures

Monoclonal Antibodies Passively Protect BALB/c Mice Against Burkholderia mallei Aerosol Challenge

DTIC Science & Technology

2006-03-01

November 2005 Glanders is a debilitating disease with no vaccine available. Murine monoclonal antibodies were produced against Burkholderia mallei , the... Glanders is a debilitating disease with no vaccine available. Murine monoclonal antibodies were produced against Burkholderia mallei , the etiologic... Burkholderia mallei auxotroph protects against aerosol-initiated glanders in mice. Vaccine 23:1986–1992. 17. Vyshelesskii, S. N. 1974. Glanders (Equinia). Tr

DDE poisoning in an adult bald eagle

USGS Publications Warehouse

Garcelon, D.K.; Thomas, N.J.

1997-01-01

A 12-year-old female bald eagle (Haliaeetus leucocephalus) was found in May 1993 on Santa Catalina Island, California (USA), in a debilitated condition, exhibiting ataxia and tremors; it died within hours. On necropsy, the bird was emaciated but had no evidence of disease or physical injury. Chemical analyses were negative for organophosphorus pesticides and lead poisoning. High concentrations of DDE (wet weight basis) were found in the brain (212 ppm), liver (838 ppm), and serum (53 ppm). Mobilization of DDE, from depleted fat deposits, probably resulted in the lethal concentration in the eagle's brain.

Multifocal Tubercular Dactylitis: A Rare Presentation of Skeletal Tuberculosis in an Adult.

PubMed

Thatoi, Pravat; Parida, Manoj; Barik, Rakesh; Das, Bidyut

2017-06-01

Tubercular dactylitis is an uncommon form of osteo-articular tuberculosis seen in children. Multifocal involvement, simultaneously involving hands and feet is extremely uncommon. Here we report an adult patient with tubercular dactylitis involving multiple digits of both hands and second digit of right foot in absence of any risk factors like immunodeficiency or any debilitating condition. The patient was successfully treated with anti-tubercular drugs for six months. Mycobacterium tuberculosis infection of bones and joints can present in an unusual way but early diagnosis and treatment caries a good prognosis.

Obesity therapy: altering the energy intake-and-expenditure balance sheet.

PubMed

Crowley, Vivion E F; Yeo, Giles S H; O'Rahilly, Stephen

2002-04-01

Obesity is associated with numerous health complications, which range from non-fatal debilitating conditions such as osteoarthritis, to life-threatening chronic diseases such as coronary heart disease, diabetes and certain cancers. The psychological consequences of obesity can range from lowered self-esteem to clinical depression. Despite the high prevalence of obesity and the many advances in our understanding of how it develops, current therapies have persistently failed to achieve long-term success. This review focuses on how fat mass can be reduced by altering the balance between energy intake and expenditure.

The inflammatory role of phagocyte apoptotic pathways in rheumatic diseases.

PubMed

Cuda, Carla M; Pope, Richard M; Perlman, Harris

2016-08-23

Rheumatoid arthritis affects nearly 1% of the world's population and is a debilitating autoimmune condition that can result in joint destruction. During the past decade, inflammatory functions have been described for signalling molecules classically involved in apoptotic and non-apoptotic death pathways, including, but not limited to, Toll-like receptor signalling, inflammasome activation, cytokine production, macrophage polarization and antigen citrullination. In light of these remarkable advances in the understanding of inflammatory mechanisms of the death machinery, this Review provides a snapshot of the available evidence implicating death pathways, especially within the phagocyte populations of the innate immune system, in the perpetuation of rheumatoid arthritis and other rheumatic diseases. Elevated levels of signalling mediators of both extrinsic and intrinsic apoptosis, as well as the autophagy, are observed in the joints of patients with rheumatoid arthritis. Furthermore, risk polymorphisms are present in signalling molecules of the extrinsic apoptotic and autophagy death pathways. Although research into the mechanisms underlying these pathways has made considerable progress, this Review highlights areas where further investigation is particularly needed. This exploration is critical, as new discoveries in this field could lead to the development of novel therapies for rheumatoid arthritis and other rheumatic diseases.

Detoxification of ammonia in mouse cortical GABAergic cell cultures increases neuronal oxidative metabolism and reveals an emerging role for release of glucose-derived alanine.

PubMed

Leke, Renata; Bak, Lasse K; Anker, Malene; Melø, Torun M; Sørensen, Michael; Keiding, Susanne; Vilstrup, Hendrik; Ott, Peter; Portela, Luis V; Sonnewald, Ursula; Schousboe, Arne; Waagepetersen, Helle S

2011-04-01

Cerebral hyperammonemia is believed to play a pivotal role in the development of hepatic encephalopathy (HE), a debilitating condition arising due to acute or chronic liver disease. In the brain, ammonia is thought to be detoxified via the activity of glutamine synthetase, an astrocytic enzyme. Moreover, it has been suggested that cerebral tricarboxylic acid (TCA) cycle metabolism is inhibited and glycolysis enhanced during hyperammonemia. The aim of this study was to characterize the ammonia-detoxifying mechanisms as well as the effects of ammonia on energy-generating metabolic pathways in a mouse neuronal-astrocytic co-culture model of the GABAergic system. We found that 5 mM ammonium chloride affected energy metabolism by increasing the neuronal TCA cycle activity and switching the astrocytic TCA cycle toward synthesis of substrate for glutamine synthesis. Furthermore, ammonia exposure enhanced the synthesis and release of alanine. Collectively, our results demonstrate that (1) formation of glutamine is seminal for detoxification of ammonia; (2) neuronal oxidative metabolism is increased in the presence of ammonia; and (3) synthesis and release of alanine is likely to be important for ammonia detoxification as a supplement to formation of glutamine.

Working women and the menopause.

PubMed

Kopenhager, T; Guidozzi, F

2015-06-01

Women are living longer, working more and retiring later. About 45% of the over 50-year-old workforce in virtually all forms of employment are women, all of whom will experience the menopause and its symptoms, which in some women will be mild to moderate, whilst in others they may be severe and debilitating. About half of these women will find it somewhat, or fairly difficult, to cope with their work, about half will not be affected and only about 5% will be severely compromised. Poor concentration, tiredness, poor memory, depression, feeling low, lowered confidence, sleepiness and particularly hot flushes are all cited as contributing factors. As with any longstanding health-related condition, the need for support and understanding from line management is crucial and can make a major difference to how a woman will deal with the adverse impact the menopausal symptoms may have on her productivity, her job satisfaction and her efficiency. A number of plausible strategies have been proposed that can be realistically implemented in the workplace and which could certainly make a significant difference. Careful thought, planning, consideration and effort may be required but, if instituted, they will, in the final analysis, benefit both employer and employee.

Acute changes in foot strike pattern and cadence affect running parameters associated with tibial stress fractures.

PubMed

Yong, Jennifer R; Silder, Amy; Montgomery, Kate L; Fredericson, Michael; Delp, Scott L

2018-05-18

Tibial stress fractures are a common and debilitating injury that occur in distance runners. Runners may be able to decrease tibial stress fracture risk by adopting a running pattern that reduces biomechanical parameters associated with a history of tibial stress fracture. The purpose of this study was to test the hypothesis that converting to a forefoot striking pattern or increasing cadence without focusing on changing foot strike type would reduce injury risk parameters in recreational runners. Running kinematics, ground reaction forces and tibial accelerations were recorded from seventeen healthy, habitual rearfoot striking runners while running in their natural running pattern and after two acute retraining conditions: (1) converting to forefoot striking without focusing on cadence and (2) increasing cadence without focusing on foot strike. We found that converting to forefoot striking decreased two risk factors for tibial stress fracture: average and peak loading rates. Increasing cadence decreased one risk factor: peak hip adduction angle. Our results demonstrate that acute adaptation to forefoot striking reduces different injury risk parameters than acute adaptation to increased cadence and suggest that both modifications may reduce the risk of tibial stress fractures. Copyright © 2018 Elsevier Ltd. All rights reserved.

Epilepsia partialis continua responsive to neocortical electrical stimulation.

PubMed

Valentin, Antonio; Ughratdar, Ismail; Cheserem, Beverly; Morris, Robert; Selway, Richard; Alarcon, Gonzalo

2015-08-01

Epilepsia partialis continua (EPC), defined as a syndrome of continuous focal jerking, is a rare form of focal status epilepticus that usually affects a distal limb, and when prolonged, can produce long-lasting deficits in limb function. Substantial electrophysiologic evidence links the origin of EPC to the motor cortex; thus surgical resection carries the risk of significant handicap. We present two patients with focal, drug-resistant EPC, who were admitted for intracranial video-electroencephalography monitoring to elucidate the location of the epileptogenic focus and identification of eloquent motor cortex with functional mapping. In both cases, the focus resided at or near eloquent motor cortex and therefore precluded resective surgery. Chronic cortical stimulation delivered through subdural strips at the seizure focus (continuous stimulation at 60-130 Hz, 2-3 mA) resulted in >90% reduction in seizures and abolition of the EPC after a follow-up of 22 months in both patients. Following permanent implantation of cortical stimulators, no adverse effects were noted. EPC restarted when intensity was reduced or batteries depleted. Battery replacement restored previous improvement. This two-case report opens up avenues for the treatment of this debilitating condition. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

3-D segmentation of articular cartilages by graph cuts using knee MR images from osteoarthritis initiative

NASA Astrophysics Data System (ADS)

Shim, Hackjoon; Lee, Soochan; Kim, Bohyeong; Tao, Cheng; Chang, Samuel; Yun, Il Dong; Lee, Sang Uk; Kwoh, Kent; Bae, Kyongtae

2008-03-01

Knee osteoarthritis is the most common debilitating health condition affecting elderly population. MR imaging of the knee is highly sensitive for diagnosis and evaluation of the extent of knee osteoarthritis. Quantitative analysis of the progression of osteoarthritis is commonly based on segmentation and measurement of articular cartilage from knee MR images. Segmentation of the knee articular cartilage, however, is extremely laborious and technically demanding, because the cartilage is of complex geometry and thin and small in size. To improve precision and efficiency of the segmentation of the cartilage, we have applied a semi-automated segmentation method that is based on an s/t graph cut algorithm. The cost function was defined integrating regional and boundary cues. While regional cues can encode any intensity distributions of two regions, "object" (cartilage) and "background" (the rest), boundary cues are based on the intensity differences between neighboring pixels. For three-dimensional (3-D) segmentation, hard constraints are also specified in 3-D way facilitating user interaction. When our proposed semi-automated method was tested on clinical patients' MR images (160 slices, 0.7 mm slice thickness), a considerable amount of segmentation time was saved with improved efficiency, compared to a manual segmentation approach.

Persian language version of the "Tinnitus Handicap Inventory": translation, standardization, validity and reliability.

PubMed

Mahmoudian, Saeid; Shahmiri, Elaheh; Rouzbahani, Masoumeh; Jafari, Zahra; Keyhani, Mohammad; Rahimi, Farzad; Mahmoudian, Guiti; Akbarvand, Leila; Barzegar, Gholamreza; Farhadi, Mohammad

2011-01-01

Tinnitus is a debilitating condition that is widespread yet difficult to successfully diagnose and treat. This symptom can seriously affect the individual's life quality. The aim of current study was to compose and validate a Persian version of the Tinnitus Handicap Inventory (THI-P). The linguistic validation of the original version of THI into Persian version (THI-P) included translation, back translation and data gathering. The THI-P was administered to 112 tinnitus subjects. Age, gender, medical history and tinnitus characteristics were recorded as baseline information. All participants complained of chronic unilateral or bilateral subjective idiopathic tinnitus lasting for at least 6 months before consulting about their tinnitus. There was no significant difference between gender, age, hearing impairment and total score and subscales of THI-P. Pearson product-moment correlations revealed adequate test-retest reliability for the THI-P (r = 0.96). Cronbach's-alpha coefficient indicated adequate internal stability of the THI-P (r= 0.943), with a total item correction varying between r=0.939 and r=0.944, indicating its reproducibility. The present study proved the internal consistency/ coherency of the Persian version of THI (THI-P). This provides satisfactory application in clinical/research environments.

At-Home Application of Autologous Platelet Rich Plasma as Treatment for Pressure Sore and Related Anemia.

PubMed

Tendas, Andrea; Niscola, Pasquale; Giovannini, Marco; Costa, Adriana; Venditti, Daniela; Volta, Laura; Malandruccolo, Luigi; Sabbadini, Stefania; Lasorella, Rosa; Fabritiis, Paolo de; Cassetta, Rita; Perrotti, Alessio P

2017-01-01

Pressure sores are a major complication in the bed-ridden older patient. In this report, we present the case of platelet rich plasma (PRP) application for the treatment of a pressure sore in an 88-year-old female affected by transfusion-dependent chronic inflammatory disease anemia associated with the congenital and inherited condition of thalassemic trait carrier. A weekly application schedule was planned athome, given the patient's debilitation and her decreased performance status as well as personal and family difficulties to go as outpatients at our treatment center. After 9 PRP applications, a remarkable sore improvement was achieved so that PRP was discontinued; nevertheless, sore rapidly improved until the full resolution and the complete closing after 4 months from the start of PRP treatment. Noteworthy, transfusion support was interrupted and a significant recovery and a sustained stabilization of hemoglobin (Hb) level at 1 year after ulcer healing were observed. The present case suggests that PRP application, performed athome in our case, is a feasible and effective treatment for pressure sores and related complications. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Basics of Radiation Biology When Treating Hyperproliferative Benign Diseases.

PubMed

Rödel, Franz; Fournier, Claudia; Wiedemann, Julia; Merz, Felicitas; Gaipl, Udo S; Frey, Benjamin; Keilholz, Ludwig; Seegenschmiedt, M Heinrich; Rödel, Claus; Hehlgans, Stephanie

2017-01-01

For decades, low- and moderate-dose radiation therapy (RT) has been shown to exert a beneficial therapeutic effect in a multitude of non-malignant conditions including painful degenerative muscoloskeletal and hyperproliferative disorders. Dupuytren and Ledderhose diseases are benign fibroproliferative diseases of the hand/foot with fibrotic nodules and fascial cords, which determine debilitating contractures and deformities of fingers/toes, while keloids are exuberant scar formations following burn damage, surgery, and trauma. Although RT has become an established and effective option in the management of these diseases, experimental studies to illustrate cellular composites and factors involved remain to be elucidated. More recent findings, however, indicate the involvement of radiation-sensitive targets like mitotic fibroblasts/myofibroblasts as well as inflammatory cells. Radiation-related molecular mechanisms affecting these target cells include the production of free radicals to hamper proliferative activity and interference with growth factors and cytokines. Moreover, an impairment of activated immune cells involved in both myofibroblast proliferative and inflammatory processes may further contribute to the clinical effects. We here aim at briefly describing mechanisms contributing to a modulation of proliferative and inflammatory processes and to summarize current concepts of treating hyperproliferative diseases by low and moderate doses of ionizing radiation.

BRCA1 and BRCA2 gene variants and nonsyndromic cleft lip/palate.

PubMed

Rodriguez, Nicholas; Maili, Lorena; Chiquet, Brett T; Blanton, Susan H; Hecht, Jacqueline T; Letra, Ariadne

2018-06-19

Nonsyndromic cleft lip with or without cleft palate (NSCL/P) is a debilitating condition that not only affects the individual, but the entire family. The purpose of this study was to investigate the association of BRCA1 and BRCA2 genes with NSCL/P. Twelve polymorphisms in/nearby BRCA1 and BRCA2 were genotyped using Taqman chemistry. Our data set consisted of 3,473 individuals including 2,191 nonHispanic white (NHW) individuals (from 151 multiplex and 348 simplex families) and 1,282 Hispanic individuals (from 92 multiplex and 216 simplex families). Data analysis was performed using Family-Based Association Test (FBAT), stratified by ethnicity and family history of NSCL/P. Nominal associations were found between NSCL/P and BRCA1 in Hispanics and BRCA2 in NHW and Hispanics (p < .05). Significant haplotype associations were found between NSCL/P and both BRCA1 and BRCA2 (p ≤ .004). Our results suggest a modest association between BRCA1 and BRCA2 and NSCL/P. Further studies in additional populations and functional studies are needed to elucidate the role of these genes in developmental processes and signaling pathways contributing to NSCL/P. © 2018 Wiley Periodicals, Inc.

Pathogenic plasticity of Kv7.2/3 channel activity is essential for the induction of tinnitus.

PubMed

Li, Shuang; Choi, Veronica; Tzounopoulos, Thanos

2013-06-11

Tinnitus, the perception of phantom sound, is often a debilitating condition that affects many millions of people. Little is known, however, about the molecules that participate in the induction of tinnitus. In brain slices containing the dorsal cochlear nucleus, we reveal a tinnitus-specific increase in the spontaneous firing rate of principal neurons (hyperactivity). This hyperactivity is observed only in noise-exposed mice that develop tinnitus and only in the dorsal cochlear nucleus regions that are sensitive to high frequency sounds. We show that a reduction in Kv7.2/3 channel activity is essential for tinnitus induction and for the tinnitus-specific hyperactivity. This reduction is due to a shift in the voltage dependence of Kv7 channel activation to more positive voltages. Our in vivo studies demonstrate that a pharmacological manipulation that shifts the voltage dependence of Kv7 to more negative voltages prevents the development of tinnitus. Together, our studies provide an important link between the biophysical properties of the Kv7 channel and the generation of tinnitus. Moreover, our findings point to previously unknown biological targets for designing therapeutic drugs that may prevent the development of tinnitus in humans.

High negative pressure subcutaneous suction drain for managing debilitating subcutaneous emphysema secondary to tube thoracostomy for an iatrogenic post computed tomography guided transthoracic needle biopsy pneumothorax: Case report and review of literature.

PubMed

Ahmed, Zeeshan; Patel, Pinakin; Singh, Suresh; Sharma, Raj Govind; Somani, Pankaj; Gouri, Abdul Rauf; Singh, Shiv

2016-01-01

Subcutaneous emphysema is a common complication of tube thoracostomy. Though self-limiting, it should be treated when it causes palpebral closure, dyspnea, dysphagia or undue disfigurement resulting in anxiety and distress to the patient. A 72year old man who was a known case of COPD on bronchodilators developed a large pneumothorax and respiratory distress after a CT guided transthoracic lung biopsy done for a lung opacity (approx. 3×3cm) at the right hilar region on Chest X-ray. Within 24h of an urgent tube thoracostomy, patient developed intractable subcutaneous emphysema with closure of palpebral fissure and dyspnea unresponsive to increasing suction on chest tube. A subcutaneous fenestrated drain was placed mid-way between the nipple and clavicle in the mid-clavicular line bilaterally. Continuous negative suction (-150mmHg) resulted in immediate, sustained relief and complete resolution within 5days. Extensive and debilitating SE (subcutaneous emphysema) has to be treated promptly to relieve patient discomfort, dysphagia or imminent respiratory compromise. A variety of treatment have been tried including infraclavicular blow-hole incisions, subcutaneous drains +/- negative pressure suction, fenestrated angiocatheters, Vacuum assisted dressings and increasing suction on a pre-existing chest tube. We describe a high negative pressure subcutaneous suction drain which provides immediate and sustained relief in debilitating SE. Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. High negative pressure subcutaneous suction drain provides immediate and sustained relief in extensive and debilitating SE. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Support for voluntary and nonvoluntary euthanasia: what roles do conditions of suffering and the identity of the terminally ill play?

PubMed

Ho, Robert; Chantagul, Natalie

2015-01-01

This study investigated the level of support for voluntary and nonvoluntary euthanasia under three conditions of suffering (pain; debilitated nature of the body; burden on the family) experienced by oneself, a significant other, and a person in general. The sample consisted of 1,897 Thai adults (719 males, 1,178 females) who voluntarily filled in the study's questionnaire. Initial multivariate analysis of variance indicated significant group (oneself, significant other, person in general) differences in level of support for voluntary and nonvoluntary euthanasia and under the three conditions of suffering. Multigroup path analysis conducted on the posited euthanasia model showed that the three conditions of suffering exerted differential direct and indirect influences on the support of voluntary and nonvoluntary euthanasia as a function of the identity of the person for whom euthanasia was being considered. The implications of these findings are discussed.

Establishing 'quality of life' parameters using behavioural guidelines for humane euthanasia of captive non-human primates.

PubMed

Lambeth, Sp; Schapiro, Sj; Bernacky, Bj; Wilkerson, Gk

2013-09-01

Chronic pain and distress are universally accepted conditions that may adversely affect an animal's quality of life (QOL) and lead to the humane euthanasia of an animal. At most research institutions and zoological parks in the USA, a veterinarian, who has physically examined the animal and reviewed the clinical records, ultimately decides when an animal has reached a humane endpoint. To aid in the difficult process of interpreting pain and distress, we have developed specific behavioural guidelines, in addition to standard clinical information, to help define unique characteristics and traits of primates to assess and promote discussion of an individual primate's QOL, and thereby, to assist in the decision-making process regarding euthanasia. These guidelines advocate the creation of a QOL team when the animal is diagnosed with a life-threatening or debilitating chronic condition, or at the time the animal is entered into a terminal study. The team compiles a list of characteristics unique to that individual animal by utilising a questionnaire and a behavioural ethogram. This list enables the team to quantitatively assess any deviations from the established normal behavioural repertoire of that individual. Concurrently, the QOL team determines the number of behavioural deviations that are needed to trigger an immediate discussion of the necessity for humane euthanasia of the animal. The team remains intact once created, and revisits the animal's condition as frequently as deemed necessary. This process improves animal welfare by continuing the quest to optimally define QOL for captive primates, and potentially for all captive animals.

Establishing ‘quality of life’ parameters using behavioural guidelines for humane euthanasia of captive non-human primates

PubMed Central

Lambeth, SP; Schapiro, SJ; Bernacky, BJ; Wilkerson, GK

2014-01-01

Chronic pain and distress are universally accepted conditions that may adversely affect an animal’s quality of life (QOL) and lead to the humane euthanasia of an animal. At most research institutions and zoological parks in the USA, a veterinarian, who has physically examined the animal and reviewed the clinical records, ultimately decides when an animal has reached a humane endpoint. To aid in the difficult process of interpreting pain and distress, we have developed specific behavioural guidelines, in addition to standard clinical information, to help define unique characteristics and traits of primates to assess and promote discussion of an individual primate’s QOL, and thereby, to assist in the decision-making process regarding euthanasia. These guidelines advocate the creation of a QOL team when the animal is diagnosed with a life-threatening or debilitating chronic condition, or at the time the animal is entered into a terminal study. The team compiles a list of characteristics unique to that individual animal by utilising a questionnaire and a behavioural ethogram. This list enables the team to quantitatively assess any deviations from the established normal behavioural repertoire of that individual. Concurrently, the QOL team determines the number of behavioural deviations that are needed to trigger an immediate discussion of the necessity for humane euthanasia of the animal. The team remains intact once created, and revisits the animal’s condition as frequently as deemed necessary. This process improves animal welfare by continuing the quest to optimally define QOL for captive primates, and potentially for all captive animals. PMID:25505822

Studies of the aggregation of mutant proteins in vitro provide insights into the genetics of amyloid diseases.

PubMed

Chiti, Fabrizio; Calamai, Martino; Taddei, Niccolo; Stefani, Massimo; Ramponi, Giampietro; Dobson, Christopher M

2002-12-10

Protein aggregation and the formation of highly insoluble amyloid structures is associated with a range of debilitating human conditions, which include Alzheimer's disease, Parkinson's disease, and the Creutzfeldt-Jakob disease. Muscle acylphosphatase (AcP) has already provided significant insights into mutational changes that modulate amyloid formation. In the present paper, we have used this system to investigate the effects of mutations that modify the charge state of a protein without affecting significantly the hydrophobicity or secondary structural propensities of the polypeptide chain. A highly significant inverse correlation was found to exist between the rates of aggregation of the protein variants under denaturing conditions and their overall net charge. This result indicates that aggregation is generally favored by mutations that bring the net charge of the protein closer to neutrality. In light of this finding, we have analyzed natural mutations associated with familial forms of amyloid diseases that involve alteration of the net charge of the proteins or protein fragments associated with the diseases. Sixteen mutations have been identified for which the mechanism of action that causes the pathological condition is not yet known or fully understood. Remarkably, 14 of these 16 mutations cause the net charge of the corresponding peptide or protein that converts into amyloid deposits to be reduced. This result suggests that charge has been a key parameter in molecular evolution to ensure the avoidance of protein aggregation and identifies reduction of the net charge as an important determinant in at least some forms of protein deposition diseases.

Spontaneous and deliberate dissociative states in military personnel: are such states helpful?

PubMed

Morgan, Charles A; Taylor, Marcus K

2013-08-01

This study explored distinctions between spontaneous and deliberate dissociative states in 335 military personnel exposed to stressful survival training. Participants completed the Clinician-Administered Dissociative States Scale (CADSS) after a stressful mock-captivity event. They were also asked to indicate whether the dissociative experiences just happened (i.e., spontaneous), or whether they chose to have them happen (i.e., deliberate); and whether they appraised the dissociative experience as helpful (i.e., facilitative) or hurtful (i.e., debilitative) to their ability to cope with the stressful event. A majority (95.4%) endorsed dissociative states during stress. More than half (57.4%) described dissociative experiences as spontaneous, 13.0% as deliberate, and 29.5% endorsed neither. In Special Forces soldiers only, those who endorsed facilitative dissociation exhibited higher total CADSS scores than those who endorsed debilitative dissociation. Seventy-three percent of spontaneous dissociators described the experience as debilitative to coping with stress; conversely, 76% of deliberate dissociators said these experiences facilitated coping with stress. Individuals with prior trauma exposure tended to appraise dissociative states as more debilitative to coping. This research may enhance the fidelity of studies of dissociation constructs and may offer pivot points for prevention and treatment of stress-related disorders. Published 2013. This article is a US Government work and is in the public domain in the USA.

Fibromyalgia and Myofascial Pain Syndrome-A Dilemma

PubMed Central

Chandola, H C; Chakraborty, Arunangshu

2009-01-01

Summary Pain and fatigue associated to the musculoskeletal system are among the leading causes of patients to visit their physicians and nearly one-third of such patients suffer from fibromyalgia. Fibromyalgia syndrome (FMS) is a chronic debilitating disorder characterized by widespread pain with tenderness in specific areas, leading to fatigue, headache and sleep disorder. Myofascial Pain Syndrome (MPS), is also a localized musculoskeletal pain producing condition whose diagnostic and management criteria differ from FMS but still considered by many only a subtype of FMS. Till date no exact cause has been held responsible for these painful conditions, therefore treatment of these disorders is always a challenge. The therapies are not precise but multimodal including pharmacological and alternative approaches. This article describes the existing knowledge pertaining to these conditions in regard of causative factors diagnosis and management. PMID:20640108

Dextromethorphan plus ultra low-dose quinidine reduces pseudobulbar affect.

PubMed

Pioro, Erik P; Brooks, Benjamin Rix; Cummings, Jeffrey; Schiffer, Randolph; Thisted, Ronald A; Wynn, Daniel; Hepner, Adrian; Kaye, Randall

2010-11-01

To evaluate dextromethorphan combined with ultra low-dose quinidine (DMq) for treating pseudobulbar affect (PBA) in patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). In a 12-week randomized, double-blind trial, ALS and MS patients with clinically significant PBA (a baseline score ≥13 on the Center for Neurologic Studies-Lability Scale [CNS-LS]) were maintained, twice daily, on placebo, DMq at 30/10mg (DMq-30), or DMq at 20/10mg (DMq-20). In 326 randomized patients (of whom 283, or 86.8%, completed the study), the PBA-episode daily rate was 46.9% (p < 0.0001) lower for DMq-30 than for placebo and 49.0% (p < 0.0001) lower for DMq-20 than for placebo by longitudinal negative binomial regression, the prespecified primary analysis. Mean CNS-LS scores decreased by 8.2 points for DMq-30 and 8.2 for DMq-20, vs 5.7 for placebo (p= 0.0002 and p= 0.0113, respectively). Other endpoints showing statistically significant DMq benefit included, for both dosage levels, the likelihood of PBA remission during the final 14 days and, for the higher dosage, improvement on measures of social functioning and mental health. Both dosages were safe and well tolerated. DMq markedly reduced PBA frequency and severity, decreasing the condition's detrimental impact on a patient's life, with satisfactory safety and high tolerability. The findings expand the clinical evidence that DMq may be an important treatment for patients suffering from the socially debilitating symptoms of PBA.

Balancing Overscreening and Underdiagnosis in Secondary Hypertension: The Case of Fibromuscular Dysplasia.

PubMed

Ruzicka, Marcel; Kucharski, Sarah E; Hiremath, Swapnil

2017-05-01

Knowledge about fibromuscular dysplasia (FMD) has broadened over the last several decades. It is no longer considered a rare and benign entity limited to renal arteries and causing just hypertension. It affects other parts of the arterial tree nearly as frequently as the renal arteries. Complications of undiagnosed and untreated extrarenal FMD can be debilitating and life threatening. However, this disease, specifically extrarenal FMD, is not well known to many physicians and patients. Combined with the nonspecific symptoms and signs of the disease, this leads to delayed diagnosis and missed opportunity to prevent serious vascular complications. Copyright © 2016 Elsevier Inc. All rights reserved.

Hope and fatigue in chronic illness: The role of perceived stress.

PubMed

Hirsch, Jameson K; Sirois, Fuschia M

2016-04-01

Fatigue is a debilitating symptom of chronic illness that is deleteriously affected by perceived stress, a process particularly relevant to inflammatory disease. Hopefulness, a goal-based motivational construct, may beneficially influence stress and fatigue, yet little research has examined these associations. We assessed the relation between hope and fatigue, and the mediating effect of stress, in individuals with fibromyalgia, arthritis, and inflammatory bowel disease. Covarying age, sex, and pain, stress partially mediated the association between hope and fatigue; those with greater hope reported less stress and consequent fatigue. Therapeutically, bolstering hope may allow proactive management of stressors, resulting in less fatigue. © The Author(s) 2014.

Endocannabinoid signalling and the deteriorating brain

PubMed Central

Di Marzo, Vincenzo; Stella, Nephi; Zimmer, Andreas

2015-01-01

Ageing is characterized by the progressive impairment of physiological functions and increased risk of developing debilitating disorders, including chronic inflammation and neurodegenerative diseases. These disorders have common molecular mechanisms that can be targeted therapeutically. In the wake of the approval of the first cannabinoid-based drug for the symptomatic treatment of multiple sclerosis, we examine how endocannabinoid (eCB) signalling controls — and is affected by — normal ageing and neuroinflammatory and neurodegenerative disorders. We propose a conceptual framework linking eCB signalling to the control of the cellular and molecular hallmarks of these processes, and categorize the key components of endocannabinoid signalling that may serve as targets for novel therapeutics. PMID:25524120

Increased incidence of red imported fire ant (Hymenoptera: Formicidae) presence in loggerhead sea turtle (Testudines: Cheloniidae) nests and observations of hatchling mortality

USGS Publications Warehouse

Parris, L.B.; Lamont, M.M.; Carthy, R.R.

2002-01-01

Hatching sea turtles may be at risk to fire ant predation during egg incubation, and especially at risk once pipped from the egg, prior to hatchling emergence from the nest. In addition to direct mortality, fire ants have the potential to inflict debilitating injuries that may directly affect survival of the young. The increased incidence of red imported fire ant induced mortality and envenomization of loggerhead sea turtle hatchlings on Cape San Blas suggests this invasive ant species may pose a serious threat to the future of this genetically distinct population.

Endometriosis: translation of molecular insights to management.

PubMed

Langan, K L; Farrell, M E; Keyser, E A; Salyer, B A; Burney, R O

2014-09-01

Endometriosis is a debilitating gynecologic disorder causing pelvic pain and infertility and characterized by the implantation of endometrial tissue to extrauterine locations. Though aspects of the condition remain enigmatic, the molecular pathophysiology of endometriosis appears to be clarifying. Estrogen dependence of the disease is a sentinel endocrine feature and reduction of estrogen bioavailability is the therapeutic principle upon which traditional treatment and prevention approaches have been based. Endometriosis is a chronic inflammatory condition associated with lesional neoangiogenesis and attenuated progesterone action at the level of the endometrium. The elucidation of the molecular pathways mediating these observations has revealed new targets for directed medical and surgical treatment. This paper will review current approaches to the management of endometriosis in the context of the molecular pathophysiology.

Girls Can Play Ball: Stereotype Threat Reduces Variability in a Motor Skill

PubMed Central

Huber, Meghan E.; Brown, Adam J.; Sternad, Dagmar

2016-01-01

The majority of research on stereotype threat shows what is expected: threat debilitates performance. However, facilitation is also possible, although seldom reported. This study investigated how stereotype threat influences novice females when performing the sensorimotor task of bouncing a ball to target. We tested the predictions of two prevailing accounts for debilitation and facilitation due to ST effects: working memory and mere effort. Experimental results showed that variability in performance decreased more in stigmatized females than in control females, consistent with the prediction of the mere effort account, but inconsistent with the working memory account. These findings suggest that stereotype threat effects may be predicated upon the correctness of the dominant motor behavior rather than on a novice-expert distinction or task difficulty. Further, a comprehensive understanding should incorporate the fact that stereotype threat can facilitate, as well as debilitate, performance. PMID:27249638

Girls can play ball: Stereotype threat reduces variability in a motor skill.

PubMed

Huber, Meghan E; Brown, Adam J; Sternad, Dagmar

2016-09-01

The majority of research on stereotype threat shows what is expected: threat debilitates performance. However, facilitation is also possible, although seldom reported. This study investigated how stereotype threat influences novice females when performing the sensorimotor task of bouncing a ball to a target. We tested the predictions of two prevailing accounts for debilitation and facilitation due to sterotype threat effects: working memory and mere effort. Experimental results showed that variability in performance decreased more in stigmatized females than in control females, consistent with the prediction of the mere effort account, but inconsistent with the working memory account. These findings suggest that stereotype threat effects may be predicated upon the correctness of the dominant motor behavior, rather than on a novice-expert distinction or task difficulty. Further, a comprehensive understanding should incorporate the fact that stereotype threat can facilitate, as well as debilitate, performance. Copyright © 2016 Elsevier B.V. All rights reserved.

Prevalence of fatigue and chronic fatigue syndrome in a primary care practice.

PubMed

Bates, D W; Schmitt, W; Buchwald, D; Ware, N C; Lee, J; Thoyer, E; Kornish, R J; Komaroff, A L

1993-12-27

Our goals were to determine the prevalence of unusual, debilitating fatigue and the frequency with which it was associated with the chronic fatigue syndrome (CFS) or other physical or psychological illness in an outpatient clinic population. We prospectively evaluated a cohort of 1000 consecutive patients in a primary care clinic in an urban, hospital-based general medicine practice. The study protocol included a detailed history, physical examination, and laboratory and psychiatric testing. Five patients who came because of CFS studies were excluded. Of the remaining 995, 323 reported fatigue, and 271 (27%) complained of at least 6 months of unusual fatigue that interfered with their daily lives. Of the 271, self-report or record review revealed a medical or psychiatric condition that could have explained the fatigue in 186 (69%). Thus, 85 (8.5%) of 995 patients had a debilitating fatigue of at least 6 months' duration, without apparent cause. Of these patients, 48 refused further evaluation, and 11 were unavailable for follow-up; 26 completed the protocol. Three of the 26 were hypothyroid, and one had a major psychiatric disorder. Of the remaining 22 patients, three met Centers for Disease Control and Prevention criteria for CFS, four met British criteria, and 10 met the Australian case definition. The point prevalences of CFS were thus 0.3% (95% confidence interval [CI], 0% to 0.6%), 0.4% (95% CI, 0% to 0.8%), and 1.0% (95% CI, 0.4% to 1.6%) using the Centers for Disease Control and Prevention, British, and Australian case definitions, respectively. These estimates were conservative, because they assumed that none of the patients who refused evaluation or were unavailable for follow-up would meet criteria for CFS. While chronic, debilitating fatigue is common in medical outpatients, CFS is relatively uncommon. Prevalence depends substantially on the case definition used.

Neurodegeneration in a Drosophila model of adrenoleukodystrophy: the roles of the Bubblegum and Double bubble acyl-CoA synthetases

PubMed Central

Sivachenko, Anna; Gordon, Hannah B.; Kimball, Suzanne S.; Gavin, Erin J.; Bonkowsky, Joshua L.; Letsou, Anthea

2016-01-01

ABSTRACT Debilitating neurodegenerative conditions with metabolic origins affect millions of individuals worldwide. Still, for most of these neurometabolic disorders there are neither cures nor disease-modifying therapies, and novel animal models are needed for elucidation of disease pathology and identification of potential therapeutic agents. To date, metabolic neurodegenerative disease has been modeled in animals with only limited success, in part because existing models constitute analyses of single mutants and have thus overlooked potential redundancy within metabolic gene pathways associated with disease. Here, we present the first analysis of a very-long-chain acyl-CoA synthetase (ACS) double mutant. We show that the Drosophila bubblegum (bgm) and double bubble (dbb) genes have overlapping functions, and that the consequences of double knockout of both bubblegum and double bubble in the fly brain are profound, affecting behavior and brain morphology, and providing the best paradigm to date for an animal model of adrenoleukodystrophy (ALD), a fatal childhood neurodegenerative disease associated with the accumulation of very-long-chain fatty acids. Using this more fully penetrant model of disease to interrogate brain morphology at the level of electron microscopy, we show that dysregulation of fatty acid metabolism via disruption of ACS function in vivo is causal of neurodegenerative pathologies that are evident in both neuronal cells and their supporting cell populations, and leads ultimately to lytic cell death in affected areas of the brain. Finally, in an extension of our model system to the study of human disease, we describe our identification of an individual with leukodystrophy who harbors a rare mutation in SLC27a6 (encoding a very-long-chain ACS), a human homolog of bgm and dbb. PMID:26893370

Herpes simplex virus vector-mediated gene delivery for the treatment of lower urinary tract pain

PubMed Central

Goins, WF; Goss, JR; Chancellor, MB; de Groat, WC; Glorioso, JC; Yoshimura, N

2009-01-01

Interstitial cystitis (IC)/painful bladder syndrome (PBS) is a painful debilitating chronic visceral pain disorder of unknown etiology that affects an estimated 1 million people in the, United States alone. It is characterized by inflammation of the bladder that results in chronic pelvic pain associated with bladder symptoms of urinary frequency and urgency. Regardless of the etiology, IC/PBS involves either increased and/or abnormal activity in afferent nociceptive sensory neurons. Pain-related symptoms in patients with IC/PBS are often very difficult to treat. Both medical and surgical therapies have had limited clinical utility in this debilitating disease and numerous drug treatments, such as heparin, dimethylsulfoxide and amitriptyline, have proven to be palliative at best, and in some IC/PBS patients provide no relief whatsoever. Although opiate narcotics have been employed to help alleviate IC/PBS pain, this strategy is fraught with problems as systemic narcotic administration causes multiple unwanted side effects including mental status change and constipation. Moreover, chronic systemic narcotic use leads to dependency and need for dose escalation due to tolerance: therefore, new therapies are desperately needed to treat refractory IC/PBS. This has led our group to develop a gene therapy strategy that could potentially alleviate chronic pelvic pain using the herpes simplex virus-directed delivery of analgesic proteins to the bladder. PMID:19242523

Hallux rigidus: How do I approach it?

PubMed Central

Lam, Aaron; Chan, Jimmy J; Surace, Michele F; Vulcano, Ettore

2017-01-01

Hallux rigidus is a degenerative disease of the first metatarsalphalangeal (MTP) joint and affects 2.5% of people over age 50. Dorsal osteophytes and narrowed joint space leads to debilitating pain and limited range of motion. Altered gait mechanics often ensued as 119% of the body force transmit through the 1st MTP joint during gait cycle. Precise etiology remains under debate with trauma being often cited in the literature. Hallux valgus interphalangeus, female gender, inflammatory and metabolic conditions have all been identified as associative factors. Clinical symptoms, physical exam and radiographic evidence are important in assessing and grading the disease. Non-operative managements including nonsteroidal antiinflammatory drugs, intra-articular injections, shoe modification, activity modification and physical therapy, should always be attempted for all hallux rigidus patients. The goal of surgery is to relieve pain, maintain stability of the first MTP joint, and improve function and quality of life. Operative treatments can be divided into joint-sparing vs joint-sacrificing. Cheilectomy and moberg osteotomy are examples of joint-sparing techniques that have demonstrated great success in early stages of hallux rigidus. Arthrodesis is a joint-sacrificing procedure that has been the gold standard for advanced hallux rigidus. Other newer procedures such as implant arthroplasty, interpositional arthroplasty and arthroscopy, have demonstrated promising early patient outcomes. However, future studies are still needed to validate its long-term efficacy and safety. The choice of procedure should be based on the condition of the joint, patient’s goal and expectations, and surgeon’s experience with the technique. PMID:28567339

Celiac disease symptoms in a female collegiate tennis player: a case report.

PubMed

Leone, James E; Gray, Kimberly A; Massie, John E; Rossi, Jennifer M

2005-01-01

To present the case of a collegiate tennis player with celiac disease symptoms. Celiac disease is a common intestinal disorder that is often confused with other conditions. It causes severe intestinal damage manifested by several uncomfortable signs and symptoms. Failure by the sports medicine staff to recognize symptoms consistent with celiac disease and treat them appropriately can have deleterious consequences for the athlete. Irritable bowel syndrome, Crohn disease, Addison disease, lupus erythematosus, juvenile rheumatoid arthritis, lactose intolerance, herpes zoster, psychogenic disorder (depression), fibromyalgia, complex regional pain syndrome, hyperthyroidism, anemia, type I diabetes. The athlete underwent a series of blood and allergen tests to confirm or refute a diagnosis of celiac disease. When celiac disease was suspected, dietary modifications were made to eliminate all wheat-based and gluten-based products from the athlete's diet. The athlete was able to fully compete in a competitive National Collegiate Athletic Association Division I tennis program while experiencing the debilitating effects associated with celiac disease. The immediacy of symptom onset was notable because the athlete had no history of similar complaints. Celiac disease is a potentially life-threatening condition that affects more people than reported. A properly educated sports medicine staff can help to identify symptoms consistent with celiac disease early, so damage to the intestine is minimized. Prompt recognition and appropriate management allow the athlete to adjust the diet accordingly, compete at a high-caliber level, and enjoy a healthier quality of life.

Simulating the Spread of an Outbreak of Foot and Mouth Disease in California

DTIC Science & Technology

2012-06-01

the disease, but it debilitates them; leading to severely decreased meat and milk production. The economic impact on a country with an FMD...of an infected animal. Most adult animals recover from the disease, but it debilitates them, which leads to severely decreased meat and milk ...the model, we include one randomly selected cattle premise from Central California without a time until detection in this file. This premise is a Cow

Glucosamine and chondroitin use in canines for osteoarthritis: A review

PubMed Central

Bhathal, Angel; Spryszak, Meredith; Louizos, Christopher; Frankel, Grace

2017-01-01

Osteoarthritis is a slowly progressive and debilitating disease that affects canines of all breeds. Pain and decreased mobility resulting from osteoarthritis often have a negative impact on the affected canine’s quality of life, level of comfort, daily functioning, activity, behaviour, and client-pet companionship. Despite limited and conflicting evidence, the natural products glucosamine hydrochloride (HCl) and chondroitin sulfate are commonly recommended by veterinarians for treating osteoarthritis in dogs. There is a paucity of well-designed clinical veterinary studies investigating the true treatment effect of glucosamine and chondroitin. The purposes of this review article are to provide a brief background on glucosamine and chondroitin use in canine osteoarthritis and to critically review the available literature on the role of these products for improving clinical outcomes. Based on critical review, recommendations for practice are suggested and a future study design is proposed. PMID:28331832

Informed consent process: A step further towards making it meaningful!

PubMed Central

Kadam, Rashmi Ashish

2017-01-01

Informed consent process is the cornerstone of ethics in clinical research. Obtaining informed consent from patients participating in clinical research is an important legal and ethical imperative for clinical trial researchers. Although informed consent is an important process in clinical research, its effectiveness and validity are always a concern. Issues related to understanding, comprehension, competence, and voluntariness of clinical trial participants may adversely affect the informed consent process. Communication of highly technical, complex, and specialized clinical trial information to participants with limited literacy, diverse sociocultural background, diminished autonomy, and debilitating diseases is a difficult task for clinical researchers. It is therefore essential to investigate and adopt innovative communication strategies to enhance understanding of clinical trial information among participants. This review article visits the challenges that affect the informed consent process and explores various innovative strategies to enhance the consent process. PMID:28828304

Epigenetics of Addiction: Current Knowledge, Challenges, and Future Directions.

PubMed

Cecil, Charlotte A M; Walton, Esther; Viding, Essi

2016-09-01

Addiction to psychoactive substances is a debilitating condition underpinned by the interplay of genetic and environmental factors. At present, a key challenge for research is to delineate how, at a molecular level, these influences become "biologically embedded," contributing to the onset and persistence of addictive behaviors. Recently, epigenetic processes that regulate gene expression have emerged as a potential mechanism of interest. In this commentary, we discuss the relevance of epigenetics to addiction research, starting with the current state of knowledge, what challenges we have yet to overcome, and what the future may hold in terms of research methodology and translational potential.

Chronic Pancreatitis.

PubMed

Stram, Michelle; Liu, Shu; Singhi, Aatur D

2016-12-01

Chronic pancreatitis is a debilitating condition often associated with severe abdominal pain and exocrine and endocrine dysfunction. The underlying cause is multifactorial and involves complex interaction of environmental, genetic, and/or other risk factors. The pathology is dependent on the underlying pathogenesis of the disease. This review describes the clinical, gross, and microscopic findings of the main subtypes of chronic pancreatitis: alcoholic chronic pancreatitis, obstructive chronic pancreatitis, paraduodenal ("groove") pancreatitis, pancreatic divisum, autoimmune pancreatitis, and genetic factors associated with chronic pancreatitis. As pancreatic ductal adenocarcinoma may be confused with chronic pancreatitis, the main distinguishing features between these 2 diseases are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Pediatric misophonia with comorbid obsessive-compulsive spectrum disorders.

PubMed

Webber, Troy A; Johnson, Patricia L; Storch, Eric A

2014-01-01

Misophonia is a potentially debilitating condition characterized by increased sensitivity to specific sounds, which cause subsequent behavioral and emotional responses. The nature, clinical phenomenology and etiology of misophonia remain unclear, and misophonic clinical presentations are not currently accounted for by existing psychiatric or audiological disorders. We present a case of pediatric misophonia in the context of comorbid obsessive-compulsive disorder and Tourette's syndrome. Given the interrelationships among obsessive-compulsive spectrum disorders and misophonia, these disorders may share underlying pathophysiology, particularly within the dopaminergic and serotonergic neural systems. Clinical (i.e., treatment) and theoretical implications are discussed. Published by Elsevier Inc.

Living with Ankylosing Spondylitis: the patient's perspective.

PubMed

Hamilton-West, Kate E; Quine, Lyn

2009-09-01

Ankylosing Spondylitis (AS) is a potentially debilitating chronic condition that necessitates a biopsychosocial approach for successful long-term management. However, the psychosocial consequences of AS are not well understood. In this study patients (N = 68) reported impacts of AS across a wide range of life domains; negative impacts included physical effects of AS, changes in mood or personality, effects on social life and relationships with friends and family, low self-esteem, stigma and worry about the future; positive impacts included increased exercise, feelings of achievement and empathy, stronger relationships, slower pace of life and a more positive perspective. Implications for treatment are discussed.

Behavioral Models of Tinnitus and Hyperacusis in Animals

PubMed Central

Hayes, Sarah H.; Radziwon, Kelly E.; Stolzberg, Daniel J.; Salvi, Richard J.

2014-01-01

The phantom perception of tinnitus and reduced sound-level tolerance associated with hyperacusis have a high comorbidity and can be debilitating conditions for which there are no widely accepted treatments. One factor limiting the development of treatments for tinnitus and hyperacusis is the lack of reliable animal behavioral models of these disorders. Therefore, the purpose of this review is to highlight the current animal models of tinnitus and hyperacusis, and to detail the advantages and disadvantages of each paradigm. To date, this is the first review to include models of both tinnitus and hyperacusis. PMID:25278931

Coping as a mediator of the relationship between stress mindset and psychological stress response: a pilot study.

PubMed

Horiuchi, Satoshi; Tsuda, Akira; Aoki, Shuntaro; Yoneda, Kenichiro; Sawaguchi, Yusuke

2018-01-01

Coping, the cognitive and behavioral effort required to manage the effects of stressors, is important in determining psychological stress responses (ie, the emotional, behavioral, and cognitive responses to stressors). Coping was classified into categories of emotional expression (eg, negative feelings and thoughts), emotional support seeking (eg, approaching loved ones to request encouragement), cognitive reinterpretation (eg, reframing a problem positively), and problem solving (eg, working to solve the problem). Stress mindset refers to the belief that stress has enhancing (stress-is-enhancing mindset) or debilitating consequences (stress-is-debilitating mindset). This study examined whether coping mediated the relationship between stress mindset and psychological stress responses. Psychological stress responses were conceptualized as depression-anxiety, irritability-anger, and helplessness. The following two hypotheses were tested: 1) a stronger stress-is-enhancing mindset is associated with less frequent use of emotional expression, emotional support seeking, and problem solving, which in turn is associated with lower levels of depression-anxiety, irritability-anger, and helplessness; 2) a stronger stress-is-debilitating mindset is associated with more frequent use of these coping strategies, which in turn is associated with higher levels of these psychological stress responses. The participants were 30 male and 94 female undergraduate and graduate students (mean age =20.4 years). Stress mindset, coping, and psychological stress responses were measured using self-report questionnaires. Six mediation analyses were performed with stress-is-enhancing mindset or stress-is-debilitating mindset as the independent variable, one of the psychological stress responses as the dependent variable, and the four coping strategies as mediators. Emotional expression partially mediated the relationship between a strong stress-is-debilitating mindset and higher irritability-anger levels. The other three coping strategies did not exhibit mediating effects. None of the coping strategies mediated the relationship between a stress-is-enhancing mindset and psychological stress responses. These results provide initial evidence that stress mindset is associated with psychological stress responses, through coping strategies.

Coping as a mediator of the relationship between stress mindset and psychological stress response: a pilot study

PubMed Central

Horiuchi, Satoshi; Tsuda, Akira; Aoki, Shuntaro; Yoneda, Kenichiro; Sawaguchi, Yusuke

2018-01-01

Background Coping, the cognitive and behavioral effort required to manage the effects of stressors, is important in determining psychological stress responses (ie, the emotional, behavioral, and cognitive responses to stressors). Coping was classified into categories of emotional expression (eg, negative feelings and thoughts), emotional support seeking (eg, approaching loved ones to request encouragement), cognitive reinterpretation (eg, reframing a problem positively), and problem solving (eg, working to solve the problem). Stress mindset refers to the belief that stress has enhancing (stress-is-enhancing mindset) or debilitating consequences (stress-is-debilitating mindset). This study examined whether coping mediated the relationship between stress mindset and psychological stress responses. Psychological stress responses were conceptualized as depression-anxiety, irritability-anger, and helplessness. The following two hypotheses were tested: 1) a stronger stress-is-enhancing mindset is associated with less frequent use of emotional expression, emotional support seeking, and problem solving, which in turn is associated with lower levels of depression-anxiety, irritability-anger, and helplessness; 2) a stronger stress-is-debilitating mindset is associated with more frequent use of these coping strategies, which in turn is associated with higher levels of these psychological stress responses. Materials and methods The participants were 30 male and 94 female undergraduate and graduate students (mean age =20.4 years). Stress mindset, coping, and psychological stress responses were measured using self-report questionnaires. Six mediation analyses were performed with stress-is-enhancing mindset or stress-is-debilitating mindset as the independent variable, one of the psychological stress responses as the dependent variable, and the four coping strategies as mediators. Results Emotional expression partially mediated the relationship between a strong stress-is-debilitating mindset and higher irritability-anger levels. The other three coping strategies did not exhibit mediating effects. None of the coping strategies mediated the relationship between a stress-is-enhancing mindset and psychological stress responses. Conclusion These results provide initial evidence that stress mindset is associated with psychological stress responses, through coping strategies. PMID:29535562

Ophthalmologic Disease in HIV Infection: Recent Changes in Pathophysiology and Treatment.

PubMed

Stewart, Michael W

2017-10-19

Ophthalmologic conditions were among the earliest described findings in patients with the acquired immunodeficiency syndrome (AIDS). The purpose of this review is to highlight recent changes in the pathophysiology and management of ophthalmologic conditions in patients infected with the human immunodeficiency virus (HIV). The introduction of highly active antiretroviral therapy (HAART) in 1996 changed ophthalmologic findings from predominantly acute infectious diseases to chronic, slowly progressive, debilitating conditions. HIV-associated neuroretinal disorder infrequently leads to blindness, but it causes visual disability in a large percentage of patients. Cytomegalovirus retinitis is now seen less commonly in the USA, but it remains an important cause of blindness in HIV-infected patients from developing countries. Immune recovery uveitis has emerged as a major cause of visual disability in the USA. As HIV has become a chronic disease, visual disability due to chronic noninfectious diseases have become increasingly important.

Clinical features of avian vacuolar myelinopathy in American coots

USGS Publications Warehouse

Larsen, R.S.; Nutter, F.B.; Augspurger, T.; Rocke, T.E.; Tomlinson, L.; Thomas, N.J.; Stoskopf, M.K.

2002-01-01

Objectivea??To characterize clinical features of avian vacuolar myelinopathy (AVM) in American coots. Designa??Case-control study. Animalsa??26 AVM-affected American coots and 12 unaffected coots. Proceduresa??Complete physical, neurologic, hematologic, and plasma biochemical evaluations were performed. Affected coots received supportive care. All coots died or were euthanatized, and AVM status was confirmed via histopathologic findings. Resultsa??3 severely affected coots were euthanatized immediately after examination. Seventeen affected coots were found dead within 7 days of admission, but 5 affected coots survived > 21 days and had signs of clinical recovery. Abnormal physical examination findings appeared to be related to general debilitation. Ataxia (88%), decreased withdrawal reflexes (88%), proprioceptive deficits (81%), decreased vent responses (69%), beak or tongue weakness (42%), and head tremors (31%), as well as absent pupillary light responses (46%), anisocoria (15%), apparent blindness (4%), nystagmus (4%), and strabismus (4%) were detected. Few gross abnormalities were detected at necropsy, but histologically, all AVM-affected coots had severe vacuolation of white matter of the brain. None of the control coots had vacuolation. Conclusions and Clinical Relevancea??Although there was considerable variability in form and severity of clinical neurologic abnormalities, clinical signs common in AVM-affected birds were identified. Clinical recovery of some AVM-affected coots can occur when supportive care is administered. Until the etiology is identified, caution should be exercised when rehabilitating and releasing coots thought to be affected by AVM.

Vaccine against autoimmune disease: can helminths or their products provide a therapy?

PubMed

Zaccone, Paola; Cooke, Anne

2013-06-01

There is an increasing interest in exploiting the immunomodulatory effects of helminths and their products in treatment of diseases such as allergy, autoimmunity and inflammatory bowel disease. Detailed examination of the ways in which helminth derived products interact with the host immune system and with host physiology has revealed that these may be multifaceted and have almost certainly arisen following co-evolution of helminths and their hosts. Clinical trials have been initiated with encouraging results in the treatment of inflammatory bowel disease and also Multiple Sclerosis. Identification of key pathways that are manipulated by helminths to ameliorate ongoing inflammatory conditions increases the prospect of developing novel therapies for the treatment and possible prevention of a range of debilitating and life threatening conditions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Scroto-perineal hidradenitis suppurativa complicated by giant scrotal elephantiasis.

PubMed

Alharbi, Badr; Shlash, Ahmed; Bedaiwi, Khaled; Hooti, Qais Al; Almohaisen, Abdulrahman; Shlash, Saud; Said, Mohammad

2015-01-01

Scrotal elephantiasis has been a recognized complication of inguinal node irradiation, filarial infection, tumor involvement and surgical lymphatic destruction, but has rarely been reported in association with hidradenitis suppurativa (HS). HS, also known as acne inversa, is a chronic and often debilitating disease primarily affecting the axillae, inframammary regions and perineum. The location of the lesions may lead to social embarrassment and failure to seek medical treatment. Scroto-preineal HS complicated by scrotal elephantiasis is a distressing disease. Excisional surgery with reconstruction is the recommended treatment with a high likelihood of good outcome. We present a 38-year-old male patient with long-standing scroto-perineal HS complicated by giant scrotal elephantiasis.

Purinergic system in psychiatric diseases.

PubMed

Cheffer, A; Castillo, A R G; Corrêa-Velloso, J; Gonçalves, M C B; Naaldijk, Y; Nascimento, I C; Burnstock, G; Ulrich, H

2018-01-01

Psychiatric disorders are debilitating diseases, affecting >80 million people worldwide. There are no causal cures for psychiatric disorders and available therapies only treat the symptoms. The etiology of psychiatric disorders is unknown, although it has been speculated to be a combination of environmental, stress and genetic factors. One of the neurotransmitter systems implicated in the biology of psychiatric disorders is the purinergic system. In this review, we performed a comprehensive search of the literature about the role and function of the purinergic system in the development and predisposition to psychiatric disorders, with a focus on depression, schizophrenia, bipolar disorder, autism, anxiety and attention deficit/hyperactivity disorder. We also describe how therapeutics used for psychiatric disorders act on the purinergic system.

Understanding Parkinson Disease: A Complex and Multifaceted Illness.

PubMed

Gopalakrishna, Apoorva; Alexander, Sheila A

2015-12-01

Parkinson disease is an incredibly complex and multifaceted illness affecting millions of people in the United States. Parkinson disease is characterized by progressive dopaminergic neuronal dysfunction and loss, leading to debilitating motor, cognitive, and behavioral symptoms. Parkinson disease is an enigmatic illness that is still extensively researched today to search for a better understanding of the disease, develop therapeutic interventions to halt or slow progression of the disease, and optimize patient outcomes. This article aims to examine in detail the normal function of the basal ganglia and dopaminergic neurons in the central nervous system, the etiology and pathophysiology of Parkinson disease, related signs and symptoms, current treatment, and finally, the profound impact of understanding the disease on nursing care.

Acute Hydrocortisone Treatment Increases Anxiety but Not Fear in Healthy Volunteers: A Fear-Potentiated Startle Study

PubMed Central

Grillon, Christian; Heller, Randi; Hirschhorn, Elizabeth; Kling, Mitchel A.; Pine, Daniel S.; Schulkin, Jay; Vythilingam, Meena

2011-01-01

Background The debilitating effects of chronic glucocorticoids excess are well-known, but comparatively little is understood about the role of acute cortisol. Indirect evidence in rodents suggests that acute cortisone could selectively increase some forms of long-duration aversive states, such as “anxiety,” but not relatively similar, briefer aversive states, such as “fear.” However, no prior experimental studies in humans consider the unique effects of cortisol on anxiety and fear, using well-validated methods for eliciting these two similar but dissociable aversive states. The current study examines these effects, as instantiated with short- and long-duration threats. Methods Healthy volunteers (n = 18) received placebo or a low (20 mg) or a high (60 mg) dose of hydrocortisone in a double-blind crossover design. Subjects were exposed repeatedly to three 150-sec duration conditions: no shock; predictable shocks, in which shocks were signaled by a short-duration threat cue; and unpredictable shocks. Aversive states were indexed by acoustic startle. Fear was operationally defined as the increase in startle reactivity during the threat cue in the predictable condition (fear-potentiated startle). Anxiety was operationally defined as the increase in baseline startle from the no shock to the two threat conditions (anxiety-potentiated startle). Results Hydrocortisone affected neither baseline nor short-duration, fear-potentiated startle but increased long-duration anxiety-potentiated startle. Conclusions These results suggest that hydrocortisone administration in humans selectively increases anxiety but not fear. Possible mechanisms implicated are discussed in light of prior data in rodents. Specifically, hydrocortisone might increase anxiety via sensitization of corticotrophin-releasing hormones in the bed nucleus of the stria terminalis. PMID:21277566

Tankyrase as a Novel Molecular Target in Cancer and Fibrotic Diseases.

PubMed

Lakshmi, Tiruveedi Vijaya; Bale, Swarna; Khurana, Amit; Godugu, Chandraiah

2017-01-01

Tankyrases belong to a group of enzymes called poly ADP ribosyl polymerases (PARPs). With the advent of a new class of small molecule inhibitors of PARP for clinical use like OLAPARIB; that gained accelerated approval by the USFDA in treating ovarian and breast cancers, the horizons of the PARPs as a novel target in various disease conditions has risen. Tankyrases (PARP 5) are yet another class of PARPs that perform poly ADP ribosylation on different substrate proteins aiding in progression of many diseases like cancer, fibrosis, diabetes and neurological disorders even. Few of the substrates of Tankyrases are Telomeric Repeat binding Factor protein (TRF1), Axis Inhibitory protein (AXIN 1&2), Insulin Responsive Amino Peptidase (IRAP), Nuclear Mitotic Apparatus protein (NuMa), that become aberrantly active due to the apparent overexpression of the enzyme during hyper proliferative disease conditions like cancer, fibrosis and metabolic disorders like diabetes. Tankyrases intervene in many physiological processes like cell growth and survival by affecting the Wnt signaling pathways. On the other hand, these functions are overdone during cancer and fibrosis especially. The development of novel therapies for cancer is a never ending process pertaining to several issues associated with current anticancer drugs like development of drug resistance and toxicity. A fibrotic disease like lung fibrosis is a debilitating condition with limited treatment options and survival rate. Tankyrase inhibition by specific small molecule inhibitors can therefore become a good combinatorial or single treatment strategy in treating hyper proliferative diseases and diabetes. In light of all these concerns, this article aims to brief the role of Tankyrase and the relevance of its inhibition to overcome the hurdles faced by current treatment regimens. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Does the 'P300' speller depend on eye gaze?

NASA Astrophysics Data System (ADS)

Brunner, P.; Joshi, S.; Briskin, S.; Wolpaw, J. R.; Bischof, H.; Schalk, G.

2010-10-01

Many people affected by debilitating neuromuscular disorders such as amyotrophic lateral sclerosis, brainstem stroke or spinal cord injury are impaired in their ability to, or are even unable to, communicate. A brain-computer interface (BCI) uses brain signals, rather than muscles, to re-establish communication with the outside world. One particular BCI approach is the so-called 'P300 matrix speller' that was first described by Farwell and Donchin (1988 Electroencephalogr. Clin. Neurophysiol. 70 510-23). It has been widely assumed that this method does not depend on the ability to focus on the desired character, because it was thought that it relies primarily on the P300-evoked potential and minimally, if at all, on other EEG features such as the visual-evoked potential (VEP). This issue is highly relevant for the clinical application of this BCI method, because eye movements may be impaired or lost in the relevant user population. This study investigated the extent to which the performance in a 'P300' speller BCI depends on eye gaze. We evaluated the performance of 17 healthy subjects using a 'P300' matrix speller under two conditions. Under one condition ('letter'), the subjects focused their eye gaze on the intended letter, while under the second condition ('center'), the subjects focused their eye gaze on a fixation cross that was located in the center of the matrix. The results show that the performance of the 'P300' matrix speller in normal subjects depends in considerable measure on gaze direction. They thereby disprove a widespread assumption in BCI research, and suggest that this BCI might function more effectively for people who retain some eye-movement control. The applicability of these findings to people with severe neuromuscular disabilities (particularly in eye-movements) remains to be determined.

Facilitating and debilitating trait anxiety, situational anxiety, and coping with an anticipated stressor: a process analysis.

PubMed

Raffety, B D; Smith, R E; Ptacek, J T

1997-04-01

Participants completed anxiety and coping diaries during 10 periods that began 7 days before an academic stressor and continued through the evening after the stressor. Profile analysis was used to examine the anxiety and coping processes in relation to 2 trait anxiety grouping variables: debilitating and facilitating test anxiety (D-TA and F-TA). Anxiety and coping changed over time, and high and low levels of D-TA and F-TA were associated with different daily patterns of anxiety and coping. Participants with a debilitative, as opposed to facilitative, trait anxiety style had lower examination scores, higher anxiety, and less problem-solving coping. Covarying F-TA, high D-TA was associated with a pattern of higher levels of tension, worry, distraction, and avoidant coping, as well as lower levels of proactive coping. Covarying D-TA, high F-TA was associated with higher levels of tension (but not worry or distraction), support seeking, proactive and problem-solving coping.

Tumor Necrosis Factor-α Regulates Distinct Molecular Pathways and Gene Networks in Cultured Skeletal Muscle Cells

PubMed Central

Gupta, Sanjay K.; Dahiya, Saurabh; Lundy, Robert F.; Kumar, Ashok

2010-01-01

Background Skeletal muscle wasting is a debilitating consequence of large number of disease states and conditions. Tumor necrosis factor-α (TNF-α) is one of the most important muscle-wasting cytokine, elevated levels of which cause significant muscular abnormalities. However, the underpinning molecular mechanisms by which TNF-α causes skeletal muscle wasting are less well-understood. Methodology/Principal Findings We have used microarray, quantitative real-time PCR (QRT-PCR), Western blot, and bioinformatics tools to study the effects of TNF-α on various molecular pathways and gene networks in C2C12 cells (a mouse myoblastic cell line). Microarray analyses of C2C12 myotubes treated with TNF-α (10 ng/ml) for 18h showed differential expression of a number of genes involved in distinct molecular pathways. The genes involved in nuclear factor-kappa B (NF-kappaB) signaling, 26s proteasome pathway, Notch1 signaling, and chemokine networks are the most important ones affected by TNF-α. The expression of some of the genes in microarray dataset showed good correlation in independent QRT-PCR and Western blot assays. Analysis of TNF-treated myotubes showed that TNF-α augments the activity of both canonical and alternative NF-κB signaling pathways in myotubes. Bioinformatics analyses of microarray dataset revealed that TNF-α affects the activity of several important pathways including those involved in oxidative stress, hepatic fibrosis, mitochondrial dysfunction, cholesterol biosynthesis, and TGF-β signaling. Furthermore, TNF-α was found to affect the gene networks related to drug metabolism, cell cycle, cancer, neurological disease, organismal injury, and abnormalities in myotubes. Conclusions TNF-α regulates the expression of multiple genes involved in various toxic pathways which may be responsible for TNF-induced muscle loss in catabolic conditions. Our study suggests that TNF-α activates both canonical and alternative NF-κB signaling pathways in a time-dependent manner in skeletal muscle cells. The study provides novel insight into the mechanisms of action of TNF-α in skeletal muscle cells. PMID:20967264

Attraction of the cutaneous leishmaniasis vector Nyssomyia neivai (Diptera: Psychodidae) to host odour components in a wind tunnel

PubMed Central

2012-01-01

Background Laboratory studies of host-seeking olfactory behaviour in sandflies have largely been restricted to the American visceral leishmaniasis vector Lutzomyia longipalpis. In comparison, almost nothing is known about the chemical ecology of related species, which transmit American cutaneous leishmaniasis (ACL), due in part to difficulties in raising these insects in the laboratory. Understanding how ACL vectors locate their hosts will be essential to developing new vector control strategies to combat this debilitating disease. Methods This study examined host-odour seeking behaviour of the ACL vector Nyssomyia neivai (Pinto) (=Lutzomyia neivai) using a wind tunnel olfactometer. The primary aim was to determine whether field-collected female N. neivai would respond to host odours in the laboratory, thereby eliminating the need to maintain colonies of these insects for behavioural experiments. Responses to two key host odour components, 1-octen-3-ol and lactic acid, and a commercially-available mosquito lure (BG-Lure™) were assessed and compared relative to an air control. We also tested whether trials could be conducted outside of the normal evening activity period of N. neivai without impacting on fly behaviour, and whether the same flies could be used to assess baseline responses to air without affecting responses to octenol, thereby reducing the number of flies required for experiments. Results Octenol was found to both activate host-seeking behaviour and attract female N. neivai in the wind tunnel, while lactic acid elicited weaker responses of activation and attractiveness under identical conditions. The BG-Lure did not activate or attract N. neivai under test conditions. Further experiments showed that sandfly behaviour in the wind tunnel was not affected by time of day, such that experiments need not be restricted to nocturnal hours. Moreover, using the same flies to measure both baseline responses to air and attraction to test compounds did not affect odour-seeking behaviour. Conclusions The results of this study demonstrate that N. neivai taken from the field are suitable for use in laboratory olfactometer experiments. It is hoped this work will facilitate further research into chemical ecology of this species, and other ACL vectors. PMID:23009099

Attraction of the cutaneous leishmaniasis vector Nyssomyia neivai (Diptera: Psychodidae) to host odour components in a wind tunnel.

PubMed

Pinto, Mara C; Bray, Daniel P; Eiras, Alvaro E; Carvalheira, Henrique P; Puertas, Camila P

2012-09-25

Laboratory studies of host-seeking olfactory behaviour in sandflies have largely been restricted to the American visceral leishmaniasis vector Lutzomyia longipalpis. In comparison, almost nothing is known about the chemical ecology of related species, which transmit American cutaneous leishmaniasis (ACL), due in part to difficulties in raising these insects in the laboratory. Understanding how ACL vectors locate their hosts will be essential to developing new vector control strategies to combat this debilitating disease. This study examined host-odour seeking behaviour of the ACL vector Nyssomyia neivai (Pinto) (=Lutzomyia neivai) using a wind tunnel olfactometer. The primary aim was to determine whether field-collected female N. neivai would respond to host odours in the laboratory, thereby eliminating the need to maintain colonies of these insects for behavioural experiments. Responses to two key host odour components, 1-octen-3-ol and lactic acid, and a commercially-available mosquito lure (BG-Lure™) were assessed and compared relative to an air control. We also tested whether trials could be conducted outside of the normal evening activity period of N. neivai without impacting on fly behaviour, and whether the same flies could be used to assess baseline responses to air without affecting responses to octenol, thereby reducing the number of flies required for experiments. Octenol was found to both activate host-seeking behaviour and attract female N. neivai in the wind tunnel, while lactic acid elicited weaker responses of activation and attractiveness under identical conditions. The BG-Lure did not activate or attract N. neivai under test conditions. Further experiments showed that sandfly behaviour in the wind tunnel was not affected by time of day, such that experiments need not be restricted to nocturnal hours. Moreover, using the same flies to measure both baseline responses to air and attraction to test compounds did not affect odour-seeking behaviour. The results of this study demonstrate that N. neivai taken from the field are suitable for use in laboratory olfactometer experiments. It is hoped this work will facilitate further research into chemical ecology of this species, and other ACL vectors.

Debilitating beliefs and emotional distress in patients given immunotherapy for insect sting allergy: a prospective study.

PubMed

Confino-Cohen, Ronit; Melamed, Samuel; Goldberg, Arnon

2009-01-01

Patients who receive venom immunotherapy (VIT) for systemic reactions (SRs) to insect stings are advised that once they reach the maintenance dose they are almost 100% protected against future SRs. However, initial evidence indicates that some patients continue to perceive themselves as highly debilitated by the allergy and are preoccupied with the allergic event. These factors have significant impact on their emotional well-being and allergy-related quality of life (ARQOL). We aimed to explore prospectively whether patients would experience these adverse psychological outcomes after receiving VIT coupled with professional explanation and reassurance of protection. Thirty-four patients who received VIT for systemic insect allergy and were under close medical surveillance were included. Before and 1 year after initiation of treatment, patients completed a questionnaire that measured debilitating beliefs, preoccupation with the SR event, emotional distress ARQOL, and QOL in general. Physician-graded severity of the reaction was recorded as well. VIT had a beneficial effect on all allergy-related variables. Self-imposed debilitating beliefs, preoccupation with the anaphylactic event, and ARQOL significantly but modestly improved over time. No association was found between ARQOL and QOL in general. The later variable as well as emotional distress remained unchanged after the VIT. This study shows that patients with sting allergy guided by trained personnel and treated with VIT show a reduction in dysfunctional beliefs and an improvement in ARQOL. Disputing medically unfounded beliefs that persist in some patients might improve their ARQOL.

Antidepressant-like effects of erythropoietin: a focus on behavioural and hippocampal processes.

PubMed

Osborn, Meagan; Rustom, Nazneen; Clarke, Melanie; Litteljohn, Darcy; Rudyk, Chris; Anisman, Hymie; Hayley, Shawn

2013-01-01

Depression is a chronic and debilitating condition with a significant degree of relapse and treatment resistance that could stem, at least in part, from disturbances of neuroplasticity. This has led to an increased focus on treatment strategies that target brain derived neurotrophic factor (BDNF), synaptic plasticity and adult neurogenesis. In the current study we aimed to assess whether erythropoietin (EPO) would have antidepressant-like effects given its already established pro-trophic actions. In particular, we assessed whether EPO would diminish the deleterious effects of a social stressor in mice. Indeed, EPO induced anxiolytic and antidepressant-like responses in a forced swim test, open field, elevated-plus maze, and a novelty test, and appeared to blunt some of the negative behavioural effects of a social stressor. Furthermore, EPO promoted adult hippocampal neurogenesis, an important feature of effective antidepressants. Finally, a separate study using the mTOR inhibitor rapamycin revealed that antagonizing this pathway prevented the impact of EPO upon forced swim performance. These data are consistent with previous findings showing that the mTOR pathway and its neurogenic and synaptogenic effects might mediate the behavioral consequences of antidepressant agents. Our findings further highlight EPO as a possible adjunct treatment for affective disorders, as well as other stressor associated disorders of impaired neuroplasticity.

Genetics and genomics of Parkinson’s disease

PubMed Central

2014-01-01

Parkinson’s disease (PD) is a progressively debilitating neurodegenerative syndrome. Although best described as a movement disorder, the condition has prominent autonomic, cognitive, psychiatric, sensory and sleep components. Striatal dopaminergic innervation and nigral neurons are progressively lost, with associated Lewy pathology readily apparent on autopsy. Nevertheless, knowledge of the molecular events leading to this pathophysiology is limited. Current therapies offer symptomatic benefit but they fail to slow progression and patients continue to deteriorate. Recent discoveries in sporadic, Mendelian and more complex forms of parkinsonism provide novel insight into disease etiology; 28 genes, including those encoding alpha-synuclein (SNCA), leucine-rich repeat kinase 2 (LRRK2) and microtubule-associated protein tau (MAPT), have been linked and/or associated with PD. A consensus regarding the affected biological pathways and molecular processes has also started to emerge. In early-onset and more a typical PD, deficits in mitophagy pathways and lysosomal function appear to be prominent. By contrast, in more typical late-onset PD, chronic, albeit subtle, dysfunction in synaptic transmission, early endosomal trafficking and receptor recycling, as well as chaperone-mediated autophagy, provide a unifying synthesis of the molecular pathways involved. Disease-modification (neuroprotection) is no longer such an elusive goal given the unparalleled opportunity for diagnosis, translational neuroscience and therapeutic development provided by genetic discovery. PMID:25061481

Pharmacogenetics of drug response in Parkinson's disease.

PubMed

Džoljić, Eleonora; Novaković, Ivana; Krajinovic, Maja; Grbatinić, Ivan; Kostić, Vladimir

2015-01-01

Parkinson's disease (PD) is a debilitating, demoralizing and financially devastating condition affecting 1% of population at the age of 60 years. Thus, very important issue to address is individual therapy optimization. Recent results have shown evidence that variable efficacy of treatment and risk of motor and mental complications could have genetic origin. Significant roles in that process play (pharmaco)genomic/genetic studies of PD. Variability in genes coding for drug-metabolizing enzymes, drug receptors and proteins involved in drug pathway signaling is an important factor determining inter-individual variability in drug responses. Interpersonal differences in drug responses are clearly documented although individualized treatment of PD is not widely known. Treatment with antiparkinsonian drugs is associated with the development of complications, such as L-DOPA-induced dyskinesia (LID), hallucinations and excessive daytime sleepiness. Carriers of specific genetic polymorphisms are particularly susceptible to development of some of these drug adverse effects. Pharmacogenomics aims to understand the relationship between genetic factors and inter-individual variations in drug responses, and to translate this information in therapy tailored to individual patient genetics. Relatively few efforts have been made to investigate the role of pharmacogenetics in the individual response to anti-PD drugs. Thus, many genetic variations and polymorphisms in myriad of different proteins can influence individual response to anti-PD drugs.

A preliminary case series evaluating the safety and immediate to short-term clinical benefits of joint mobilization in hemophilic arthritis of the lower limb.

PubMed

Scaddan, Emma; Rowell, John; O'Leary, Shaun

2017-09-01

Arthritis resulting from recurrent intra-articular bleeding in individuals with hemophilia can be severely debilitating due to joint pain and stiffness with subsequent loss of mobility and function. Very limited studies have investigated the potential benefits of joint mobilization for this condition. This case series is a preliminary investigation of safety, as well as immediate and short-term clinical benefits, associated with gentle knee and ankle joint mobilization in people with hemophilic arthropathy. A single intervention of joint mobilization was applied to the affected knees and/or ankles of 16 individuals with severe or moderate hemophilia within a public hospital setting. Adverse events, as well as immediate (pain-free passive joint range, Timed Up and Go Test with maximum pain numerical rating scale) and short-term (Lower Extremity Functional Scale) effects of the intervention were evaluated with a repeated measures ANOVA. There were no adverse events. An immediate significant increase was observed in pain-free passive ankle joint range of motion ( p  < 0.05) following the joint mobilization intervention. The findings of this case series suggest that gentle joint mobilization techniques may be safely considered as part of a multimodal management approach for hemophilic arthropathy.

Assessing the Effectiveness of Yoga as a Complementary and Alternative Treatment for Post-Traumatic Stress Disorder: A Review and Synthesis.

PubMed

Sciarrino, Nicole A; DeLucia, Christian; O'Brien, Kaitlin; McAdams, Kristen

2017-10-01

Posttraumatic stress disorder (PTSD) is a debilitating condition that affects many who have experienced trauma. In addition to skills-focused treatments, exposure-based treatments, cognitive therapy, combination treatments, and EMDR, a number of alternative treatments for PTSD have emerged in recent years. The search for alternative treatments is justified based on the empirical observation that a large percentage of individuals fail to benefit optimally from existing treatments (e.g., between 30 and 60). Moreover, current studies often utilize stringent inclusion criteria (e.g., absence of comorbid disorders), raising the likelihood that results will not generalize to many individuals currently experiencing PTSD. The primary objective of the current paper was to explore the effects of one type of alternative treatment: yoga. A comprehensive review of the literature was conducted targeting research examining yoga postures and PTSD. Seven randomized controlled trials (RCTs) were identified and reviewed, and effect sizes were computed for the post-test assessments. Cohen's d for each study ranged (in absolute value) from a low of -0.06 to a high of 1.42 (average weighted d across studies was 0.48; 95% CI: 0.26, 0.69). Putative mechanisms of action for the possible beneficial effects of yoga for PTSD-related symptomatology and clinical implications are discussed.

Palliative and end-of-life care for adults with advanced chronic obstructive pulmonary disease: a rapid review focusing on patient and family caregiver perspectives.

PubMed

Mathews, Gillian; Johnston, Bridget

2017-12-01

The aim of the review was to explore patient and family caregiver perspectives on key issues for ensuring quality of end-of-life care for people with chronic obstructive pulmonary disease (COPD). The growing evidence on the value of specialist palliative care services demonstrates significant improvements in treatments and provisions; however, much of the literature is generic in nature or centred on people with a cancer diagnosis. In this review, we examine the literature to ascertain the views and needs of patients and carers affected by advanced COPD, a highly debilitating condition that can have a profoundly negative impact on the quality of end-of-life experience. A total of 19 papers were included in the review. The main themes in the literature were Holistic Care, Illness Trajectory and Technology. Areas of unmet need emphasized across physical, psychosocial and spiritual domains were identified, particularly in relation to appropriate and timely conversations. Positive developments in the care and treatment of advanced COPD include the use of the STIOLTO Respimat inhaler, a brief educative and psychosocial intervention based on cognitive-behavioural therapy, and high-intensity exercise training. There is some evidence regarding the use of technology in end-stage COPD.

Tissue Engineering-based Therapeutic Strategies for Vocal Fold Repair and Regeneration

PubMed Central

Li, Linqing; Stiadle, Jeanna M.; Lau, Hang K.; Zerdoum, Aidan B.; Jia, Xinqiao; L.Thibeault, Susan; Kiick, Kristi L.

2016-01-01

Vocal folds are soft laryngeal connective tissues with distinct layered structures and complex multicomponent matrix compositions that endow phonatory and respiratory functions. This delicate tissue is easily damaged by various environmental factors and pathological conditions, altering vocal biomechanics and causing debilitating vocal disorders that detrimentally affect the daily lives of suffering individuals. Modern techniques and advanced knowledge of regenerative medicine have led to a deeper understanding of the microstructure, microphysiology, and micropathophysiology of vocal fold tissues. State-of-the-art materials ranging from extracecullar-matrix (ECM)-derived biomaterials to synthetic polymer scaffolds have been proposed for the prevention and treatment of voice disorders including vocal fold scarring and fibrosis. This review intends to provide a thorough overview of current achievements in the field of vocal fold tissue engineering, including the fabrication of injectable biomaterials to mimic in vitro cell microenvironments, novel designs of bioreactors that capture in vivo tissue biomechanics, and establishment of various animal models to characterize the in vivo biocompatibility of these materials. The combination of polymeric scaffolds, cell transplantation, biomechanical stimulation, and delivery of antifibrotic growth factors will lead to successful restoration of functional vocal folds and improved vocal recovery in animal models, facilitating the application of these materials and related methodologies in clinical practice. PMID:27619243

The impact of neuroscience on society: cognitive enhancement in neuropsychiatric disorders and in healthy people

PubMed Central

Sahakian, Barbara J.; Bruhl, Annette B.; Cook, Jennifer; Killikelly, Clare; Savulich, George; Piercy, Thomas; Hafizi, Sepehr; Perez, Jesus; Fernandez-Egea, Emilio; Suckling, John; Jones, Peter B.

2015-01-01

In addition to causing distress and disability to the individual, neuropsychiatric disorders are also extremely expensive to society and governments. These disorders are both common and debilitating and impact on cognition, functionality and wellbeing. Cognitive enhancing drugs, such as cholinesterase inhibitors and methylphenidate, are used to treat cognitive dysfunction in Alzheimer's disease and attention deficit hyperactivity disorder, respectively. Other cognitive enhancers include specific computerized cognitive training and devices. An example of a novel form of cognitive enhancement using the technological advancement of a game on an iPad that also acts to increase motivation is presented. Cognitive enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects ‘cold’ cognition, but also improves ‘hot’ cognition, such as emotion recognition and task-related motivation. The lifestyle use of ‘smart drugs' raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups (e.g. military, doctors) under what conditions (e.g. war, shift work) and by what methods we would wish to improve and flourish. PMID:26240429

The impact of neuroscience on society: cognitive enhancement in neuropsychiatric disorders and in healthy people.

PubMed

Sahakian, Barbara J; Bruhl, Annette B; Cook, Jennifer; Killikelly, Clare; Savulich, George; Piercy, Thomas; Hafizi, Sepehr; Perez, Jesus; Fernandez-Egea, Emilio; Suckling, John; Jones, Peter B

2015-09-19

In addition to causing distress and disability to the individual, neuropsychiatric disorders are also extremely expensive to society and governments. These disorders are both common and debilitating and impact on cognition, functionality and wellbeing. Cognitive enhancing drugs, such as cholinesterase inhibitors and methylphenidate, are used to treat cognitive dysfunction in Alzheimer's disease and attention deficit hyperactivity disorder, respectively. Other cognitive enhancers include specific computerized cognitive training and devices. An example of a novel form of cognitive enhancement using the technological advancement of a game on an iPad that also acts to increase motivation is presented. Cognitive enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects 'cold' cognition, but also improves 'hot' cognition, such as emotion recognition and task-related motivation. The lifestyle use of 'smart drugs' raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups (e.g. military, doctors) under what conditions (e.g. war, shift work) and by what methods we would wish to improve and flourish.

The Burden of Diverticular Disease on Patients and Healthcare Systems

PubMed Central

Reddy, Vikram B.; Longo, Walter E.

2013-01-01

Diverticulitis is a debilitating complication of diverticular disease that affects approximately 2.5 million individuals in the United States. Compared to many other gastrointestinal conditions, diverticular disease is poorly understood in terms of its burden on patients and healthcare systems. This review examines the existing literature and discusses the current knowledge of the burden of diverticular disease. Literature confirmed that bothersome symptoms (such as abdominal pain and bloating) and potentially serious, disease-related complications (such as diverticulitis and diverticular bleeding) place a significant burden on patients. Broad-spectrum antibiotic therapy and surgery are the generally accepted mainstays of treatment for acute complications of diverticular disease. Despite these options, patients frequently experience substantially reduced quality of life (particularly in terms of social and emotional functioning) and increased mortality (predominantly due to disease-related complications) compared to healthy controls. Furthermore, diverticular disease accounted for 254,179 inpatient discharges and 1,493,865 outpatient clinic visits in the United States in 2002, at an estimated cost per hospitalization of $9,742-$11,729. Enhancing the quality of life of patients with diverticular disease and reducing disease exacerbations and complications will substantially benefit patients and healthcare systems. However, long-established treatment algorithms fall short of these therapeutic goals. Research into new treatment options for patients with diverticular disease should therefore be pursued. PMID:24707230

Imaging of acute and chronic thromboembolic disease: state of the art.

PubMed

Ruggiero, A; Screaton, N J

2017-05-01

Acute pulmonary embolism (PE) is a life-threatening condition that requires prompt diagnosis and treatment. Recent advances in imaging allow acute and rapid recognition even by the non-specialist radiologist. Most acute emboli resolve on anticoagulation without sequelae; however, some emboli fail to fully resolve becoming endothelialised with the development of chronic thromboembolic disease (CTED). Increased pulmonary vascular resistance arising from CTED may lead to chronic thromboembolic pulmonary hypertension (CTEPH) a debilitating disease affecting up to 5% of survivors of acute PE. Diagnostic evaluation is more complex in CTEPH/CTED than acute PE with subtle imaging features often being overlooked or misinterpreted. Differentiation of acute from chronic PE and from other forms of pulmonary hypertension has profound therapeutic implications. Diverse imaging techniques are available to diagnose and monitor PEs both in the acute and chronic setting. Broadly they include techniques that provide data on lung parenchymal perfusion (ventilation-perfusion [VQ] scintigraphy), angiographic techniques (computed tomography [CT], magnetic resonance imaging [MRI], and invasive angiography) or a combination of both (MR angiography and time-resolved angiography or dual-energy CT angiography). This review aims to describe state of the art imaging highlighting the strength and weaknesses of individual techniques in the diagnosis of acute and chronic PE. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Molecular Biology, Epidemiology, and Pathogenesis of Progressive Multifocal Leukoencephalopathy, the JC Virus-Induced Demyelinating Disease of the Human Brain

PubMed Central

Ferenczy, Michael W.; Marshall, Leslie J.; Nelson, Christian D. S.; Atwood, Walter J.; Nath, Avindra; Khalili, Kamel

2012-01-01

Summary: Progressive multifocal leukoencephalopathy (PML) is a debilitating and frequently fatal central nervous system (CNS) demyelinating disease caused by JC virus (JCV), for which there is currently no effective treatment. Lytic infection of oligodendrocytes in the brain leads to their eventual destruction and progressive demyelination, resulting in multiple foci of lesions in the white matter of the brain. Before the mid-1980s, PML was a relatively rare disease, reported to occur primarily in those with underlying neoplastic conditions affecting immune function and, more rarely, in allograft recipients receiving immunosuppressive drugs. However, with the onset of the AIDS pandemic, the incidence of PML has increased dramatically. Approximately 3 to 5% of HIV-infected individuals will develop PML, which is classified as an AIDS-defining illness. In addition, the recent advent of humanized monoclonal antibody therapy for the treatment of autoimmune inflammatory diseases such as multiple sclerosis (MS) and Crohn's disease has also led to an increased risk of PML as a side effect of immunotherapy. Thus, the study of JCV and the elucidation of the underlying causes of PML are important and active areas of research that may lead to new insights into immune function and host antiviral defense, as well as to potential new therapies. PMID:22763635

Combining nutrition, food science and engineering in developing solutions to Inflammatory bowel diseases--omega-3 polyunsaturated fatty acids as an example.

PubMed

Ferguson, Lynnette R; Smith, Bronwen G; James, Bryony J

2010-10-01

The Inflammatory bowel diseases, Crohn's disease and ulcerative colitis, are debilitating conditions, characterised by lifelong sensitivity to certain foods, and often a need for surgery and life-long medication. The anti-inflammatory effects of long chain omega-3 polyunsaturated acids justify their inclusion in enteral nutrition formulas that have been associated with disease remission. However, there have been variable data in clinical trials to test supplementary omega-3 polyunsaturated fatty acids in inducing or maintaining remission in these diseases. Although variability in trial design has been suggested as a major factor, we suggest that variability in processing and presentation of the products may be equally or more important. The nature of the source, and rapidity of getting the fish or other food source to processing or to market, will affect the percentage of the various fatty acids, possible presence of heavy metal contaminants and oxidation status of the various fatty acids. For dietary supplements or fortified foods, whether the product is encapsulated or not, whether storage is under nitrogen or not, and length of time between harvest, processing and marketing will again profoundly affect the properties of the final product. Clinical trials to test efficacy of these products in IBD to date have utilised the relevant skills of pharmacology and gastroenterology. We suggest that knowledge from food science, nutrition and engineering will be essential to establish the true role of this important group of compounds in these diseases. This journal is © The Royal Society of Chemistry 2010

Defining future directions for endometriosis research: workshop report from the 2011 World Congress of Endometriosis In Montpellier, France.

PubMed

Rogers, Peter A W; D'Hooghe, Thomas M; Fazleabas, Asgerally; Giudice, Linda C; Montgomery, Grant W; Petraglia, Felice; Taylor, Robert N

2013-05-01

Endometriosis, defined as estrogen-dependent lesions containing endometrial glands and stroma outside the uterus, is a chronic and often painful gynecological condition that affects 6% to 10% of reproductive age women. Endometriosis has estimated annual costs of US $12 419 per woman (approximately €9579), comprising one-third of the direct health care costs with two-thirds attributed to loss of productivity. Decreased quality of life is the most important predictor of direct health care and total costs. It has been estimated that there is a mean delay of 6.7 years between onset of symptoms and a surgical diagnosis of endometriosis, and each affected woman loses on average 10.8 hours of work weekly, mainly owing to reduced effectiveness while working. To encourage and facilitate research into this debilitating disease, a consensus workshop to define future directions for endometriosis research was held as part of the 11th World Congress on Endometriosis in September 2011 in Montpellier, France. The objective of this workshop was to review and update the endometriosis research priorities consensus statement developed following the 10th World Congress on Endometriosis in 2008.(1) A total of 56 recommendations for research have been developed, grouped under 6 subheadings: (1) diagnosis, (2) classification and prognosis, (3) clinical trials, treatment, and outcomes, (4) epidemiology, (5) pathophysiology, and (6) research policy. By producing this consensus international research priorities statement, it is the hope of the workshop participants that researchers will be encouraged to develop new interdisciplinary research proposals that will attract increased funding support for work on endometriosis.

Dichlorophenyl piperazines, including a recently-approved atypical antipsychotic, are potent inhibitors of DHCR7, the last enzyme in cholesterol biosynthesis.

PubMed

Genaro-Mattos, Thiago C; Tallman, Keri A; Allen, Luke B; Anderson, Allison; Mirnics, Karoly; Korade, Zeljka; Porter, Ned A

2018-06-15

While antipsychotic medications provide important relief from debilitating psychotic symptoms, they also have significant adverse side effects, which might have relevant impact on human health. Several research studies, including ours, have shown that commonly used antipsychotics such as haloperidol and aripiprazole affect cholesterol biosynthesis at the conversion of 7-dehydrocholesterol (7-DHC) to cholesterol. This transformation is promoted by the enzyme DHCR7 and its inhibition causes increases in plasma and tissue levels of 7-DHC. The inhibition of this enzymatic step by mutations in the Dhcr7 gene leads to Smith-Lemli-Opitz syndrome, a devastating human condition that can be replicated in rats by small molecule inhibitors of DHCR7. The fact that two compounds, brexpiprazole and cariprazine, that were recently approved by the FDA have substructural elements in common with the DHCR7 inhibitor aripiprazole, prompted us to evaluate the effect of brexpiprazole and cariprazine on cholesterol biosynthesis. We report that cariprazine affects levels of 7-DHC and cholesterol in cell culture incubations at concentrations as low as 5 nM. Furthermore, a common metabolite of cariprazine and aripiprazole, 2,3-(dichlorophenyl) piperazine, inhibits DHCR7 activity at concentrations comparable to those of the potent teratogen AY9944. The cell culture experiments were corroborated in mice in studies showing that treatment with cariprazine elevated 7-DHC in brain and serum. The consequences of sterol inhibition by antipsychotics in the developing nervous system and the safety of their use during pregnancy remains to be established. Copyright © 2018 Elsevier Inc. All rights reserved.

Carbamoylated erythropoietin modulates cognitive outcomes of social defeat and differentially regulates gene expression in the dorsal and ventral hippocampus.

PubMed

Sathyanesan, Monica; Watt, Michael J; Haiar, Jacob M; Scholl, Jamie L; Davies, Shaydel R; Paulsen, Riley T; Wiederin, Jayme; Ciborowski, Pawel; Newton, Samuel S

2018-06-08

Cognitive deficits are widespread in psychiatric disorders and frequently as debilitating as the affective component. Widely prescribed antidepressants for treating depressive disorders have limited efficacy in normalizing cognitive function. Erythropoietin (Epo) has been shown to improve cognitive function in schizophrenia and treatment resistant depressed patients. However, the potent elevation of red blood cell counts by Epo can cause hematological complications in non-anemic patients. We investigated a chemically engineered, posttranslational modification of Epo, carbamoylation, which renders it non-erythropoietic. We conducted mass-spectrometry-based peptide mapping of carbamoylated Epo (Cepo) and tested its ability to improve cognitive function after social defeat stress. Gene expression analysis in discrete brain regions was performed to obtain mechanistic insight of Cepo action. Cepo reversed stress-induced spatial working memory deficits while affecting long-term (24 h) novel object recognition in these rats. Contextual fear conditioning following defeat was enhanced by Cepo, but attenuated in controls. However, Cepo improved fear extinction in all rats compared to vehicle treatment. Cepo induced differential gene expression of BDNF, VGF, Arc, TH. and neuritin in the mPFC and discrete hippocampal subfields, with strongest induction in the dorsal hippocampus. Analysis of gene-brain region-behavior interactions showed that Cepo-induced neurotrophic mechanisms influence cognitive function. Carbamoylated erythropoietin can be developed as a therapeutic neurotrophic agent to treat cognitive dysfunction in neuropsychiatric diseases. Due to its distinct mechanism of action, it is unlikely to cross react with the activity of currently prescribed small molecule drugs and can be used as an add-on biologic drug.

Defining Future Directions for Endometriosis Research

PubMed Central

D’Hooghe, Thomas M.; Fazleabas, Asgerally; Giudice, Linda C.; Montgomery, Grant W.; Petraglia, Felice; Taylor, Robert N.

2013-01-01

Endometriosis, defined as estrogen-dependent lesions containing endometrial glands and stroma outside the uterus, is a chronic and often painful gynecological condition that affects 6% to 10% of reproductive age women. Endometriosis has estimated annual costs of US $12 419 per woman (approximately €9579), comprising one-third of the direct health care costs with two-thirds attributed to loss of productivity. Decreased quality of life is the most important predictor of direct health care and total costs. It has been estimated that there is a mean delay of 6.7 years between onset of symptoms and a surgical diagnosis of endometriosis, and each affected woman loses on average 10.8 hours of work weekly, mainly owing to reduced effectiveness while working. To encourage and facilitate research into this debilitating disease, a consensus workshop to define future directions for endometriosis research was held as part of the 11th World Congress on Endometriosis in September 2011 in Montpellier, France. The objective of this workshop was to review and update the endometriosis research priorities consensus statement developed following the 10th World Congress on Endometriosis in 2008.1 A total of 56 recommendations for research have been developed, grouped under 6 subheadings: (1) diagnosis, (2) classification and prognosis, (3) clinical trials, treatment, and outcomes, (4) epidemiology, (5) pathophysiology, and (6) research policy. By producing this consensus international research priorities statement, it is the hope of the workshop participants that researchers will be encouraged to develop new interdisciplinary research proposals that will attract increased funding support for work on endometriosis. PMID:23427182

Reimbursement of Drugs for Rare Diseases through the Public Healthcare System in Canada: Where Are We Now?

PubMed

Menon, Devidas; Clark, Derek; Stafinski, Tania

2015-08-01

Over the past 20 years, the number of therapies developed for rare diseases has rapidly increased. Often, these therapies represent the only active treatment for debilitating and/or life-threatening conditions. However, they create significant challenges for public and private payers. Because they target small patient populations, clinical evidence of efficacy/effectiveness is typically limited, while the cost per patient is high. In Canada, each province/territory establishes its own mechanisms for determining which drugs for rare diseases (DRDs) to provide. To compare current mechanisms across provinces and territories, and explore their impact on access. A systematic review of relevant published and unpublished documents was performed. Electronic bibliographic databases, the internet, and government websites were scanned using structured search strategies. Information was extracted independently by two researchers, and included aspects such as program type, condition/patient/therapy eligibility criteria, role of health technology assessment (HTA), decision options, ethical assumptions, and stakeholder input. It was validated through member-checking with provincial/territorial policy experts and tabulated to facilitate qualitative analyses. Impact on access was assessed through a cross-province/territory comparison of the coverage status of all non-cancer therapies reviewed by the Common Drug Review for indications affecting <1/2,000 Canadians using the Kappa statistic. Reasons for variations were explored using qualitative techniques. Each province/territory has formal and informal mechanisms through which such therapies may be accessed. In most cases, formal mechanisms constitute the centralized HTA processes that also apply to common therapies. While several provinces have established dedicated processes/programs, whether they have affected access is not clear. Despite broadly comparable approaches, there is less than perfect agreement on publicly funded DRDs across jurisdictions. Individual jurisdictions have developed different approaches to providing access to these therapies. However, as the number increases, a more systematic approach to decision-making may be needed. Copyright © 2015 Longwoods Publishing.

Novel picornavirus associated with avian keratin disorder in Alaskan birds

USGS Publications Warehouse

Zylberberg, Maxine; Van Hemert, Caroline R.; Dumbacher, John P.; Handel, Colleen M.; Tihan, Tarik; DeRisi, Joseph L.

2016-01-01

Avian keratin disorder (AKD), characterized by debilitating overgrowth of the avian beak, was first documented in black-capped chickadees (Poecile atricapillus) in Alaska. Subsequently, similar deformities have appeared in numerous species across continents. Despite the widespread distribution of this emerging pathology, the cause of AKD remains elusive. As a result, it is unknown whether suspected cases of AKD in the afflicted species are causally linked, and the impacts of this pathology at the population and community levels are difficult to evaluate. We applied unbiased, metagenomic next-generation sequencing to search for candidate pathogens in birds affected with AKD. We identified and sequenced the complete coding region of a novel picornavirus, which we are calling poecivirus. Subsequent screening of 19 AKD-affected black-capped chickadees and 9 control individuals for the presence of poecivirus revealed that 19/19 (100%) AKD-affected individuals were positive, while only 2/9 (22%) control individuals were infected with poecivirus. Two northwestern crows (Corvus caurinus) and two red-breasted nuthatches (Sitta canadensis) with AKD-consistent pathology also tested positive for poecivirus. We suggest that poecivirus is a candidate etiological agent of AKD.

Cannabidiol as a Promising Strategy to Treat and Prevent Movement Disorders?

PubMed Central

Peres, Fernanda F.; Lima, Alvaro C.; Hallak, Jaime E. C.; Crippa, José A.; Silva, Regina H.; Abílio, Vanessa C.

2018-01-01

Movement disorders such as Parkinson's disease and dyskinesia are highly debilitating conditions linked to oxidative stress and neurodegeneration. When available, the pharmacological therapies for these disorders are still mainly symptomatic, do not benefit all patients and induce severe side effects. Cannabidiol is a non-psychotomimetic compound from Cannabis sativa that presents antipsychotic, anxiolytic, anti-inflammatory, and neuroprotective effects. Although the studies that investigate the effects of this compound on movement disorders are surprisingly few, cannabidiol emerges as a promising compound to treat and/or prevent them. Here, we review these clinical and pre-clinical studies and draw attention to the potential of cannabidiol in this field. PMID:29867488

Cytokines, IBD and colitis-associated cancer

PubMed Central

Francescone, Ralph; Hou, Vivianty; Grivennikov, Sergei I.

2015-01-01

Inflammatory bowel diseases (IBDs) are debilitating conditions that result in intestinal damage due to chronic inflammation. In addition, the perpetual state of inflammation predisposes individuals to the development of colitis associated cancer (CAC). Because of the immense immune cell infiltration into colon, cytokines produced by immune cells are major players in the initiation and progression of IBD and CAC. In this review, we will explore the functions of many key cytokines and their roles in IBD and CAC, as well as their influences on the immune system and stromal cells. Finally, we will briefly discuss current therapies and current clinical trials targeting cytokines in IBD. PMID:25563695

The Peacock versus the louse (pediculus humanus corporis): one soldier's contribution to combating trench fever in the First World War.

PubMed

Peacock, A; Pearson, W

2010-09-01

Trench fever became a major worry for the Allied High Command during the First World War because of its debilitating effects on troop performance. The causes of the fever were not previously known, but entomological research identified the body louse (pediculus humanus corporis) as the carrier, and the Royal Army Medical Corps developed effective methods of control through disinfestation. These were markedly influenced by the researches of a young entomologist, Alexander David Peacock, which were conducted under campaign conditions. Peacock subsequently occupied a Chair of Zoology at St. Andrews University for 30 years.

Regenerative Rehabilitation – a New Future?

PubMed Central

Perez-Terzic, Carmen; Childers, Martin K.

2014-01-01

Modern rehabilitation medicine is propelled by newfound knowledge aimed at offering solutions for an increasingly aging population afflicted by chronic debilitating conditions. Considered a core component of future healthcare, the roll-out of regenerative medicine underscores a paradigm shift in patient management targeted at restoring physiologic function and restituting normative impact. Nascent regenerative technologies offer unprecedented prospects in achieving repair of degenerated, diseased or damaged tissues. In this context, principles of regenerative science are increasingly integrated in rehabilitation practices as illustrated in the present Supplement. Encompassing a growing multidisciplinary domain, the emergent era of “regenerative rehabilitation” brings radical innovations at the forefront of healthcare blueprints. PMID:25310603

Virtual reality exposure therapy for combat-related posttraumatic stress disorder.

PubMed

Rothbaum, Barbara O; Rizzo, Albert Skip; Difede, JoAnn

2010-10-01

Posttraumatic stress disorder (PTSD) is a chronic, debilitating, psychological condition that occurs in a subset of individuals who experience or witness life-threatening traumatic events. PTSD is highly prevalent in those who served in the military. In this paper, we present the underlying theoretical foundations and existing research on virtual reality exposure therapy, a recently emerging treatment for PTSD. Three virtual reality scenarios used to treat PTSD in active duty military and combat veterans and survivors of terrorism are presented: Virtual Vietnam, Virtual Iraq, and Virtual World Trade Center. Preliminary results of ongoing trials are presented. © 2010 Association for Research in Nervous and Mental Disease.

Appreciating Uncertainty and Personal Preference in Genetic Testing.

PubMed

Kadlac, Adam

2015-01-01

Genetic testing seems to hold out hope for the cure of a number of debilitating conditions. At the same time, many people fear the information that genetic testing can make available. In this commentary, I argue that as of now, the nature of the information revealed in such tests should lead to cautious views about the value of genetic testing. Moreover, I suggest that our overall views about such testing should account for the fact that individuals place different sorts of value on the possession of their own genetic information. As a result, we should largely defer to personal preference in thinking about the propriety of genetic testing.

Integrative Therapies and Pediatric Inflammatory Bowel Disease: The Current Evidence

PubMed Central

Misra, Sanghamitra M.

2014-01-01

Inflammatory bowel disease (IBD) primarily describes two distinct chronic conditions with unknown etiology, ulcerative colitis (UC) and Crohn’s disease (CD). UC is limited to the colon, while CD may involve any portion of the gastrointestinal tract from mouth to anus. These diseases exhibit a pattern of relapse and remission, and the disease processes are often painful and debilitating. Due to the chronic nature of IBD and the negative side effects of many of the conventional therapies, many patients and their families turn to complementary and alternative medicine (CAM) for symptom relief. This article focuses on the current available evidence behind CAM/integrative therapies for IBD. PMID:27417473

Animal models of post-traumatic stress disorder: face validity

PubMed Central

Goswami, Sonal; Rodríguez-Sierra, Olga; Cascardi, Michele; Paré, Denis

2013-01-01

Post-traumatic stress disorder (PTSD) is a debilitating condition that develops in a proportion of individuals following a traumatic event. Despite recent advances, ethical limitations associated with human research impede progress in understanding PTSD. Fortunately, much effort has focused on developing animal models to help study the pathophysiology of PTSD. Here, we provide an overview of animal PTSD models where a variety of stressors (physical, psychosocial, or psychogenic) are used to examine the long-term effects of severe trauma. We emphasize models involving predator threat because they reproduce human individual differences in susceptibility to, and in the long-term consequences of, psychological trauma. PMID:23754973

[Problems found in the isolation of mycelial fungi (Fusarium solani) from blood culture (Bacter NR-860)].

PubMed

Sanz, F; Soledad Cuétara, M; del Palacio, A; Campbell, C K; Johnson, L; Urruzunu, P; Pía Roiz, M

1993-11-01

F. solani fungemia is unusual. Patients at risk are immunosuppressed, have underlying malignancy or severe debilitating diseases. We report two cases of F. solani fungemia in two non neutropenic patients who had been treated with wide-spectrum antibiotics an/or systemic corticosteroids, parenteral nutrition and intravenous lines. Bactec NR-860 (Becton-Dickinson) system was used, and growth was detected in aerobic conditions (between 3-7 days of incubation). Removal of the catheters with or without i.v. amphotericin B were used successfully. The spectrum of Fusarium sp. fungemia is discussed. Current available antifungal therapy is also reviewed.

Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management

PubMed Central

Comin‐Colet, Josep; de Francisco, Angel; Dignass, Axel; Doehner, Wolfram; S. P. Lam, Carolyn; Macdougall, Iain C.; Rogler, Gerhard; Camaschella, Clara; Kadir, Rezan; Kassebaum, Nicholas J.; Spahn, Donat R.; Taher, Ali T.; Musallam, Khaled M.

2017-01-01

Abstract Iron deficiency, even in the absence of anemia, can be debilitating, and exacerbate any underlying chronic disease, leading to increased morbidity and mortality. Iron deficiency is frequently concomitant with chronic inflammatory disease; however, iron deficiency treatment is often overlooked, partially due to the heterogeneity among clinical practice guidelines. In the absence of consistent guidance across chronic heart failure, chronic kidney disease and inflammatory bowel disease, we provide practical recommendations for iron deficiency to treating physicians: definition, diagnosis, and disease‐specific diagnostic algorithms. These recommendations should facilitate appropriate diagnosis and treatment of iron deficiency to improve quality of life and clinical outcomes. PMID:28612425

Oral submucous fibrosis: an overview of the aetiology, pathogenesis, classification, and principles of management.

PubMed

Arakeri, Gururaj; Brennan, Peter A

2013-10-01

Oral submucous fibrosis (OSMF) is a complex, debilitating, and precancerous condition. Formerly confined to the Indian subcontinent, it is now often seen in the Asian populations of the United Kingdom, USA, and other developed countries, and is therefore a serious problem for global health. The well-known causative agent of the disease, areca-nut is now recognised as a group one carcinogen. We review and discuss all components of OSMF, including the terminology, presentation, aetiology, and pathogenesis, and provide a brief overview of its management. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Hand-arm vibration syndrome: A rarely seen diagnosis.

PubMed

Campbell, Rebecca A; Janko, Matthew R; Hacker, Robert I

2017-06-01

Hand-arm vibration syndrome (HAVS) is a collection of sensory, vascular, and musculoskeletal symptoms caused by repetitive trauma from vibration. This case report demonstrates how to diagnose HAVS on the basis of history, physical examination, and vascular imaging and its treatment options. A 41-year-old man who regularly used vibrating tools presented with nonhealing wounds on his right thumb and third digit. Arteriography revealed occlusions of multiple arteries in his hand with formation of collaterals. We diagnosed HAVS, and his wounds healed after several weeks with appropriate treatment. HAVS is a debilitating condition with often irreversible vascular damage, requiring early diagnosis and treatment.

Laser light visual cueing for freezing of gait in Parkinson disease: A pilot study with male participants.

PubMed

Bunting-Perry, Lisette; Spindler, Meredith; Robinson, Keith M; Noorigian, Joseph; Cianci, Heather J; Duda, John E

2013-01-01

Freezing of gait (FOG) is a debilitating feature of Parkinson disease (PD). In this pilot study, we sought to assess the efficacy of a rolling walker with a laser beam visual cue to treat FOG in PD patients. We recruited 22 subjects with idiopathic PD who experienced on- and off-medication FOG. Subjects performed three walking tasks both with and without the laser beam while on medications. Outcome measures included time to complete tasks, number of steps, and number of FOG episodes. A crossover design allowed within-group comparisons between the two conditions. No significant differences were observed between the two walking conditions across the three tasks. The laser beam, when applied as a visual cue on a rolling walker, did not diminish FOG in this study.

Improvement of bench life-tests for automotive batteries

NASA Astrophysics Data System (ADS)

Richter, G.

A common method for rating the endurance of automotive batteries is the bench life-test according to DIN, IEC, SAE or JIS. With an increasing number of maintenance-free batteries on the market, the application of these tests becomes more problematic. This is due to a step-by-step capacity decline during cycling if the content of autimony in the grid-alloy is decreased. The degradation in performance is caused by the phenomenon of acid stratification. Because this debilitating effect occurs only rarely in service (vehicle movement) if charging and discharging is well balanced, there is a need for a new bench life-test with conditions that are more representative of practical conditions. Research has shown that the main changes should be: (i) an accelerated (moved) battery during cycling; (ii) slightly lower charging or discharging capacity amplitude, also with a lower mean value.

Diagnosis and Management of Systemic Sclerosis: A Practical Approach.

PubMed

Lee, Jason J; Pope, Janet E

2016-02-01

Systemic sclerosis is a devastating multisystem rheumatologic condition that is characterized by autoimmunity, tissue fibrosis, obliterative vasculopathy and inflammation. Clinical presentation and course of the condition vary greatly, which complicates both diagnosis and corresponding treatment. In this regard, recent advances in disease understanding, both clinically and biochemically, have led to newer classification criteria for systemic sclerosis that are more inclusive than ever before. Still, significant disease modifying therapies do not yet exist for most patients. Therefore, organ-based management strategies are employed and research has been directed within this paradigm focusing on either the most debilitating symptoms, such as Raynaud's phenomenon, digital ulcers and cutaneous sclerosis, or life-threatening organ involvement such as interstitial lung disease and pulmonary arterial hypertension. The current trends in systemic sclerosis diagnosis, evidence-based treatment recommendations and potential future directions in systemic sclerosis treatment are discussed.

Acoustic characteristics of underwater tail slaps used by Norwegian and Icelandic killer whales (Orcinus orca) to debilitate herring (Clupea harengus).

PubMed

Simon, Malene; Wahlberg, Magnus; Ugarte, Fernando; Miller, Lee A

2005-06-01

Norwegian killer whales debilitate prey by slapping their tails into herring schools. These underwater tail slaps produce a thud-like sound. It is unclear whether this sound is caused by cavitation and/or physical contact between herring and whale tail. Also the forces causing debilitation of the fish are not understood. Here we present an acoustic analysis of underwater tail slaps using a multi-channel wide (150 kHz) band recording system. Underwater tail slaps produced by Norwegian killer whales generated sounds consisting of multiple pulses with source levels of 186+/-5.4 dB (pp) re.1 microPa at 1 m (+/-1 s.d., N = 4). The -3 dB and 97% energy bandwidths were 36.8+/-22.5 kHz and 130.5+/-17.5 kHz (+/-1 s.d., N = 13), respectively, with a centre frequency of 46.1+/-22.3 kHz. The similarities between the acoustic properties of underwater tail slaps recorded from killer whales in Norway, and thud-like sounds recorded from killer whales in Iceland suggest that Norwegian and Icelandic killer whales use similar hunting techniques. The acoustic characteristics of sounds produced by underwater tail slaps were similar to the ones from other cavitation sound sources described in the literature, both in term of temporal and frequency features as well as in source level. We suggest that multiple factors generated by the tail slaps like particle fluctuations, turbulence, pressure changes and physical impact cause debilitation of herring.

Analysis of isokinetic muscle function and postural control in individuals with intermittent claudication

PubMed Central

Lanzarin, Morgan; Parizoto, Patricia; Santos, Gilmar M.

2016-01-01

BACKGROUND: Intermittent claudication (IC) is a debilitating condition that mostly affects elderly people. IC is manifested by a decrease in ambulatory function. Individuals with IC present with motor and sensory nerve dysfunction in the lower extremities, which may lead to deficits in balance. OBJECTIVE: This study aimed to measure postural control and isokinetic muscle function in individuals with intermittent claudication. METHOD: The study included 32 participants of both genders, 16 IC participants (mean age: 64 years, SD=6) and 16 healthy controls (mean age: 67 years, SD=5), which were allocated into two groups: intermittent claudication group (ICG) and control group (CG). Postural control was assessed using the displacement and velocity of the center of pressure (COP) during the sensory organization test (SOT) and the motor control test (MCT). Muscle function of the flexor and extensor muscles of the knee and ankle was measured by an isokinetic dynamometer. Independent t tests were used to calculate the between-group differences. RESULTS: The ICG presented greater displacement (p =0.027) and speed (p =0.033) of the COP in the anteroposterior direction (COPap) during the MCT, as well as longer latency (p =0.004). There were no between-group differences during the SOT. The ICG showed decreased muscle strength and power in the plantar flexors compared to the CG. CONCLUSION: Subjects with IC have lower values of strength and muscle power of plantiflexores, as well as changes in postural control in dynamic conditions. These individuals may be more vulnerable to falls than healthy subjects. PMID:26786077

Arthroscopic capsular plication for microtraumatic anterior shoulder instability in overhead athletes.

PubMed

Jones, Kristofer J; Kahlenberg, Cynthia A; Dodson, Christopher C; Nam, Denis; Williams, Riley J; Altchek, David W

2012-09-01

Extreme loading conditions at the glenohumeral joint during overhead athletic activities can result in both soft tissue and osseous adaptative changes at the shoulder. Subtle alterations in the stabilizing structures may lead to anterior instability and debilitating shoulder pain with subsequent inability to participate in athletics. There is currently a paucity of data documenting clinical outcomes after arthroscopic capsular plication in overhead athletes who demonstrate objective findings of pain and anterior instability on physical examination. To evaluate outcomes after arthroscopic capsular plication for anterior instability in overhead athletes with an emphasis on postoperative range of motion, postoperative shoulder function, and return to sport. Case series; Level of evidence, 4. The authors identified 20 overhead athletes with debilitating shoulder pain and a failed trial of nonoperative management who underwent arthroscopic capsular plication (12 suture plication, 8 suture anchor plication) for anterior instability related to isolated capsular redundancy. Patients were evaluated with the Single Assessment Numerical Evaluation (SANE) and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, and they were interviewed to determine the rate of return to athletic activity. Failures of treatment included patients who demonstrated debilitating pain that precluded return to sport. At a mean follow-up of 3.6 years (range, 2.0-5.5 years), 18 (90%) patients returned to overhead sports, with 17 (85%) at their preinjury level. The mean (SD) SANE score was 86 (17.5%; range, 30%-100%), and the mean (SD) KJOC score was 82 (18.2; range, 28-100). When compared with the contralateral extremity, there were no significant differences in glenohumeral range of motion. Two patients with associated rotator cuff injury experienced persistent pain with overhead activity and were unable to return to sport, representing a 10% failure rate. Arthroscopic capsular plication for anterior instability related to isolated capsular redundancy is an effective procedure that yields a high rate of patient satisfaction and return to overhead athletic activity with an acceptably low failure rate. Patients with associated rotator cuff injury may be at higher risk for treatment failure.

MicroRNA-206: A Potential Circulating Biomarker Candidate for Amyotrophic Lateral Sclerosis

PubMed Central

Toivonen, Janne M.; Manzano, Raquel; Oliván, Sara; Zaragoza, Pilar; García-Redondo, Alberto; Osta, Rosario

2014-01-01

Amyotrophic lateral sclerosis (ALS) is a lethal motor neuron disease that progressively debilitates neuronal cells that control voluntary muscle activity. Biomarkers are urgently needed to facilitate ALS diagnosis and prognosis, and as indicators of therapeutic response in clinical trials. microRNAs (miRNAs), small posttranscriptional modifiers of gene expression, are frequently altered in disease conditions. Besides their important regulatory role in variety of biological processes, miRNAs can also be released into the circulation by pathologically affected tissues and display remarkable stability in body fluids. In a mouse model of ALS that expresses mutated human superoxide dismutase 1 (SOD1-G93A) skeletal muscle is one of the tissues affected early by mutant SOD1 toxicity. To find biomarkers for ALS, we studied miRNA alterations from skeletal muscle and plasma of SOD1-G93A mice, and subsequently tested the levels of the affected miRNAs in the serum from human ALS patients. Fast-twitch and slow-twitch muscles from symptomatic SOD1-G93A mice (age 90 days) and their control littermates were first studied using miRNA microarrays and then evaluated with quantitative PCR from five age groups from neonatal to the terminal disease stage (10–120 days). Among those miRNA changed in various age/gender/muscle groups (miR-206, -1, -133a, -133b, -145, -21, -24), miR-206 was the only one consistently altered during the course of the disease pathology. In both sexes, mature miR-206 was increased in fast-twitch muscles preferably affected in the SOD1-G93A model, with highest expression towards the most severely affected animals. Importantly, miR-206 was also increased in the circulation of symptomatic animals and in a group of 12 definite ALS patients tested. We conclude that miR-206 is elevated in the circulation of symptomatic SOD1-G93A mice and possibly in human ALS patients. Although larger scale studies on ALS patients are warranted, miR-206 is a promising candidate biomarker for this motor neuron disease. PMID:24586506

Human pancreatic cancer xenografts recapitulate key aspects of cancer cachexia.

PubMed

Delitto, Daniel; Judge, Sarah M; Delitto, Andrea E; Nosacka, Rachel L; Rocha, Fernanda G; DiVita, Bayli B; Gerber, Michael H; George, Thomas J; Behrns, Kevin E; Hughes, Steven J; Wallet, Shannon M; Judge, Andrew R; Trevino, Jose G

2017-01-03

Cancer cachexia represents a debilitating syndrome that diminishes quality of life and augments the toxicities of conventional treatments. Cancer cachexia is particularly debilitating in patients with pancreatic cancer (PC). Mechanisms responsible for cancer cachexia are under investigation and are largely derived from observations in syngeneic murine models of cancer which are limited in PC. We evaluate the effect of human PC cells on both muscle wasting and the systemic inflammatory milieu potentially contributing to PC-associated cachexia. Specifically, human PC xenografts were generated by implantation of pancreatic cancer cells, L3.6pl and PANC-1, either in the flank or orthotopically within the pancreas. Mice bearing orthotopic xenografts demonstrated significant muscle wasting and atrophy-associated gene expression changes compared to controls. Further, despite the absence of adaptive immunity, splenic tissue from orthotopically engrafted mice demonstrated elevations in several pro-inflammatory cytokines associated with cancer cachexia, including TNFα, IL1β, IL6 and KC (murine IL8 homologue), when compared to controls. Therefore, data presented here support further investigation into the complexity of cancer cachexia in PC to identify potential targets for this debilitating syndrome.

Recent insights into the immunopathogenesis of psoriasis provide new therapeutic opportunities

PubMed Central

Nickoloff, Brian J.; Nestle, Frank O.

2004-01-01

Chronic and excessive inflammation in skin and joints causes significant morbidity in psoriasis patients. As a prevalent T lymphocyte–mediated disorder, psoriasis, as well as the side effects associated with its treatment, affects patients globally. In this review, recent progress is discussed in the areas of genetics, the immunological synapse, the untangling of the cytokine web and signaling pathways, xenotransplantation models, and the growing use of selectively targeted therapies. Since psoriasis is currently incurable, new management strategies are proposed to replace previous serendipitous approaches. Such strategic transition from serendipity to the use of novel selective agents aimed at defined targets in psoriatic lesions is moving rapidly from research benches to the bedsides of patients with this chronic and debilitating disease. PMID:15199399

Treatment of Chlamydia-associated ocular disease via a recombinant protein based vaccine in the koala (Phascolarctos cinereus).

PubMed

Waugh, Courtney; Austin, Ray; Polkinghorne, Adam; Timms, Peter

2016-11-01

Koalas (Phascolarctos cinereus) are affected by debilitating chlamydial disease that can lead to blindness, infertility, and death. The causative agent is the intracellular bacterium Chlamydia pecorum. While antibiotics can be used to treat koala chlamydial infection, they are often ineffective or cause severe dysbiosis to the animal's unique gut flora. Recent work has progressed on the development of a protective vaccine for Chlamydia in the koala. This study demonstrates that the use of a vaccine can have a positive effect in koalas already with clinical signs of ocular disease, suggesting a possible therapeutic effect and an alternative to antibiotic therapy. Copyright © 2016 International Alliance for Biological Standardization. All rights reserved.

A diagnostic and therapeutic approach to primary burning mouth syndrome.

PubMed

Moghadam-Kia, Siamak; Fazel, Nasim

Primary burning mouth syndrome (BMS) is an oral mucosal disorder that is characterized by a chronic and often debilitating intraoral burning sensation for which no localized or systemic cause can be found. BMS most commonly affects postmenopausal women. The pathophysiology of primary BMS is not well understood. Diagnosing BMS can prove to be challenging. BMS patients can also pose a therapeutic challenge to clinicians who are consulted to evaluate these patients. Most commonly used therapies include tricyclic antidepressants, α-lipoic acid, clonazepam, and cognitive-behavioral therapy. Clinical judgment, patient counseling, and monitoring of pain are important. Further research is required to assess the effectiveness of serotonin and newer serotonin-noradrenalin reuptake inhibitors. Copyright © 2017 Elsevier Inc. All rights reserved.

Meta-analysis of 375,000 individuals identifies 38 susceptibility loci for migraine.

PubMed

Gormley, Padhraig; Anttila, Verneri; Winsvold, Bendik S; Palta, Priit; Esko, Tonu; Pers, Tune H; Farh, Kai-How; Cuenca-Leon, Ester; Muona, Mikko; Furlotte, Nicholas A; Kurth, Tobias; Ingason, Andres; McMahon, George; Ligthart, Lannie; Terwindt, Gisela M; Kallela, Mikko; Freilinger, Tobias M; Ran, Caroline; Gordon, Scott G; Stam, Anine H; Steinberg, Stacy; Borck, Guntram; Koiranen, Markku; Quaye, Lydia; Adams, Hieab H H; Lehtimäki, Terho; Sarin, Antti-Pekka; Wedenoja, Juho; Hinds, David A; Buring, Julie E; Schürks, Markus; Ridker, Paul M; Hrafnsdottir, Maria Gudlaug; Stefansson, Hreinn; Ring, Susan M; Hottenga, Jouke-Jan; Penninx, Brenda W J H; Färkkilä, Markus; Artto, Ville; Kaunisto, Mari; Vepsäläinen, Salli; Malik, Rainer; Heath, Andrew C; Madden, Pamela A F; Martin, Nicholas G; Montgomery, Grant W; Kurki, Mitja I; Kals, Mart; Mägi, Reedik; Pärn, Kalle; Hämäläinen, Eija; Huang, Hailiang; Byrnes, Andrea E; Franke, Lude; Huang, Jie; Stergiakouli, Evie; Lee, Phil H; Sandor, Cynthia; Webber, Caleb; Cader, Zameel; Muller-Myhsok, Bertram; Schreiber, Stefan; Meitinger, Thomas; Eriksson, Johan G; Salomaa, Veikko; Heikkilä, Kauko; Loehrer, Elizabeth; Uitterlinden, Andre G; Hofman, Albert; van Duijn, Cornelia M; Cherkas, Lynn; Pedersen, Linda M; Stubhaug, Audun; Nielsen, Christopher S; Männikkö, Minna; Mihailov, Evelin; Milani, Lili; Göbel, Hartmut; Esserlind, Ann-Louise; Christensen, Anne Francke; Hansen, Thomas Folkmann; Werge, Thomas; Kaprio, Jaakko; Aromaa, Arpo J; Raitakari, Olli; Ikram, M Arfan; Spector, Tim; Järvelin, Marjo-Riitta; Metspalu, Andres; Kubisch, Christian; Strachan, David P; Ferrari, Michel D; Belin, Andrea C; Dichgans, Martin; Wessman, Maija; van den Maagdenberg, Arn M J M; Zwart, John-Anker; Boomsma, Dorret I; Smith, George Davey; Stefansson, Kari; Eriksson, Nicholas; Daly, Mark J; Neale, Benjamin M; Olesen, Jes; Chasman, Daniel I; Nyholt, Dale R; Palotie, Aarno

2016-08-01

Migraine is a debilitating neurological disorder affecting around one in seven people worldwide, but its molecular mechanisms remain poorly understood. There is some debate about whether migraine is a disease of vascular dysfunction or a result of neuronal dysfunction with secondary vascular changes. Genome-wide association (GWA) studies have thus far identified 13 independent loci associated with migraine. To identify new susceptibility loci, we carried out a genetic study of migraine on 59,674 affected subjects and 316,078 controls from 22 GWA studies. We identified 44 independent single-nucleotide polymorphisms (SNPs) significantly associated with migraine risk (P < 5 × 10(-8)) that mapped to 38 distinct genomic loci, including 28 loci not previously reported and a locus that to our knowledge is the first to be identified on chromosome X. In subsequent computational analyses, the identified loci showed enrichment for genes expressed in vascular and smooth muscle tissues, consistent with a predominant theory of migraine that highlights vascular etiologies.

Food, nutrients and nutraceuticals affecting the course of inflammatory bowel disease.

PubMed

Uranga, José Antonio; López-Miranda, Visitación; Lombó, Felipe; Abalo, Raquel

2016-08-01

Inflammatory bowel diseases (ulcerative colitis; Crohn's disease) are debilitating relapsing inflammatory disorders affecting the gastrointestinal tract, with deleterious effect on quality of life, and increasing incidence and prevalence. Mucosal inflammation, due to altered microbiota, increased intestinal permeability and immune system dysfunction underlies the symptoms and may be caused in susceptible individuals by different factors (or a combination of them), including dietary habits and components. In this review we describe the influence of the Western diet, obesity, and different nutraceuticals/functional foods (bioactive peptides, phytochemicals, omega 3-polyunsaturated fatty acids, vitamin D, probiotics and prebiotics) on the course of IBD, and provide some hints that could be useful for nutritional guidance. Hopefully, research will soon offer enough reliable data to slow down the spread of the disease and to make diet a cornerstone in IBD therapy. Copyright © 2016 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Eye and Periocular Skin Involvement in Herpes Zoster Infection

PubMed Central

Kalogeropoulos, Chris D.; Bassukas, Ioannis D.; Moschos, Marilita M.; Tabbara, Khalid F.

2015-01-01

Herpes zoster ophthalmicus (HZO) is a clinical manifestation of the reactivation of latent varicella zoster virus (VZV) infection and is more common in people with diminished cell-mediated immunity. Lesions and pain correspond to the affected dermatomes, mostly in first or second trigeminal branch and progress from maculae, papules to vesicles and form pustules, and crusts. Complications are cutaneous, visceral, neurological, ocular, but the most debilitating is post-herpetic neuralgia. Herpes zoster ophthalmicus may affect all the ophthalmic structures, but most severe eye-threatening complications are panuveitis, acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN) as well. Antiviral medications remain the primary therapy, mainly useful in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of HZO are critical in limiting visual morbidity. Vaccine in adults over 60 was found to be highly effective to boost waning immunity what reduces both the burden of herpes zoster (HZ) disease and the incidence of post-herpetic neuralgia (PHN). PMID:27800502

Blood-Injection-Injury Phobia and Dog Phobia in Youth: Psychological Characteristics and Associated Features in a Clinical Sample.

PubMed

Oar, Ella L; Farrell, Lara J; Waters, Allison M; Ollendick, Thomas H

2016-05-01

Blood-Injection-Injury (BII) phobia is a particularly debilitating condition that has been largely ignored in the child literature. The present study examined the clinical phenomenology of BII phobia in 27 youths, relative to 25 youths with dog phobia-one of the most common and well-studied phobia subtypes in youth. Children were compared on measures of phobia severity, functional impairment, comorbidity, threat appraisals (danger expectancies and coping), focus of fear, and physiological responding, as well as vulnerability factors including disgust sensitivity and family history. Children and adolescents with BII phobia had greater diagnostic severity. In addition, they were more likely to have a comorbid diagnosis of a physical health condition, to report more exaggerated danger expectancies, and to report fears that focused more on physical symptoms (e.g., faintness and nausea) in comparison to youth with dog phobia. The present study advances knowledge relating to this poorly understood condition in youth. Copyright © 2016. Published by Elsevier Ltd.

Orofacial pain management: current perspectives.

PubMed

Romero-Reyes, Marcela; Uyanik, James M

2014-01-01

Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities.

Orofacial pain management: current perspectives

PubMed Central

Romero-Reyes, Marcela; Uyanik, James M

2014-01-01

Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. PMID:24591846

Concurrent Treatment of Substance Use and PTSD.

PubMed

Flanagan, Julianne C; Korte, Kristina J; Killeen, Therese K; Back, Sudie E

2016-08-01

Substance use disorders (SUD) and posttraumatic stress disorder (PTSD) are chronic, debilitating conditions that frequently co-occur. Individuals with co-occurring SUD and PTSD suffer a more complicated course of treatment and less favorable treatment outcomes compared to individuals with either disorder alone. The development of effective psychosocial and pharmacological interventions for co-occurring SUD and PTSD is an active and critically important area of investigation. Several integrated psychosocial treatments for co-occurring SUD and PTSD have demonstrated promising outcomes. While recent studies examining medications to treat co-occurring SUD and PTSD have yielded encouraging findings, there remain substantial gaps in the evidence base regarding the treatment of co-occurring SUD and PTSD. This review will summarize the findings from clinical trials targeting a reduction in SUD and PTSD symptoms simultaneously. These results may improve our knowledge base and subsequently enhance our ability to develop effective interventions for this complex comorbid condition.

The Brain Reward Circuitry in Mood Disorders

PubMed Central

Russo, Scott J.; Nestler, Eric J.

2013-01-01

Mood disorders are common and debilitating conditions characterized in part by profound deficits in reward-related behavioral domains. A recent literature has identified important structural and functional alterations within the brain’s reward circuitry —particularly in the ventral tegmental area to nucleus accumbens pathway — that are associated with symptoms such as anhedonia and aberrant reward-associated perception and memory. This review synthesizes recent data from human and rodent studies from which emerges a circuit-level framework for understanding reward deficits in depression. We also discuss some of the molecular and cellular underpinnings of this framework, ranging from adaptations in glutamatergic synapses and neurotrophic factors to transcriptional and epigenetic mechanisms. PMID:23942470

Surgical strategies for pediatric epilepsy

PubMed Central

Guan, Jian; Karsy, Michael; Ducis, Katrina

2016-01-01

Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Approximately 20–30% of children with recurrent seizures have drug-resistant epilepsy (DRE). For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes. The spectrum of surgical options is vast, ranging from outpatient procedures such as vagus nerve stimulation to radical interventions including hemispherectomy. The thread connecting all of these interventions is a common goal—seizure freedom, an outcome that can be achieved safely and durably in a large proportion of patients. In this review, we discuss many of the most commonly performed surgical interventions and describe the indications, complications, and outcomes specific to each. PMID:27186522

Update on the use of alitretinoin in treating chronic hand eczema.

PubMed

Ghasri, Pedram; Scheinfeld, Noah

2010-04-19

Chronic hand eczema is a debilitating dermatological condition with significant economic, social, and functional impacts. To date, conventional treatments such as topical corticosteroids, phototherapy, and systemic immunosuppressants have yielded disappointing results, owing to either a lack of efficacy or significant adverse events. Oral alitretinoin (9-cis-retinoic acid) is a unique panagonist retinoid with immunomodulatory and anti-inflammatory activity that has emerged as a novel treatment for chronic hand eczema. Several large-scale clinical studies have demonstrated oral alitretinoin's high efficacy rate of 28% to 89%, its safe tolerability profile, and its positive impact on quality of life, validating it as a therapeutic option for patients with severe chronic hand eczema refractory to standard treatment.

Neuro-linguistic programming and application in treatment of phobias.

PubMed

Karunaratne, Mahishika

2010-11-01

Phobias are a prevalent and often debilitating mental health problem all over the world. This article aims to explore what is known about the use of Neuro-linguistic Programming (NLP) as a treatment for this condition. Whilst there is abundant experiential evidence from NLP practitioners attesting to the efficacy of this method as a treatment for phobias, experimental research in this area is somewhat limited. This paper reviews evidence available in literature produced in the UK and US and reveals that NLP is a successful treatment for phobias as well as being particularly efficient due to the relatively brief time period it takes to effect an improvement. Copyright © 2010 Elsevier Ltd. All rights reserved.

A Review on the Possible Neuroprotective Effects of Moringa Oleifera Leaf Extract.

PubMed

Igado, O O; Olopade, J O

2017-03-06

Moringa oleifera is an edible plant that has been reputed to be a miracle plant by numerous authors, with effects on practically every body system. Phytochemical analyses have demonstrated that the leaves are rich in various minerals, vitamins and antioxidants. Its use in some continents dates back to Antiquity. Neurodegeneration are chronic diseases of the nervous system. There is currently an increase in the use of natural products to combat these debilitating diseases. So far, no suitable cure has been found, and conditions are managed and the symptoms treated. This article reviews the literature on the effects of Moringa oleifera leaves on the nervous system in vivo and in vitro.

The role of animal models in tendon research

PubMed Central

Hast, M. W.; Zuskov, A.; Soslowsky, L. J.

2014-01-01

Tendinopathy is a debilitating musculoskeletal condition which can cause significant pain and lead to complete rupture of the tendon, which often requires surgical repair. Due in part to the large spectrum of tendon pathologies, these disorders continue to be a clinical challenge. Animal models are often used in this field of research as they offer an attractive framework to examine the cascade of processes that occur throughout both tendon pathology and repair. This review discusses the structural, mechanical, and biological changes that occur throughout tendon pathology in animal models, as well as strategies for the improvement of tendon healing. Cite this article: Bone Joint Res 2014;3:193–202. PMID:24958818

Marked Atrophic Changes of the Brain in a Patient with Subacute Sclerosing Panencephalitis.

PubMed

Yasin, Faizan; Assad, Salman; Nadeem, Muhammad; Zahid, Mehr

2017-08-21

Subacute Sclerosing Panencephalitis (SSPE) is a debilitating disorder associated with the measles infection in childhood. It is a very rare manifestation in children. It usually presents with measles before the age of two. We report a similar case of SSPE in a 14-year-old girl who developed this life-threatening condition in spite of receiving the measles vaccination. Despite the vaccination, the patient had suffered from measles before the age of two. This highlights the dilemma of ineffective vaccinations in developing countries. We also describe the radiologic features of SSPE in this patient, with marked atrophy seen in the occipital region following hyperintensities noticed at a relatively earlier stage.

Patient preference and willingness to pay for knee osteoarthritis treatments

PubMed Central

Posnett, John; Dixit, Sanjeev; Oppenheimer, Brooks; Kili, Sven; Mehin, Nazanin

2015-01-01

Purpose To review treatments for osteoarthritis of the knee (OAK) received by patients across five European countries, and to obtain patients’ perceptions and willingness to pay for current treatments. Patients and methods A prospective, internet-based, double-blind survey of adults with OAK was conducted in France, Germany, Italy, Spain, and the United Kingdom. The questionnaire included questions about diagnosis, treatment history, and perceptions of OAK treatments, followed by a discrete choice-based conjoint exercise to identify preferred attributes of OAK treatments, evaluating 14 sets of four unbranded products. Results Two thousand and seventy-three patients with self-reported OAK completed the survey; 17.4% of patients rated their knee pain as drastically affecting their ability to perform normal daily activities, and 39.3% of employed patients reported that they had lost work time because of OAK. The most common treatments were exercise (69.7%), physical therapy (68.2%), and nonprescription oral pain medication (73.9%). Treatments perceived as most effective were: viscosupplement injections (74.1%), narcotics (67.8%), and steroid injection (67.6%). Patient co-pay, duration of pain relief, and type of therapy exhibited the largest impact on patient preference for OAK treatments. The average patient was willing to pay €35 and €64 more in co-pay for steroid and viscosupplement injections, respectively, over the cost of oral over-the-counter painkillers (per treatment course, per knee) (each P<0.05). Conclusion OAK is a debilitating condition that affects normal daily activities. In general, treatments most commonly offered to patients are not those perceived as being the most effective. Patients are willing to pay a premium for treatments that they perceive as being more effective and result in longer-lasting pain relief, and those that can be administered with fewer visits to a physician. PMID:26089650

Spinal cord stimulation for patients with refractory angina and previous coronary surgery.

PubMed

Lapenna, Elisabetta; Rapati, Dino; Cardano, Paola; De Bonis, Michele; Lullo, Francesca; Zangrillo, Alberto; Alfieri, Ottavio

2006-11-01

Refractory angina pectoris is an exceptionally debilitating condition affecting patients who have typically failed multiple percutaneous and surgical revascularizations and optimal medical therapy and who are not amenable for further revascularization procedures. Spinal cord stimulation (SCS) has been adopted in this context at our institution and midterm mortality, anginal status, and quality of life have been evaluated. From 1998 to 2004, 51 patients with refractory class III-IV angina, who were not considered candidates for revascularization procedures, underwent SCS. All patients had already undergone previous surgical revascularization and a median of two percutaneous procedures. Transmyocardial laser revascularization had been previously performed in 8 cases (15.6%). Most of the patients (70.5%) had experienced a myocardial infarction. Mean ejection fraction was 0.42 +/- 0.121, Canadian Cardiovascular Society class 3.5 +/- 0.5, quality of life (Spitzer index) 4.5 +/- 1.2, and the median frequency of weekly angina episodes was 10. There were no SCS implantation-related complications. At follow-up (100% complete, mean 24 +/- 18 months), a significant improvement of anginal symptoms (>50% reduction of weekly anginal episodes) occurred in 45 patients (88.2%). In those patients (Responders), the quality of life improved significantly (6.8 +/- 1.5; p < 0.0001), CCS class decreased to 2 +/- 0.7 (p < 0.0001), and the median frequency of weekly angina episodes to 3 (p < 0.0001). At 3 years, Responders' survival was 91.8 +/- 4.6% and the freedom from cardiac events 72.6 +/- 8.42%. Spinal cord stimulation is a safe and effective procedure in truly no-option patients affected by refractory angina. A midterm sustained improvement of symptoms and quality of life have been documented with a satisfactory 3-year survival rate.

Factors influencing survivorship of rehabilitating green sea turtles (Chelonia mydas) with fibropapillomatosis.

PubMed

Page-Karjian, Annie; Norton, Terry M; Krimer, Paula; Groner, Maya; Nelson, Steven E; Gottdenker, Nicole L

2014-09-01

Marine turtle fibropapillomatosis (FP) is a debilitating, infectious neoplastic disease that has reached epizootic proportions in several tropical and subtropical populations of green turtles (Chelonia mydas). FP represents an important health concern in sea turtle rehabilitation facilities. The objectives of this study were to describe the observed epidemiology, biology, and survival rates of turtles affected by FP (FP+ turtles) in a rehabilitation environment; to evaluate clinical parameters as predictors of survival in affected rehabilitating turtles; and to provide information about case progression scenarios and potential outcomes for FP+ sea turtle patients. A retrospective case series analysis was performed using the medical records of the Georgia Sea Turtle Center (GSTC), Jekyll Island, Georgia, USA, during 2009-2013. Information evaluated included signalment, morphometrics, presenting complaint, time to FP onset, tumor score (0-3), co-morbid conditions, diagnostic test results, therapeutic interventions, and case outcomes. Overall, FP was present in 27/362 (7.5%) of all sea turtles admitted to the GSTC for rehabilitation, either upon admittance or during their rehabilitation. Of these, 25 were green and 2 were Kemp's ridley turtles. Of 10 turtles that had only plaque-like FP lesions, 60% had natural tumor regression, all were released, and they were significantly more likely to survive than those with classic FP (P = 0.02 [0.27-0.75, 95% CI]). Turtles without ocular FP were eight times more likely to survive than those with ocular FP (odds ratio = 8.75, P = 0.032 [1.21-63.43, 95% CI]). Laser-mediated tumor removal surgery is the treatment of choice for FP+ patients at the GSTC; number of surgeries was not significantly related to case outcome.

Multimodality Review of Amyloid-related Diseases of the Central Nervous System

PubMed Central

Sipe, Adam L.; Benzinger, Tammie L. S.; McConathy, Jonathan; Connolly, Sarah; Schwetye, Katherine E.

2016-01-01

Amyloid-β (Aβ) is ubiquitous in the central nervous system (CNS), but pathologic accumulation of Aβ results in four distinct neurologic disorders that affect middle-aged and elderly adults, with diverse clinical presentations ranging from chronic debilitating dementia to acute life-threatening intracranial hemorrhage. The characteristic imaging patterns of Aβ-related CNS diseases reflect the pathophysiology of Aβ deposition in the CNS. Aβ is recognized as a key component in the neuronal damage that characterizes the pathophysiology of Alzheimer disease, the most common form of dementia. Targeted molecular imaging shows pathologic accumulation of Aβ and tau protein, and fluorine 18 fluorodeoxyglucose positron emission tomography and anatomic imaging allow differentiation of typical patterns of neuronal dysfunction and loss in patients with Alzheimer disease from those seen in patients with other types of dementia. Cerebral amyloid angiopathy (CAA) is an important cause of cognitive impairment and spontaneous intracerebral hemorrhage in the elderly. Hemorrhage and white matter injury seen at imaging reflect vascular damage caused by the accumulation of Aβ in vessel walls. The rare forms of inflammatory angiopathy attributed to Aβ, Aβ-related angiitis and CAA-related inflammation, cause debilitating neurologic symptoms that improve with corticosteroid therapy. Imaging shows marked subcortical and cortical inflammation due to perivascular inflammation, which is incited by vascular Aβ accumulation. In the rarest of the four disorders, cerebral amyloidoma, the macroscopic accumulation of Aβ mimics the imaging appearance of tumors. Knowledge of the imaging patterns and pathophysiology is essential for accurate diagnosis of Aβ-related diseases of the CNS. ©RSNA, 2016 PMID:27399239

Disc herniations in the national football league.

PubMed

Gray, Benjamin L; Buchowski, Jacob M; Bumpass, David B; Lehman, Ronald A; Mall, Nathan A; Matava, Matthew J

2013-10-15

Retrospective analysis of a prospectively collected database. To determine the overall incidence, location, and type of disc herniations in professional football players to target treatment issues and prevention. Disc herniations represent a common and debilitating injury to the professional athlete. The NFL's (National Football League's) Sports Injury Monitoring System is a surveillance database created to monitor the league for all injuries, including injuries to the cervical, thoracic, and lumbar spine. A retrospective analysis was performed on all disc herniations to the cervical, thoracic, and lumbar spine during a 12-season period (2000-2012) using the NFL's surveillance database. The primary data points included the location of the injury, player position, activity at time of injury, and playing time lost due to injury. During the 12 seasons, 275 disc herniations occurred in the spine. In regard to location, 76% occurred in the lumbar spine and most frequently affected the L5-S1 disc. The offensive linemen were most frequently injured. As expected, blocking was the activity that caused most injuries. Lumbar disc herniations rose in prevalence and had a mean loss of playing time of more than half the season (11 games). Thoracic disc herniations led to the largest mean number of days lost overall, whereas players with cervical disc herniations missed the most practices. Disc herniations represent a significant cause of morbidity in the NFL. Although much attention is placed on spinal cord injuries, preventive measures targeting the cervical, thoracic, and lumbar spine may help to reduce the overall incidence of these debilitating injuries.Level of Evidence: N/A.

Disc herniations in the National Football League.

PubMed

Gray, Benjamin L; Buchowski, Jacob M; Bumpass, David B; Lehman, Ronald A; Mall, Nathan A; Matava, Matthew J

2013-10-15

Retrospective analysis of a prospectively collected database. To determine the overall incidence, location, and type of disc herniations in professional football players to target treatment issues and prevention. Disc herniations represent a common and debilitating injury to the professional athlete. The NFL's (National Football League's) Sports Injury Monitoring System is a surveillance database created to monitor the league for all injuries, including injuries to the cervical, thoracic, and lumbar spine. A retrospective analysis was performed on all disc herniations to the cervical, thoracic, and lumbar spine during a 12-season period (2000–2012) using the NFL's surveillance database. The primary data points included the location of the injury, player position, activity at time of injury, and playing time lost due to injury. During the 12 seasons, 275 disc herniations occurred in the spine. In regard to location, 76% occurred in the lumbar spine and most frequently affected the L5–S1 disc. The offensive linemen were most frequently injured. As expected, blocking was the activity that caused most injuries. Lumbar disc herniations rose in prevalence and had a mean loss of playing time of more than half the season (11 games). Thoracic disc herniations led to the largest mean number of days lost overall, whereas players with cervical disc herniations missed the most practices. Disc herniations represent a significant cause of morbidity in the NFL. Although much attention is placed on spinal cord injuries, preventive measures targeting the cervical, thoracic, and lumbar spine may help to reduce the overall incidence of these debilitating injuries. N/A

Medical marijuana and the developing role of the pharmacist.

PubMed

Seamon, Matthew J; Fass, Jennifer A; Maniscalco-Feichtl, Maria; Abu-Shraie, Nada A

2007-05-15

The pharmacology, therapeutic uses, safety, drug-drug interactions, and drug-disease interactions of medical marijuana are reviewed, and the legal issues related to its use and the implications of medical marijuana for the pharmacist are presented. Marijuana contains more than 460 active chemicals and over 60 unique cannabinoids. The legal landscape surrounding marijuana is surprisingly complex and unsettled. In the United States, 11 states and several municipalities have legalized medical marijuana. Another state provides legislation that allows patients to claim a defense of medical necessity. Nevertheless, patients using medical marijuana may never interact with a pharmacist. Marijuana is a Schedule I controlled substance and its use is illegal under federal law. Marijuana has a number of purported therapeutic uses with a broad range of supporting evidence. There are five general indications for medical marijuana: (1) severe nausea and vomiting associated with cancer chemotherapy or other causes, (2) weight loss associated with debilitating illnesses, including HIV infection and cancer, (3) spasticity secondary to neurologic diseases, such as multiple sclerosis, (4) pain syndromes, and (5) other uses, such as for glaucoma. Marijuana is associated with adverse psychiatric, cardiovascular, respiratory, and immunologic events. Moreover, marijuana may interact with a number of prescription drugs and concomitant disease states. Several states have legalized the use of marijuana for chronic and debilitating medication conditions. Pharmacists need to understand the complex legal framework surrounding this issue so that they can protect themselves and better serve their patients.

High burden and unmet patient needs in chronic kidney disease

PubMed Central

Braun, LeeAnn; Sood, Vipan; Hogue, Susan; Lieberman, Bonnie; Copley-Merriman, Catherine

2012-01-01

Chronic kidney disease (CKD) is a complex debilitating condition affecting more than 70 million people worldwide. With the increased prevalence in risk factors such as diabetes, hypertension, and cardiovascular disease in an aging population, CKD prevalence is also expected to increase. Increased awareness and understanding of the overall CKD burden by health care teams (patients, clinicians, and payers) is warranted so that overall care and treatment management may improve. This review of the burden of CKD summarizes available evidence of the clinical, humanistic, and economic burden of CKD and the current unmet need for new treatments and serves as a resource on the overall burden. Across countries, CKD prevalence varies considerably and is dependent upon patient characteristics. The prevalence of risk factors including diabetes, hypertension, cardiovascular disease, and congestive heart failure is noticeably higher in patients with lower estimated glomerular filtration rates (eGFRs) and results in highly complex CKD patient populations. As CKD severity worsens, there is a subsequent decline in patient health-related quality of life and an increased use of health care resources as well as burgeoning costs. With current treatment, nearly half of patients progress to unfavorable renal and cardiovascular outcomes. Although curative treatment that will arrest kidney deterioration is desired, innovative agents under investigation for CKD to slow kidney deterioration, such as atrasentan, bardoxolone methyl, and spherical carbon adsorbent, may offer patients healthier and more productive lives. PMID:23293534

Oxidative Stress: A Unifying Mechanism for Cell Damage Induced by Noise, (Water-Pipe) Smoking, and Emotional Stress-Therapeutic Strategies Targeting Redox Imbalance.

PubMed

Golbidi, Saeid; Li, Huige; Laher, Ismail

2018-03-20

Modern technologies have eased our lives but these conveniences can impact our lifestyles in destructive ways. Noise pollution, mental stresses, and smoking (as a stress-relieving solution) are some environmental hazards that affect our well-being and healthcare budgets. Scrutinizing their pathophysiology could lead to solutions to reduce their harmful effects. Recent Advances: Oxidative stress plays an important role in initiating local and systemic inflammation after noise pollution, mental stress, and smoking. Lipid peroxidation and release of lysolipid by-products, disturbance in activation and function of nuclear factor erythroid 2-related factor 2 (Nrf2), induction of stress hormones and their secondary effects on intracellular kinases, and dysregulation of intracellular Ca 2+ can all potentially trigger other vicious cycles. Recent clinical data suggest that boosting the antioxidant system through nonpharmacological measures, for example, lifestyle changes that include exercise have benefits that cannot easily be achieved with pharmacological interventions alone. Indiscriminate manipulation of the cellular redox network could lead to a new series of ailments. An ideal approach requires meticulous scrutiny of redox balance mechanisms for individual pathologies so as to create new treatment strategies that target key pathways while minimizing side effects. Extrapolating our understanding of redox balance to other debilitating conditions such as diabetes and the metabolic syndrome could potentially lead to devising a unifying therapeutic strategy. Antioxid. Redox Signal. 28, 741-759.

Developmental vitamin D deficiency and schizophrenia: the role of animal models

PubMed Central

Schoenrock, S. A.; Tarantino, L. M.

2016-01-01

Schizophrenia is a debilitating neuropsychiatric disorder that affects 1% of the US population. Based on twin and genome-wide association studies, it is clear that both genetics and environmental factors increase the risk for developing schizophrenia. Moreover, there is evidence that conditions in utero, either alone or in concert with genetic factors, may alter neurodevelopment and lead to an increased risk for schizophrenia. There has been progress in identifying genetic loci and environmental exposures that increase risk, but there are still considerable gaps in our knowledge. Furthermore, very little is known about the specific neurodevelopmental mechanisms upon which genetics and the environment act to increase disposition to developing schizophrenia in adulthood. Vitamin D deficiency during the perinatal period has been hypothesized to increase risk for schizophrenia in humans. The developmental vitamin D (DVD) deficiency hypothesis of schizophrenia arises from the observation that disease risk is increased in individuals who are born in winter or spring, live further from the equator or live in urban vs. rural settings. These environments result in less exposure to sunlight, thereby reducing the initial steps in the production of vitamin D. Rodent models have been developed to characterize the behavioral and developmental effects of DVD deficiency. This review focuses on these animal models and discusses the current knowledge of the role of DVD deficiency in altering behavior and neurobiology relevant to schizophrenia. PMID:26560996

The dental implications of bisphosphonates and bone disease.

PubMed

Cheng, A; Mavrokokki, A; Carter, G; Stein, B; Fazzalari, N L; Wilson, D F; Goss, A N

2005-12-01

In 2002/2003 a number of patients presented to the South Australian Oral and Maxillofacial Surgery Unit with unusual non-healing extraction wounds of the jaws. All were middle-aged to elderly, medically compromised and on bisphosphonates for bone pathology. Review of the literature showed similar cases being reported in the North American oral and maxillofacial surgery literature. This paper reviews the role of bisphosphonates in the management of bone disease. There were 2.3 million prescriptions for bisphosphonates in Australia in 2003. This group of drugs is very useful in controlling bone pain and preventing pathologic fractures. However, in a small number of patients on bisphosphonates, intractable, painful, non-healing exposed bone occurs following dental extractions or denture irritation. Affected patients are usually, but not always, over 55 years, medically compromised and on the potent nitrogen containing bisphosphonates pamidronate (Aredia/Pamisol), alendronate (Fosamax) and zolendronate (Zometa) for non-osteoporotic bone disease. Currently, there is no simple, effective treatment and the painful exposed bone may persist for years. The main complications are marked weight loss from difficulty in eating and severe jaw and neck infections. Possible preventive and therapeutic strategies are presented although at this time there is no evidence of their effectiveness. Dentists must ask about bisphosphonate usage for bone disease when recording medical histories and take appropriate actions to avoid the development of this debilitating condition in their patients.

Acute Stress-Induced Epigenetic Modulations and Their Potential Protective Role Toward Depression.

PubMed

Rusconi, Francesco; Battaglioli, Elena

2018-01-01

Psychiatric disorders entail maladaptive processes impairing individuals' ability to appropriately interface with environment. Among them, depression is characterized by diverse debilitating symptoms including hopelessness and anhedonia, dramatically impacting the propensity to live a social and active life and seriously affecting working capability. Relevantly, besides genetic predisposition, foremost risk factors are stress-related, such as experiencing chronic psychosocial stress-including bullying, mobbing and abuse-, and undergoing economic crisis or chronic illnesses. In the last few years the field of epigenetics promised to understand core mechanisms of gene-environment crosstalk, contributing to get into pathogenic processes of many disorders highly influenced by stressful life conditions. However, still very little is known about mechanisms that tune gene expression to adapt to the external milieu. In this Perspective article, we discuss a set of protective, functionally convergent epigenetic processes induced by acute stress in the rodent hippocampus and devoted to the negative modulation of stress-induced immediate early genes (IEGs) transcription, hindering stress-driven morphostructural modifications of corticolimbic circuitry. We also suggest that chronic stress damaging protective epigenetic mechanisms, could bias the functional trajectory of stress-induced neuronal morphostructural modification from adaptive to maladaptive, contributing to the onset of depression in vulnerable individuals. A better understanding of the epigenetic response to stress will be pivotal to new avenues of therapeutic intervention to treat depression, especially in light of limited efficacy of available antidepressant drugs.

A phenomenological study of day-to-day experiences of living with heart failure: do cultural differences matter?

PubMed

Chiaranai, Chantira

2014-07-01

Although there is a significant body of literature addressing heart failure (HF) epidemiology, physiology, and treatment, little is known about the experiences of Thai patients living with this chronic condition. The primary goal of this study was to gain a better understanding of how Thai patients with HF live with chronic and debilitating illness. A phenomenological approach was chosen to investigate the experience of living with HF. Fifteen Thai men and women with HF in New York Heart Association classes I to III, aged between 47 and 75 years, were interviewed with open-ended questions. Data were analyzed using qualitative inductive content analysis. Three themes emerged from the data analysis: identifying losses or changes in their lives, accepting the losses, and regaining some control. Unlike their western counterparts, the Thai patients with HF incorporated their karma, a Buddhist belief system, as a tool to rationalize the occurrence of their HF experience. The participants of this study used kreng jai as a cultural desire not to disrupt the happiness of others, even at the expense of efficiency, or to burden others, which might affect their own quality of life. The Thai patients with HF faced many limitations. The Thai patients with HF use religion and traditional culture to overcome their life situations. To support Thai patients with HF, healthcare providers must have an understanding of cultural differences.

Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete.

PubMed

Saxena, Amol; Fournier, Magali; Gerdesmeyer, Ludger; Gollwitzer, Hans

2012-10-01

Plantar fasciitis can be a chronic and debilitating condition affecting athletes of all levels. The aim of this study is to compare treatment outcomes for the treatment of chronic plantar fasciitis in athletes, comparing focused extra corporeal sound wave therapy (ESWT) and the surgical endoscopic plantar fasciotomy (EPF). A total of 37 eligible patients were enrolled in the study between May 2006 and December 2008 at a single institution. Patients were either enrolled in the surgical group, or to the ESWT group which included a placebo controlled, randomized group (P-ESWT). Pre and post Visual Analog Scores (VAS) and Roles and Maudlsey (RM) scores were recorded and compared between the three groups. The patient's return to activity (RTA) was also documented. The results showed statistical improvement within the EPF and ESWT groups with both VAS & RM scores, with EPF being significantly better than both ESWT and P-ESWT in terms of treatment outcomes. Patients enrolled in the ESWT were able though to continue with their exercise regimen, while the EPF group was able to return to their athletic activity in an average of 2.8 months. In conclusion, EPF and ESWT are both effective forms of treatment for chronic plantar fasciitis; EPF being superior in outcomes yet ESWT treatment could be preferable since the athlete can remain active during treatment. II.

Visceral caseous lymphadenitis in thin ewe syndrome: isolation of Corynebacterium, Staphylococcus, and Moraxella spp from internal abscesses in emaciated ewes.

PubMed

Renshaw, H W; Graff, V P; Gates, N L

1979-08-01

The relationship between the visceral form of caseous lymphadenitis and a chronic debilitating condition of mature sheep designated as the thin ewe syndrome was investigated. Internal abscesses were found during necropsy in 81% of animals with thin ewe syndrome and Corynebacterium pseudotuberculosis (C ovis) was recovered from 86% of the animals with internal abscesses. Other pyogenic bacteria, including C pyogenes, C equi, Staphylococcus epidermis, S aureus, and Pseudomonas aeruginosa were often recovered in association with C pseudotuberculosis. Moraxella sp was recovered in 41% of the animals with internal abscesses. In some abscesses, Moraxella sp was the dominant microorganism isolated and in others, they were outnumbered only by C pseudotuberculosis. Species isolated included M bovis, M osloensis, and M nonliquefaciens. The potential importance of Moraxella sp to the cause and pathogenesis of the thin ewe syndrome is not known. The results of the present study indicate that visceral caseous lymphadenitis is either an important contributing factor to the development of thin ewe syndrome or that the presence of thin ewe syndrome may predispose affected sheep to the development of visceral caseous lymphadenitis. A skin test reagent prepared by sonicating C pseudotuberculosis was of limited value in detecting animals with visceral caseous lymphadenitis. Only 56% of the animals with abscesses caused by C pseudotuberculosis gave positive delayed-type hypersensitivity skin test responses.

Acute Stress-Induced Epigenetic Modulations and Their Potential Protective Role Toward Depression

PubMed Central

Rusconi, Francesco; Battaglioli, Elena

2018-01-01

Psychiatric disorders entail maladaptive processes impairing individuals’ ability to appropriately interface with environment. Among them, depression is characterized by diverse debilitating symptoms including hopelessness and anhedonia, dramatically impacting the propensity to live a social and active life and seriously affecting working capability. Relevantly, besides genetic predisposition, foremost risk factors are stress-related, such as experiencing chronic psychosocial stress—including bullying, mobbing and abuse—, and undergoing economic crisis or chronic illnesses. In the last few years the field of epigenetics promised to understand core mechanisms of gene-environment crosstalk, contributing to get into pathogenic processes of many disorders highly influenced by stressful life conditions. However, still very little is known about mechanisms that tune gene expression to adapt to the external milieu. In this Perspective article, we discuss a set of protective, functionally convergent epigenetic processes induced by acute stress in the rodent hippocampus and devoted to the negative modulation of stress-induced immediate early genes (IEGs) transcription, hindering stress-driven morphostructural modifications of corticolimbic circuitry. We also suggest that chronic stress damaging protective epigenetic mechanisms, could bias the functional trajectory of stress-induced neuronal morphostructural modification from adaptive to maladaptive, contributing to the onset of depression in vulnerable individuals. A better understanding of the epigenetic response to stress will be pivotal to new avenues of therapeutic intervention to treat depression, especially in light of limited efficacy of available antidepressant drugs. PMID:29904343

Kindling and Oxidative Stress as Contributors to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

PubMed Central

Jason, L. A.; Porter, N.; Herrington, J.; Sorenson, M.; Kubow, S.

2010-01-01

Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS) is one of the more complex illnesses involving multiple systems within the body. Onset of ME/CFS frequently occurs quickly, and many patients report a prior exposure to a viral infection. This debilitating illness can affect the immune, neuroendocrine, autonomic, and neurologic systems. Abnormal biological findings among some patients have included aberrant ion transport and ion channel activity, cortisol deficiency, sympathetic nervous system hyperactivity, EEG spike waves, left ventricular dysfunction in the heart, low natural killer cell cytotoxicity, and a shift from Th1 to Th2 cytokines. We propose that the kindling and oxidative stress theories provide a heuristic template for better understanding the at times conflicting findings regarding the etiology and pathophysiology of this illness. PMID:21253446

[Geohelminths].

PubMed

Prieto-Pérez, Laura; Pérez-Tanoira, Ramón; Cabello-Úbeda, Alfonso; Petkova-Saiz, Elizabet; Górgolas-Hernández-Mora, Miguel

2016-01-01

Millions of people in in rural areas and deprived tropical and subtropical regions are infected by soil-transmitted helminths: Ascaris lumbricoides, Trichuris trichiura, hookworms (Ancylostoma duodenale and Necator americanus), and Strongyloides stercoralis. Large migratory flows have made their worldwide distribution easier. Besides being debilitating and producing a significant mortality, they cause high morbidity, leading to physical and intellectual impairment in millions of children who live in poverty. Along with the use of benzimidazoles (albendazole and mebendazole), large-scale international campaigns for treatment and prevention have decreased the number of affected individuals. However, re-infestations and benzimidazole-resistance are frequent, so there needs to be awareness about the importance and consequences of these neglected parasites. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Management of hepatitis C infection in the era of direct-acting antiviral therapy

NASA Astrophysics Data System (ADS)

Zain, L. H.; Sungkar, T.

2018-03-01

Hepatitis C viral infection globally affects millions of people and commonly results in debilitating complications and mortality. Initial mainstay therapy consisted of pegylated interferon α (pegIFNα) with additional ribavirin that showed unsatisfactory cure rate, common side effects and complicated dosing, contributing to high discontinuation rate. Over the last few years, newer antivirals have been extensively studied, that are Direct-Acting Antivirals (DAAs). Specifically targeting viral protein mainly during replication phase, DAAs showed greater cure rate (commonly measured as sustained virologic response), improved safety profile and shorter treatment duration compared to traditional interferon-ribavirin therapy. Current guidelines have also included Interferon-free, often ribavirin-free, DAAs combinations that suggest promising outcomes. The current review highlights development of rapidly growing hepatitis C treatment including DAAs recommendations.

Physiological Comparison of Concentric and Eccentric Arm Cycling in Males and Females

PubMed Central

Beaven, C. Martyn; Willis, Sarah J.; Cook, Christian J.; Holmberg, Hans-Christer

2014-01-01

Lower body eccentric exercise is well known to elicit high levels of muscular force with relatively low cardiovascular and metabolic strain. As a result, eccentric exercise has been successfully utilised as an adaptive stressor to improve lower body muscle function in populations ranging from the frail and debilitated, to highly-trained individuals. Here we investigate the metabolic, cardiorespiratory, and energy costs of upper body eccentric exercise in a healthy population. Seven men and seven women performed 4-min efforts of eccentric (ECC) or concentric (CON) arm cycling on a novel arm ergometer at workloads corresponding to 40, 60, and 80% of their peak workload as assessed in an incremental concentric trial. The heart rate, ventilation, cardiac output, respiratory exchange ratio, and blood lactate concentrations were all clearly greater in CON condition at all of the relative workloads (all p<0.003). Effect size calculations demonstrated that the magnitude of the differences in VO2 and work economy between the ECC and CON exercise ranged from very large to extremely large; however, in no case did mechanical efficiency (ηMECH) differ between the conditions (all p>0.05). In contrast, delta efficiency (ηΔ), as previously defined by Coyle and colleagues in 1992, demonstrated a sex difference (men>women; p<0.05). Sex differences were also apparent in arteriovenous oxygen difference and heart rate during CON. Here, we reinforce the high-force, low cost attributes of eccentric exercise which can be generalised to the muscles of the upper body. Upper body eccentric exercise is likely to form a useful adjunct in debilitative, rehabilitative, and adaptive clinical exercise programs; however, reports of a shift towards an oxidative phenotype should be taken into consideration by power athletes. We suggest delta efficiency as a sensitive measure of efficiency that allowed the identification of sex differences. PMID:25372404

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: study protocol for a pilot randomised controlled trial.

PubMed

Strauss, Clara; Rosten, Claire; Hayward, Mark; Lea, Laura; Forrester, Elizabeth; Jones, Anna-Marie

2015-04-16

Obsessive Compulsive Disorder (OCD) is a distressing and debilitating condition affecting 1-2% of the population. Exposure and response prevention (ERP) is a behaviour therapy for OCD with the strongest evidence for effectiveness of any psychological therapy for the condition. Even so, only about half of people offered ERP show recovery after the therapy. An important reason for ERP failure is that about 25% of people drop out early, and even for those who continue with the therapy, many do not regularly engage in ERP tasks, an essential element of ERP. A mindfulness-based approach has the potential to reduce drop-out from ERP and to improve ERP task engagement with an emphasis on accepting difficult thoughts, feelings and bodily sessions and on becoming more aware of urges, rather than automatically acting on them. This is a pilot randomised controlled trial of mindfulness-based ERP (MB-ERP) with the aim of establishing parameters for a definitive trial. Forty participants diagnosed with OCD will be allocated at random to a 10-session ERP group or to a 10-session MB-ERP group. Primary outcomes are OCD symptom severity and therapy engagement. Secondary outcomes are depressive symptom severity, wellbeing and obsessive-compulsive beliefs. A semi-structured interview with participants will guide understanding of change processes. Findings from this pilot study will inform future research in this area, and if effect sizes on primary outcomes are in favour of MB-ERP in comparison to ERP, funding for a definitive trial will be sought. Current Controlled Trials registration number ISRCTN52684820. Registered on 30 January 2014.

The reliability of non-invasive biophysical outcome measures for evaluating normal and hyperkeratotic foot skin.

PubMed

Hashmi, Farina; Wright, Ciaran; Nester, Christopher; Lam, Sharon

2015-01-01

Hyperkeratosis of foot skin is a common skin problem affecting people of different ages. The clinical presentation of this condition can range from dry flaky skin, which can lead to fissures, to hard callused skin which is often painful and debilitating. The purpose of this study was to test the reliability of certain non-invasive skin measurement devices on foot skin in normal and hyperkeratotic states, with a view to confirming their use as quantitative outcome measures in future clinical trials. Twelve healthy adult participants with a range of foot skin conditions (xerotic skin, heel fissures and plantar calluses) were recruited to the study. Measurements of normal and hyperkeratotic skin sites were taken using the following devices: Corneometer® CM 825, Cutometer® 580 MPA, Reviscometer® RVM 600, Visioline® VL 650 Quantiride® and Visioscan® VC 98, by two investigators on two consecutive days. The intra and inter rater reliability and standard error of measurement for each device was calculated. The data revealed the majority of the devices to be reliable measurement tools for normal and hyperkeratotic foot skin (ICC values > 0.6). The surface evaluation parameters for skin: SEsc and SEsm have greater reliability compared to the SEr measure. The Cutometer® is sensitive to soft tissue movement within the probe, therefore measurement of plantar soft tissue areas should be approached with caution. Reviscometer® measures on callused skin demonstrated an unusually high degree of error. These results confirm the intra and inter rater reliability of the Corneometer®, Cutometer®, Visioline® and Visioscan® in quantifying specific foot skin biophysical properties.

Selected Reaction Monitoring to Differentiate and Relatively Quantitate Isomers of Sulfated and Unsulfated Core 1 O-Glycans from Salivary MUC7 Protein in Rheumatoid Arthritis*

PubMed Central

Flowers, Sarah A.; Ali, Liaqat; Lane, Catherine S.; Olin, Magnus; Karlsson, Niclas G.

2013-01-01

Rheumatoid arthritis is a common and debilitating systemic inflammatory condition affecting up to 1% of the world's population. This study aimed to investigate the immunological significance of O-glycans in chronic arthritis at a local and systemic level. O-Glycans released from synovial glycoproteins during acute and chronic arthritic conditions were compared and immune-reactive glycans identified. The sulfated core 1 O-glycan (Galβ1–3GalNAcol) was immune reactive, showing a different isomeric profile in the two conditions. From acute reactive arthritis, three isomers could be sequenced, but in patients with chronic rheumatoid arthritis, only a single 3-Gal sulfate-linked isomer could be identified. The systemic significance of this glycan epitope was investigated using the salivary mucin MUC7 in patients with rheumatoid arthritis and normal controls. To analyze this low abundance glycan, a selected reaction monitoring (SRM) method was developed to differentiate and relatively quantitate the core 1 O-glycan and the sulfated core 1 O-glycan Gal- and GalNAc-linked isomers. The acquisition of highly sensitive full scan linear ion trap MS/MS spectra in addition to quantitative SRM data allowed the 3- and 6-linked Gal isomers to be differentiated. The method was used to relatively quantitate the core 1 glycans from MUC7 to identify any systemic changes in this carbohydrate epitope. A statistically significant increase in sulfation was identified in salivary MUC7 from rheumatoid arthritis patients. This suggests a potential role for this epitope in chronic inflammation. This study was able to develop an SRM approach to specifically identify and relatively quantitate sulfated core 1 isomers and the unsulfated structure. The expansion of this method may afford an avenue for the high throughput investigation of O-glycans. PMID:23457413

Health‐related quality of life and economic burden of vestibular loss in older adults

PubMed Central

Agrawal, Yuri; Semenov, Yevgeniy R.

2017-01-01

Objectives Vestibular loss is a debilitating condition, and despite its high prevalence in older adults, the quality of life (QoL) burden of vestibular loss in older individuals has not been well‐studied. This report quantifies the impact on overall QoL and identifies domains of health most affected. We hypothesize vestibular loss will be associated with impairment in diverse domains of health‐related QoL. Study Design Prospective, case‐control study. Methods A convenience sample of 27 patients age ≥60 years with vestibular physiologic loss was recruited from an academic neurotology clinic. The patients did not have any identifiable cause of their vestibular loss other than aging. The convenience sample was compared to an age‐matched cross‐sectional sample of the general US population (n = 1266). The main outcome was QoL measured by the Ontario Health Utilities Index Mark III (HUI3). Results Compared to the general population, patients with vestibular loss had significantly lower overall unadjusted HUI3 scores (−0.32, p < 0.001). Multivariate regression analysis showed vestibular loss was significantly associated with poorer performance in vision (−0.11 p < 0.0001), speech (−0.15, p < 0.0001), dexterity (−0.13, p < 0.0001), and emotion (−0.07, p = 0.0065). Adjusted aggregate HUI3 was also significantly lower for vestibular loss (−0.15, p = 0.0105). These QoL decrements resulted in an average loss of 1.30 Quality‐Adjusted Life Years (QALYs). When using a $50,000/QALY willingness‐to‐pay threshold, vestibular loss was associated with a $64,929 lifetime economic burden per affected older adult, resulting in a total lifetime societal burden of $227 billion for the US population ≥60 years of age. Conclusions Loss of vestibular function with aging significantly decreases quality of life across multiple domains of well‐being. These QoL reductions are responsible for heavy societal economic burdens of vestibular loss, which reveal potential benefits of prompt diagnosis and treatment of this condition. Level of Evidence 3 PMID:29492463

The human genome project: an historical perspective for social workers.

PubMed

Saunders, Marlene

2011-01-01

Having mapped the human genome, the Human Genome Project maintains that certain genes can be linked to specific diseases and certain forms of human behavior. This breakthrough, it is hoped, will lead to the effective treatment, even the elimination of serious, debilitating illnesses for all groups of people. However, because the project conjures up memories of eugenics, the project raises concerns about its potential for identifying and linking diseases and social conditions (e.g., criminal behavior) to certain groups. This article places the Human Genome Project in historical context in terms of its resemblance to the eugenics movement in America and a period in social work history when the profession embraced eugenics and was guided by the movement's premises in its response to poor people.

Update on the use of alitretinoin in treating chronic hand eczema

PubMed Central

Ghasri, Pedram; Scheinfeld, Noah

2010-01-01

Chronic hand eczema is a debilitating dermatological condition with significant economic, social, and functional impacts. To date, conventional treatments such as topical corticosteroids, phototherapy, and systemic immunosuppressants have yielded disappointing results, owing to either a lack of efficacy or significant adverse events. Oral alitretinoin (9-cis-retinoic acid) is a unique panagonist retinoid with immunomodulatory and anti-inflammatory activity that has emerged as a novel treatment for chronic hand eczema. Several large-scale clinical studies have demonstrated oral alitretinoin’s high efficacy rate of 28% to 89%, its safe tolerability profile, and its positive impact on quality of life, validating it as a therapeutic option for patients with severe chronic hand eczema refractory to standard treatment. PMID:21437060

The first dentists sent to the Western Front during the First World War.

PubMed

Gray, F S S

2017-06-09

At the outbreak of the First World War there was insufficient dental provision for serving military personnel. No army dental specialists were available overseas when the troops joined the British Expeditionary Force (BEF). However, the pain of toothache together with the ensuing limited mastication was debilitating and demoralising for the British soldiers. The result was that men were being withdrawn from the front for treatment at base hospitals. This was limited to extractions by medical officers, which frequently incurred unnecessary loss of dentition when restorative work would have been preferable. Other consequences of dental neglect were indigestion and malnutrition. Additionally, the painful condition of acute necrotising ulcerative gingivitis, then commonly referred to as 'trench mouth', was prevalent.

Euthanasia: India's position in the global scenario.

PubMed

Shekhar, Skand; Goel, Ashish

2013-11-01

Euthanasia requests have increased as the number of debilitated patients rises in both developed and developing countries such as India due to medical, psychosocial-emotional, socioenvironmental, and existential issues amid fears of potential misuse. WORLD'S POSITION: Albania, Colombia, the Netherlands, and Switzerland permit euthanasia conditionally. Australia's legalization of euthanasia has been withdrawn. The United States permits withdrawal of life support. Mexico and Norway permit active euthanasia. INDIA'S POSITION: Following the Aruna Shanbaug case the Supreme Court granted legal sanction to passive, but not active, euthanasia that is valid till the Parliament legislates on euthanasia. HANDLING EUTHANASIA REQUESTS: Acknowledging the complexity of the problem; individualizing the palliative approach; and accepting the 'There is no alternative' or 'There is no answer' (TINA) factor.

Burning Mouth Syndrome: Aetiopathogenesis and Principles of Management

PubMed Central

Fourie, J.; Bouckaert, M.; Ballyram, R.; Lemmer, J.

2017-01-01

Burning mouth syndrome (BMS) is a chronic debilitating oral condition characterised by a burning sensation of the oral mucosa in an otherwise apparently normal person. Its aetiology and pathogenesis are obscure, but both psychogenic factors and peripheral and central neuropathies appear to be implicated. There is no cure for BMS, and treatment with either local or systemic medications focuses on the relief of symptoms and on improving quality of life. In recalcitrant cases, psychological/psychiatric intervention may be helpful. In order to improve treatment outcomes, a better understanding of the pathogenesis of this syndrome might provide a basis for the development of more effective management strategies. In this short review, we discuss current knowledge of the diagnosis, aetiopathogenesis, and management of BMS. PMID:29180911

Concerns of an itinerant surgeon: results of a Guatemalan surgical aid trip.

PubMed

Kavolus, Joseph J; Ritter, Merrill A; Claverie, Jorge G; Barfield, William R; Lackland, Daniel T; Trousdale, Robert T

2014-05-01

Over the past decade the popularity of foreign medical aid has increased and gained notoriety. Operation Walk is a philanthropic organization dedicated to improving the ambulatory potential of patients in developing countries by providing free surgical treatment for patients who otherwise lack access to care of debilitating bone and joint conditions. During Operation Walk Mooresville's 2013 trip to Guatemala 40 patients prospectively completed a Likert Scale style survey. The 63-question survey assessed patient impressions and concerns regarding the care they receive as part of itinerant surgical aid trips. Mean scores were calculated and then concerns were ranked accordingly. We are aware of no other investigation assessing these sorts of patient centered perspectives for international surgical aid trips. © 2013.

Biomechanical properties of the spinal cord: implications for tissue engineering and clinical translation.

PubMed

Bartlett, Richard D; Choi, David; Phillips, James B

2016-10-01

Spinal cord injury is a severely debilitating condition which can leave individuals paralyzed and suffering from autonomic dysfunction. Regenerative medicine may offer a promising solution to this problem. Previous research has focused primarily on exploring the cellular and biological aspects of the spinal cord, yet relatively little remains known about the biomechanical properties of spinal cord tissue. Given that a number of regenerative strategies aim to deliver cells and materials in the form of tissue-engineered therapies, understanding the biomechanical properties of host spinal cord tissue is important. We review the relevant biomechanical properties of spinal cord tissue and provide the baseline knowledge required to apply these important physical concepts to spinal cord tissue engineering.

Impact of Fecal Incontinence and Its Treatment on Quality of Life in Women

PubMed Central

Richter, Holly E.

2015-01-01

Fecal incontinence (FI) is a physically and psychosocially debilitating disorder which negatively impacts quality of life (QOL). It bears a significant burden not only on patients but also on their families, caretakers, as well as society as a whole. Even though it is considered a somewhat common condition, especially as women age, the prevalence is often underestimated due to patients’ reluctance to report symptoms or seek care. The evaluation and treatment of FI can be also hindered by lack of understanding of the current management options among healthcare providers and how they impact on QOL. This article provides a comprehensive review on the impact of FI and its treatment on QOL in women. PMID:25776296

Expanding the definition of addiction: DSM-5 vs. ICD-11.

PubMed

Grant, Jon E; Chamberlain, Samuel R

2016-08-01

While considerable efforts have been made to understand the neurobiological basis of substance addiction, the potentially "addictive" qualities of repetitive behaviors, and whether such behaviors constitute "behavioral addictions," is relatively neglected. It has been suggested that some conditions, such as gambling disorder, compulsive stealing, compulsive buying, compulsive sexual behavior, and problem Internet use, have phenomenological and neurobiological parallels with substance use disorders. This review considers how the issue of "behavioral addictions" has been handled by latest revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), leading to somewhat divergent approaches. We also consider key areas for future research in order to address optimal diagnostic classification and treatments for such repetitive, debilitating behaviors.

Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management.

PubMed

Cappellini, Maria Domenica; Comin-Colet, Josep; de Francisco, Angel; Dignass, Axel; Doehner, Wolfram; Lam, Carolyn S; Macdougall, Iain C; Rogler, Gerhard; Camaschella, Clara; Kadir, Rezan; Kassebaum, Nicholas J; Spahn, Donat R; Taher, Ali T; Musallam, Khaled M

2017-10-01

Iron deficiency, even in the absence of anemia, can be debilitating, and exacerbate any underlying chronic disease, leading to increased morbidity and mortality. Iron deficiency is frequently concomitant with chronic inflammatory disease; however, iron deficiency treatment is often overlooked, partially due to the heterogeneity among clinical practice guidelines. In the absence of consistent guidance across chronic heart failure, chronic kidney disease and inflammatory bowel disease, we provide practical recommendations for iron deficiency to treating physicians: definition, diagnosis, and disease-specific diagnostic algorithms. These recommendations should facilitate appropriate diagnosis and treatment of iron deficiency to improve quality of life and clinical outcomes. © 2017 The Authors American Journal of Hematology Published by Wiley Periodicals, Inc.

Burning Mouth Syndrome: Aetiopathogenesis and Principles of Management.

PubMed

Feller, L; Fourie, J; Bouckaert, M; Khammissa, R A G; Ballyram, R; Lemmer, J

2017-01-01

Burning mouth syndrome (BMS) is a chronic debilitating oral condition characterised by a burning sensation of the oral mucosa in an otherwise apparently normal person. Its aetiology and pathogenesis are obscure, but both psychogenic factors and peripheral and central neuropathies appear to be implicated. There is no cure for BMS, and treatment with either local or systemic medications focuses on the relief of symptoms and on improving quality of life. In recalcitrant cases, psychological/psychiatric intervention may be helpful. In order to improve treatment outcomes, a better understanding of the pathogenesis of this syndrome might provide a basis for the development of more effective management strategies. In this short review, we discuss current knowledge of the diagnosis, aetiopathogenesis, and management of BMS.

Towards the development of improved tests for negative symptoms of schizophrenia in a validated animal model.

PubMed

Sahin, Ceren; Doostdar, Nazanin; Neill, Joanna C

2016-10-01

Negative symptoms in schizophrenia remain an unmet clinical need. There is no licensed treatment specifically for this debilitating aspect of the disorder and effect sizes of new therapies are too small to make an impact on quality of life and function. Negative symptoms are multifactorial but often considered in terms of two domains, expressive deficit incorporating blunted affect and poverty of speech and avolition incorporating asociality and lack of drive. There is a clear need for improved understanding of the neurobiology of negative symptoms which can be enabled through the use of carefully validated animal models. While there are several tests for assessing sociability in animals, tests for blunted affect in schizophrenia are currently lacking. Two paradigms have recently been developed for assessing negative affect of relevance to depression in rats. Here we assess their utility for studying negative symptoms in schizophrenia using our well validated model for schizophrenia of sub-chronic (sc) treatment with Phencyclidine (PCP) in adult female rats. Results demonstrate that sc PCP treatment produces a significant negative affect bias in response to a high value reward in the optimistic and affective bias tests. Our results are not easily explained by the known cognitive deficits induced by sc PCP and support the hypothesis of a negative affective bias in this model. We suggest that further refinement of these two tests will provide a means to investigate the neurobiological basis of negative affect in schizophrenia, thus supporting the assessment of efficacy of new targets for this currently untreated symptom domain. Copyright © 2016 Elsevier B.V. All rights reserved.

An overview of the use of compression in lower-limb chronic oedema.

PubMed

Elwell, Rebecca

2016-01-01

Chronic oedema in the lower limbs can be a debilitating condition and has a negative effect on a patient's quality of life. As yet, there is no known cure for this condition; however, it can be controlled and managed, and its recurrence can be prevented. One of the most common and successful ways of managing this condition is the use of compression hosiery. With an expanding knowledge base of compression hosiery, lymphoedema specialists are now able to address historical problems of poor fit and concordance. Moreover, there is a wide choice of garments available today for clinicians to use, that not only help to control and treat the oedema, but have also improved patients' quality of life because the garments are comfortable and inconspicuous. Evidence has shown that concordance is greatly increased when patients participate in their treatment and help to decide on the most suitable garment for themselves. This article gives an overview of the use of compression garments when treating lower-limb chronic oedema in patients, and explains the aspects to bear in mind when choosing and prescribing compression hosiery.

Monitoring and Correcting Autonomic Function Aboard Mir: NASA Technology Used in Space and on Earth to Facilitate Adaptation

NASA Technical Reports Server (NTRS)

Cowings, P.; Toscano, W.; Taylor, B.; DeRoshia, C.; Kornilova, L.; Koslovskaya, I.; Miller, N.

1999-01-01

The broad objective of the research was to study individual characteristics of human adaptation to long duration spaceflight and possibilities of their correction using autonomic conditioning. The changes in autonomic state during adaptation to microgravity can have profound effects on the operational efficiency of crewmembers and may result in debilitating biomedical symptoms. Ground-based and inflight experiment results showed that certain responses of autonomic nervous system were correlated with, or consistently preceded, reports of performance decrements or the symptoms. Autogenic-Feedback-Training Exercise (AFTE) is a physiological conditioning method that has been used to train people to voluntary control several of their own physiological responses. The specific objectives were: 1) To study human autonomic nervous system (ANS) responses to sustained exposure to microgravity; 2) To study human behavior/performance changes related to physiology; 3) To evaluate the effectiveness of preflight autonomic conditioning (AFTE) for facilitating adaptation to space and readaptation to Earth; and 4) To archive these data for the NASA Life Sciences Data Archive and thereby make this information available to the international scientific community.

Struggling toward reward: Recent experience of anhedonia interacts with motivation to predict reward pursuit in the face of a stressful manipulation.

PubMed

Bryant, Jessica; Winer, E Samuel; Salem, Taban; Nadorff, Michael R

2017-01-01

Anhedonia, or the loss of interest and/or pleasure, is a core symptom of depression. Individuals experiencing anhedonia have difficulty motivating themselves to pursue rewarding stimuli, which can result in dysfunction. Action orientation is a motivational factor that might interact with anhedonia to potentially buffer against this dysfunction, as action-oriented individuals upregulate positive affect to quickly motivate themselves to complete goals in the face of stress. The Effort-Expenditure for Rewards Task (EEfRT) is a promising new method for examining differences in motivation in individuals experiencing anhedonia. In the EEfRT, participants choose either easier tasks associated with smaller monetary rewards or harder tasks associated with larger monetary rewards. We examined the relationship between action orientation and EEfRT performance following a negative mood induction in a sample with varying levels of anhedonia. There were two competing hypotheses: (1) action orientation would act as a buffer against anhedonia such that action-oriented individuals, regardless of anhedonic symptoms, would be motivated to pursue greater rewards despite stress, or (2) anhedonia would act as a debilitating factor such that individuals with elevated anhedonic symptoms, regardless of action orientation, would not pursue greater rewards. We examined these hypotheses via Generalized Estimating Equations and found an interaction between anhedonia and action orientation. At low levels of anhedonia, action orientation was associated with effort for reward, but this relationship was not present at high levels of anhedonia. Thus, at low levels of anhedonia, action orientation acted as a buffer against stress, but at high levels, anhedonia debilitated action orientation so that it was no longer a promotive factor.

Application of Dynamic Mode Decomposition: Temporal Evolution of Flow Structures in an Aneurysm

NASA Astrophysics Data System (ADS)

Conlin, William; Yu, Paulo; Durgesh, Vibhav

2017-11-01

An aneurysm is an enlargement of a weakened arterial wall that can be fatal or debilitating on rupture. Aneurysm hemodynamics is integral to developing an understanding of aneurysm formation, growth, and rupture. The flow in an aneurysm exhibits complex fluid dynamics behavior due to an inherent unsteady inflow condition and its interactions with large-scale flow structures present in the aneurysm. The objective of this study is to identify the large-scale structures in the aneurysm, study temporal behavior, and quantify their interaction with the inflow condition. For this purpose, detailed Particle Image Velocimetry (PIV) measurements were performed at the center plane of an idealized aneurysm model for a range of inflow conditions. Inflow conditions were precisely controlled using a ViVitro SuperPump system. Dynamic Modal Decomposition (DMD) of the velocity field was used to identify coherent structures and their temporal behavior. DMD was successful in capturing the large-scale flow structures and their temporal behavior. A low dimensional approximation to the flow field was obtained with the most relevant dynamic modes and was used to obtain temporal information about the coherent structures and their interaction with the inflow, formation, evolution, and growth.

Intravenous immunogobulin therapy for severe gastrointestinal involvement in systemic sclerosis.

PubMed

Clark, Kristina E N; Etomi, Oseme; Denton, Christopher P; Ong, Voon H; Murray, Charles D

2015-01-01

Gastrointestinal (GI) disease is one of the major causes of morbidity in patients with systemic sclerosis (SSc). The most common manifestation of GI disease is oesophageal involvement affecting 70-90% of patients. Severe GI disease is uncommon, but results in symptoms such as early satiety, pseudo-obstruction, weight loss and malnutrition. The pathogenesis is relatively poorly understood, and management focuses on symptomatic control rather than immunomodulation. We describe two cases of patients with SSc myositis overlap syndrome with severe GI involvement who demonstrated improvements in swallowing, early satiety and diarrhoea following the administration of intravenous immunoglobulin (IVIg). Clinical data related to the two cases were collected by review of medical records. GI complications range from mild symptoms to debilitating and life threatening. We propose that IVIg may have an immunomodulatory effect in a subset of patients with SSc myositis overlap syndrome.

Managing outbreaks of norovirus in an NHS hospital.

PubMed

Aziz, Ann-Marie

Noroviruses are highly infectious and easily transmitted by contact with contaminated surfaces and objects, as airborne particles and by contact between individuals. While illness caused by norovirus is usually self-limiting, it can be serious in very young and elderly people, or in those who are debilitated or have a serious illness; they may require hospital treatment. Norovirus outbreaks in hospitals create significant disruption to patient care. They also have huge cost implications for NHS trusts through staff absence and ward closures, which are extremely disruptive and increase pressures on bed demand. The three most important actions during an outbreak of norovirus are effective hand hygiene, isolation of affected patients and enhanced cleaning of the environment. This article outlines how to identify norovirus infection and outbreaks, and describes how an acute trust managed outbreaks of norovirus and the procedures it adopted.

Opioid-Induced Bowel Dysfunction

PubMed Central

Cheng, Vivian; Lembo, Anthony

2013-01-01

Opioid-induced bowel dysfunction (OIBD) is a potentially debilitating side effect of chronic opioid use. It refers to a collection of primarily gastrointestinal motility disorders induced by opioids, of which opioid-induced constipation (OIC) is the most common. Management of OIBD is difficult, and affected patients will often limit their opioid intake at the expense of experiencing more pain, to reduce the negative impact of OIBD on their quality of life. Effective pharmacologic therapy for OIC is considered an unmet need and several agents have recently been given priority review and approval for OIC. Furthermore, multiple agents currently in development show promise in treating OIC without significant impact on analgesia or precipitation of withdrawal symptoms. The approval and availability of such medications would represent a significant improvement in the management of OIC and OIBD in patients with chronic pain. PMID:23900996

The effect of laparoscopic Roux-en-Y gastric bypass on fibromyalgia.

PubMed

Saber, Alan A; Boros, Michael J; Mancl, Tara; Elgamal, Mohamed H; Song, Susrap; Wisadrattanapong, Therawat

2008-06-01

Fibromyalgia is a chronic debilitating disorder affecting 3-5% of the US population. Treatment of this disorder is a challenge. The incidental finding of improvement of fibromyalgia following laparoscopic Roux-en-Y gastric bypass stimulated us to study this phenomenon. A retrospective chart review of patients with fibromyalgia who underwent laparoscopic Roux-en-Y gastric bypass. Postoperative decrease in median of BMI from 49.4 to 29.7 was significant (p value = 0.0010). This was associated with statistically significant improvement in median of pain score (p value = 0.0010) and median points of tenderness (p value = 0.0010). Significant weight loss following laparoscopic Roux-en-Y gastric bypass is associated with resolution or improvement of fibromyalgia. Consequently, the bariatric surgeon should be a member of the multidisciplinary team approach for treating fibromyalgia.

PGD for all cystic fibrosis carrier couples: novel strategy for preventive medicine and cost analysis.

PubMed

Tur-Kaspa, I; Aljadeff, G; Rechitsky, S; Grotjan, H E; Verlinsky, Y

2010-08-01

Over 1000 children affected with cystic fibrosis (CF) are born annually in the USA. Since IVF with preimplantation genetic diagnosis (PGD) is an alternative to raising a sick child or to aborting an affected fetus, a cost-benefit analysis was performed for a national IVF-PGD program for preventing CF. The amount spent to deliver healthy children for all CF carrier-couples by IVF-PGD was compared with the average annual and lifetime direct medical costs per CF patient avoided. Treating annually about 4000 CF carrier-couples with IVF-PGD would result in 3715 deliveries of non-affected children at a cost of $57,467 per baby. Because the average annual direct medical cost per CF patient was $63,127 and life expectancy is 37 years, savings would be $2.3 million per patient and $2.2 billion for all new CF patients annually in lifetime treatment costs. Cumulated net saving of an IVF-PGD program for all carrier-couples for 37 years would be $33.3 billion. A total of 618,714 cumulative years of patients suffering because of CF and thousands of abortions could be prevented. A national IVF-PGD program is a highly cost-effective novel modality of preventive medicine and would avoid most births of individuals affected with debilitating genetic disease. 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Rapid Remission of Conditioned Fear Expression with Extinction Training Paired with Vagus Nerve Stimulation

PubMed Central

Peña, David F.; Engineer, Navzer D.; McIntyre, Christa K.

2012-01-01

Background Fearful experiences can produce long-lasting and debilitating memories. Extinction of conditioned fear requires consolidation of new memories that compete with fearful associations. In human subjects, as well as rats, posttraining stimulation of the vagus nerve enhances memory consolidation. Subjects with posttraumatic stress disorder (PTSD) show impaired extinction of conditioned fear. The objective of this study was to determine whether vagus nerve stimulation (VNS) can enhance the consolidation of extinction of conditioned fear. Methods Male Sprague-Dawley rats were trained on an auditory fear conditioning task followed by 1–10 days of extinction training. Treatment with vagus nerve or sham stimulation was administered concurrently with exposure to the fear conditioned stimulus. Another group was given VNS and extinction training but the VNS was not paired with exposure to conditioned cues. Retention of fear conditioning was tested 24 hours after each treatment. Results VNS paired with exposure to conditioned cues enhanced the extinction of conditioned fear. After a single extinction trial, rats given VNS stimulation demonstrated a significantly lower level of freezing, compared to that of sham controls. When extinction trials were extended to 10 days, paired VNS accelerated extinction of the conditioned response. Conclusions Extinction paired with VNS is more rapid than extinction paired with sham stimulation. As it is currently approved by the Federal Food and Drug Administration for depression and seizure prevention, VNS is a readily-available and promising adjunct to exposure therapy for the treatment of severe anxiety disorders. PMID:23245749

Catechol-O-Methyltransferase moderates effect of stress mindset on affect and cognition

PubMed Central

Akinola, Modupe; Turnwald, Bradley P.; Kaptchuk, Ted J.; Hall, Kathryn T.

2018-01-01

There is evidence that altering stress mindset—the belief that stress is enhancing vs. debilitating—can change cognitive, affective and physiological responses to stress. However individual differences in responsiveness to stress mindset manipulations have not been explored. Given the previously established role of catecholamines in both placebo effects and stress, we hypothesized that genetic variation in catechol-O-methyltransferase (COMT), an enzyme that metabolizes catecholamines, would moderate responses to an intervention intended to alter participants’ mindsets about stress. Participants (N = 107) were exposed to a stress mindset manipulation (videos highlighting either the enhancing or debilitating effects of stress) prior to engaging in a Trier Social Stress task and subsequent cognitive tasks. The associations of the COMT rs4680 polymorphism with the effect of stress mindset video manipulations on cognitive and affective responses were examined. Genetic variation at rs4680 modified the effects of stress mindset on affective and cognitive responses to stress. Individuals homozygous for rs4680 low-activity allele (met/met) were responsive to the stress-is-enhancing mindset manipulation as indicated by greater increases in positive affect, improved cognitive functioning, and happiness bias in response to stress. Conversely, individuals homozygous for the high-activity allele (val/val) were not as responsive to the stress mindset manipulation. These results suggest that responses to stress mindset intervention may vary with COMT genotype. These findings contribute to the understanding of gene by environment interactions for mindset interventions and stress reactivity and therefore warrant further investigations. PMID:29677196

The Chicken or the Egg? The Direction of the Relationship Between Mathematics Anxiety and Mathematics Performance.

PubMed

Carey, Emma; Hill, Francesca; Devine, Amy; Szücs, Dénes

2015-01-01

This review considers the two possible causal directions between mathematics anxiety (MA) and poor mathematics performance. Either poor maths performance may elicit MA (referred to as the Deficit Theory), or MA may reduce future maths performance (referred to as the Debilitating Anxiety Model). The evidence is in conflict: the Deficit Theory is supported by longitudinal studies and studies of children with mathematical learning disabilities, but the Debilitating Anxiety Model is supported by research which manipulates anxiety levels and observes a change in mathematics performance. It is suggested that this mixture of evidence might indicate a bidirectional relationship between MA and mathematics performance (the Reciprocal Theory), in which MA and mathematics performance can influence one another in a vicious cycle.

Multilevel context of depression in two American Indian tribes.

PubMed

Kaufman, Carol E; Beals, Janette; Croy, Calvin; Jiang, Luohua; Novins, Douglas K

2013-12-01

Depression is a major debilitating disease. For American Indians living in tribal reservations, who endure disproportionately high levels of stress and poverty often associated with depression, determining the patterns and correlates is key to appropriate clinical assessment and intervention development. Yet little attention has been given to the cultural context of correlates for depression, including the influence of family, cultural traditions or practices, or community conditions. We used data from a large representative psychiatric epidemiological study among American Indians in 2 reservation communities to estimate nested individual and multilevel models of past-year major depressive episode (MDE) accounting for family, cultural, and community conditions. We found that models including culturally informed individual-level measures significantly improved the model fit over demographics alone. We found significant community-level variation in the probability of past-year MDE diagnosis in 1 tribe even after accounting for individual-level characteristics. Accounting for culture, family, and community context will facilitate research, clinician assessment, and treatment of depression in diverse settings.

Transient acidosis while retrieving a fear-related memory enhances its lability

PubMed Central

Du, Jianyang; Price, Margaret P; Taugher, Rebecca J; Grigsby, Daniel; Ash, Jamison J; Stark, Austin C; Hossain Saad, Md Zubayer; Singh, Kritika; Mandal, Juthika; Wemmie, John A; Welsh, Michael J

2017-01-01

Attenuating the strength of fearful memories could benefit people disabled by memories of past trauma. Pavlovian conditioning experiments indicate that a retrieval cue can return a conditioned aversive memory to a labile state. However, means to enhance retrieval and render a memory more labile are unknown. We hypothesized that augmenting synaptic signaling during retrieval would increase memory lability. To enhance synaptic transmission, mice inhaled CO2 to induce an acidosis and activate acid sensing ion channels. Transient acidification increased the retrieval-induced lability of an aversive memory. The labile memory could then be weakened by an extinction protocol or strengthened by reconditioning. Coupling CO2 inhalation to retrieval increased activation of amygdala neurons bearing the memory trace and increased the synaptic exchange from Ca2+-impermeable to Ca2+-permeable AMPA receptors. The results suggest that transient acidosis during retrieval renders the memory of an aversive event more labile and suggest a strategy to modify debilitating memories. DOI: http://dx.doi.org/10.7554/eLife.22564.001 PMID:28650315

Estimation of limb adiposity by bioimpedance spectroscopy in lymphoedema

NASA Astrophysics Data System (ADS)

Ward, L. C.; Essex, T.; Gaw, R.; Czerniec, S.; Dylke, E.; Abell, B.; Kilbreath, S. L.

2013-04-01

Lymphoedema is a chronic debilitating condition that may occur in approximately 25% of women treated for breast cancer. As the condition progresses, accumulated lymph fluid becomes fibrotic with infiltration of adipose tissue. Bioelectrical impedance spectroscopy is the preferred method for early detection of lymphoedema based on the measurement of impedance of extracellular fluid. The present study assessed whether these impedance measurements could also be used to estimate the adipose tissue content of the arm based on a model previously used to predict whole body composition. Estimates of arm adipose tissue in a cohort of women with lymphoedema were found to be highly correlated (r > 0.82) with measurements of adipose tissue obtained using the reference method of dual energy X-ray absorptiometry. Paired t-tests confirmed that there was no significant difference between the adipose tissue volumes obtained by the two methods. These results support the view that the method shows promise for the estimation of arm adiposity in lymphoedema.

Key issues in the prevention of obesity.

PubMed

Gill, T P

1997-01-01

Obesity is a serious, chronic medical condition which is associated with a wide range of debilitating and life-threatening conditions. It imposes huge financial burdens on health care systems and the community at large. Obesity develops over time and once it has done so, is difficult to treat. Therefore, the prevention of weight gain offers the only truly effective means of controlling obesity. Very little research has directly addressed the issue of obesity prevention and previous efforts to prevent obesity amongst individuals, groups or whole communities have had very limited success. However, we have learned sufficient from past preventive activities to realise that the management of obesity will require a comprehensive range of strategies with actions that target those with existing weight problems, those at high risk of developing obesity as well as the community as a whole. The prevention and management of obesity in children should be considered a priority as there is a high risk of persistence into adulthood.

Multilevel Context of Depression in Two American Indian Tribes

PubMed Central

Kaufman, Carol E.; Beals, Janette; Croy, Calvin; Jiang, Luohua; Novins, Douglas K.

2015-01-01

Objective Depression is a major debilitating disease. For American Indians living in tribal reservations, who endure disproportionately high levels of stress and poverty often associated with depression, determining the patterns and correlates is key to appropriate clinical assessment and intervention development. Yet, little attention has been given to the cultural context of correlates for depression, including the influence of family, cultural traditions or practices, or community conditions. Method We used data from a large representative psychiatric epidemiological study among American Indians in two reservation communities to estimate nested individual and multilevel models of past-year Major Depressive Episode (MDE) accounting for family, cultural, and community conditions. Results We found that models including culturally informed individual-level measures significantly improved the model fit over demographics alone. We found significant community-level variation in the probability of past-year MDE diagnosis in one tribe even after accounting for individual-level characteristics. Conclusions Accounting for culture, family, and community context will facilitate research, clinician assessment, and treatment of depression in diverse settings. PMID:24016293

A review of the clinical implications of bisphosphonates in dentistry.

PubMed

Borromeo, G L; Tsao, C E; Darby, I B; Ebeling, P R

2011-03-01

Bisphosphonates are drugs that suppress bone turnover and are commonly prescribed to prevent skeletal related events in malignancy and for benign bone diseases such as osteoporosis. Bisphosphonate associated jaw osteonecrosis (ONJ) is a potentially debilitating, yet poorly understood condition. A literature review was undertaken to review the dental clinical implications of bisphosphonates. The present paper briefly describes the postulated pathophysiology of ONJ and conditions with similar clinical presentations. The implications of bisphosphonates for implantology, periodontology, orthodontics and endodontics are reviewed. Whilst bisphosphonates have potential positive applications in some clinical settings, periodontology particularly, further clinical research is limited by the risk of ONJ. Prevention and management are reviewed, including guidelines for reducing cumulative intravenous bisphosphonate dose, cessation of bisphosphonates prior to invasive dental treatment or after ONJ development, and the use of serum beta-CTX-1 in assessing risk. In the context of substantial uncertainty, the implications of bisphosphonate use in the dental clinical setting are still being determined. © 2010 Australian Dental Association.

Are Medications Involved in Vision and intracranial Pressure Changes Seen in Spaceflight?

NASA Technical Reports Server (NTRS)

Wotring, V. E.

2016-01-01

Some crewmembers have experienced changes in their vision after long-duration spaceflight on the ISS. These impairments include visual performance decrements, development of cotton-wool spots or choroidal folds, optic-disc edema, optic nerve sheath distention, and/or posterior globe flattening with varying degrees of severity and permanence. These changes are now used to define the visual impairment/intracranial pressure (VIIP) syndrome. The reasons for these potentially debilitating medical issues are currently unknown. The potential role of administered medications has not yet been examined, but it is known that many medications can have side effects that are similar to VIIP symptoms. Some medications raise blood pressure, which can affect intracranial pressure. Many medications that act in the central nervous system can affect intracranial pressures and/or vision. About 40% of the medications in the ISS kit are known to cause side effects involving changes in blood pressure, intracranial pressure and/or vision. For this reason, we proposed an investigation of the potential relationship between ISS medications and their risk of causing or exacerbating VIIP-like symptoms. The purpose of this study was to use medication usage records for affected and unaffected crew to determine if use of particular medications seemed to correlate with VIIP occurrence or severity.

Cognitive dysfunction in Body Dysmorphic Disorder: New implications for nosological systems & neurobiological models

PubMed Central

Jefferies-Sewell, K; Chamberlain, SR; Fineberg, NA; Laws, KR

2017-01-01

Background Body dysmorphic disorder (BDD) is a debilitating disorder, characterised by obsessions and compulsions relating specifically to perceived appearance, newly classified within the DSM-5 Obsessive-Compulsive and Related Disorders grouping. Until now, little research has been conducted into the cognitive profile of this disorder. Materials and Methods Participants with BDD (n=12) and healthy controls (n=16) were tested using a computerised neurocognitive battery investigating attentional set-shifting (Intra/Extra Dimensional Set Shift Task), decision-making (Cambridge Gamble Task), motor response-inhibition (Stop-Signal Reaction Time Task) and affective processing (Affective Go-No Go Task). The groups were matched for age, IQ and education. Results In comparison to controls, patients with BDD showed significantly impaired attentional set shifting, abnormal decision-making, impaired response inhibition and greater omission and commission errors on the emotional processing task. Conclusions Despite the modest sample size, our results showed that individuals with BDD performed poorly compared to healthy controls on tests of cognitive flexibility, reward and motor impulsivity and affective processing. Results from separate studies in OCD patients suggest similar cognitive dysfunction. Therefore, these findings are consistent with the re-classification of BDD alongside OCD. These data also hint at additional areas of decision-making abnormalities that might contribute specifically to the psychopathology of BDD. PMID:27899165

Affective dysfunction in a mouse model of Rett syndrome: Therapeutic effects of environmental stimulation and physical activity.

PubMed

Kondo, Mari A; Gray, Laura J; Pelka, Gregory J; Leang, Sook-Kwan; Christodoulou, John; Tam, Patrick P L; Hannan, Anthony J

2016-02-01

Rett syndrome (RTT) is a neurodevelopmental disorder associated with mutations in the X-linked gene encoding methyl-CpG-binding protein 2 (MeCP2) and consequent dysregulation of brain maturation. Patients suffer from a range of debilitating physical symptoms, however, behavioral and emotional symptoms also severely affect their quality of life. Here, we present previously unreported and clinically relevant affective dysfunction in the female heterozygous Mecp2(tm1Tam) mouse model of RTT (129sv and C57BL6 mixed background). The affective dysfunction and aberrant anxiety-related behavior of the Mecp2(+/-) mice were found to be reversible with environmental enrichment (EE) from 4 weeks of age. The effect of exercise alone (via wheel running) was also explored, providing the first evidence that increased voluntary physical activity in an animal model of RTT is beneficial for some phenotypes. Mecp2(+/-) mutants displayed elevated corticosterone despite decreased Crh expression, demonstrating hypothalamic-pituitary-adrenal axis dysregulation. EE of Mecp2(+/-) mice normalized basal serum corticosterone and hippocampal BDNF protein levels. The enrichment-induced rescue appears independent of the transcriptional regulation of the MeCP2 targets Bdnf exon 4 and Crh. These findings provide new insight into the neurodevelopmental role of MeCP2 and pathogenesis of RTT, in particular the affective dysfunction. The positive outcomes of environmental stimulation and physical exercise have implications for the development of therapies targeting the affective symptoms, as well as behavioral and cognitive dimensions, of this devastating neurodevelopmental disorder. © 2015 Wiley Periodicals, Inc.

Developmental vitamin D deficiency and schizophrenia: the role of animal models.

PubMed

Schoenrock, S A; Tarantino, L M

2016-01-01

Schizophrenia is a debilitating neuropsychiatric disorder that affects 1% of the US population. Based on twin and genome-wide association studies, it is clear that both genetics and environmental factors increase the risk for developing schizophrenia. Moreover, there is evidence that conditions in utero, either alone or in concert with genetic factors, may alter neurodevelopment and lead to an increased risk for schizophrenia. There has been progress in identifying genetic loci and environmental exposures that increase risk, but there are still considerable gaps in our knowledge. Furthermore, very little is known about the specific neurodevelopmental mechanisms upon which genetics and the environment act to increase disposition to developing schizophrenia in adulthood. Vitamin D deficiency during the perinatal period has been hypothesized to increase risk for schizophrenia in humans. The developmental vitamin D (DVD) deficiency hypothesis of schizophrenia arises from the observation that disease risk is increased in individuals who are born in winter or spring, live further from the equator or live in urban vs. rural settings. These environments result in less exposure to sunlight, thereby reducing the initial steps in the production of vitamin D. Rodent models have been developed to characterize the behavioral and developmental effects of DVD deficiency. This review focuses on these animal models and discusses the current knowledge of the role of DVD deficiency in altering behavior and neurobiology relevant to schizophrenia. © 2015 John Wiley & Sons Ltd and International Behavioural and Neural Genetics Society.

Foot overuse diseases in rock climbing: an epidemiologic study.

PubMed

Buda, Roberto; Di Caprio, Francesco; Bedetti, Letizia; Mosca, Massimiliano; Giannini, Sandro

2013-01-01

Literature examining the incidence of foot diseases in rock climbing is limited to traumatic injuries. We examined a large sample of climbers, assessed the chronic diseases of the foot, and correlated them with foot morphology, shoe type, and type of climbing practiced. Between May 1 and September 30, 2009, 144 climbers (mean age, 31.7 years) were examined to analyze the effect of rock climbing on the various foot diseases found at the time of the evaluation. Eighty-six percent of the climbers were affected by a pathologic condition. Nail disease was found in 65.3% of patients, followed by recurrent ankle sprains (27.8%), retrocalcaneal bursitis (19.4%), Achilles tendinitis (12.5%), metatarsalgia (12.5%), and plantar fasciitis (5.6%). Male sex, the use of high-type shoes, the high degree of climbing difficulty, and the competitive level were often related to the onset of foot diseases. Climbing shoes are usually smaller than common footwear. This "shoe-size reduction" averaged 2.3 sizes, forcing the foot into a supinated and cavus posture that favors lateral instability. The posterior edge of the shoe aperture produces increased pressure on the heel, with retrocalcaneal bursitis. Overuse foot diseases related to rock climbing are particularly frequent and debilitating. Detailed knowledge of these diseases and their predisposing factors may help us implement effective preventive or therapeutic measures, including changes in the type of climbing, correction of body weight, degree of difficulty, footwear, orthoses, and measures that maximize the support of the foot to the ground.

Inferring rubella outbreak risk from seroprevalence data in Belgium.

PubMed

Abrams, Steven; Kourkouni, Eleni; Sabbe, Martine; Beutels, Philippe; Hens, Niel

2016-12-07

Rubella is usually a mild disease for which infections often pass by unnoticed. In approximately 50% of the cases, there are no or only few clinical symptoms. However, rubella contracted during early pregnancy could lead to spontaneous abortion, to central nervous system defects, or to one of a range of other serious and debilitating conditions in a newborn such as the congenital rubella syndrome. Before the introduction of mass vaccination, rubella was a common childhood infection occurring all over the world. However, since the introduction of rubella antigen-containing vaccines, the incidence of rubella has declined dramatically in high-income countries. Recent large-scale mumps outbreaks, one of the components in the combined measles-mumps-rubella vaccine, occurring in countries throughout Europe with high vaccination coverage, provide evidence of pathogen-specific waning of vaccine-induced immunity and primary vaccine failure. In addition, recent measles outbreaks affecting populations with suboptimal vaccination coverages stress the importance of maintaining high vaccination coverages. In this paper, we focus on the assessment of rubella outbreak risk using a previously developed method to identify geographic regions of high outbreak potential. The methodology relies on 2006 rubella seroprevalence data and vaccination coverage data from Belgium and information on primary and secondary vaccine failure obtained from extensive literature reviews. We estimated the rubella outbreak risk in Belgium to be low, however maintaining high levels of immunisation and surveillance are of utmost importance to avoid future outbreaks. Copyright © 2016 Elsevier Ltd. All rights reserved.

The operative management of children with complex perianal Crohn's disease.

PubMed

Seemann, Natashia M; King, Sebastian K; Elkadri, Abdul; Walters, Thomas; Fish, Joel; Langer, Jacob C

2016-12-01

Perianal Crohn's disease (PCD) can affect both quality of life and psychological wellbeing. A subset of pediatric patients with complex PCD require surgical intervention, although appropriate timing and treatment regimens remain unclear. This study aimed to describe a large pediatric cohort in a tertiary center to determine the range of surgical management in children with complex PCD. A retrospective review of children requiring operative intervention for PCD over 13 years (2002-2014) was performed. PCD was divided into simple and complex based on the type of surgical procedure, and the two groups were compared. The 57 children were divided into two groups: the simple group (N=43) underwent abscess drainage ± seton insertion alone, and the complex group (N=14) underwent loop ileostomy ± more extensive surgery. In the complex group, females were more predominant (57% of complex vs 30% of simple), and the average age at diagnosis was lower. Anti-TNF therapy was utilized in 79.1% of simple and 100% of complex PCD. All 14 complex patients underwent a defunctioning ileostomy, with 7 requiring further operations (subtotal colectomy=4, proctocolectomy ± anal sparing=5, plastic surgery reconstruction with perineal flap/graft=4). Complex PCD represents a small but challenging subset of patients in which major surgical intervention may be necessary to alleviate the symptoms of this debilitating condition. retrospective case study with no control group - level IV. Copyright © 2016 Elsevier Inc. All rights reserved.

Nicotinic receptors as CNS targets for Parkinson's disease.

PubMed

Quik, Maryka; Bordia, Tanuja; O'Leary, Kathryn

2007-10-15

Parkinson's disease is a debilitating neurodegenerative movement disorder characterized by damage to the nigrostriatal dopaminergic system. Current therapies are symptomatic only and may be accompanied by serious side effects. There is therefore a continual search for novel compounds for the treatment of Parkinson's disease symptoms, as well as to reduce or halt disease progression. Nicotine administration has been reported to improve motor deficits that arise with nigrostriatal damage in parkinsonian animals and in Parkinson's disease. In addition, nicotine protects against nigrostriatal damage in experimental models, findings that have led to the suggestion that the reduced incidence of Parkinson's disease in smokers may be due to the nicotine in tobacco. Altogether, these observations suggest that nicotine treatment may be beneficial in Parkinson's disease. Nicotine interacts with multiple nicotinic receptor (nAChR) subtypes in the peripheral and central nervous system, as well as in skeletal muscle. Work to identify the subtypes affected in Parkinson's disease is therefore critical for the development of targeted therapies. Results show that striatal alpha6beta2-containing nAChRs are particularly susceptible to nigrostriatal damage, with a decline in receptor levels that closely parallels losses in striatal dopamine. In contrast, alpha4beta2-containing nAChRs are decreased to a much smaller extent under the same conditions. These observations suggest that development of nAChR agonists or antagonists targeted to alpha6beta2-containing nAChRs may represent a particularly relevant target for Parkinson's disease therapeutics.

Mirror therapy in complex regional pain syndrome type 1 of the upper limb in stroke patients.

PubMed

Cacchio, Angelo; De Blasis, Elisabetta; De Blasis, Vincenzo; Santilli, Valter; Spacca, Giorgio

2009-10-01

Complex regional pain syndrome type 1 (CRPSt1) of the upper limb is a painful and debilitating condition, frequent after stroke, and interferes with the rehabilitative process and outcome. However, treatments used for CRPSt1 of the upper limb are limited. . This randomized controlled study was conducted to compare the effectiveness on pain and upper limb function of mirror therapy on CRPSt1 of upper limb in patients with acute stroke. . Of 208 patients with first episode of unilateral stroke admitted to the authors' rehabilitation center, 48 patients with CRPSt1 of the affected upper limb were enrolled in a randomized controlled study, with a 6-month follow-up, and assigned to either a mirror therapy group or placebo control group. The primary end points were a reduction in the visual analogue scale score of pain at rest, on movement, and brush-induced tactile allodynia. The secondary end points were improvement in motor function as assessed by the Wolf Motor Function Test and Motor Activity Log. . The mean scores of both the primary and secondary end points significantly improved in the mirror group (P < .001). No statistically significant improvement was observed in any of the control group values (P > .001). Moreover, statistically significant differences after treatment (P < .001) and at the 6-month follow-up were found between the 2 groups. . The results indicate that mirror therapy effectively reduces pain and enhances upper limb motor function in stroke patients with upper limb CRPSt1.

The economic burden of meningitis to households in Kassena-Nankana district of Northern Ghana.

PubMed

Akweongo, Patricia; Dalaba, Maxwell A; Hayden, Mary H; Awine, Timothy; Nyaaba, Gertrude N; Anaseba, Dominic; Hodgson, Abraham; Forgor, Abdulai A; Pandya, Rajul

2013-01-01

To estimate the direct and indirect costs of meningitis to households in the Kassena-Nankana District of Ghana. A Cost of illness (COI) survey was conducted between 2010 and 2011. The COI was computed from a retrospective review of 80 meningitis cases answers to questions about direct medical costs, direct non-medical costs incurred and productivity losses due to recent meningitis incident. The average direct and indirect costs of treating meningitis in the district was GH¢152.55 (US$101.7) per household. This is equivalent to about two months minimum wage earned by Ghanaians in unskilled paid jobs in 2009. Households lost 29 days of work per meningitis case and thus those in minimum wage paid jobs lost a monthly minimum wage of GH¢76.85 (US$51.23) due to the illness. Patients who were insured spent an average of GH¢38.5 (US$25.67) in direct medical costs whiles the uninsured patients spent as much as GH¢177.9 (US$118.6) per case. Patients with sequelae incurred additional costs of GH¢22.63 (US$15.08) per case. The least poor were more exposed to meningitis than the poorest. Meningitis is a debilitating but preventable disease that affects people living in the Sahel and in poorer conditions. The cost of meningitis treatment may further lead to impoverishment for these households. Widespread mass vaccination will save households' an equivalent of GH¢175.18 (US$117) and impairment due to meningitis.

Hyperglycemia and diabetes mellitus are related to vestibular organs dysfunction: truth or suggestion? A literature review.

PubMed

Gioacchini, Federico Maria; Albera, Roberto; Re, Massimo; Scarpa, Alfonso; Cassandro, Claudia; Cassandro, Ettore

2018-06-23

Diabetes mellitus is an independent risk factor for falling, particularly in the elderly. Due to chronic hyperglycemia and hyperinsulinemia patients with diabetes mellitus may have neurological deficits as peripheral neuropathy that is a debilitating micro-vascular complication affecting the proximal and distal peripheral sensory and motor nerves. Sensory neuropathy is prominent and represents the chief contributor to postural instability in diabetic subjects. Diabetic retinopathy is another complication consequent to a breakdown of the inner blood-retinal barrier with accumulation of extracellular fluids in the macula and growth of new vessels causing retinal detachment. Together peripheral neuropathy and retinopathy contribute to increase the risk of falls in diabetic patients, but a certain vestibular organs impairment should not be underestimated. Nevertheless, the exact mechanism and localization of peripheral vestibular damage consequent to chronic hyperglycemia and hyperinsulinemia are currently not still understood. Moreover it is not defined the possible role of these two blood conditions in worsening the prognosis of typical vestibular pathologies like "benign paroxysmal positional vertigo" and "Meniere disease". The aim of this review was to retrieve all studies investigating about the balance system alterations in patients suffering of diabetes. A search thorough Ovid MEDLINE was performed to enroll all eligible articles. Fourteen studies comprising a total of 1364 patients were included and analyzed in detail. On the basis of data reported in our review it appears plausible to hypothesize a direct connection among chronic hyperglycemic/hyperinsulinemic damage and peripheral vestibular organ dysfunction.

Double autologous lymph node transplantation (ALNT) at the level of the knee and inguinal region for advanced lymphoedema of the lower limb (elephantiasis).

PubMed

Gómez Martín, C; Murillo, C; Maldonado, A A; Cristóbal, L; Fernández-Cañamaque, J L

2014-02-01

Primary lower-limb lymphoedema is a chronic, progressive and debilitating condition with a difficult management, especially in advanced cases (elephantiasis). Recently, autologous lymph node transplantation (ALNT) appears to be a promising treatment for extremity lymphoedema. A case of a double ALNT for an advanced primary lower-limb lymphoedema is here reported: a contralateral inguinal lymph node flap was transferred to the knee and, in a second surgery, a thoracic lymph node flap was transplanted to the inguinal region. Clinical outcomes at 5 months postoperatively are very satisfactory with reduction in limb circumferences and improvement in skin quality and social impairment. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Molecular and Cellular Mechanisms that Initiate Pain and Itch

PubMed Central

Luo, Jialie; Feng, Jing; Liu, Shenbin; Walters, Edgar T.

2015-01-01

Somatosensory neurons mediate our sense of touch. They are critically involved in transducing pain and itch sensations under physiological and pathological conditions, along with other skin resident cells. Tissue damage and inflammation can produce a localized or systemic sensitization of our senses of pain and itch, which can facilitate our detection of threats in the environment. Although acute pain and itch protect us from further damage, persistent pain and itch are debilitating. Recent exciting discoveries have significantly advanced our knowledge of the roles of membrane-bound G protein-coupled receptors and ion channels in the encoding of information leading to pain and itch sensations. This review focuses on molecular and cellular events that are important in early stages of the biological processing that culminates in our senses of pain and itch. PMID:25894692

Microphthalmia and anophthalmia in Chuuk State, Federated States of Micronesia.

PubMed

Yomai, A A; Pavlin, B I

2010-04-01

Microphthalmia ('small eye') and anophthalmia ('no eye') are rare congenital defects of eye development. Previous studies utilizing a variety of methodologies have estimated their combined incidence at anywhere from 4 to 30 cases per 100,000 live births. In Chuuk, Federated States of Micronesia, there have been 42 cases detected since 1988, yielding an estimated incidence of 140 cases per 100,000. A number of putative genetic and environmental causes have previously been associated with microphthalmia and anophthalmia, including vitamin A deficiency. To date, it is unclear which of these factors may play a role in the alarmingly high rates observed in Chuuk. The Chuuk Division of Public Health has proposed a study to explore these potential causes, which will hopefully shed light on the prevention of these rare but debilitating conditions.

Targeting the Autophagy/Lysosomal Degradation Pathway in Parkinson's Disease.

PubMed

Rivero-Ríos, Pilar; Madero-Pérez, Jesús; Fernández, Belén; Hilfiker, Sabine

2016-01-01

Autophagy is a cellular quality control mechanism crucial for neuronal homeostasis. Defects in autophagy are critically associated with mechanisms underlying Parkinson's disease (PD), a common and debilitating neurodegenerative disorder. Autophagic dysfunction in PD can occur at several stages of the autophagy/lysosomal degradative machinery, contributing to the formation of intracellular protein aggregates and eventual neuronal cell death. Therefore, autophagy inducers may comprise a promising new therapeutic approach to combat neurodegeneration in PD. Several currently available FDA-approved drugs have been shown to enhance autophagy, which may allow for their repurposing for use in novel clinical conditions including PD. This review summarizes our current knowledge of deficits in the autophagy/lysosomal degradation pathways associated with PD, and highlight current approaches which target this pathway as possible means towards novel therapeutic strategies.

Fatal Serratia marcescens meningitis and myocarditis in a patient with an indwelling urinary catheter.

PubMed

Johnson, J S; Croall, J; Power, J S; Armstrong, G R

1998-10-01

Serratia marcescens is commonly isolated from the urine of patients with an indwelling urinary catheter and in the absence of symptoms is often regarded as a contaminant. A case of fatal Serratia marcescens septicaemia with meningitis, brain abscesses, and myocarditis discovered at necropsy is described. The patient was an 83 year old man with an indwelling urinary catheter who suffered from several chronic medical conditions and from whose urine Serratia marcescens was isolated at the time of catheterisation. Serratia marcescens can be a virulent pathogen in particular groups of patients and when assessing its significance in catheter urine specimens, consideration should be given to recognised risk factors such as old age, previous antibiotic treatment, and underlying chronic or debilitating disease, even in the absence of clinical symptoms.

Acute suppurative parotitis: a dreadful complication in elderly surgical patients.

PubMed

Lampropoulos, Pavlos; Rizos, Spyros; Marinis, Athanasios

2012-08-01

Acute suppurative parotitis (ASP) is a severe infection seen particularly in elderly surgical patients. Factors that increase the risk of ASP include post-operative dehydration, debilitating conditions, and immunosuppressed states. Case report and literature review. An 82-year-old female patient was admitted because of paralytic ileus, dehydration, and poor oral hygiene, and was in distress. After two days of hospitalization, the patient developed a progressive painful swelling of her right parotid gland and fever up to 39.0°C. Computed tomography scanning showed an abscess in the parotid gland. Because of her progressive clinical deterioration, the patient underwent operative drainage of the abscess and removal of the necrotic material. Unfortunately, she suffered multiple organ dysfunction syndrome and died. Acute suppurative parotitis requires prompt aggressive treatment that nevertheless may fail.

The Chicken or the Egg? The Direction of the Relationship Between Mathematics Anxiety and Mathematics Performance

PubMed Central

Carey, Emma; Hill, Francesca; Devine, Amy; Szücs, Dénes

2016-01-01

This review considers the two possible causal directions between mathematics anxiety (MA) and poor mathematics performance. Either poor maths performance may elicit MA (referred to as the Deficit Theory), or MA may reduce future maths performance (referred to as the Debilitating Anxiety Model). The evidence is in conflict: the Deficit Theory is supported by longitudinal studies and studies of children with mathematical learning disabilities, but the Debilitating Anxiety Model is supported by research which manipulates anxiety levels and observes a change in mathematics performance. It is suggested that this mixture of evidence might indicate a bidirectional relationship between MA and mathematics performance (the Reciprocal Theory), in which MA and mathematics performance can influence one another in a vicious cycle. PMID:26779093

Autogenic feedback training experiment: A preventative method for space motion sickness

NASA Technical Reports Server (NTRS)

Cowings, Patricia S.

1993-01-01

Space motion sickness is a disorder which produces symptoms similar to those of motion sickness on Earth. This syndrome has affected approximately 50 percent of all astronauts and cosmonauts exposed to microgravity in space, but it differs from what is commonly known as motion sickness in a number of critical ways. There is currently no ground-based method for predicting susceptibility to motion sickness in space. Antimotion sickness drugs have had limited success in preventing or counteracting symptoms in space, and frequently caused debilitating side effects. The objectives were: (1) to evaluate the effectiveness of Autogenic-Feedback Training as a countermeasure for space motion sickness; (2) to compare physiological data and in-flight symptom reports to ground-based motion sickness data; and (3) to predict susceptibility to space motion sickness based on pre-flight data of each treatment group crew member.

Drivers and challenges of personal health systems in workplace health promotion.

PubMed

Ilvesmäki, Antti

2007-01-01

Novel technologies such as wearable sensors, electronic health diaries and personalized web services are thought to have the potential to improve population health in a cost- efficient manner. The use of personal health systems in workplace health promotion is of particular interest, since the workplace often provides an excellent setting and infrastructure to support health- related interventions. Compared to the elderly or those already debilitated by disease, working people are also generally more capable of taking advantage of information technology. Extant research on the use of ICT in health promotion has recognized several functional and technological requirements, but relatively little is known about other factors that affect the commercialization and adoption of such systems. This paper attempts to identify some economic and structural drivers and challenges that may be relevant to the success of personal health systems in workplace health promotion.

Transdiagnostic Treatment of Bipolar Disorder and Comorbid Anxiety with the Unified Protocol: A Clinical Replication Series

PubMed Central

Ellard, Kristen K.; Deckersbach, Thilo; Sylvia, Louisa G.; Nierenberg, Andrew A.; Barlow, David H.

2013-01-01

Bipolar disorder (BD) is a chronic, debilitating disorder with recurrent manic and depressive episodes. Over 75% of bipolar patients have a current or lifetime diagnosis of a comorbid anxiety disorder. Comorbid anxiety in BD is associated with greater illness severity, greater functional impairment, and poorer illness-related outcomes. Effectively treating comorbid anxiety in individuals with BD has been recognized as one of the biggest unmet needs in the field of bipolar disorder. Recently, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was developed to be applicable to the full range of anxiety and mood disorders, based upon converging evidence from genetics, cognitive and affective neuroscience, and behavioral research suggesting common, core emotion-related pathology. Here, we present a preliminary evaluation of the efficacy of the UP for the treatment of BD with comorbid anxiety, in a clinical replication series consisting of three cases. PMID:22822175

Evaluating Problems With Footwear in the Geriatric Population.

PubMed

Ikpeze, Tochukwu C; Omar, Adan; Elfar, John H

2015-12-01

Foot pathologies are common in nearly 80% of all elderly patients, and studies have indicated inappropriate footwear as one of the major underlying cause. It has been postulated that ill-fitting shoe wear affects plantar pressure, thus exacerbating weak balance. Complications arising from foot pathologies, which include difficulty in maintaining balance, have increased the risk of falls that can result in fractures and other serious injuries. The link between footwear and the onset or progression of certain foot pathologies has emphasized the need to explore and promote preventative measures to combat the issue. Wider and higher toe boxed shoes, along with sneakers, are examples of footwear documented to evenly distribute plantar pressure, increase comfort, and facilitate appropriate balance and gait. Ultimately, the use of appropriate footwear can help to better stabilize the foot, thus reducing the risk of sustaining debilitating physical injuries known to drastically decrease the quality of life among the geriatric population.

Pathogenesis of osteoporotic hip fractures.

PubMed

McClung, Michael R

2003-01-01

Osteoporosis is characterized late in the course of the disease by an increased risk of fracture, particularly in the elderly. It occurs in both sexes, affecting approximately 8 million women and 2 million men aged > or = 50 years (1). While low bone density is a predictor of fractures, it is not the only determinant of fracture risk. Other factors include advanced age, altered bone quality, a personal or family history of falls, frailty, poor eyesight, debilitating diseases, and high bone turnover. A diet with sufficient calcium and vitamin D is important to minimize bone loss and, along with regular exercise, to maintain muscle strength. Bisphosphonates have been shown to reduce the risk of hip fracture. For elderly patients, the use of hip protectors may be used as a treatment of last resort. Regardless of the age of the patient, individual patient risk factors must be considered to target appropriate treatment and prevent fracture.

Breastfeeding and postmenopausal osteoporosis.

PubMed

Grimes, Julia P; Wimalawansa, Sunil J

2003-06-01

Bone loss associated with osteoporosis occurs with high frequency among the elderly and often results in debilitating fractures. A combination of lifestyle behaviors, genetic predisposition, and disease processes contributes to bone metabolism. Therefore, any discussion regarding bone health must address these factors. The impact of menopause on bone turnover has been generally well studied and characterized. Breastfeeding places significant stress on calcium metabolism and, as a consequence, directly influences bone metabolism. The most significant factors affecting bone mineral density (BMD) and bone metabolism are the duration and frequency of lactation, the return of menses, and pre-pregnancy weight. Although transient, lactation is associated with bone loss. As clinical guidelines and public health policies are being formulated, there is a compelling need for further investigation into the relationship of lactation, BMD, and subsequent risk of osteoporosis. Better understanding of this relationship will provide new opportunities for early intervention and ultimately help in the prevention of bone loss in postmenopausal women.

Oestrogenic pollutants promote the growth of a parasite in male sticklebacks.

PubMed

Macnab, Vicki; Katsiadaki, Ioanna; Tilley, Ceinwen A; Barber, Iain

2016-05-01

Aquatic environments are especially susceptible to anthropogenic chemical pollution. Yet although knowledge on the biological effects of pollutants on aquatic organisms is increasing, far less is known about how ecologically-important interspecific interactions are affected by chemicals. In particular, the consequences of anthropogenic pollution for the interaction of hosts and parasites are poorly understood. Here, we examine how exposure to 17β-oestradiol (E2)-a natural oestrogen and a model endocrine disrupting chemical (EDC) -affects infection susceptibility and emergent infection phenotypes in an experimental host-parasite system; three spined sticklebacks (Gasterosteus aculeatus) infected with the common, debilitating cestode Schistocephalus solidus. We exposed individual sticklebacks to a 0ngl(-1) (control), 10ngl(-1) or 100ngl(-1) E2 treatment before feeding them infective stages of S. solidus. E2 exposure significantly elevated vitellogenin (VTG) levels-a biomarker of exposure to xenoestrogens-in both female and male fish, and reduced their body condition. Susceptibility to parasite infection was unaffected by EDC exposure; however, E2 treatment and fish sex interacted significantly to determine the growth rate of parasites, which grew quickest in male hosts held under the higher (100ngl(-1)) E2 treatment. Tissue VTG levels and parasite mass correlated positively across the whole sample of experimentally infected fish, but separate regressions run on the male and female datasets demonstrated a significant relationship only among male fish. Hence, among males-but not females-elevated VTG levels elicited by E2 exposure led to more rapid parasite growth. We outline plausible physiological mechanisms that could explain these results. Our results demonstrate that oestrogenic pollutants can alter host-parasite interactions by promoting parasite growth, and that male hosts may be disproportionately affected. Because ecologically-relevant effects of infection on host antipredator responses, growth, energetics and reproductive development all depend on parasite mass in this host-parasite system, our results indicate that EDCs can mediate the ecological consequences of infections. We therefore consider the implications of our results for the ecology of hosts and parasites in polluted environments. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Hyperemesis Gravidarum (HG)

MedlinePlus

... of vomiting (e.g. gastric ulcers, esophageal bleeding, malnutrition, etc.) may also contribute to and worsen ongoing ... vomiting include debilitating fatigue, gastric irritation, ketosis, and malnutrition. Aggressive care early in pregnancy is very important ...

Epidemiology of tennis injuries: An eight-year review of Davis Cup retirements.

PubMed

Maquirriain, Javier; Baglione, Roberto

2016-01-01

Tennis practice, especially at elite levels, may place players at risk for debilitating musculoskeletal injuries. The aim of this study was to analyse the epidemiological pattern of retirements due to medical conditions sustained by tennis players during Davis Cup matches in the 2006-2013 period. All uncompleted matches due to a medical condition (injuries and illnesses) occurred in the above-mentioned competition were collected from the official source, registered and analysed according to published guidelines. The overall incidence of match retirements was 1.66% (12/719). The injury rate was 6.05/1000 playing hours; and 6.64/1000 match exposures. Musculotendinous lesions were the most common type of injury (66.66%). The incidence of lower-limb injuries was higher than upper-limb and trunk lesions. The incidence of retired matches due to medical conditions was higher in hard courts than in clay courts (2.97% and 0.90%, respectively; p = 0.04), while the median value of inactivity of injuries was 32.0 days (range 3-297). In conclusion, the incidence of retirements due to medical conditions in Davis Cup matches was low supporting the assumption that elite tennis is a low-risk sport activity. Findings provided scientific evidences of injury patterns among male professional tennis players and may contribute to conduct better injury prevention strategies.

Impact of Inflow Conditions on Coherent Structures in an Aneurysm

NASA Astrophysics Data System (ADS)

Yu, Paulo; Durgesh, Vibhav; Johari, Hamid

2017-11-01

An aneurysm is an enlargement of a weakened arterial wall that can be debilitating or fatal on rupture. Studies have shown that hemodynamics is integral to developing an understanding of aneurysm formation, growth, and rupture. This investigation focuses on a comprehensive study of the impact of varying inflow conditions and aneurysm shapes on spatial and temporal behavior of flow parameters and structures in an aneurysm. Two different shapes of an idealized rigid aneurysm model were studied and the non-dimensional frequency and Reynolds number were varied between 2-5 and 50-250, respectively. A ViVitro Labs SuperPump system was used to precisely control inflow conditions. Particle Image Velocimetry (PIV) measurements were performed at three different locations inside the aneurysm sac to obtain detailed velocity flow field information. The results of this study showed that aneurysm morphology significantly impacts spatial and temporal behavior of large-scale flow structures as well as wall shear stress distribution. The flow behavior and structures showed a significant difference with change in inflow conditions. A primary fluctuating flow structure was observed for Reynolds number of 50, while for higher Reynolds numbers, primary and secondary flow structures were observed. Furthermore, the paths of these coherent structures were dependent on aneurysm shape and inflow parameters.

Aerobic exercise conditioning: a nonpharmacological antiarrhythmic intervention.

PubMed

Billman, George E

2002-02-01

Sudden, unexpected cardiac death due to ventricular fibrillation is the leading cause of death in most industrially developed countries. Yet, despite the enormity of this problem, the development of safe and effective antiarrhythmic therapies has proven to be an elusive goal. In fact, many initially promising antiarrhythmic medications were subsequently found to increase rather than to decrease cardiac mortality. It is now known that cardiac disease alters cardiac autonomic balance and that the patients with the greatest changes in this cardiac neural regulation (i.e., decreased parasympathetic coupled with increased sympathetic activity) are also the patients at the greatest risk for sudden death. A growing body of experimental and epidemiological data demonstrates that aerobic exercise conditioning can dramatically reduce cardiac mortality, even in patients with preexisting cardiac disease. Conversely, the lack of exercise is strongly associated with an increased incidence of many chronic debilitating diseases, including coronary heart disease. Because it is well established that aerobic exercise conditioning can alter autonomic balance (increasing parasympathetic tone and decreasing sympathetic activity), a prudently designed exercise program could prove to be an effective and nonpharmacological way to enhance cardiac electrical stability, thereby protecting against sudden cardiac death.

A pilot study on Ayurvedic management of oral submucous fibrosis

PubMed Central

Patel, Kundan R.; Rajagopala, Manjusha; Vaghela, Dharmendrasinh B.; Shah, Ashok

2015-01-01

Introduction: Oral submucous fibrosis (OSMF) is a chronic debilitating disease and a well-recognized potentially premalignant condition of the oral cavity. Various medical and surgical treatment modalities have been used in modern science, but results are not satisfactory owing to recurrence, adverse effects, and sometimes worsening the condition. On analyzing the disease condition with Ayurvedic approach, it seems to be nearer to Vata-Pitta dominant chronic Sarvasara Mukharoga and needs to be treated at local as well as systemic level. Aim: To evaluate the effect of proposed Ayurvedic treatment protocol in the patients of OSMF. Materials and Methods: It was an open-label nonrandomized clinical trial with black box design comprising of holistic Ayurvedic approach in which 22 patients of OSMF completed the treatment. In all of them after Koshthashuddhi (mild purgation) and Shodhana Nasya (errhine therapy); Pratisarana (external application) with Madhupippalyadi Yoga, Kavala (gargling) with Ksheerabala Taila and internally Rasayana Yoga were given for 2 months and followed for 1 month. Results: It revealed statistically highly significant relief in almost all signs and symptoms as well in inter incisal distance improvement. Furthermore, sustained relief was found in follow-up. Conclusion: Ayurvedic treatment protocol is effective in the management of OSMF. PMID:26730136

A pilot study on Ayurvedic management of oral submucous fibrosis.

PubMed

Patel, Kundan R; Rajagopala, Manjusha; Vaghela, Dharmendrasinh B; Shah, Ashok

2015-01-01

Oral submucous fibrosis (OSMF) is a chronic debilitating disease and a well-recognized potentially premalignant condition of the oral cavity. Various medical and surgical treatment modalities have been used in modern science, but results are not satisfactory owing to recurrence, adverse effects, and sometimes worsening the condition. On analyzing the disease condition with Ayurvedic approach, it seems to be nearer to Vata-Pitta dominant chronic Sarvasara Mukharoga and needs to be treated at local as well as systemic level. To evaluate the effect of proposed Ayurvedic treatment protocol in the patients of OSMF. It was an open-label nonrandomized clinical trial with black box design comprising of holistic Ayurvedic approach in which 22 patients of OSMF completed the treatment. In all of them after Koshthashuddhi (mild purgation) and Shodhana Nasya (errhine therapy); Pratisarana (external application) with Madhupippalyadi Yoga, Kavala (gargling) with Ksheerabala Taila and internally Rasayana Yoga were given for 2 months and followed for 1 month. It revealed statistically highly significant relief in almost all signs and symptoms as well in inter incisal distance improvement. Furthermore, sustained relief was found in follow-up. Ayurvedic treatment protocol is effective in the management of OSMF.

Design of a Virtual Reality System for Affect Analysis in Facial Expressions (VR-SAAFE); Application to Schizophrenia.

PubMed

Bekele, E; Bian, D; Peterman, J; Park, S; Sarkar, N

2017-06-01

Schizophrenia is a life-long, debilitating psychotic disorder with poor outcome that affects about 1% of the population. Although pharmacotherapy can alleviate some of the acute psychotic symptoms, residual social impairments present a significant barrier that prevents successful rehabilitation. With limited resources and access to social skills training opportunities, innovative technology has emerged as a potentially powerful tool for intervention. In this paper, we present a novel virtual reality (VR)-based system for understanding facial emotion processing impairments that may lead to poor social outcome in schizophrenia. We henceforth call it a VR System for Affect Analysis in Facial Expressions (VR-SAAFE). This system integrates a VR-based task presentation platform that can minutely control facial expressions of an avatar with or without accompanying verbal interaction, with an eye-tracker to quantitatively measure a participants real-time gaze and a set of physiological sensors to infer his/her affective states to allow in-depth understanding of the emotion recognition mechanism of patients with schizophrenia based on quantitative metrics. A usability study with 12 patients with schizophrenia and 12 healthy controls was conducted to examine processing of the emotional faces. Preliminary results indicated that there were significant differences in the way patients with schizophrenia processed and responded towards the emotional faces presented in the VR environment compared with healthy control participants. The preliminary results underscore the utility of such a VR-based system that enables precise and quantitative assessment of social skill deficits in patients with schizophrenia.

Achievement Motivation and Fear of Failure in Family and School

ERIC Educational Resources Information Center

Hermans, Hubert J. M.; And Others

1972-01-01

Results indicate that the achievement motivation and the debilitating anxiety of the child manifest themselves in the social interaction patterns both within the family and within the classroom. (Authors)

Perinatal Risks and Childhood Premorbid Indicators of Later Psychosis: Next Steps for Early Psychosocial Interventions

PubMed Central

Liu, Cindy H.; Keshavan, Matcheri S.; Tronick, Ed; Seidman, Larry J.

2015-01-01

Schizophrenia and affective psychoses are debilitating disorders that together affect 2%–3% of the adult population. Approximately 50%–70% of the offspring of parents with schizophrenia manifest a range of observable difficulties including socioemotional, cognitive, neuromotor, speech-language problems, and psychopathology, and roughly 10% will develop psychosis. Despite the voluminous work on premorbid vulnerabilities to psychosis, especially on schizophrenia, the work on premorbid intervention approaches is scarce. While later interventions during the clinical high-risk (CHR) phase of psychosis, characterized primarily by attenuated positive symptoms, are promising, the CHR period is a relatively late phase of developmental derailment. This article reviews and proposes potential targets for psychosocial interventions during the premorbid period, complementing biological interventions described by others in this Special Theme issue. Beginning with pregnancy, parents with psychoses may benefit from enhanced prenatal care, social support, parenting skills, reduction of symptoms, and programs that are family-centered. For children at risk, we propose preemptive early intervention and cognitive remediation. Empirical research is needed to evaluate these interventions for parents and determine whether interventions for parents and children positively influence the developmental course of the offspring. PMID:25904724

Relationships between negative affect and academic achievement among secondary school students: the mediating effects of habituated exercise.

PubMed

Hashim, Hairul A; Freddy, Golok; Rosmatunisah, Ali

2012-09-01

The current study was undertaken to examine the associations between self-determination, exercise habit, anxiety, depression, stress, and academic achievement among adolescents aged 13 and 14 years in eastern Malaysia. The sample consisted of 750 secondary school students (mean age = 13.4 years, SD = 0.49). Participants completed self-report measures of exercise behavioral regulation, negative affect, and exercise habit strength. Midyear exam results were used as an indicator of academic performance. Structural equation modeling was used to analyze the data. The results of structural equation modeling revealed a close model fit for the hypothesized model, which indicates that higher levels of self-determination were positively associated with habituated exercise behavior. In turn, exercise habit strength fostered academic achievement and buffered the debilitative effect of stress, depression, and anxiety on student academic performance. The analysis of model invariance revealed a nonsignificant difference between male and female subjects. The findings support the notion that habituated exercise fosters academic performance. In addition, we found that habituated exercise buffers the combined effects of stress, anxiety and depression on academic performance. The finding also supports the roles of self-determination in promoting exercise habituation.

Perceived social restriction in leprosy-affected inhabitants of a former leprosy colony in northeast Brazil.

PubMed

Lesshafft, Hannah; Heukelbach, Jörg; Barbosa, Jaqueline Caracas; Rieckmann, Nina; Liesenfeld, Oliver; Feldmeier, Hermann

2010-03-01

In Brazil, isolation of individuals affected with leprosy was compulsory by law from 1920 to 1962, but in reality, confinement of patients to leprosaria continued until the 1980s. The social participation restriction of people still living in these institutions has never been investigated systematically. To examine the extent and type of participation restriction perceived by former leprosy patients living in the Centro de Convivência Antônio Diogo (CCAD), a previous leprosy colony in rural Northeast Brazil, by using the Participation Scale. Forty (51-9%) out of 77 individuals reported significant participation restrictions, mainly related to work and mobility. Perceived participation restriction was significantly higher in people living in nursing units of the CCAD (P = 0-001), if diagnosis of leprosy was made before 1982 (P = 0.002), in the presence of walking limitation (P < 0.001) and visible physical alterations (P = 0-002), such as foot deformities (P = 0.002), saddle nose (P = 0.03) and blindness (P = 0.04), and in those individuals who did not receive visitors (P = 0.004). Social rehabilitation, especially in the areas of work and mobility, is strongly needed together with prevention of debilitating physical sequelae and reduction of stigmatisation.

Role of Gabapentin in Managing Mucositis Pain in Patients Undergoing Radiation Therapy to the Head and Neck.

PubMed

Milazzo-Kiedaisch, Carol Ann; Itano, Joanne; Dutta, Pinaki R

2016-12-01

Oral mucositis (OM) is a painful and debilitating side effect that affects 80%-100% of patients undergoing radiation therapy for head and neck cancer. This dose-limiting side effect may potentially lead to pain, dehydration, malnutrition, infection, and treatment breaks. Treatment breaks can lead to decreased disease control and suboptimal patient outcomes. No primary prevention exists for OM, and management is focused on pain control. Compelling evidence exists that OM pain has somatic and neuropathic components. This article reviews the existing literature on the use of gabapentin (Neurontin®) as a co-analgesic in treating the neuropathic pain in OM. A literature search was performed using CINAHL® and PubMed with the search terms gabapentin and oral mucositis. The selected articles were briefly screened for relevance, and three were included in this review. No systematic reviews exist on the role of gabapentin for neuropathic pain in radiation-induced OM. Two retrospective studies concluded that gabapentin reduced escalation of opioid doses and unplanned treatment breaks. One retrospective study demonstrated favorable swallowing outcomes. Pain and OM are nursing-sensitive outcomes that can be significantly affected by evidence-based nursing interventions.

Diet regulates liver autophagy differentially in murine acute Trypanosoma cruzi infection

PubMed Central

Lizardo, Kezia; Almonte, Vanessa; Law, Calvin; Aiyyappan, Janeesh Plakkal; Cui, Min-Hui; Nagajyothi, Jyothi F

2017-01-01

Chagas disease is a tropical parasitic disease caused by the protozoan Trypanosoma cruzi, which affects about 10 million people in its endemic regions of Latin America. After the initial acute stage of infection, 60–80% of infected individuals remain asymptomatic for several years to a lifetime; however, the rest develop the debilitating symptomatic stage, which affects the nervous system, digestive system and heart. The challenges of Chagas disease have become global due to immigration. Despite well documented dietary changes accompanying immigration, as well as a transition to a western style diet in the Chagas endemic regions, the role of host metabolism in the pathogenesis of Chagas disease remains underexplored. We have previously used a mouse model to show that host diet is a key factor regulating cardiomyopathy in Chagas disease. In this study we investigated the effect of a high fat diet on liver morphology and physiology, lipid metabolism, immune signaling, energy homeostasis, and stress responses in the murine model of acute T. cruzi infection. Our results indicate that in T. cruzi infected mice diet differentially regulates several liver processes, including autophagy, a stress response mechanism, with corresponding implications for human Chagas disease patients. PMID:27987056

A Comparison of Traditional and Self-Control Desensitization.

ERIC Educational Resources Information Center

Deffenbacher, Jerry L.; Parks, Donald H.

1979-01-01

Compared effectiveness of counterconditioning and self-control models of systematic desensitization in reducing targeted and nontargeted anxieties. Treatments were equally effective in reducing and maintaining reduction of targeted anxiety, debilitating test anxiety. (Author)

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Treatment

MedlinePlus

... practitioner, might help with pain for some patients. Depression, Stress, and Anxiety Adjusting to a chronic, debilitating ... Consequence Pathogens and Pathology (DHCPP) Email Recommend Tweet YouTube Instagram Listen Watch RSS ABOUT About CDC Jobs ...

A possible case of complex regional pain syndrome of the nose?

PubMed

Faraj-Hakim, S; Bleys, R L A W; Buwalda, J; de Ru, J A

2012-01-01

We present a case report of a patient with a putative diagnosis of complex regional pain syndrome of the nose. We would like to bring this disorder to the attention of rhinologists. A 53-year-old man presented with a history of extreme, constant, debilitating pain in his nose that started after he underwent several extensive nasal surgeries. Examination revealed atrophic nasal mucous membranes at the nasal septum. No other abnormalities were found. The pain did not diminish despite administration of analgesics and neuropathic pain medications. We propose a diagnosis of complex regional pain syndrome of the nose. The large number of nasal surgeries performed worldwide and the far reaching consequences of this debilitating syndrome indicate that it merits further investigation to determine whether it is a distinct disorder that should be recognized as such.

Nonverbal expressive behaviour in schizophrenia and social phobia.

PubMed

Del-Monte, Jonathan; Raffard, Stéphane; Salesse, Robin N; Marin, Ludovic; Schmidt, Richard C; Varlet, Manuel; Bardy, Benoît G; Philippe Boulenger, Jean; Christine Gély-Nargeot, Marie; Capdevielle, Delphine

2013-11-30

Expressive behaviour plays a crucial role in the success of social interactions. Abnormality of expressive behaviour has been reported in interpersonal interactions of patients suffering from schizophrenia and social phobia, two debilitating mental disorders with important social deficits. However, no study has compared the expressive behaviour in these two disorders. Thirty schizophrenia patients, 21 social phobia patients and 30 healthy controls were evaluated and compared on expressive, cognitive and clinical dimensions. Expressive behaviour was assessed using the Motor Affective subscale of the Motor-Affective-Social-Scale (MASS). Covariables include the Positive and Negative Syndrome Scale (PANSS), the anxiety level Liebowitz-Social-Anxiety-Scale (LSAS) and cognitive tasks. After controlling for depression, schizophrenia and social phobia patients both exhibited significantly fewer expressive behaviours compared to healthy controls. Moreover, our results showed specific signatures: schizophrenia patients performed fewer spontaneous gestures (hand gestures and smiles) whereas social phobia patients had an impaired ability to produce voluntary smiles in comparison to healthy controls. Interestingly, poor social functioning was significantly correlated with a decrease of expressive behaviour for schizophrenia patients. Expressive behaviour is impaired in different ways in social phobia and schizophrenia and is associated in schizophrenia with poorer social functioning. The Motor Affective subscale of the MASS is an interesting tool for assessing the dysfunction of interpersonal expressive behaviour in mental disorders. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Biology of the Glutamatergic System and Potential Role in Migraine

PubMed Central

Gasparini, C. F.; Griffiths, L. R.

2013-01-01

Migraine is a common genetically linked neurovascular disorder. Approximately ∼12% of the Caucasian population are affected including 18% of adult women and 6% of adult men (1, 2). A notable female bias is observed in migraine prevalence studies with females affected ∼3 times more than males and is credited to differences in hormone levels arising from reproductive achievements. Migraine is extremely debilitating with wide-ranging socioeconomic impact significantly affecting people’s health and quality of life. A number of neurotransmitter systems have been implicated in migraine, the most studied include the serotonergic and dopaminergic systems. Extensive genetic research has been carried out to identify genetic variants that may alter the activity of a number of genes involved in synthesis and transport of neurotransmitters of these systems. The biology of the Glutamatergic system in migraine is the least studied however there is mounting evidence that its constituents could contribute to migraine. The discovery of antagonists that selectively block glutamate receptors has enabled studies on the physiologic role of glutamate, on one hand, and opened new perspectives pertaining to the potential therapeutic applications of glutamate receptor antagonists in diverse neurologic diseases. In this brief review, we discuss the biology of the Glutamatergic system in migraine outlining recent findings that support a role for altered Glutamatergic neurotransmission from biochemical and genetic studies in the manifestation of migraine and the implications of this on migraine treatment. PMID:23675283

Health anxiety and hypochondriasis: Description and treatment issues highlighted through a case illustration.

PubMed

Hart, John; Björgvinsson, Thröstur

2010-01-01

Health anxiety and hypochondriasis are serious and debilitating conditions that are poorly understood by health care providers and general public. This is so partly because of the derogatory use of the term hypochondriasis by the general public. There has been a push by mental health professionals in recent years to use the term health anxiety and to use hypochondriasis only for its extreme form. The Internet has become a popular medium, through Web sites and chat rooms, for patients to seek information, reassurance, and exchange of medical information, sometimes of limited veracity. The term cyberchondria has even been coined to describe this phenomenon. The authors review the research literature related to health anxiety and discuss the beneficial treatments of CBT and pharmacology. The utilization of intensive cognitive-behavioral therapy is highlighted with a case illustration.

Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system

PubMed Central

Miller, Larry E; Block, Jon E

2014-01-01

Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry® SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed. PMID:24851059

Lactate release from astrocytes to neurons contributes to cocaine memory formation.

PubMed

Boury-Jamot, Benjamin; Halfon, Olivier; Magistretti, Pierre J; Boutrel, Benjamin

2016-12-01

The identification of neural substrates underlying the long lasting debilitating impact of drug cues is critical for developing novel therapeutic tools. Metabolic coupling has long been considered a key mechanism through which astrocytes and neurons actively interact in response of neuronal activity, but recent findings suggested that disrupting metabolic coupling may represent an innovative approach to prevent memory formation, in particular drug-related memories. Here, we review converging evidence illustrating how memory and addiction share neural circuitry and molecular mechanisms implicating lactate-mediated metabolic coupling between astrocytes and neurons. With several aspects of addiction depending on mnemonic processes elicited by drug experience, disrupting lactate transport involved in the formation of a pathological learning, linking the incentive, and motivational effects of drugs with drug-conditioned stimuli represent a promising approach to encourage abstinence. © 2016 WILEY Periodicals, Inc.

Gadolinium-Induced Fibrosis.

PubMed

Todd, Derrick J; Kay, Jonathan

2016-01-01

Gadolinium-based contrast agents (GBCAs), once believed to be safe for patients with renal disease, have been strongly associated with nephrogenic systemic fibrosis (NSF), a severe systemic fibrosing disorder that predominantly afflicts individuals with advanced renal dysfunction. We provide a historical perspective on the appearance and disappearance of NSF, including its initial recognition as a discrete clinical entity, its association with GBCA exposure, and the data supporting a causative relationship between GBCA exposure and NSF. On the basis of this body of evidence, we propose that the name gadolinium-induced fibrosis (GIF) more accurately reflects the totality of knowledge regarding this disease. Use of high-risk GBCAs, such as formulated gadodiamide, should be avoided in patients with renal disease. Restriction of GBCA use in this population has almost completely eradicated new cases of this debilitating condition. Emerging antifibrotic therapies may be useful for patients who suffer from GIF.

Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system.

PubMed

Miller, Larry E; Block, Jon E

2014-01-01

Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry(®) SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed.

Lifestyle modifications and the resolution of obstructive sleep apnea syndrome: a case report

PubMed Central

Gala, Thaddeus R.; Seaman, David R.

2011-01-01

Objective This purpose of this case study is to describe a natural method to help in management of obstructive sleep apnea syndrome (OSAS), which is known to be a common and debilitating condition. Clinical Features Obstructive sleep apnea syndrome is typically managed with a continuous positive airway pressure (CPAP) device, which the patient wears during sleep to help maintain respiration. This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years. Intervention and Outcome After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later. Conclusion Dietary modifications may be an effective tool to improve the management of OSAS. PMID:22014867

Lung Involvement in Systemic Sclerosis

PubMed Central

Hassoun, Paul M.

2011-01-01

Summary Scleroderma is a multisystem disease characterized by a severe inflammatory process and exuberant fibrosis. Lung involvement is a frequent complication and a leading cause of morbidity and mortality in this syndrome. Two major pulmonary syndromes are associated with scleroderma; a pulmonary vascular disorder evolving over time into relatively isolated pulmonary arterial hypertension (PAH), and interstitial lung disease (ILD). Each syndrome, when present, is a cause of morbidity and significantly reduces survival of scleroderma patients when compared to patients free of lung complication. When pulmonary hypertension and ILD are combined, survival is further reduced. Current therapy appears to have no meaningful effect on either condition and, thus, there is a need for better understanding of underlying pathogenic mechanisms. This review focuses on clinical, diagnostic, and therapeutic features of PAH and ILD as well as other frequent but less debilitating lung complications of scleroderma. PMID:21195581

[Why and how should serous otitis media be treated?].

PubMed

François, M; Bonfils, P; Van Haver, K; Narcy, P

1992-10-01

Serous otitis media is an extremely commonplace condition in pediatric patients and tends to resolve spontaneously. Only some forms warrant treatment. Indications for treatment include frequent superinfections, lasting hearing impairment with adverse consequences on socialization, or debilitation of the tympanic membrane carrying a risk for the ear. Tympanostomy tubes are a palliative treatment for serous otitis which restores hearing within a few hours and eliminates unfixated retractions of the tympanic membrane within a few weeks. Tympanostomy tubes may lead to complications including otorrhea and perforation of the tympanic membrane and should therefore be used only in patients with severe otitis media. Etiologic treatment of serous otitis rests on restoration of satisfactory nasal ventilation (education to improve nose-blowing, adenoidectomy), improvement of eustachian tube patency (corticosteroids), and modification of the characteristics of middle ear secretions (mucolytic agents and mucomodifying agents).

Growth factor delivery for oral and periodontal tissue engineering

PubMed Central

Kaigler, Darnell; Cirelli, Joni A; Giannobile, William V

2008-01-01

The treatment of oral and periodontal diseases and associated anomalies accounts for a significant proportion of the healthcare burden, with the manifestations of these conditions being functionally and psychologically debilitating. Growth factors are critical to the development, maturation, maintenance and repair of craniofacial tissues, as they establish an extracellular environment that is conducive to cell and tissue growth. Tissue-engineering principles aim to exploit these properties in the development of biomimetic materials that can provide an appropriate microenvironment for tissue development. These materials have been constructed into devices that can be used as vehicles for delivery of cells, growth factors and DNA. In this review, different mechanisms of drug delivery are addressed in the context of novel approaches to reconstruct and engineer oral- and tooth-supporting structures, namely the periodontium and alveolar bone. PMID:16948560

Autoinflammatory Skin Disorders: The Inflammasomme in Focus

PubMed Central

Gurung, Prajwal; Kanneganti, Thirumala-Devi

2016-01-01

Autoinflammatory skin disorders are a group of heterogeneous diseases that include diseases such as cryopyrin-associated periodic syndrome (CAPS) and familial Mediterranean fever (FMF). Therapeutic strategies targeting IL-1 cytokines have proved helpful in ameliorating some of these diseases. While inflammasomes are the major regulators of IL-1 cytokines, inflammasome-independent complexes can also process IL-1 cytokines. Herein, we focus on recent advances in our understanding of how IL-1 cytokines, stemming from inflammasome-dependent and -independent pathways are involved in the regulation of skin conditions. Importantly, we discuss several mouse models of skin inflammation generated to help elucidate the basic cellular and molecular effects and modulation of IL-1 in the skin. Such models offer perspectives on how these signaling pathways could be targeted to improve therapeutic approaches in the treatment of these rare and debilitating inflammatory skin disorders. PMID:27267764

Occipital neuralgia: anatomic considerations.

PubMed

Cesmebasi, Alper; Muhleman, Mitchel A; Hulsberg, Paul; Gielecki, Jerzy; Matusz, Petru; Tubbs, R Shane; Loukas, Marios

2015-01-01

Occipital neuralgia is a debilitating disorder first described in 1821 as recurrent headaches localized in the occipital region. Other symptoms that have been associated with this condition include paroxysmal burning and aching pain in the distribution of the greater, lesser, or third occipital nerves. Several etiologies have been identified in the cause of occipital neuralgia and include, but are not limited to, trauma, fibrositis, myositis, fracture of the atlas, and compression of the C-2 nerve root, C1-2 arthrosis syndrome, atlantoaxial lateral mass osteoarthritis, hypertrophic cervical pachymeningitis, cervical cord tumor, Chiari malformation, and neurosyphilis. The management of occipital neuralgia can include conservative approaches and/or surgical interventions. Occipital neuralgia is a multifactorial problem where multiple anatomic areas/structures may be involved with this pathology. A review of these etiologies may provide guidance in better understanding occipital neuralgia. © 2014 Wiley Periodicals, Inc.

Gut Microbiota and Salivary Diagnostics: The Mouth Is Salivating to Tell Us Something.

PubMed

Kodukula, Krishna; Faller, Douglas V; Harpp, David N; Kanara, Iphigenia; Pernokas, Julie; Pernokas, Mark; Powers, Whitney R; Soukos, Nikolaos S; Steliou, Kosta; Moos, Walter H

2017-01-01

The microbiome of the human body represents a symbiosis of microbial networks spanning multiple organ systems. Bacteria predominantly represent the diversity of human microbiota, but not to be forgotten are fungi, viruses, and protists. Mounting evidence points to the fact that the "microbial signature" is host-specific and relatively stable over time. As our understanding of the human microbiome and its relationship to the health of the host increases, it is becoming clear that many and perhaps most chronic conditions have a microbial involvement. The oral and gastrointestinal tract microbiome constitutes the bulk of the overall human microbial load, and thus presents unique opportunities for advancing human health prognosis, diagnosis, and therapy development. This review is an attempt to catalog a broad diversity of recent evidence and focus it toward opportunities for prevention and treatment of debilitating illnesses.

Psoriasis treatment considerations in military patients: unique patients, unique drugs.

PubMed

Evans, Thomas; Davidson, Nathan; Logemann, Nicholas

2016-12-01

Psoriasis is a common dermatologic problem with a chronic and sometimes debilitating course. Psoriasis can impair a service member's ability to perform job-related activities and should certainly be treated; however, use of immunosuppressive treatments can prevent deployment to strategic locations around the world for numerous reasons, such as the need for laboratory monitoring, minimal access to climate-controlled storage, and potential increased risk of exposure to virulent pathogens while on these medications. Similar obstacles can exist for nonmilitary patients who are placed in austere conditions or participate in worldwide travel. Although treatment efficacy, cost, and side-effect profiles are always paramount considerations in deciding on treatment regimens with patients, herein we focus our discussion on a consideration that might be easily overlooked when treating patients in modern society, that being the "logistics" of treatment.

21 CFR 520.1870 - Praziquantel tablets.

Code of Federal Regulations, 2011 CFR

2011-04-01

... debilitated animals and for assistance in the diagnosis, treatment, and control of parasitism. (B) If labeled..., treatment, and control of parasitism. [46 FR 60570, Dec. 11, 1981, as amended at 47 FR 26377, June 18, 1982...

21 CFR 522.1335 - Medetomidine hydrochloride injection.

Code of Federal Regulations, 2011 CFR

2011-04-01

... solution contains 1.0 milligram of medetomidine hydrochloride. (b) Sponsor. See 052483 in § 510.600(c) of... diseases, dogs in shock, dogs which are severly debilitated, or dogs which are stressed due to extreme heat...

21 CFR 522.1335 - Medetomidine hydrochloride injection.

Code of Federal Regulations, 2013 CFR

2013-04-01

... solution contains 1.0 milligram of medetomidine hydrochloride. (b) Sponsor. See 052483 in § 510.600(c) of... diseases, dogs in shock, dogs which are severly debilitated, or dogs which are stressed due to extreme heat...

21 CFR 522.1335 - Medetomidine hydrochloride injection.

Code of Federal Regulations, 2012 CFR

2012-04-01

... solution contains 1.0 milligram of medetomidine hydrochloride. (b) Sponsor. See 052483 in § 510.600(c) of... diseases, dogs in shock, dogs which are severly debilitated, or dogs which are stressed due to extreme heat...

21 CFR 522.1335 - Medetomidine hydrochloride injection.

Code of Federal Regulations, 2010 CFR

2010-04-01

... solution contains 1.0 milligram of medetomidine hydrochloride. (b) Sponsor. See 052483 in § 510.600(c) of... diseases, dogs in shock, dogs which are severly debilitated, or dogs which are stressed due to extreme heat...

The social and psychological impact of endometriosis on women's lives: a critical narrative review.

PubMed

Culley, Lorraine; Law, Caroline; Hudson, Nicky; Denny, Elaine; Mitchell, Helene; Baumgarten, Miriam; Raine-Fenning, Nick

2013-01-01

BACKGROUND Endometriosis is a chronic condition affecting between 2 and 17% of women of reproductive age. Common symptoms are chronic pelvic pain, fatigue, congestive dysmenorrhoea, heavy menstrual bleeding and deep dyspareunia. Studies have demonstrated the considerable negative impact of this condition on women's quality of life (QoL), especially in the domains of pain and psychosocial functioning. The impact of endometriosis is likely to be exacerbated by the absence of an obvious cause and the likelihood of chronic, recurring symptoms. The aims of this paper are to review the current body of knowledge on the social and psychological impact of endometriosis on women's lives; to provide insights into women's experience of endometriosis; to provide a critical commentary on the current state of knowledge and to make recommendations for future psycho-social research. METHODS The review draws on a method of critical narrative synthesis to discuss a heterogeneous range of both quantitative and qualitative studies from several disciplines. This included a systematic search, a structured process for selecting and collecting data and a systematic thematic analysis of results. RESULTS A total of 42 papers were included in the review; 23 used quantitative methods, 16 used qualitative methods and 3 were mixed methods studies. The majority of papers came from just four countries: UK (10), Australia (8), Brazil (6) and the USA (5). Key categories of impact identified in the thematic analysis were diagnostic delay and uncertainty; 'QoL' and everyday activities; intimate relationships; planning for and having children; education and work; mental health and emotional wellbeing and medical management and self-management. CONCLUSIONS Endometriosis has a significant social and psychological impact on the lives of women across several domains. Many studies have methodological limitations and there are significant gaps in the literature especially in relation to a consideration of the impact on partners and children. We recommend additional prospective and longitudinal research utilizing mixed methods approaches and endometriosis-specific instruments to explore the impact of endometriosis in more diverse populations and settings. Furthermore, there is an urgent need to develop and evaluate interventions for supporting women and partners living with this chronic and often debilitating condition.

Development of an Algorithm to Perform a Comprehensive Study of Autonomic Dysreflexia in Animals with High Spinal Cord Injury Using a Telemetry Device.

PubMed

Popok, David; West, Christopher; Frias, Barbara; Krassioukov, Andrei V

2016-07-29

Spinal cord injury (SCI) is a debilitating neurological condition characterized by somatic and autonomic dysfunctions. In particular, SCI above the mid-thoracic level can lead to a potentially life-threatening hypertensive condition called autonomic dysreflexia (AD) that is often triggered by noxious or non-noxious somatic or visceral stimuli below the level of injury. One of the most common triggers of AD is the distension of pelvic viscera, such as during bladder and bowel distension or evacuation. This protocol presents a novel pattern recognition algorithm developed for a JAVA platform software to study the fluctuations of cardiovascular parameters as well as the number, severity and duration of spontaneously occurring AD events. The software is able to apply a pattern recognition algorithm on hemodynamic data such as systolic blood pressure (SBP) and heart rate (HR) extracted from telemetry recordings of conscious and unrestrained animals before and after thoracic (T3) complete transection. With this software, hemodynamic parameters and episodes of AD are able to be detected and analyzed with minimal experimenter bias.

Droxidopa for Symptomatic Neurogenic Hypotension.

PubMed

Ferguson-Myrthil, Nadia

Droxidopa is a first-in-class, orally available, synthetic amino acid precursor of norepinephrine that received accelerated Food and Drug Administration approval in February 2014 after Orphan Drug status for a debilitating condition known as symptomatic neurogenic orthostatic hypotension. Neurogenic disorders often lead to postural hypotension as a result of poor norepinephrine release from its storage sites. Clinical data suggest increases in standing systolic blood pressure and improvements in many other markers for subjective relief in patients with symptomatic neurogenic hypotension who received droxidopa therapy over 1-2 weeks. Studies evaluating the sustained effects of droxidopa are ongoing. With minimal drug interactions (even with carbidopa use) or adverse effects, droxidopa therapy can be used safely in patients with a variety of neurologic conditions; however, more data are needed to determine its appropriate pharmacotherapeutic role. In all, droxidopa is a safe and effective medication for the treatment of orthostatic dizziness/lightheadedness, or the "feeling that you are about to black out" in adult patients with symptomatic neurogenic orthostatic hypotension secondary to primary autonomic failure (Parkinson's disease, multiple system atrophy, and pure autonomic failure), dopamine beta-hydroxylase deficiency, and nondiabetic autonomic neuropathy.

Low-residue euthanasia of stranded mysticetes.

PubMed

Harms, Craig A; McLellan, William A; Moore, Michael J; Barco, Susan G; Clarke, Elsburgh O; Thayer, Victoria G; Rowles, Teresa K

2014-01-01

Euthanasia of stranded large whales poses logistic, safety, pharmaceutical, delivery, public relations, and disposal challenges. Reasonable arguments may be made for allowing a stranded whale to expire naturally. However, slow cardiovascular collapse from gravitational effects outside of neutral buoyancy, often combined with severely debilitating conditions, motivate humane efforts to end the animal's suffering. The size of the animal and prevailing environmental conditions often pose safety concerns for stranding personnel, which take priority over other considerations. When considering chemical euthanasia, the size of the animal also necessitates large quantities of euthanasia agents. Drug residues are a concern for relay toxicity to scavengers, particularly for pentobarbital-containing euthanasia solutions. Pentobarbital is also an environmental concern because of its stability and long persistence in aquatic environments. We describe a euthanasia technique for stranded mysticetes using readily available, relatively inexpensive, preanesthetic and anesthetic drugs (midazolam, acepromazine, xylazine) followed by saturated KCl delivered via custom-made needles and a low-cost, basic, pressurized canister. This method provides effective euthanasia while moderating personnel exposure to hazardous situations and minimizing drug residues of concern for relay toxicity.

Bartonella: emerging pathogen or emerging awareness?

PubMed

Mogollon-Pasapera, Elin; Otvos, Laszlo; Giordano, Antonio; Cassone, Marco

2009-01-01

The number of known Bartonella species is rapidly growing. Some of them are responsible for distinct infectious diseases and show different prevalence and antibiotic susceptibility profiles. Not only have some vectors of Bartonella not been fully characterized, but also intermediate hosts are actually much more numerous and diverse than previously thought. Among these, dogs differ from cats because they tend to suffer an overt disease similar to humans, thus providing the base for a useful animal indicator and research model. Among the debilitating conditions with an unclear impact on the course of these infections, specific conditions (e.g., homelessness, alcoholism) have been linked to a much higher prevalence and to high risk of unfavorable outcome. Due to the limited arsenal of antibiotics effective in vivo on this peculiar intracellular pathogen, the risk/benefit balance of antibiotic therapy is sometimes difficult to draw. In this evolving picture, the recent discoveries of new species highlights the importance of basic molecular biology resources that would bring major public health benefits if available in endemic areas, and specifically in many areas of Peru and Bolivia.

Fibromyalgia and chronic fatigue syndrome in children.

PubMed

Itoh, Yasuhiko; Shigemori, Tomoko; Igarashi, Tohru; Fukunaga, Yoshitaka

2012-04-01

Fibromyalgia (FM) is characterized by widespread persistent pain and the presence of multiple discrete tender points. Chronic fatigue syndrome (CFS) is a syndrome characterized by debilitating fatigue associated with a variable number of non-specific complaints. Because neither condition had necessarily been recognized in children until recently, those patients have been treated as having school refusal without being diagnosed as having either syndrome. There is a considerable overlap of clinical symptoms between these two syndromes. It is therefore controversial as to whether these syndromes have the same pathogenesis or not. The aim of the present study was to clarify the relationship between these syndromes in children. Fifteen patients with FM and 21 patients with CFS were investigated both clinically and immunologically. Immunological assessments included thorough analysis of autoantibodies using several techniques. Anti-nuclear antibody titers were higher and the prevalence of anti-Sa antibody was far more frequent in CFS patients than in FM patients. CFS and FM are different from each other at least in childhood, from an immunological aspect, although some patients could have both conditions. © 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.

'What is it like to have ME?': the discursive construction of ME in computer-mediated communication and face-to-face interaction.

PubMed

Guise, Jennifer; Widdicombe, Sue; McKinlay, Andy

2007-01-01

ME (Myalgic Encephalomyelitis) or CFS (chronic fatigue syndrome) is a debilitating illness for which no cause or medical tests have been identified. Debates over its nature have generated interest from qualitative researchers. However, participants are difficult to recruit because of the nature of their condition. Therefore, this study explores the utility of the internet as a means of eliciting accounts. We analyse data from focus groups and the internet in order to ascertain the extent to which previous research findings apply to the internet domain. Interviews were conducted among 49 members of internet groups (38 chatline, 11 personal) and 7 members of two face-to-face support groups. Discourse analysis of descriptions and accounts of ME or CFS revealed similar devices and interactional concerns in both internet and face-to-face communication. Participants constructed their condition as serious, enigmatic and not psychological. These functioned to deflect problematic assumptions about ME or CFS and to manage their accountability for the illness and its effects.

Metabolic flexibility of a prospective bioremediator: Desulfitobacterium hafniense Y51 challenged in chemostats.

PubMed

Marozava, Sviatlana; Vargas-López, Raquel; Tian, Ye; Merl-Pham, Juliane; Braster, Martin; Meckenstock, Rainer U; Smidt, Hauke; Röling, Wilfred F M; Westerhoff, Hans V

2018-06-19

Desulfitobacterium hafniense Y51 has been widely used in investigations of perchloroethylene (PCE) biodegradation, but limited information exists on its other physiological capabilities. We investigated how D. hafniense Y51 confronts the debilitating limitations of not having enough electron donor (lactate), or electron acceptor (fumarate) during cultivation in chemostats. The residual concentrations of the substrates supplied in excess were much lower than expected. Transcriptomics, proteomics, and fluxomics were integrated to investigate how this phenomenon was regulated. Through diverse regulation at both transcriptional and translational levels, strain Y51 turned to fermenting the excess lactate and disproportionating the excess fumarate under fumarate- and lactate-limiting conditions, respectively. Genes and proteins related to the utilization of a variety of alternative electron donors and acceptors absent from the medium were induced, apparently involving the Wood-Ljungdahl pathway. Through this metabolic flexibility, D. hafniense Y51 may be able to switch between different metabolic capabilities under limiting conditions. This article is protected by copyright. All rights reserved. © 2018 Society for Applied Microbiology and John Wiley & Sons Ltd.

ADad 8: School Phobia and Anxiety Disorders among adolescents in a rural community population in India.

PubMed

Nair, M K C; Russell, Paul Swamidhas Sudhakar; Subramaniam, Vinod Shanmukham; Nazeema, Suma; Chembagam, Neethu; Russell, Sushila; Shankar, Satya Raj; Jakati, Praveen Kumar; Charles, Helen

2013-11-01

School Phobia (SP), although is not a formal psychiatric diagnosis, is widely prevalent debilitating phenomenon with a gamut of underlying psychiatric conditions in an overwhelming majority of cases. This study documents the prevalence, symptom presentation and the relationship between the various subtypes of Anxiety Disorders (AD) and School Phobia. In a prospective community survey of 500 adolescents, independent raters administered the Screen for Child Anxiety Related Emotional Disorders and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime to identify SP and subtype of AD respectively. Descriptive statistics for the prevalence and symptom presentation, Spearman's Correlation test, Independent t tests, on-way ANOVA and Chi-square tests were done to compare the prevalence and severity of School Phobia among various age groups and gender. Univariate and multivariate analyses were done for documenting the relationship between the School Phobia and Anxiety Disorders. School Phobia was noted in 4.8% of adolescents. Although age was related to SP, gender, school grade the adolescent was attending and family structure were not related to SP. Somatic symptoms were more often noted than cognitive-emotional symptoms among adolescents with SP. Panic Disorder (OR = 8.62), Social Anxiety Disorder (OR = 8.63), and Separation Anxiety Disorder (OR = 6.26), were significantly related to SP. School Phobia is noted in a significant proportion of adolescents in the community. Anxiety Disorder is a major underlying factor resulting in SP. Community and clinical intervention and service models should include anxiety alleviation methods in adolescents with School Phobia.

The effect of endoscopic sterilization on reproductive behavior and pair bond maintenance of feral pigeons (Columba livia).

PubMed

Heiderich, E; Failing, K; Lierz, M; Schildger, B

2016-01-01

Problems related to feral pigeons (Columba livia) in cities mainly result from their large numbers due to uncontrolled population growth. The aim of this study was to evaluate whether endoscopic guided sterilization affects the reproductive behavior of feral pigeons under experimental conditions, with the intention of assessing this technique as a potential method for feral pigeon population control. Five groups of four pairs of feral pigeons each were studied from 8 weeks before, to 7 weeks after sterilization. Both the male and female of the first pair of each group were sterilized, in the second pair only the female and in the third pair only the male was sterilized. The fourth pair acted as a control. All eggs laid were candled to assess fertility. Surgical sterilization had minimal effects on behavior and therefore seems not to have impact on possible field application for population control. All pairs maintained their pair bonds and continued to defend their nesting sites against other pigeons. Only one female copulated with a foreign fertile male while her primary partner was debilitated due to surgery, but returned to him as soon as he recovered. All eggs laid more than 5 days after male sterilization were infertile, whereas all control pairs had fertile eggs. Only one fertile clutch was produced, 5 days after the male's sterilization. Therefore it is assumed that males remain fertile for a limited period of time. Endoscopic sterilization seems to be a promising method for field control of feral pigeon populations and sterilization of the male only seems sufficient.

Mindfulness meditation for insomnia: A meta-analysis of randomized controlled trials.

PubMed

Gong, Hong; Ni, Chen-Xu; Liu, Yun-Zi; Zhang, Yi; Su, Wen-Jun; Lian, Yong-Jie; Peng, Wei; Jiang, Chun-Lei

2016-10-01

Insomnia is a widespread and debilitating condition that affects sleep quality and daily productivity. Although mindfulness meditation (MM) has been suggested as a potentially effective supplement to medical treatment for insomnia, no comprehensively quantitative research has been conducted in this field. Therefore, we performed a meta-analysis on the findings of related randomized controlled trials (RCTs) to evaluate the effects of MM on insomnia. Related publications in PubMed, EMBASE, the Cochrane Library and PsycINFO were searched up to July 2015. To calculate the standardized mean differences (SMDs) and 95% confidence intervals (CIs), we used a fixed effect model when heterogeneity was negligible and a random effect model when heterogeneity was significant. A total of 330 participants in 6 RCTs that met the selection criteria were included in this meta-analysis. Analysis of overall effect revealed that MM significantly improved total wake time and sleep quality, but had no significant effects on sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, total wake time, ISI, PSQI and DBAS. Subgroup analyses showed that although there were no significant differences between MM and control groups in terms of total sleep time, significant effects were found in total wake time, sleep onset latency, sleep quality, sleep efficiency, and PSQI global score (absolute value of SMD range: 0.44-1.09, all p<0.05). The results suggest that MM may mildly improve some sleep parameters in patients with insomnia. MM can serve as an auxiliary treatment to medication for sleep complaints. Copyright © 2016 Elsevier Inc. All rights reserved.

Review article: pathogenesis and clinical manifestations of gastrointestinal involvement In systemic sclerosis

PubMed Central

Kumar, Sumit; Singh, Jagmohan; Rattan, Satish; DiMarino, Anthony J; Cohen, Sidney; Jimenez, Sergio A.

2017-01-01

SUMMARY Background Gastrointestinal tract involvement is a common cause of debilitating symptoms in patients with systemic sclerosis. There are no disease modifying therapies for this condition and the treatment remains symptomatic, largely owing to the lack of a clear understanding of its pathogenesis. Aim To investigate novel aspects of the pathogenesis of gastrointestinal involvement in systemic sclerosis To summarize existing knowledge regarding the cardinal clinical gastrointestinal manifestations of systemic sclerosis and its pathogenesis, emphasizing recent investigations that may be valuable in identifying potentially novel therapeutic targets. Methods Electronic (Pubmed/Medline) and manual Google search Results The gastrointestinal tract is the most common internal organ involved in systemic sclerosis. Any part of the gastrointestinal tract from the mouth to the anus can be affected. There is substantial variability in clinical manifestations and disease course and symptoms are non-specific and overlapping for a particular anatomical site. Gastrointestinal involvement can occur in the in the absence of cutaneous disease. Up to 8% of systemic sclerosis patients develop severe gastrointestinal tract symptoms. This subset of patients display increased mortality with only 15% survival at 9 years. Dysmotiity of the gastrointestinal tract causes the majority of symptoms. Recent investigations have identified a novel mechanism in the pathogenesis of gastrointestinal tract dysmotility mediated by functional anti-muscarinic receptor autoantibodies. Conclusion Despite extensive investigation the pathogenesis of gastrointestinal involvement in systemic sclerosis remains elusive. Although treatment currently remains symptomatic, an improved understanding of novel pathogenic mechanisms may allow the development of potentially highly effective approaches including intravenous immunoglobulin and microRNA based therapeutic interventions. PMID:28185291

The Sigma-2 Receptor Selective Agonist Siramesine (Lu 28-179) Decreases Cocaine-Reinforced Pavlovian Learning and Alters Glutamatergic and Dopaminergic Input to the Striatum

PubMed Central

Klawonn, Anna M.; Nilsson, Anna; Rådberg, Carl F.; Lindström, Sarah H.; Ericson, Mia; Granseth, Björn; Engblom, David; Fritz, Michael

2017-01-01

Drug addiction is a chronic, debilitating disease that affects millions of people around the world causing a substantial societal burden. Despite decades of research efforts, treatment possibilities remain limited and relapse represents the most treatment-resistant element. Neurosteroid sigma-1 receptors have been meticulously studied in psychostimulant reinforced Pavlovian learning, while the sigma-2 receptor subtype has remained unexplored. Recent development of selective sigma-2 receptor ligands have now made it possible to investigate if the sigma-2 receptor system is a potential target to treat drug addiction. We examined the effect of the sigma-2 receptor agonist Siramesine (Lu 28-179) on cocaine-associated locomotion, Pavlovian learning, and reward neurocircuitry using electrophysiology recordings and in vivo microdialysis. We found that Siramesine significantly attenuated conditioned place preference acquisition and expression, as well as it completely blocked cocaine-primed reinstatement. Siramesine, in a similar manner as the selective sigma-1 receptor antagonist BD 1063, decreased acute locomotor responses to cocaine. Immunohistochemistry suggests co-expression of progesterone receptor membrane component 1/sigma-2 receptors and vesicular glutamate transporter 1 in presynaptic boutons of the nucleus accumbens (NAc). Whole-cell voltage clamp recordings of neurons in the NAc indicated that Siramesine decreases the presynaptic release probability of glutamate. Further, we demonstrated, via in vivo microdialysis, that Siramesine significantly decreased cocaine-evoked dopamine release in the striatum of freely moving mice. Collectively, these findings demonstrate that sigma-2 receptors regulate neurocircuitry responsible for positive reinforcement and thereby play a role in cocaine-reinforced Pavlovian behaviors. PMID:29066971

Selective mutism.

PubMed

Hua, Alexandra; Major, Nili

2016-02-01

Selective mutism is a disorder in which an individual fails to speak in certain social situations though speaks normally in other settings. Most commonly, this disorder initially manifests when children fail to speak in school. Selective mutism results in significant social and academic impairment in those affected by it. This review will summarize the current understanding of selective mutism with regard to diagnosis, epidemiology, cause, prognosis, and treatment. Studies over the past 20 years have consistently demonstrated a strong relationship between selective mutism and anxiety, most notably social phobia. These findings have led to the recent reclassification of selective mutism as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. In addition to anxiety, several other factors have been implicated in the development of selective mutism, including communication delays and immigration/bilingualism, adding to the complexity of the disorder. In the past few years, several randomized studies have supported the efficacy of psychosocial interventions based on a graduated exposure to situations requiring verbal communication. Less data are available regarding the use of pharmacologic treatment, though there are some studies that suggest a potential benefit. Selective mutism is a disorder that typically emerges in early childhood and is currently conceptualized as an anxiety disorder. The development of selective mutism appears to result from the interplay of a variety of genetic, temperamental, environmental, and developmental factors. Although little has been published about selective mutism in the general pediatric literature, pediatric clinicians are in a position to play an important role in the early diagnosis and treatment of this debilitating condition.

Relationships between epistaxis, migraines, and triggers in hereditary hemorrhagic telangiectasia.

PubMed

Elphick, Amy; Shovlin, Claire L

2014-07-01

To identify whether relationships exist between epistaxis and migraines in hereditary hemorrhagic telangiectasia (HHT), to potentially provide further preventative and therapeutic options for the debilitating nosebleeds that are often very difficult to manage in clinical practice. Study participants were recruited from a UK specialist service, and online following advertisement by the HHT Foundation International. They completed a nonbiased questionnaire in which paired questions on nosebleeds and migraines were separated by at least 17 other questions. Migraines were defined as headaches with associated autonomic and/or neurological features. The reported frequencies and precipitants of epistaxis and migraines were compared using numerical scales applied equally for each condition. The 220 HHT-affected respondents reported frequent nosebleeds, 153 (69.5%) used iron tablets, and 39 (17.7%) had received at least 10 blood transfusions. Migraines displaying typical features were reported by 51 (23.2%), and were more common with pulmonary or cerebral arteriovenous malformations. Thirty of 51 (58.8%) migraine sufferers reported that nosebleeds occurred at the same time as their migraines. More frequent migraines were reported by patients with more frequent nosebleeds (r2=15%, P=.007), or transfusions (r2=16.9%, P=.004). In menstrual, lifestyle, and dietary analyses, consistency was observed between factors having no effect, and those provoking both nosebleeds and migraines in multiple patients (premenses; activity; lack of sleep; stress; caffeine, cheese, alcohol, and chocolate). We demonstrate an unexpected and provocative association between nosebleeds and migraines in HHT patients. Evaluation of whether antimigraine approaches limit HHT nosebleeds may be appropriate. 4. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Potential for Intrathecal Baclofen in Treatment of Essential Tremor.

PubMed

Hamad, Mousa; Holland, Ryan; Kamal, Naveed; Luceri, Robert; Mammis, Antonios

2017-09-01

Essential tremor (ET) is the most common movement disorder of adults, affecting an estimated 7 million Americans. Symptoms of ET range from slightly noticeable to debilitating, with 1 cohort study finding 15% of patients were forced into early retirement. Additionally, depression has also been correlated with the severity of disability of ET. Treatment options include propranolol and primidone. Current treatment options are not very effective, with more than half (56.3%) of patients discontinuing medications because of no changes in symptoms. Unfortunately, there is a relative void and controversy in the literature explaining ET pathophysiology; however, the gamma-aminobutyric acid (GABA) hypothesis is the strongest. We conducted a PubMed search on 30 September 2015 with no time constraints using the search terms "essential tremor" and "baclofen," which resulted in a total of 5 articles. Neurohistopathologic studies have demonstrated decreased GABA-A and GABA-B receptors in the cerebellar cortex of ET patients. GABA, the major inhibitory neurotransmitter in the central nervous system, is proposed to have an inhibitory effect on pacemaker output activity of the cerebello-thalamo-cortical pathway, with lower receptors resulting in decreased inhibition of baseline tremors. Tariq et al showed delayed onset and intensity of tremor with oral administration of R-baclofen in a mouse model of ET. With a better side-effect profile and success in a physiologically related condition, we propose more clinical trials and research be carried out on intrathecal baclofen as a potential treatment option, especially drug refractory ET, so as to increase the quality of life of this patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

The relationship between self-report of depression and media usage

PubMed Central

Block, Martin; Stern, Daniel B.; Raman, Kalyan; Lee, Sang; Carey, Jim; Humphreys, Ashlee A.; Mulhern, Frank; Calder, Bobby; Schultz, Don; Rudick, Charles N.; Blood, Anne J.; Breiter, Hans C.

2014-01-01

Depression is a debilitating condition that adversely affects many aspects of a person's life and general health. Earlier work has supported the idea that there may be a relationship between the use of certain media and depression. In this study, we tested if self-report of depression (SRD), which is not a clinically based diagnosis, was associated with increased internet, television, and social media usage by using data collected in the Media Behavior and Influence Study (MBIS) database (N = 19,776 subjects). We further assessed the relationship of demographic variables to this association. These analyses found that SRD rates were in the range of published rates of clinically diagnosed major depression. It found that those who tended to use more media also tended to be more depressed, and that segmentation of SRD subjects was weighted toward internet and television usage, which was not the case with non-SRD subjects, who were segmented along social media use. This study found that those who have suffered either economic or physical life setbacks are orders of magnitude more likely to be depressed, even without disproportionately high levels of media use. However, among those that have suffered major life setbacks, high media users—particularly television watchers—were even more likely to report experiencing depression, which suggests that these effects were not just due to individuals having more time for media consumption. These findings provide an example of how Big Data can be used for medical and mental health research, helping to elucidate issues not traditionally tested in the fields of psychiatry or experimental psychology. PMID:25309388

The relationship between self-report of depression and media usage.

PubMed

Block, Martin; Stern, Daniel B; Raman, Kalyan; Lee, Sang; Carey, Jim; Humphreys, Ashlee A; Mulhern, Frank; Calder, Bobby; Schultz, Don; Rudick, Charles N; Blood, Anne J; Breiter, Hans C

2014-01-01

Depression is a debilitating condition that adversely affects many aspects of a person's life and general health. Earlier work has supported the idea that there may be a relationship between the use of certain media and depression. In this study, we tested if self-report of depression (SRD), which is not a clinically based diagnosis, was associated with increased internet, television, and social media usage by using data collected in the Media Behavior and Influence Study (MBIS) database (N = 19,776 subjects). We further assessed the relationship of demographic variables to this association. These analyses found that SRD rates were in the range of published rates of clinically diagnosed major depression. It found that those who tended to use more media also tended to be more depressed, and that segmentation of SRD subjects was weighted toward internet and television usage, which was not the case with non-SRD subjects, who were segmented along social media use. This study found that those who have suffered either economic or physical life setbacks are orders of magnitude more likely to be depressed, even without disproportionately high levels of media use. However, among those that have suffered major life setbacks, high media users-particularly television watchers-were even more likely to report experiencing depression, which suggests that these effects were not just due to individuals having more time for media consumption. These findings provide an example of how Big Data can be used for medical and mental health research, helping to elucidate issues not traditionally tested in the fields of psychiatry or experimental psychology.

Progression of Ulcerative Dermatitis Lesions in C57BL/6Crl Mice and the Development of a Scoring System for Dermatitis Lesions

PubMed Central

Hampton, Anna L; Hish, Gerald A; Aslam, Muhammad N; Rothman, Edward D; Bergin, Ingrid L; Patterson, Kathleen A; Naik, Madhav; Paruchuri, Tejaswi; Varani, James; Rush, Howard G

2012-01-01

Ulcerative dermatitis (UD) is a common, spontaneous condition in mice with a C57BL/6 background. Although initial lesions may be mild, UD is a progressive disease that often results in ulcerations or debilitating fibrotic contractures. In addition, lesions typically are unresponsive to treatment. Euthanasia is often warranted in severe cases, thereby affecting study outcomes through the loss of research subjects. Because the clinical assessment of UD can be subjective, a quantitative scoring method and documentation of the likely time-frame of progression may be helpful in predicting when animals that develop dermatitis should be removed from a study. Such a system may also be helpful in quantitatively assessing success of various treatment strategies and be valuable to clinical laboratory animal veterinarians. In this 1.5-y, prospective cohort study, we followed 200 mice to monitor the development and course of UD. Mice were examined every 2 wk. A clinical sign (alopecia, pruritus, or peripheral lymphadenopathy) was not identified that predicted development of UD lesions in the subsequent 2-wk period. Once UD developed, pruritus, the character of the lesion (single or multiple crust, coalescing crust, erosion, or ulceration), and the size of the lesion were the only parameters that changed (increased) over the course of the disease. Pruritus was a factor in the rapid progression of UD lesions. We used these findings to develop a quantitative scoring system for the severity of UD. This enhanced understanding of the progression of UD and the quantitative scoring system will enhance the monitoring of UD. PMID:23312087

Pattern of Corticospinal Projections Defined by Brain Mapping During Resective Epilepsy Surgery in a Patient with Congenital Hemiparesis and Intractable Epilepsy.

PubMed

Yang, Chen-Ya; Chen, Hsin-Hung; Chen, Chien; Chiu, Jan-Wei; Chou, Chen-Liang; Yang, Tsui-Fen

2017-11-01

Congenital or early-onset brain structural lesions often cause contralateral hemiparesis, cognitive deficits, developmental delays, and seizures. Seizure is the most debilitating condition, as it greatly impairs quality of life in both the affected individuals and their caregivers and prevents them from active social participation. A 34-year-old man with hemiparesis and early-onset seizures since childhood owing to a congenital brain lesion developed intractable seizures in the last 2 years and was subsequently admitted for resective epileptic surgery. During the operation, we employed an innovative intraoperative neurophysiologic monitoring technique. In contrast to routine application for transcranial stimulation, we recorded compound muscle action potentials over the bilateral limb muscles simultaneously, instead of over the contralateral muscles only, to determine the patterns of the corticospinal projections. Transcranial stimulation over the bilateral hemispheres was applied before craniotomy, and direct cortical stimulation over the lesioned hemisphere was applied after craniotomy. By integrating both approaches, we could first identify the pattern of corticospinal projections before craniotomy and then accurately define the noneloquent area, which guided the resection to successfully accomplish the surgical goal. This technique is simple because no patient participation is required. We believe that it has the potential to replace conventional preoperative functional magnetic resonance imaging and transcranial magnetic stimulation in resective epilepsy surgery, particularly for young patients. Not only can it improve the safety of surgical procedures, but also it can help predict functional outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

Predictable enriched environment prevents development of hyper-emotionality in the VPA rat model of autism.

PubMed

Favre, Mônica R; La Mendola, Deborah; Meystre, Julie; Christodoulou, Dimitri; Cochrane, Melissa J; Markram, Henry; Markram, Kamila

2015-01-01

Understanding the effects of environmental stimulation in autism can improve therapeutic interventions against debilitating sensory overload, social withdrawal, fear and anxiety. Here, we evaluate the role of environmental predictability on behavior and protein expression, and inter-individual differences, in the valproic acid (VPA) model of autism. Male rats embryonically exposed (E11.5) either to VPA, a known autism risk factor in humans, or to saline, were housed from weaning into adulthood in a standard laboratory environment, an unpredictably enriched environment, or a predictably enriched environment. Animals were tested for sociability, nociception, stereotypy, fear conditioning and anxiety, and for tissue content of glutamate signaling proteins in the primary somatosensory cortex, hippocampus and amygdala, and of corticosterone in plasma, amygdala and hippocampus. Standard group analyses on separate measures were complemented with a composite emotionality score, using Cronbach's Alpha analysis, and with multivariate profiling of individual animals, using Hierarchical Cluster Analysis. We found that predictable environmental enrichment prevented the development of hyper-emotionality in the VPA-exposed group, while unpredictable enrichment did not. Individual variation in the severity of the autistic-like symptoms (fear, anxiety, social withdrawal and sensory abnormalities) correlated with neurochemical profiles, and predicted their responsiveness to predictability in the environment. In controls, the association between socio-affective behaviors, neurochemical profiles and environmental predictability was negligible. This study suggests that rearing in a predictable environment prevents the development of hyper-emotional features in animals exposed to an autism risk factor, and demonstrates that unpredictable environments can lead to negative outcomes, even in the presence of environmental enrichment.

Predictable enriched environment prevents development of hyper-emotionality in the VPA rat model of autism

PubMed Central

Favre, Mônica R.; La Mendola, Deborah; Meystre, Julie; Christodoulou, Dimitri; Cochrane, Melissa J.; Markram, Henry; Markram, Kamila

2015-01-01

Understanding the effects of environmental stimulation in autism can improve therapeutic interventions against debilitating sensory overload, social withdrawal, fear and anxiety. Here, we evaluate the role of environmental predictability on behavior and protein expression, and inter-individual differences, in the valproic acid (VPA) model of autism. Male rats embryonically exposed (E11.5) either to VPA, a known autism risk factor in humans, or to saline, were housed from weaning into adulthood in a standard laboratory environment, an unpredictably enriched environment, or a predictably enriched environment. Animals were tested for sociability, nociception, stereotypy, fear conditioning and anxiety, and for tissue content of glutamate signaling proteins in the primary somatosensory cortex, hippocampus and amygdala, and of corticosterone in plasma, amygdala and hippocampus. Standard group analyses on separate measures were complemented with a composite emotionality score, using Cronbach's Alpha analysis, and with multivariate profiling of individual animals, using Hierarchical Cluster Analysis. We found that predictable environmental enrichment prevented the development of hyper-emotionality in the VPA-exposed group, while unpredictable enrichment did not. Individual variation in the severity of the autistic-like symptoms (fear, anxiety, social withdrawal and sensory abnormalities) correlated with neurochemical profiles, and predicted their responsiveness to predictability in the environment. In controls, the association between socio-affective behaviors, neurochemical profiles and environmental predictability was negligible. This study suggests that rearing in a predictable environment prevents the development of hyper-emotional features in animals exposed to an autism risk factor, and demonstrates that unpredictable environments can lead to negative outcomes, even in the presence of environmental enrichment. PMID:26089770

Development and Validity of Western University's On-Road Assessment.

PubMed

Classen, Sherrilene; Krasniuk, Sarah; Alvarez, Liliana; Monahan, Miriam; Morrow, Sarah A; Danter, Tim

2017-01-01

Although used across North America, many on-road studies do not explicitly document the content and metrics of on-road courses and accompanying assessments. This article discusses the development of the University of Western Ontario's on-road course, and elucidates the validity of its accompanying on-road assessment. We identified main components for developing an on-road course and used measurement theory to establish face, content, and initial construct validity. Five adult volunteer drivers and 30 drivers with multiple sclerosis participated in the study. The road course had face and content validity, representing 100% of roadway components determined through a content validity matrix and index. The known-groups method showed that debilitated drivers (vs. not debilitated), made more driving errors ( W = 463.50, p = .03), and failed the on-road course, indicating preliminary construct validity of the on-road assessment. This research guides and empirically supports a process for developing a road course and its assessment.

Chronic debilitating fatigue in Irish general practice: a survey of general practitioners' experience.

PubMed

Fitzgibbon, E J; Murphy, D; O'Shea, K; Kelleher, C

1997-10-01

Doctors are called upon to treat chronic debilitating fatigue without the help of a protocol of care. To estimate the incidence of chronic debilitating fatigue in Irish general practice, to obtain information on management strategy and outcome, to explore the attitudes of practitioners (GPs) towards the concept of a chronic fatigue syndrome (CFS), and to recruit practitioners to a prospective study of chronic fatigue in primary care. A total of 200 names were selected from the database of the Irish College of General Practitioners (ICGP); 164 of these were eligible for the study. Altogether, 118 questionnaires were returned (72%). Ninety-two (78%) responders identified cases of chronic fatigue, giving an estimated 2.1 cases per practice and an incidence of 1 per 1000 population. All social classes were represented, with a male to female ratio of 1:2. Eleven disparate approaches to treatment were advocated. Many (38%) were dissatisfied with the quality of care delivered, and 45% seldom or hardly ever referred cases for specialist opinion. The majority (58%) accepted CFS as a distinct entity, 34% were undecided, and 8% rejected it. Forty-two (35%) GPs volunteered for a prospective study. Chronic fatigue is found in Irish general practice among patients of both sexes and all social classes. Doctors differ considerably in their management of patients and are dissatisfied with the quality of care they deliver. Many cases are not referred for specialist opinion. A prospective database is required to accurately assess the scale of this public health problem and to develop a protocol of care.

Evidence of accelerated beak growth associated with avian keratin disorder in black-capped chickadees (Poecile atricapillus)

USGS Publications Warehouse

Van Hemert, Caroline R.; Handel, Colleen M.; O'Hara, Todd M.

2012-01-01

We recently documented an epizootic of beak deformities in more than 2,000 Blackcapped Chickadees (Poecile atricapillus) and other wild bird species in North America. This emerging avian disease, which has been termed avian keratin disorder, results in gross overgrowth of the rhamphotheca, the outer, keratinized layer of the beak. To test the hypothesis that the beak deformities characteristic of this disorder are associated with accelerated keratin production, we measured rates of beak growth and wear in affected Black-capped Chickadees (n=16) and a control sample of unaffected chickadees (n=14) collected from south-central (61°09'-61°38'N, 149°11' -149°48'W) and interior Alaska (64°51' -64°53'N, 147°49' -147°59'W). Rates of absolute growth were 50-100% higher in affected birds than they were in control birds and exceeded records from other passerine species. These results suggest that abnormally rapid epidermal growth is the primary physical mechanism by which beak deformities develop and are maintained in affected chickadees. Although beak overgrowth typically worsened over time, differential patterns of wear influenced the severity and morphology of deformities. In some cases, the effects of accelerated keratin growth were partially mitigated by frequent breakage of rhamphothecal tips. However, mortalities occurred in 9 of 16 birds (56%) with beak deformities during the study, suggesting that avian keratin disorder results in severe health consequences for affected birds. Additional study of factors that control beak keratin production is needed to understand the pathogenesis of this debilitating disease in wild birds.

An International Genetic Survey of Breed-Specific Diseases in Working Dogs from the United States, Israel, and Poland.

PubMed

Shaffer, Lisa G; Ramirez, Christina J; Phelps, Patricia; Aviram, Maya; Walczak, Marta; Bar-Gal, Gila Kahila; Ballif, Blake C

2017-01-01

Genetic diseases occur in breeds used for law enforcement. As important team members, dogs are expected to operate at peak performance for several years and are significant investments for both the initial purchase and extensive, specialized training. Previous studies have not focused on causes for retirement or euthanasia as genetic (inherited) versus acquired (environmental). We performed direct mutational analysis for breed-specific conditions on samples from 304 dogs including 267 law enforcement (122 US, 87 Israeli, and 58 Polish) and 37 search and rescue dogs. Genetic testing identified 29% (n = 89) of the dogs tested to be carriers of a genetic mutation and 6% (n = 19) to be at risk for a debilitating inherited condition that may eventually impair the dog's ability to work. At-risk dogs included Labrador Retrievers (n = 4) with exercise-induced collapse, Bloodhounds (n = 2) with degenerative myelopathy (DM), and German Shepherd dogs with DM (n = 12) or leukocyte adhesion deficiency, type III (n = 1). A substantial number of working dogs were shown to be at risk for genetic conditions that may shorten the dog's career. The loss of dogs, due to early retirement or euthanasia, as a result of preventable genetic conditions has an emotional cost to handlers and financial cost to service organizations that can be avoided with genetic screening prior to breeding, buying, or training. © 2018 S. Karger AG, Basel.

Withdrawal of food and fluid.

PubMed

Daly, B J

1990-05-01

John S. is a 72-year-old patriarch of a large, extended family. He underwent a mitral and aortic valve replacement, followed by a complicated postoperative course. His recovery was complicated by hemodynamic instability, several cardiac arrests, acute renal failure, and sepsis. He has been in the ICU for 14 weeks and has been unable to wean from mechanical ventilation. After many conferences between the patient's family and the ICU staff, a decision was made to remove ventilator support. This was done 3 days ago. John's condition seems stable now, but it is clear that he will not regain his former state of health. He is very debilitated, may require chronic dialysis, and has suffered some anoxic brain damage during his arrests. The nursing and medical staff are now faced with the question of further withdrawal of treatment and are considering whether or not to discontinue his parenteral nutrition and all IV fluids.

Inflammatory mediators as biomarkers in brain disorders.

PubMed

Nuzzo, Domenico; Picone, Pasquale; Caruana, Luca; Vasto, Sonya; Barera, Annalisa; Caruso, Calogero; Di Carlo, Marta

2014-06-01

Neurodegenerative diseases such as Alzheimer, Parkinson, amyotrophic lateral sclerosis, and Huntington are incurable and debilitating conditions that result in progressive death of the neurons. The definite diagnosis of a neurodegenerative disorder is disadvantaged by the difficulty in obtaining biopsies and thereby to validate the clinical diagnosis with pathological results. Biomarkers are valuable indicators for detecting different phases of a disease such as prevention, early onset, treatment, progression, and monitoring the effect of pharmacological responses to a therapeutic intervention. Inflammation occurs in neurodegenerative diseases, and identification and validation of molecules involved in this process could be a strategy for finding new biomarkers. The ideal inflammatory biomarker needs to be easily measurable, must be reproducible, not subject to wide variation in the population, and unaffected by external factors. Our review summarizes the most important inflammation biomarkers currently available, whose specificity could be utilized for identifying and monitoring distinctive phases of different neurodegenerative diseases.

Is bile acid malabsorption underdiagnosed? An evaluation of accuracy of diagnosis by measurement of SeHCAT retention.

PubMed Central

Merrick, M V; Eastwood, M A; Ford, M J

1985-01-01

The cause of intractable chronic diarrhoea was found to be malabsorption of bile acid in five out of 42 patients thought to have the irritable bowel syndrome, six out of 29 patients with persistent diarrhoea after surgery for peptic ulcer, 23 who had undergone small bowel resection, and two others. Specific treatment brought symptomatic relief. The diagnosis was established by measuring the proportion of SeHCAT, a synthetic bile salt, retained one week after oral administration of a tracer dose of less than 100 micrograms of the compound labelled with 40 kBq (1 microCi) of selenium-75. These results indicate that malabsorption of bile acid is a more common cause of chronic diarrhoea than is generally appreciated. Measurement of retention of SeHCAT is a simple, accurate, and acceptable means of establishing the diagnosis of this debilitating but treatable condition. PMID:3918708

Is bile acid malabsorption underdiagnosed? An evaluation of accuracy of diagnosis by measurement of SeHCAT retention.

PubMed

Merrick, M V; Eastwood, M A; Ford, M J

1985-03-02

The cause of intractable chronic diarrhoea was found to be malabsorption of bile acid in five out of 42 patients thought to have the irritable bowel syndrome, six out of 29 patients with persistent diarrhoea after surgery for peptic ulcer, 23 who had undergone small bowel resection, and two others. Specific treatment brought symptomatic relief. The diagnosis was established by measuring the proportion of SeHCAT, a synthetic bile salt, retained one week after oral administration of a tracer dose of less than 100 micrograms of the compound labelled with 40 kBq (1 microCi) of selenium-75. These results indicate that malabsorption of bile acid is a more common cause of chronic diarrhoea than is generally appreciated. Measurement of retention of SeHCAT is a simple, accurate, and acceptable means of establishing the diagnosis of this debilitating but treatable condition.

Diagnosis and management of post-traumatic stress disorder.

PubMed

Grinage, Bradley D

2003-12-15

Although post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder that may cause significant distress and increased use of health resources, the condition often goes undiagnosed. The lifetime prevalence of PTSD in the United States is 8 to 9 percent, and approximately 25 to 30 percent of victims of significant trauma develop PTSD. The emotional and physical symptoms of PTSD occur in three clusters: re-experiencing the trauma, marked avoidance of usual activities, and increased symptoms of arousal. Before a diagnosis of PTSD can be made, the patient's symptoms must significantly disrupt normal activities and last for more than one month. Approximately 80 percent of patients with PTSD have at least one comorbid psychiatric disorder. The most common comorbid disorders include depression, alcohol and drug abuse, and other anxiety disorders. Treatment relies on a multidimensional approach, including supportive patient education, cognitive behavior therapy, and psychopharmacology. Selective serotonin reuptake inhibitors are the mainstay of pharmacologic treatment.

Benzimidazoles: an ideal privileged drug scaffold for the design of multitargeted anti-inflammatory ligands.

PubMed

Kaur, Gaganpreet; Kaur, Maninder; Silakari, Om

2014-01-01

The recent research area endeavors to discover ultimate multi-target ligands, an increasingly feasible and attractive alternative to existing mono-targeted drugs for treatment of complex, multi-factorial inflammation process which underlays plethora of debilitated health conditions. In order to improvise this option, exploration of relevant chemical core scaffold will be an utmost need. Privileged benzimidazole scaffold being historically versatile structural motif could offer a viable starting point in the search for novel multi-target ligands against multi-factorial inflammation process since, when appropriately substituted, it can selectively modulate diverse receptors, pathways and enzymes associated with the pathogenesis of inflammation. Despite this remarkable capability, the multi-target capacity of the benzimidazole scaffold remains largely unexploited. With this in focus, the present review article attempts to provide synopsis of published research to exemplify the valuable use of benzimidazole nucleus and focus on their suitability as starting scaffold to develop multi-targeted anti-inflammatory ligands.

Athletic Hip Injuries.

PubMed

Lynch, T Sean; Bedi, Asheesh; Larson, Christopher M

2017-04-01

Historically, athletic hip injuries have garnered little attention; however, these injuries account for approximately 6% of all sports injuries and their prevalence is increasing. At times, the diagnosis and management of hip injuries can be challenging and elusive for the team physician. Hip injuries are seen in high-level athletes who participate in cutting and pivoting sports that require rapid acceleration and deceleration. Described previously as the "sports hip triad," these injuries consist of adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement. These disorders can happen in isolation but frequently occur in combination. To add to the diagnostic challenge, numerous intra-articular disorders and extra-articular soft-tissue restraints about the hip can serve as pain generators, in addition to referred pain from the lumbar spine, bowel, bladder, and reproductive organs. Athletic hip conditions can be debilitating and often require a timely diagnosis to provide appropriate intervention.

Behavioral testing in rodent models of orofacial neuropathic and inflammatory pain

PubMed Central

Krzyzanowska, Agnieszka; Avendaño, Carlos

2012-01-01

Orofacial pain conditions are often very debilitating to the patient and difficult to treat. While clinical interest is high, the proportion of studies performed in the orofacial region in laboratory animals is relatively low, compared with other body regions. This is partly due to difficulties in testing freely moving animals and therefore lack of reliable testing methods. Here we present a comprehensive review of the currently used rodent models of inflammatory and neuropathic pain adapted to the orofacial areas, taking into account the difficulties and drawbacks of the existing approaches. We examine the available testing methods and procedures used for assessing the behavioral responses in the face in both mice and rats and provide a summary of some pharmacological agents used in these paradigms to date. The use of these agents in animal models is also compared with outcomes observed in the clinic. PMID:23139912

A New Technique for Surgical Treatment of Proximal Hamstring Tendinopathy in a Triathlon Athlete.

PubMed

Costa, Lincoln Paiva; Barros, Antônio Augusto Guimarães; Vassalo, Carlos Cesar; Sonnery-Cottet, Bertrand; Barbosa, Victor Atsushi Kasuya; Temponi, Eduardo Frois

2016-01-01

Proximal hamstring tendinopathy (PHT) is the result of chronic overload caused by repetitive eccentric contraction. Surgical treatment becomes an option for patients with chronic symptoms that do not respond to conservative treatment. This report describes a case of a 48-year-old man, an amateur triathlete, with deep gluteal pain in the left hip for 12 months, leading to a decline in sports performance. Magnetic resonance imaging revealed abnormalities that suggested a PHT. Surgery was indicated following the failure of conservative treatments. Debridement of the conjoint tendon and its reinsertion associated with semimembranosus tenotomy showed good results and is thus an option for the treatment of this pathology after 12 months of follow-up. This article provides surgeons with a new surgical option for this debilitating condition with clinical and functional improvement after 12 months of follow-up.

A New Technique for Surgical Treatment of Proximal Hamstring Tendinopathy in a Triathlon Athlete

PubMed Central

Costa, Lincoln Paiva; Barros, Antônio Augusto Guimarães; Vassalo, Carlos Cesar; Sonnery-Cottet, Bertrand; Barbosa, Victor Atsushi Kasuya; Temponi, Eduardo Frois

2016-01-01

Introduction: Proximal hamstring tendinopathy (PHT) is the result of chronic overload caused by repetitive eccentric contraction. Surgical treatment becomes an option for patients with chronic symptoms that do not respond to conservative treatment. Case Report: This report describes a case of a 48-year-old man, an amateur triathlete, with deep gluteal pain in the left hip for 12 months, leading to a decline in sports performance. Magnetic resonance imaging revealed abnormalities that suggested a PHT. Surgery was indicated following the failure of conservative treatments. Debridement of the conjoint tendon and its reinsertion associated with semimembranosus tenotomy showed good results and is thus an option for the treatment of this pathology after 12 months of follow-up. Conclusion: This article provides surgeons with a new surgical option for this debilitating condition with clinical and functional improvement after 12 months of follow-up. PMID:28507970

Treating selective mutism using modular CBT for child anxiety: a case study.

PubMed

Reuther, Erin T; Davis, Thompson E; Moree, Brittany N; Matson, Johnny L

2011-01-01

Selective mutism is a rare, debilitating condition usually seen in children. Unfortunately, there is little research examining effective treatments for this disorder, and designing an evidence-based treatment plan can be difficult. This case study presents the evidence-based treatment of an 8-year-old Caucasian boy with selective mutism using an established treatment for anxiety--Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders (Chorpita, 2007). The treatment consisted of 21 sessions and included modules on psychoeducation, exposure, cognitive restructuring, social skills, and maintenance and relapse prevention. The client's symptoms were greatly improved by the end of treatment based on fear hierarchy ratings, self-report and parent-report questionnaires, and child and parent clinical interviews. In addition, at discharge the client no longer met criteria for selective mutism. Improvements were maintained when the client was reassessed at 1-month and 6-month follow-up appointments.

Neuroinflammatory genes associated with post-traumatic stress disorder: implications for comorbidity.

PubMed

Zass, Lyndon J; Hart, Stephanie A; Seedat, Soraya; Hemmings, Sian M J; Malan-Müller, Stefanie

2017-02-01

Post-traumatic stress disorder (PTSD) is a debilitating condition that only occurs in the aftermath of traumatic event exposure and is characterized by an impaired stress response and chronic, low-grade inflammation. Dysregulation of the immune system may contribute towards central nervous system tissue damage and exacerbation of fear memories following trauma. Patients with PTSD often have comorbid psychiatric and somatic disorders that are of themselves associated with heightened inflammation. Several immune-related genes have been associated with PTSD and other co-occurring disorders. In this review, we propose that chronic inflammation, particularly neuroinflammation, is an important contributory factor towards PTSD comorbidity. Thus, novel treatments that target dysregulated inflammatory processes could provide symptomatic relief from PTSD and its comorbid disorders. This review investigates the intricate links between chronic stress, anxiety and neuroinflammation and the potential impact of increased neuroinflammation on PTSD pathology and comorbidity.

Case Study of High-Dose Ketamine for Treatment of Complex Regional Pain Syndrome in the Pediatric Intensive Care Unit.

PubMed

Pasek, Tracy Ann; Crowley, Kelli; Campese, Catherine; Lauer, Rachel; Yang, Charles

2017-06-01

Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient. The expertise of advanced practice nurses blended exquisitely to ensure patient and family-centered care and the coordination of care across the illness trajectory. The patient experienced positive outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Congenital Partial Absence of Trapezius with Variant Pattern of Rectus Sheath.

PubMed

Tigga, Sarika Rachel; Goswami, Preeti; Khanna, Jugesh

2016-04-01

Musculocutaneous pedicled/free flaps are an essential prerequisite for reconstructive surgery. Amongst the trunk muscles commonly harvested for flaps, the trapezius and rectus abdominis provide satisfactory coverage for cranial and trunk defects. unilateral/bilateral or partial congenital absence of trapezius muscle is well documented and may result in muscular imbalances compromising posture and limb movements. During routine cadaveric dissection, we encountered a case of bilateral partial absence of occipital part of the trapezius muscle. Concurrently, the ventral abdominal musculature displayed the aponeurosis of transversus abdominis muscle solely forming the posterior wall of the rectus sheath. These conjointly occurring anomalies advocate a compensatory strengthening of the anterior wall of rectus sheath in response to the congenital absence of occipital part of the trapezius, probably to counteract the postural instability. The present study focuses on recognition of compensatory mechanisms resulting from congenital variations as identification of such processes may prevent chronic debilitating conditions.

A novel full-angle scanning light scattering profiler to quantitatively evaluate forward and backward light scattering from intraocular lenses

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walker, Bennett N., E-mail: bennett.walker@fda.hhs.gov; Office of Device Evaluation, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland 20993; James, Robert H.

Glare, glistenings, optical defects, dysphotopsia, and poor image quality are a few of the known deficiencies of intraocular lenses (IOLs). All of these optical phenomena are related to light scatter. However, the specific direction that light scatters makes a critical difference between debilitating glare and a slightly noticeable decrease in image quality. Consequently, quantifying the magnitude and direction of scattered light is essential to appropriately evaluate the safety and efficacy of IOLs. In this study, we introduce a full-angle scanning light scattering profiler (SLSP) as a novel approach capable of quantitatively evaluating the light scattering from IOLs with a nearlymore » 360° view. The SLSP method can simulate in situ conditions by controlling the parameters of the light source including angle of incidence. This testing strategy will provide a more effective nonclinical approach for the evaluation of IOL light scatter.« less

[The Ehlers-Danlos syndrome: hystory of a clinical hendiadys].

PubMed

Brazzaventre, Cristina; Celletti, Claudia; Gobattoni, Paolo; Santilli, Valter; Camerota, Filippo

2013-01-01

Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of inherited connective tissue disorders characterized by joint hypermobility, skin hyperextensibility and tissue fragility, which results in easy bruising and abnormal scarring. The condition shows a phenotypic variance from milder to serious presentations. Complaints related to activity (hypermobility, dislocations, impaired balance), to pain (general pain, headache, jaw and tooth pain) and to skin (bruises, fragility, impaired wound healing) are frequent. It was first noted by Hippocrates in 400 BC in his writing 'Airs Water and Places' that the nomads Scythians had lax joints and multiple scars. Whereas the additional flexibility can give benefits in term of mobility and agility, adverse effects of tissue laxity and fragility can give rise to clinical consequences. We recognize that it is important that, in those hypermobility patients, who develop potentially debilitating symptoms of chronicfatigue or widespread pain, there should be prompt an appropriate intervention.

The Hyperspectral Infrared Imager (HyspIRI) Public Health and Air Quality Applications

NASA Technical Reports Server (NTRS)

Luvall, Jeffrey C.; Hook, Simon J.

2014-01-01

The neglected tropical diseases (NTDs), a group of chronic, debilitating, and poverty-promoting parasitic, bacterial, and some viral and fungal infections, are among the most common causes of illness of the poorest people living in developing countries. Abiotic environmental factors are important in determining the distribution of disease-causing vectors and their life-cycles. HyspIRI observations can be merged through a Land Data Assimilation System (LDAS) be used to drive spatially-explicit ecological models of NTD vectors distribution and life cycles. Assimilations will be driven by observational data LDAS and satellite-derived meteorological forcing data, parameter datasets, and assimilation observations. HyspIRI hyperspectral measurements would provide global measurements of surface mineralogy and biotic crusts important in accessing the impact of dust in human health. HyspIRI surface thermal measurements would also help identify the variability of dust sources due to surface moisture conditions and map mineralogy.

Use of stereotactic intensity-modulated radiotherapy in thyroid-related ophthalmopathy. Case report.

PubMed

Espinoza, Salvador; Saboori, Mehran; Forman, Scott; Moorthy, Chitti R; Benzil, Deborah L

2004-11-01

Thyroid-related ophthalmopathy (TRO), a debilitating condition involving a range of visual and orbital symptoms, occurs in up to 40% of patients with Graves disease. The goals of treatment include correcting thyroid dysfunction, relieving ocular pain, preserving vision, and improving cosmetic appearance. Options for therapy include symptomatic treatment, glucocorticoid medication, radiation therapy, and surgery. Traditional radiation treatment uses small opposed bilateral fields consisting of retrobulbar volumes and customized blocks to shield periorbital structures. The combination of intensity-modulated radiotherapy (IMRT) and stereotactic technology facilitates the administration of radiation to patients suffering from TRO and provides greater safety and efficacy than traditional treatment. The authors present the case of a patient with severe TRO whose symptoms resolved rapidly after treatment with stereotactic IMRT. The outcome in this case supports stereotactic IMRT as an effective treatment option for patients with TRO who also undergo radiation therapy.

The Hyperspectral Infrared Imager (HyspIRI) Public Health and Air Quality Applications

NASA Technical Reports Server (NTRS)

Luvall, Jeffrey C.; Hook, Simon J.

2013-01-01

The neglected tropical diseases (NTDs), a group of chronic, debilitating, and poverty-promoting parasitic, bacterial, and some viral and fungal infections, are among the most common causes of illness of the poorest people living in developing countries. Abiotic environmental factors are important in determining the distribution of disease-causing vectors and their life-cycles. HyspIRI observations can be merged through a Land Data Assimilation System (LDAS) be used to drive spatially-explicit ecological models of NTD vectors distribution & life cycles. Assimilations will be driven by observational data LDAS and satellite-derived meteorological forcing data, parameter datasets, and assimilation observations. HyspIRI hyperspectral measurements would provide global measurements of surface mineralogy and biotic crusts important in accessing the impact of dust in human health. HyspIRI surface thermal measurements would also help identify the variability of dust sources due to surface moisture conditions and map mineralogy.

The Hyperspectral Infrared Imager (HyspIRI) Public Health & Air Quality Applications

NASA Technical Reports Server (NTRS)

Luvall, Jeffrey C.; Hook, Simon J.

2013-01-01

The neglected tropical diseases (NTDs), a group of chronic, debilitating, and poverty-promoting parasitic, bacterial, and some viral and fungal infections, are among the most common causes of illness of the poorest people living in developing countries. Abiotic environmental factors are important in determining the distribution of disease-causing vectors and their life-cycles. HyspIRI observations can be merged through a Land Data Assimilation System (LDAS) be used to drive spatially-explicit ecological models of NTD vectors distribution & life cycles. Assimilations will be driven by observational data LDAS and satellite-derived meteorological forcing data, parameter datasets, and assimilation observations. HyspIRI hyperspectral measurements would provide global measurements of surface mineralogy and biotic crusts important in accessing the impact of dust in human health. HyspIRI surface thermal measurements would also help identify the variability of dust sources due to surface moisture conditions and map mineralogy.

Gut Microbiota and Salivary Diagnostics: The Mouth Is Salivating to Tell Us Something

PubMed Central

Kodukula, Krishna; Faller, Douglas V.; Harpp, David N.; Kanara, Iphigenia; Pernokas, Julie; Pernokas, Mark; Powers, Whitney R.; Soukos, Nikolaos S.; Steliou, Kosta; Moos, Walter H.

2017-01-01

Abstract The microbiome of the human body represents a symbiosis of microbial networks spanning multiple organ systems. Bacteria predominantly represent the diversity of human microbiota, but not to be forgotten are fungi, viruses, and protists. Mounting evidence points to the fact that the “microbial signature” is host-specific and relatively stable over time. As our understanding of the human microbiome and its relationship to the health of the host increases, it is becoming clear that many and perhaps most chronic conditions have a microbial involvement. The oral and gastrointestinal tract microbiome constitutes the bulk of the overall human microbial load, and thus presents unique opportunities for advancing human health prognosis, diagnosis, and therapy development. This review is an attempt to catalog a broad diversity of recent evidence and focus it toward opportunities for prevention and treatment of debilitating illnesses. PMID:29098118

Neurobiology of fear and specific phobias.

PubMed

Garcia, René

2017-09-01

Fear, which can be expressed innately or after conditioning, is triggered when a danger or a stimulus predicting immediate danger is perceived. Its role is to prepare the body to face this danger. However, dysfunction in fear processing can lead to psychiatric disorders in which fear outweighs the danger or possibility of harm. Although recognized as highly debilitating, pathological fear remains insufficiently treated, indicating the importance of research on fear processing. The neurobiological basis of normal and pathological fear reactions is reviewed in this article. Innate and learned fear mechanisms, particularly those involving the amygdala, are considered. These fear mechanisms are also distinguished in specific phobias, which can indeed be nonexperiential (implicating innate, learning-independent mechanisms) or experiential (implicating learning-dependent mechanisms). Poor habituation and poor extinction are presented as dysfunctional mechanisms contributing to persistence of nonexperiential and experiential phobias, respectively. © 2017 Garcia; Published by Cold Spring Harbor Laboratory Press.

The persistence of attachment: complicated grief, threat, and reaction times to the deceased's name.

PubMed

Mancini, Anthony D; Bonanno, George A

2012-08-01

Complicated grief is increasingly recognized as a debilitating disorder with significant mental and health consequences. The underlying mechanisms of complicated grief remain unclear, however. In the present study, we investigated a specific mechanism of complicated grief (CG) derived from attachment theory: the accessibility of the deceased's mental representation under threat. In a matched comparison of complicated (n=26) and asymptomatic grievers (n=30), we used an emotional Stroop task following subliminal threat or neutral primes to examine the accessibility of mental representations of the deceased, current attachment figures, and close others. Complicated grievers did not evidence differential accessibility to the deceased's mental representation across priming conditions, whereas asymptomatic grievers showed reduced accessibility (deactivation) of the deceased's mental representation specifically in the threat prime condition. These effects were independent of depressive symptoms. Across grievers, attachment anxiety and avoidance uniquely predicted accessibility of the deceased's name in the threat condition. The limitations of this study are its small sample size and reliance on analog attachment threats. These data support that accessibility of the deceased's mental representation in threatening contexts is an important component of complicated and asymptomatic grieving and that attachment insecurity contributes to a maladaptive reliance on the deceased as an attachment figure. Copyright © 2012 Elsevier B.V. All rights reserved.

A Multimodal Approach in Dealing with Chronic Epstein-Barr Viral Syndrome.

ERIC Educational Resources Information Center

Weikel, William J.

1989-01-01

Discusses Epstein-Barr Viral Syndrome, a puzzling and controversial disease with a variety of symptoms that frequently include depression and emotional debilitation. Offers diagnostic signs and suggests a possible treatment strategy based on the multimodal approach. (Author/ABL)

Art Therapy for Chronic Pain: Applications and Future Directions

ERIC Educational Resources Information Center

Angheluta, Anne-Marie; Lee, Bonnie K.

2011-01-01

Chronic pain is acknowledged as a phenomenological experience resulting from biological, psychological, and social interactions. Consequently, treatment for this complex and debilitating health phenomenon is often approached from multidisciplinary and biopsychosocial perspectives. One approach to treating chronic pain involves implementing…

Economic costs of endemic non-filarial elephantiasis in Wolaita Zone, Ethiopia.

PubMed

Tekola, Fasil; Mariam, Damen H; Davey, Gail

2006-07-01

Endemic non-filarial elephantiasis or podoconiosis is a chronic and debilitating geochemical disease occurring in individuals exposed to red clay soil derived from alkalic volcanic rock. It is a major public health problem in countries in tropical Africa, Central America and North India. To estimate the direct and the average productivity cost attributable to podoconiosis, and to compare the average productivity time of podoconiosis patients with non-patients. Matched comparative cross sectional survey involving 702 study subjects (patients and non-patients) supplemented by interviews with key informants in Wolaita Zone, southern Ethiopia. Total direct costs of podoconiosis amounted to the equivalent of US$ 143 per patient per year. The total productivity loss for a patient amounted to 45% of the total working days per year, causing a monetary loss equivalent to US$ 63. In Wolaita zone, the overall cost of podoconiosis exceeds US$ 16 million per year. Podoconiosis has enormous economic impact in affected areas. Simple preventive measures (such as use of robust footwear) must be promoted by health policy makers.

Factors influencing hand/eye synchronicity in the computer age.

PubMed

Grant, A H

1992-09-01

In using a computer, the relation of vision to hand/finger actuated keyboard usage in performing fine motor-coordinated functions is influenced by the physical location, size, and collective placement of the keys. Traditional nonprehensile flat/rectangular keyboard applications usually require a high and nearly constant level of visual attention. Biometrically shaped keyboards would allow for prehensile hand-posturing, thus affording better tactile familiarity with the keys, requiring less intense and less constant level of visual attention to the task, and providing a greater measure of freedom from having to visualize the key(s). Workpace and related physiological changes, aging, onset of monocularization (intermittent lapsing of binocularity for near vision) that accompanies presbyopia, tool colors, and background contrast are factors affecting constancy of visual attention to task performance. Capitas extension, excessive excyclotorsion, and repetitive strain injuries (such as carpal tunnel syndrome) are common and debilitating concomitants to computer usage. These problems can be remedied by improved keyboard design. The salutary role of mnemonics in minimizing visual dependency is discussed.

Clinical impact of migraine for the management of glaucoma patients.

PubMed

Nguyen, Bao N; Lek, Jia Jia; Vingrys, Algis J; McKendrick, Allison M

2016-03-01

Migraine is a common and debilitating primary headache disorder that affects 10-15% of the general population, particularly people of working age. Migraine is relevant to providers of clinical eye-care because migraine attacks are associated with a range of visual sensory symptoms, and because of growing evidence that the results of standard tests of visual function necessary for the diagnosis and monitoring of glaucoma (visual fields, electrophysiology, ocular imaging) can be abnormal due to migraine. These abnormalities are measureable in-between migraine events (the interictal period), despite patients being asymptomatic and otherwise healthy. This picture is further complicated by epidemiological data that suggests an increased prevalence of migraine in patients with glaucoma, particularly in patients with normal tension glaucoma. We discuss how migraine, as a co-morbidity, can confound the results and interpretation of clinical tests that form part of contemporary glaucoma evaluation, and provide practical evidence-based recommendations for the clinical testing and management of patients with migraine who attend eye-care settings. Copyright © 2015 Elsevier Ltd. All rights reserved.

Component processes of memory in alcoholism: pattern of compromise and neural substrates.

PubMed

Pitel, Anne-Lise; Eustache, Francis; Beaunieux, Helene

2014-01-01

Initially, alcohol-related memory deficits were considered only through the prism of Korsakoff's syndrome (KS). It is now clear, however, that chronic alcohol consumption results in memory disorders in alcoholics without ostensible neurologic complications, such as Wernicke's encephalopathy and KS. Most of the principal memory components are affected, including working memory, episodic memory, semantic memory, perceptual memory, and procedural memory. The extent of those cognitive impairments depends on several factors, such as age, gender, nutritional status, and psychiatric comorbidity. While memory disorders, especially episodic memory deficits, are largely definitive in patients with KS, recovery of memory abilities has been described with abstinence in uncomplicated alcoholics. Neuropsychologic impairments, and especially memory disorders, must be evaluated at alcohol treatment entry because they could impede patients from benefiting fully from cognitive and behavioral treatment approaches for alcohol dependence. Screening of memory deficits could also enable clinicians to detect, among alcoholics without ostensible neurologic complications, those at risk of developing permanent and debilitating amnesia that features KS. © 2014 Elsevier B.V. All rights reserved.

Host-Microbiome Cross-talk in Oral Mucositis

PubMed Central

Vasconcelos, R.M.; Sanfilippo, N.; Paster, B.J.; Kerr, A.R.; Li, Y.; Ramalho, L.; Queiroz, E.L.; Smith, B.; Sonis, S.T.; Corby, P.M.

2016-01-01

Oral mucositis (OM) is among the most common, painful, and debilitating toxicities of cancer regimen–related treatment, resulting in the formation of ulcers, which are susceptible to increased colonization of microorganisms. Novel discoveries in OM have focused on understanding the host-microbial interactions, because current pathways have shown that major virulence factors from microorganisms have the potential to contribute to the development of OM and may even prolong the existence of already established ulcerations, affecting tissue healing. Additional comprehensive and disciplined clinical investigation is needed to carefully characterize the relationship between the clinical trajectory of OM, the local levels of inflammatory changes (both clinical and molecular), and the ebb and flow of the oral microbiota. Answering such questions will increase our knowledge of the mechanisms engaged by the oral immune system in response to mucositis, facilitating their translation into novel therapeutic approaches. In doing so, directed clinical strategies can be developed that specifically target those times and tissues that are most susceptible to intervention. PMID:27053118

Strategies to enhance the therapeutic efficacy of antidepressants: targeting residual symptoms

PubMed Central

Kurian, Benji T; Greer, Tracy L; Trivedi, Madhukar H

2009-01-01

Major depressive disorder (MDD) is an illness of great morbidity that affects many people across the world. The current goal for treatment of MDD is to achieve remission (i.e., no depressive symptoms). However, despite scientific advances in the treatment for MDD, antidepressants as first-line agents yield only modest remission rates. In fact, a recent study indicated that only one out of three subjects who received a standard, first-line antidepressant attained remission. Not achieving remission from depressive symptoms increases the risk of a more chronic and debilitating course of illness with frequent recurrences. Although a number of reasons contribute to these modest outcomes, the presence of residual symptoms is a major problem. Residual symptoms are defined as symptoms that linger despite an adequate dose and duration of an antidepressant medication. This article reviews the prevalence and clinical impact of common residual symptoms and discusses the utility of aggressively addressing residual symptoms to enhance the efficacy of antidepressant medications. PMID:19589048

Comparative proteome analysis of laboratory grown Brucella abortus 2308 and Brucella melitensis 16M.

PubMed

Eschenbrenner, Michel; Horn, Troy A; Wagner, Mary Ann; Mujer, Cesar V; Miller-Scandle, Tabbi L; DelVecchio, Vito G

2006-07-01

Brucella species are pathogenic agents that cause brucellosis, a debilitating zoonotic disease that affects a large variety of domesticated animals and humans. Brucella melitensis and Brucella abortus are considered major health threats because of their highly infectious nature and worldwide occurrence. The availability of the annotated genomes for these two species has allowed a comparative proteomics study of laboratory grown B. melitensis 16M and B. abortus 2308 by two-dimensional (2-D) gel electrophoresis and peptide mass fingerprinting. Computer-assisted analysis of the different 2-D gel images of strains 16M and 2308 revealed significant quantitative and qualitative differences in their protein expression patterns. Proteins involved in membrane transport, particularly the high affinity amino acids binding proteins, and those involved in Sec-dependent secretion systems related to type IV and type V secretion systems, were differentially expressed. Differential expression of these proteins may be responsible for conferring specific host preference in the two strains 2308 and 16M.

The Effect of Intravenous Vitamin C on Cancer- and Chemotherapy-Related Fatigue and Quality of Life

PubMed Central

Carr, Anitra C.; Vissers, Margreet C. M.; Cook, John S.

2014-01-01

Cancer patients commonly experience a number of symptoms of disease progression and the side-effects of radiation therapy and adjuvant chemotherapy, which adversely impact on their quality of life (QOL). Fatigue is one of the most common and debilitating symptom reported by cancer patients and can affect QOL more than pain. Several recent studies have indicated that intravenous (IV) vitamin C alleviates a number of cancer- and chemotherapy-related symptoms, such as fatigue, insomnia, loss of appetite, nausea, and pain. Improvements in physical, role, cognitive, emotional, and social functioning, as well as an improvement in overall health, were also observed. In this mini review, we briefly cover the methods commonly used to assess health-related QOL in cancer patients, and describe the few recent studies examining the effects of IV vitamin C on cancer- and chemotherapy-related QOL. We discuss potential mechanisms that might explain an improvement in QOL and also considerations for future studies. PMID:25360419

Diabetic neuropathy and painful diabetic neuropathy: Cinderella complications in South East Asia.

PubMed

Almuhannadi, Hamad; Ponirakis, Georgios; Khan, Adnan; Malik, Rayaz Ahmed

2018-01-01

The most common and debilitating microvascular complication of diabetes is diabetic peripheral neuropathy (DPN), affecting 50-90% of people with diabetes. The major manifestations of DPN are painful (pDPN) and painless diabetic peripheral neuropathy. Painful symptoms, occur in the feet and are worse at night and whilst they alert both the patient and physician, are often misdiagnosed and mismanaged. The devastating presentation of painless neuropathy with loss of sensation is foot ulceration and Charcot foot. The explosion of diabetes, especially in the South East Asian (SEA) region will result in an increasing prevalence of both painful and painless diabetic peripheral neuropathy. PubMed, EMBASE, Medline and Google Scholar databases were searched between 1990 and 2017. This highlights the widely varying prevalence of DPN and pDPN in the World Health Organization (WHO) defined SEA countries and the dearth of published studies, especially in pDPN. We believe this will provide new direction for future research on DPN in the SEA region.

Correction of respiratory disorders in a mouse model of Rett syndrome

PubMed Central

Abdala, Ana P. L.; Dutschmann, Mathias; Bissonnette, John M.; Paton, Julian F. R.

2010-01-01

Rett syndrome (RTT) is an autism spectrum disorder caused by mutations in the X-linked gene that encodes the transcription factor methyl-CpG-binding protein 2 (MeCP2). A major debilitating phenotype in affected females is frequent apneas, and heterozygous Mecp2-deficient female mice mimic the human respiratory disorder. GABA defects have been demonstrated in the brainstem of Mecp2-deficient mice. Here, using an intact respiratory network, we show that apnea in RTT mice is characterized by excessive excitatory activity in expiratory cranial and spinal nerves. Augmenting GABA markedly improves the respiratory phenotype. In addition, a serotonin 1a receptor agonist that depresses expiratory neuron activity also reduces apnea, corrects the irregular breathing pattern, and prolongs survival in MeCP2 null males. Combining a GABA reuptake blocker with a serotonin 1a agonist in heterozygous females completely corrects their respiratory defects. The results indicate that GABA and serotonin 1a receptor activity are candidates for treatment of the respiratory disorders in Rett syndrome. PMID:20921395

Cutaneous ulcers associated with hydroxyurea therapy.

PubMed

Quattrone, Filippo; Dini, Valentina; Barbanera, Sabrina; Zerbinati, Nicola; Romanelli, Marco

2013-11-01

Hydroxyurea is an antitumoral drug mainly used in the treatment of Philadelphia chromosome-negative myeloproliferative syndromes and sickle-cell disease. Ulcers represent a rare but severe long-term adverse effect of hydroxyurea therapy. Hydroxyurea-induced ulcers are often multiple and bilateral, typically developing in the perimalleolar region, although any cutaneous district is potentially affected. They generally look small, well-defined, shallow with an adherent, yellow, fibrinous necrotic base. A constant finding is also an extremely intense, treatment-resistant pain accompanying these ulcerations. Withdrawal of the drug generally leads to spontaneous healing of these lesions. Care providers tend to show insufficient awareness of this highly debilitating cutaneous side effect, and late or missed diagnoses are frequent. Instead, regular dermatologic screening should be performed on hydroxyurea-treated patients. This article will present a comprehensive review of indexed case reports and clinical studies, followed by a discussion about treatment options aiming at increasing knowledge about this specific topic. Copyright © 2013 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Role of Vitamin D in Osteoarthritis: Molecular, Cellular, and Clinical Perspectives

PubMed Central

Honsawek, Sittisak

2015-01-01

Osteoarthritis is a debilitating and degenerative disease which affects millions of people worldwide. The causes and mechanisms of osteoarthritis remain to be fully understood. Vitamin D has been hypothesised to play essential roles in a number of diseases including osteoarthritis. Many cell types within osteoarthritic joints appear to experience negative effects often at increased sensitivity to vitamin D. These findings contrast clinical research which has identified vitamin D deficiency to have a worryingly high prevalence among osteoarthritis patients. Randomised-controlled trial is considered to be the most rigorous way of determining the effects of vitamin D supplementation on the development of osteoarthritis. Studies into the effects of low vitamin D levels on pain and joint function have to date yielded controversial results. Due to the apparent conflicting effects of vitamin D in knee osteoarthritis, further research is required to fully elucidate its role in the development and progression of the disease as well as assess the efficacy and safety of vitamin D supplementation as a therapeutic strategy. PMID:26229532

Irritable bowel syndrome

PubMed Central

Enck, Paul; Aziz, Qasim; Barbara, Giovanni; Farmer, Adam D.; Fukudo, Shin; Mayer, Emeran A.; Niesler, Beate; Quigley, Eamonn M. M.; Rajilić-Stojanović, Mirjana; Schemann, Michael; Schwille-Kiuntke, Juliane; Simren, Magnus; Zipfel, Stephan; Spiller, Robin C.

2016-01-01

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence. The disorder can be debilitating in some patients, whereas others may have mild or moderate symptoms. The most important single risk factors are female sex, younger age and preceding gastrointestinal infections. Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities. Currently, the diagnosis of IBS is based on symptoms and the exclusion of other organic diseases, and therapy includes drug treatment of the predominant symptoms, nutrition and psychotherapy. Although the underlying pathogenesis is far from understood, aetiological factors include increased epithelial hyperpermeability, dysbiosis, inflammation, visceral hypersensitivity, epigenetics and genetics, and altered brain–gut interactions. IBS considerably affects quality of life and imposes a profound burden on patients, physicians and the health-care system. The past decade has seen remarkable progress in our understanding of functional bowel disorders such as IBS that will be summarized in this Primer. PMID:27159638

Effects of computer-based immediate feedback on foreign language listening comprehension and test-associated anxiety.

PubMed

Lee, Shu-Ping; Su, Hui-Kai; Lee, Shin-Da

2012-06-01

This study investigated the effects of immediate feedback on computer-based foreign language listening comprehension tests and on intrapersonal test-associated anxiety in 72 English major college students at a Taiwanese University. Foreign language listening comprehension of computer-based tests designed by MOODLE, a dynamic e-learning environment, with or without immediate feedback together with the state-trait anxiety inventory (STAI) were tested and repeated after one week. The analysis indicated that immediate feedback during testing caused significantly higher anxiety and resulted in significantly higher listening scores than in the control group, which had no feedback. However, repeated feedback did not affect the test anxiety and listening scores. Computer-based immediate feedback did not lower debilitating effects of anxiety but enhanced students' intrapersonal eustress-like anxiety and probably improved their attention during listening tests. Computer-based tests with immediate feedback might help foreign language learners to increase attention in foreign language listening comprehension.

POEMS Syndrome Diagnosed 10 Years after Disabling Peripheral Neuropathy.

PubMed

Nguyen, Viet H

2011-01-01

Peripheral neuropathy is characterized as a generalized, relatively homogeneous process affecting many peripheral nerves and predominantly affecting distal nerves. The epidemiology of peripheral neuropathy is limited since the disease presents with varying etiology, pathology, and severity. Toxic, inflammatory, hereditary, and infectious factors can cause damage to the peripheral nerves resulting in peripheral neuropathy. Peripheral neuropathy is most commonly caused by diabetes, alcohol, HIV infection, and malignancy. We report a case of a 42-year-old female with 10-year history of progressively worsening peripheral neuropathy, hypothyroidism, and skin changes who presents with dyspnea secondary to recurrent pleural and pericardial effusions. Prior to her arrival, her peripheral neuropathy was believed to be secondary to chronic demyelinating inflammatory polyneuropathy (CDIP) given elevated protein in the cerebral spinal fluid (CSF) which was treated with intravenous immunoglobulin (IVIG) and corticosteroids. Unfortunately, her peripheral neuropathy did not have any improvement. Incidentally, patient was found to have splenomegaly and papilledema on physical exam. Serum protein electrophoresis showed a monoclonal pattern of IgA lambda. Patient met the diagnostic criteria for POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome. An underlying diagnosis of POEMS syndrome should be considered in patients with chronic debilitating neuropathy and an elevated protein in the CSF.

POEMS Syndrome Diagnosed 10 Years after Disabling Peripheral Neuropathy

PubMed Central

Nguyen, Viet H.

2011-01-01

Peripheral neuropathy is characterized as a generalized, relatively homogeneous process affecting many peripheral nerves and predominantly affecting distal nerves. The epidemiology of peripheral neuropathy is limited since the disease presents with varying etiology, pathology, and severity. Toxic, inflammatory, hereditary, and infectious factors can cause damage to the peripheral nerves resulting in peripheral neuropathy. Peripheral neuropathy is most commonly caused by diabetes, alcohol, HIV infection, and malignancy. We report a case of a 42-year-old female with 10-year history of progressively worsening peripheral neuropathy, hypothyroidism, and skin changes who presents with dyspnea secondary to recurrent pleural and pericardial effusions. Prior to her arrival, her peripheral neuropathy was believed to be secondary to chronic demyelinating inflammatory polyneuropathy (CDIP) given elevated protein in the cerebral spinal fluid (CSF) which was treated with intravenous immunoglobulin (IVIG) and corticosteroids. Unfortunately, her peripheral neuropathy did not have any improvement. Incidentally, patient was found to have splenomegaly and papilledema on physical exam. Serum protein electrophoresis showed a monoclonal pattern of IgA lambda. Patient met the diagnostic criteria for POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome. An underlying diagnosis of POEMS syndrome should be considered in patients with chronic debilitating neuropathy and an elevated protein in the CSF. PMID:22013451

Pathogenesis and Treatment of Spine Disease in the Mucopolysaccharidoses

PubMed Central

Peck, Sun H.; Casal, Margret L.; Malhotra, Neil R.; Ficicioglu, Can; Smith, Lachlan J.

2016-01-01

The mucopolysaccharidoses (MPS) are a family of lysosomal storage disorders characterized by deficient activity of enzymes that degrade glycosaminoglycans (GAGs). Skeletal disease is common in MPS patients, with the severity varying both within and between subtypes. Within the spectrum of skeletal disease, spinal manifestations are particularly prevalent. Developmental and degenerative abnormalities affecting the substructures of the spine can result in compression of the spinal cord and associated neural elements. Resulting neurological complications, including pain and paralysis, significantly reduce patient quality of life and life expectancy. Systemic therapies for MPS such as hematopoietic stem cell transplantation and enzyme replacement therapy have shown limited efficacy for improving spinal manifestations in patients and animal models, and there is therefore a pressing need for new therapeutic approaches that specifically target this debilitating aspect of the disease. In this review, we examine how pathological abnormalities affecting the key substructures of the spine – the discs, vertebrae, odontoid process and dura – contribute to the progression of spinal deformity and symptomatic compression of neural elements. Specifically, we review current understanding of the underlying pathophysiology of spine disease in MPS, how the tissues of the spine respond to current clinical and experimental treatments, and discuss future strategies for improving the efficacy of these treatments. PMID:27296532

Immune and regulatory functions of neutrophils in inflammatory bone loss

PubMed Central

Hajishengallis, George; Moutsopoulos, Niki M.; Hajishengallis, Evlambia; Chavakis, Triantafyllos

2016-01-01

Although historically viewed as merely anti-microbial effectors in acute infection or injury, neutrophils are now appreciated to be functionally versatile with critical roles also in chronic inflammation. Periodontitis, a chronic inflammatory disease that destroys the tooth-supporting gums and bone, is particularly affected by alterations in neutrophil numbers or function, as revealed by observations in monogenic disorders and relevant mouse models. Besides being a significant debilitating disease and health burden in its own right, periodontitis is thus an attractive model to dissect uncharted neutrophil-associated (patho)physiological pathways. Here, we summarize recent evidence that neutrophils can contribute to inflammatory bone loss not only through the typical bystander injury dogma but intriguingly also through their absence from the affected tissue, where they normally perform important immunomodulatory functions. Moreover, we discuss recent advances in the interactions of neutrophils with the vascular endothelium and – upon extravasation – with bacteria, and how the dysregulation of these interactions leads to inflammatory tissue damage. Overall, neutrophils have both protective and destructive roles in periodontitis, as they are involved in both the maintenance of periodontal tissue homeostasis and the induction of inflammatory bone loss. This highlights the importance of developing approaches that promote or sustain a fine balance between homeostatic immunity and inflammatory pathology. PMID:26936034

Targeting the Glutamatergic System to Treat Major Depressive Disorder

PubMed Central

Mathews, Daniel C.; Henter, Ioline D.; Zarate, Carlos A.

2012-01-01

Major depressive disorder (MDD) is a severe, debilitating medical illness that affects millions of individuals worldwide. The young age of onset and chronicity of the disorder has a significant impact on the long-term disability that affected individuals face. Most existing treatments have focused on the ‘monoamine hypothesis’ for rational design of compounds. However, patients continue to experience low remission rates, residual subsyndromal symptoms, relapses and overall functional impairment. In this context, growing evidence suggests that the glutamatergic system is uniquely central to the neurobiology and treatment of MDD. Here, we review data supporting the involvement of the glutamatergic system in the pathophysiology of MDD, and discuss the efficacy of glutamatergic agents as novel therapeutics. Preliminary clinical evidence has been promising, particularly with regard to the N-methyl-D-aspartate (NMDA) antagonist ketamine as a ‘proof-of-concept’ agent. The review also highlights potential molecular and inflammatory mechanisms that may contribute to the rapid antidepressant response seen with ketamine. Because existing pharmacological treatments for MDD are often insufficient for many patients, the next generation of treatments needs to be more effective, rapid acting and better tolerated than currently available medications. There is extant evidence that the glutamatergic system holds considerable promise for developing the next generation of novel and mechanistically distinct agents for the treatment of MDD. PMID:22731961

Folate-targeted nanoparticles for rheumatoid arthritis therapy.

PubMed

Nogueira, Eugénia; Gomes, Andreia C; Preto, Ana; Cavaco-Paulo, Artur

2016-05-01

Rheumatoid arthritis (RA) is the most common inflammatory rheumatic disease, affecting almost 1% of the world population. Although the cause of RA remains unknown, the complex interaction between immune mediators (cytokines and effector cells) is responsible for the joint damage that begins at the synovial membrane. Activated macrophages are critical in the pathogenesis of RA and showed specifically express a receptor for the vitamin folic acid (FA), folate receptor β (FRβ). This particular receptor allows internalization of FA-coupled cargo. In this review we will address the potential of nanoparticles as an effective drug delivery system for therapies that will directly target activated macrophages. Special attention will be given to stealth degree of the nanoparticles as a strategy to avoid clearance by macrophages of the mononuclear phagocytic system (MPS). This review summarizes the application of FA-target nanoparticles as drug delivery systems for RA and proposes prospective future directions. Rheumatoid arthritis is a debilitating autoimmune disease of the joints which affects many people worldwide. Up till now, there is a lack of optimal therapy against this disease. In this review article, the authors outlined in depth the current mechanism of disease for rheumatoid arthritis and described the latest research in using folic acid-targeted nanoparticles to target synovial macrophages in the fight against rheumatoid arthritis. Copyright © 2016 Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kolber, Marcin K.; Shukla, Pratik A.; Kumar, Abhishek

PurposeRecurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty.Materials and MethodsA systematic review was conducted in accordancemore » with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated.ResultsThe search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision.ConclusionsTransarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.« less

The perception of psychology and the frequency of psychological strategies used by strength and conditioning practitioners.

PubMed

Radcliffe, Jon N; Comfort, Paul; Fawcett, Tom

2013-04-01

The study aimed to first examine the frequency of the psychological skills and strategies of strength and conditioning practitioners and second distinguish between demographic differences in relation to psychological skills and strategy use. The Strength and Conditioning Sport Psychology Questionnaire was developed to measure the frequency of use of 11 subscales. These consisted of goal setting, imagery, self-talk, mental toughness, attention control, relaxation, stress management, adherence, activation, self-confidence, and ego management. Each subscale demonstrated acceptable internal validity ale (mean interitem correlations ranged as 0.227-0.427). The instrument allowed up to 5 open-ended responses concerning skills considered most important to strength and conditioning practice and up to 5 psychological attributes considered detrimental within strength and conditioning. One hundred and two participants met the inclusion criteria (90 men and 12 women; age 34.7 ± 9.7 years; experience 7.4 ± 5.2 years; part time 36.5%; full time 63.5%). The respondents were registered with the following organizations: United Kingdom Strength and Conditioning Association: 41, National Strength and Conditioning Association: 48 and Australian Strength and Conditioning Association (ASCA): 48. Goal setting was found to be the most frequently used skill with mental imagery the least used with significant differences identified in the frequency of skill use. The strategies deemed to be most important were motivation and confidence with the most debilitating factors identified as a lack of motivation and a lack of confidence. When comparing demographics, overall skill use varied between practitioners with different experience with more experienced practitioners having greater skill use, both overall and particular individual skills. Participants accredited by the ASCA had a greater psychological skill use than those accredited by other bodies.

Reduced Dual-Task Performance in MS Patients Is Further Decreased by Muscle Fatigue.

PubMed

Wolkorte, Ria; Heersema, Dorothea J; Zijdewind, Inge

2015-06-01

Multiple sclerosis (MS) can be accompanied by motor, cognitive, and sensory impairments. Additionally, MS patients often report fatigue as one of their most debilitating symptoms. It is, therefore, expected that MS patients will have difficulties in performing cognitive-motor dual tasks (DTs), especially in a fatiguing condition. To determine whether MS patients are more challenged by a DT than controls in a fatiguing and less-fatiguing condition and whether DT performance is associated with perceived fatigue. A group of 19 MS patients and 19 age-, sex-, and education-matched controls performed a cognitive task (2-choice reaction time task) separately or concurrent with a low-force or a high-force motor task (index finger abduction at 10% or 30% maximal voluntary contraction). MS patients performed less well on a cognitive task than controls. Cognitive task performance under DT conditions decreased more for MS patients. Moreover, under high-force DT conditions, cognitive performance declined in both groups but to a larger degree for MS patients. Besides a decline in cognitive task performance, MS patients also showed a stronger decrease in motor performance under high-force DT conditions. DT costs were positively related to perceived fatigue as measured by questionnaires. Compared with controls, MS patients performed less well on DTs as demonstrated by a reduction in both cognitive and motor performances. This performance decrease was stronger under fatiguing conditions and was related to the sense of fatigue of MS patients. These data illustrate problems that MS patients may encounter in daily life because of their fatigue. © The Author(s) 2014.

Multiple Chronic Conditions and Hospitalizations Among Recipients of Long-Term Services and Supports

PubMed Central

Van Cleave, Janet H.; Egleston, Brian L.; Abbott, Katherine M.; Hirschman, Karen B.; Rao, Aditi; Naylor, Mary D.

2016-01-01

Background Among older adults receiving long term-services and supports (LTSS), debilitating hospitalizations is a pervasive clinical and research problem. Multiple chronic conditions (MCC) are prevalent in LTSS recipients. However, the combination of MCC and diseases associated with hospitalizations of LTSS recipients is unclear. Objective The purpose of this analysis was to determine the association between classes of MCC in newly enrolled LTSS recipients and the number of hospitalizations over a one-year period following enrollment. Methods This report is based on secondary analysis of extant data from a longitudinal cohort study of 470 new recipients of LTSS, ages 60 years and older, receiving services in assisted living facilities, nursing homes, or through home- and community-based services. Using baseline chronic conditions reported in medical records, latent class analysis (LCA) was used to identify classes of MCC and posterior probabilities of membership in each class. Poisson regressions were used to estimate the relative ratio between posterior probabilities of class membership and number of hospitalizations during the 3 month period prior to the start of LTSS (baseline) and then every three months forward through 12 months. Results Three latent MCC-based classes named Cardiopulmonary, Cerebrovascular/Paralysis, and All Other Conditions were identified. The Cardiopulmonary class was associated with elevated numbers of hospitalization compared to the All Other Conditions class (relative ratio [RR] = 1.88, 95% CI [1.33, 2.65], p < .001). Conclusion Older LTSS recipients with a combination of MCCs that includes cardiopulmonary conditions have increased risk for hospitalization. PMID:27801713

Community Colleges for International Development

ERIC Educational Resources Information Center

Hewitt, Martin J.; Lee, Ken

2006-01-01

Throughout the developing world, there is a debilitating lack of connection between tertiary education and economic growth. As a result, many tertiary institutions fail to address the particular human capital needs of the productive sector, thereby constraining economic growth, productivity and innovation. Existing employment opportunities go…

Acupuncture Reduces Breast Cancer Joint Pain | Division of Cancer Prevention

Cancer.gov

In the largest, most rigorous study of its kind, acupuncture was found to significantly reduce the debilitating joint pain experienced by tens of thousands of women each year while being treated for early stage breast cancer with aromatase inhibitors (AIs). |

77 FR 62267 - Proposed Extension of Existing Information Collection; Gamma Radiation Surveys

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-12

... Extension of Existing Information Collection; Gamma Radiation Surveys AGENCY: Mine Safety and Health...-9440 (voice); or 202-693-9441 (facsimile). SUPPLEMENTARY INFORMATION: I. Background Gamma radiation... debilitating occupational diseases. Natural sources include rocks, soils, and ground water. Gamma radiation...

Malnutrition: The Wasting of Human Potential.

ERIC Educational Resources Information Center

Taylor, Patricia S.

The paper discusses the prevalence of malnutrition in developing countries and the United States, particularly as it relates to debilitating physical and psychological disorders. Educational, social, and political factors which influence the cycle of malnutrition are described. Research on the relationship between malnutrition and intellectual…

Portrait of an Illness.

ERIC Educational Resources Information Center

Ricci, Mary Lynne L.

1993-01-01

Author relates story of her own debilitation, survival, and ultimate rehabilitation from Systemic Lupus Erythematosus. Describes effects of disease process itself and of drug therapy that caused delusions and hallucinations. Traces how patient received art therapy through hospital occupational therapy department, describing her artwork and its…

Biomarkers and Brain Mechanisms of Gulf War Illness

DTIC Science & Technology

Gulf War illness (GWI), a chronic and debilitating pain, headaches, impaired memory and thinking, fatigue, respiratory and gastrointestinal symptoms...believed to be causative of the illness . The pathobiological mechanisms of GWI are unknown; there are no validated diagnostic tests, nor are there effective

Time to Talk: 5 Things To Know About Chronic Low-Back Pain and Complementary Health Practices

MedlinePlus

... even debilitating, and difficult to treat. Spinal manipulation, acupuncture, massage and yoga are complementary health approaches often ... and physical therapists. There is fair evidence that acupuncture is helpful in relieving chronic back pain. Current ...

Charcot Neuroarthropathy of the Foot and Ankle.

PubMed

Burson, Lisa K; Schank, Christopher H

2016-03-01

Charcot neuropathy is a painless, progressive, degeneration most notably of the ankle or midfoot joints, seen in patients with diabetes and neuropathy. This article will describe the etiology, diagnosis, and treatment of this potentially debilitating joint disease and provide implications for home care clinicians.

Promoting Creative Tension within Collaborative Writing Groups.

ERIC Educational Resources Information Center

Ewald, Helen Rothschild; MacCallum, Virginia

1990-01-01

Describes a collaborative writing assignment which features a series of interconnected business messages arising out of a case study and including inhouse memos and an analytical report. Shows how the design of a collaborative writing assignment can foster creative rather than debilitative tension. (RS)

Ultrasonic predator-prey interactions in water-convergent evolution with insects and bats in air?

PubMed

Wilson, Maria; Wahlberg, Magnus; Surlykke, Annemarie; Madsen, Peter Teglberg

2013-01-01

Toothed whales and bats have independently evolved biosonar systems to navigate and locate and catch prey. Such active sensing allows them to operate in darkness, but with the potential cost of warning prey by the emission of intense ultrasonic signals. At least six orders of nocturnal insects have independently evolved ears sensitive to ultrasound and exhibit evasive maneuvers when exposed to bat calls. Among aquatic prey on the other hand, the ability to detect and avoid ultrasound emitting predators seems to be limited to only one subfamily of Clupeidae: the Alosinae (shad and menhaden). These differences are likely rooted in the different physical properties of air and water where cuticular mechanoreceptors have been adapted to serve as ultrasound sensitive ears, whereas ultrasound detection in water have called for sensory cells mechanically connected to highly specialized gas volumes that can oscillate at high frequencies. In addition, there are most likely differences in the risk of predation between insects and fish from echolocating predators. The selection pressure among insects for evolving ultrasound sensitive ears is high, because essentially all nocturnal predation on flying insects stems from echolocating bats. In the interaction between toothed whales and their prey the selection pressure seems weaker, because toothed whales are by no means the only marine predators placing a selection pressure on their prey to evolve specific means to detect and avoid them. Toothed whales can generate extremely intense sound pressure levels, and it has been suggested that they may use these to debilitate prey. Recent experiments, however, show that neither fish with swim bladders, nor squid are debilitated by such signals. This strongly suggests that the production of high amplitude ultrasonic clicks serve the function of improving the detection range of the toothed whale biosonar system rather than debilitation of prey.

Insecticide residues in Australian plague locusts (Chortoicetes terminifera Walker) after ultra-low volume aerial application of the organophosphorus insecticide fenitrothion.

PubMed

Story, Paul G; Mineau, Pierre; Mullié, Wim C

2013-12-01

The need for locust control throughout eastern Australia during spring 2010 provided an opportunity to quantify residues of the organophosphorus insecticide fenitrothion on nymphs of the Australian plague locust, Chortoicetes terminifera Walker. Residues were collected across the different physiological states--live, dead, and debilitated (characterized by ease of capture, erratic hopping, and the inability to remain upright)--of locust nymphs observed following exposure to fenitrothion. The time course of residue depletion for 72 h after spraying was quantified, and residue-per-unit dose values in the present study were compared with previous research. Fenitrothion residue-per-unit dose values ranged from 0.2 µg/g to 31.2 µg/g (mean ± standard error [SE] = 6.3 ± 1.3 µg/g) in live C. terminifera nymps, from 0.5 µg/g to 25.5 µg/g (7.8 ± 1.3 µg/g) in debilitated nymphs, and from 2.3 µg/g to 39.8 µg/g (16.5 ± 2.8 µg/g) in dead nymphs. Residues of the oxidative derivative of fenitrothion, fenitrooxon, were generally below the limit of quantitation for the analysis (0.02 µg/g), with 2 exceptions--1 live and 1 debilitated sample returned residues at the limit of quantitation. The results of the present study suggest that sampling of acridids for risk assessment should include mimicking predatory behavior and be over a longer time course (preferably 3-24 h postspray) than sampling of vegetation (typically 1-2 h postspray) and that current regulatory frameworks may underestimate the risk of pesticides applied for locust or grasshopper control. © 2013 SETAC.

Massage therapy decreases cancer-related fatigue: Results from a randomized early phase trial.

PubMed

Kinkead, Becky; Schettler, Pamela J; Larson, Erika R; Carroll, Dedric; Sharenko, Margaret; Nettles, James; Edwards, Sherry A; Miller, Andrew H; Torres, Mylin A; Dunlop, Boadie W; Rakofsky, Jeffrey J; Rapaport, Mark Hyman

2018-02-01

Cancer-related fatigue (CRF) is a prevalent and debilitating symptom experienced by cancer survivors, yet treatment options for CRF are limited. In this study, we evaluated the efficacy of weekly Swedish massage therapy (SMT) versus an active control condition (light touch [LT]) and waitlist control (WLC) on persistent CRF in breast cancer survivors. This early phase, randomized, single-masked, 6-week investigation of SMT, LT, and WLC enrolled 66 female stage 0-III breast cancer survivors (age range, 32-72 years) who had received surgery plus radiation and/or chemotherapy/chemoprevention with CRF (Brief Fatigue Inventory > 25). The primary outcome was the Multidimensional Fatigue Inventory (MFI), with the National Institutes of Health PROMIS Fatigue scale secondary. Mean baseline MFI scores for 57 evaluable subjects were 62.95 for SMT, 55.00 for LT, and 60.41 for WLC. SMT resulted in a mean (standard deviation) 6-week reduction in MFI total scores of -16.50 (6.37) (n = 20) versus -8.06 (6.50) for LT (n = 20) and an increase of 5.88 (6.48) points for WLC (n = 17) (treatment-by-time P < .0001). The mean baseline PROMIS Fatigue scores were SMT, 22.25; LT, 22.05; and WLC, 23.24. The mean (standard deviation) reduction in PROMIS Fatigue scores was -5.49 (2.53) points for SMT versus -3.24 (2.57) points for LT and -0.06 (1.88) points for WLC (treatment-by-time P = .0008). Higher credibility, expectancy, and preference for SMT than for LT did not account for these results. SMT produced clinically significant relief of CRF. This finding suggests that 6 weeks of a safe, widely accepted manual intervention causes a significant reduction in fatigue, a debilitating sequela for cancer survivors. Cancer 2018;124:546-54. © 2017 American Cancer Society. © 2017 American Cancer Society.

First Report of Protechinostoma mucronisertulatum (Echinostomatidae) in a Sandhill Crane (Grus canadensis) from Saskatchewan, Canada

USDA-ARS?s Scientific Manuscript database

We report a new host record for Protechinostoma mucronisertulatum. These small trematode parasites were found in a debilitated, immature, male sandhill crane (Grus canadensis) during Autumn migration from the Canadian prairies. Necropsy examination identified fibrinonecrotizing and ulcerative jejuni...

Managing Field Evacuations.

ERIC Educational Resources Information Center

Satz, Jay A.; McEvoy, David; Merrill, Kurt

In the event of a debilitating injury or illness, outdoor leaders should consider four critical phases in successfully managing backcountry field evaluations. The first phase, managing the immediate scene, involves assuring scene safety, medical care of the patient, instituting the emergency response plan, and providing for the needs of uninjured…

Hispanic Americans: Their Future Is our Future.

ERIC Educational Resources Information Center

Howe, Christopher K.

1995-01-01

Discusses the importance of educating the growing Hispanic population in Catholic schools, highlighting such effects of the high drop-out rate as underemployment, poorer health, debilitated self-esteem, decreased political participation, and increased criminal behavior. Provides examples of techniques and programs that help keep Hispanic students…

Retrospective Surveillance of Wastewater To Examine Seasonal Dynamics of Enterovirus Infections

EPA Science Inventory

Enteroviruses are RNA viruses that are responsible for both mild gastroenteritis and mild respiratory illnesses as well as debilitating diseases such as meningitis and myocarditis. The disease burden of enteroviruses in the United States is difficult to assess because most infect...

Reprioritization of Research for Combat Casualty Care

DTIC Science & Technology

2012-01-01

Today it is not un- common for a war casualty to sur- vive massive head trauma, multiple extremity loss, significant soft-tissue injury, and sensory ...disorder, depres- sion, and/or anxiety and the coexis- tence of debilitating pain syndromes, presents significant challenges to re- habilitation

Macular Hole Development After Vitrectomy for Floaters: A Case Report.

PubMed

Appeltans, Andrea; Mura, Marco; Bamonte, Giulio

2017-12-01

The purpose of this report is to describe a case of macular hole development after vitrectomy for floaters with induction of posterior vitreous detachment. A 44-year-old otherwise healthy man presented with visually debilitating floaters in his right eye; these had been present for more than 2 years. Preoperative examination was unremarkable in both eyes, apart from some degree of vitreous degeneration in the right eye. Preoperative visual acuity was 20/20 bilaterally. A 25-gauge transconjunctival sutureless pars plana complete vitrectomy with induction of posterior vitreous detachment was performed in the right eye. Upon examination 1 month after surgery, a small full-thickness macular hole was detected in the right eye. Visual acuity was diminished to 20/80. The macular hole was closed after a second vitrectomy with internal limiting membrane peeling and gas tamponade. Macular hole development should be listed as a possible complication of vitrectomy for visually debilitating floaters when a posterior vitreous detachment is induced during surgery.

Does increased effort compensate for performance debilitating test anxiety?

PubMed

Putwain, David W; Symes, Wendy

2018-05-24

It is well established that test anxiety is negatively related to examination performance. Based on attentional control theory, the aim of this study was to examine whether increased effort can protect against performance debilitating test anxiety. Four hundred and sixty-six participants (male = 228; 48.9%; White = 346, 74.3%; mean age = 15.7 years) completed self-report measures of test anxiety and effort that were matched to performance on a high-stakes secondary school examination. The worry and bodily symptoms components of test anxiety were negatively, and effort, positively related to examination performance. Effort moderated the negative relation between bodily symptoms and examination performance. At low effort, the negative relationship was amplified and at high effort was attenuated. Compensatory effort protects performance against bodily symptoms but not worry. It is possible that the cognitive load on working memory arising from the combination of worry and examination demands may be too high to be compensated by effort. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Sleep Problems as Predictors in Attention-Deficit Hyperactivity Disorder: Causal Mechanisms, Consequences and Treatment.

PubMed

Um, Yoo Hyun; Hong, Seung-Chul; Jeong, Jong-Hyun

2017-02-28

Attention-deficit hyperactivity disorder (ADHD) is notorious for its debilitating consequences and early age of onset. The need for early diagnosis and intervention has frequently been underscored. Previous studies have attempted to clarify the bidirectional relationship between ADHD and sleep problems, proposing a potential role for sleep problems as early predictors of ADHD. Sleep deprivation, sleep-disordered breathing, and circadian rhythm disturbances have been extensively studied, yielding evidence with regard to their induction of ADHD-like symptoms. Genetic-phenotypic differences across individuals regarding the aforementioned sleep problems have been elucidated along with the possible use of these characteristics for early prediction of ADHD. The long-term consequences of sleep problems in individuals with ADHD include obesity, poor academic performance, and disrupted parent-child interactions. Early intervention has been proposed as an approach to preventing these debilitating outcomes of ADHD, with novel treatment approaches ranging from melatonin and light therapy to myofunctional therapy and adjustments of the time point at which school starts.

Loss of myogenic potential and fusion capacity of muscle stem cells isolated from contractured muscle in children with cerebral palsy.

PubMed

Domenighetti, Andrea A; Mathewson, Margie A; Pichika, Rajeswari; Sibley, Lydia A; Zhao, Leyna; Chambers, Henry G; Lieber, Richard L

2018-04-25

Cerebral palsy (CP) is the most common cause of pediatric neurodevelopmental and physical disability in the United States. It is defined as a group of motor disorders caused by a non-progressive perinatal insult to the brain. While the brain lesion is non-progressive, there is a progressive, lifelong impact on skeletal muscles, which are shorter, spastic, and may develop debilitating contractures. Satellite cells are resident muscle stem cells that are indispensable for postnatal growth and regeneration of skeletal muscles. Here we measured the myogenic potential of satellite cells isolated from contractured muscles in children with CP. When compared to typically developing (TD) children, satellite cell-derived myoblasts from CP differentiated more slowly (Slope: 0.013{plus minus}0.013 CP vs. 0.091{plus minus}0.024 TD over 24 hours, P<0.001) and fused less (Fusion Index: 21.3{plus minus}8.6 CP vs. 81.3{plus minus}7.7 TD after 48 hours, P<0.001) after exposure to low-serum conditions that stimulated myotube formation. This impairment was associated with downregulation of several markers important for myoblast fusion and myotube formation, including DNA methylation-dependent inhibition of pro-myogenic Integrin Beta 1D (ITGB1D) protein expression levels (-50% at 42 hours), and ~25% loss of integrin-mediated FAK kinase phosphorylation. The cytidine analog 5-Azacytidine (5-AZA), a demethylating agent, restored ITGB1D levels and promoted myogenesis in CP cultures. Our data demonstrate that muscle contractures in CP are associated with loss of satellite cell myogenic potential that is dependent on DNA methylation patterns affecting expression of genetic programs associated with muscle stem cell differentiation and muscle fiber formation.

Circadian rhythms of women with fibromyalgia

NASA Technical Reports Server (NTRS)

Klerman, E. B.; Goldenberg, D. L.; Brown, E. N.; Maliszewski, A. M.; Adler, G. K.

2001-01-01

Fibromyalgia syndrome is a chronic and debilitating disorder characterized by widespread nonarticular musculoskeletal pain whose etiology is unknown. Many of the symptoms of this syndrome, including difficulty sleeping, fatigue, malaise, myalgias, gastrointestinal complaints, and decreased cognitive function, are similar to those observed in individuals whose circadian pacemaker is abnormally aligned with their sleep-wake schedule or with local environmental time. Abnormalities in melatonin and cortisol, two hormones whose secretion is strongly influenced by the circadian pacemaker, have been reported in women with fibromyalgia. We studied the circadian rhythms of 10 women with fibromyalgia and 12 control healthy women. The protocol controlled factors known to affect markers of the circadian system, including light levels, posture, sleep-wake state, meals, and activity. The timing of the events in the protocol were calculated relative to the habitual sleep-wake schedule of each individual subject. Under these conditions, we found no significant difference between the women with fibromyalgia and control women in the circadian amplitude or phase of rhythms of melatonin, cortisol, and core body temperature. The average circadian phases expressed in hours posthabitual bedtime for women with and without fibromyalgia were 3:43 +/- 0:19 and 3:46 +/- 0:13, respectively, for melatonin; 10:13 +/- 0:23 and 10:32 +/- 0:20, respectively for cortisol; and 5:19 +/- 0:19 and 4:57 +/- 0:33, respectively, for core body temperature phases. Both groups of women had similar circadian rhythms in self-reported alertness. Although pain and stiffness were significantly increased in women with fibromyalgia compared with healthy women, there were no circadian rhythms in either parameter. We suggest that abnormalities in circadian rhythmicity are not a primary cause of fibromyalgia or its symptoms.

Production of high quality brain-derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrkB) RNA from isolated populations of rat spinal cord motor neurons obtained by Laser Capture Microdissection (LCM).

PubMed

Mehta, Prachi; Premkumar, Brian; Morris, Renée

2016-08-03

The mammalian central nervous system (CNS) is composed of multiple cellular elements, making it challenging to segregate one particular cell type to study their gene expression profile. For instance, as motor neurons represent only 5-10% of the total cell population of the spinal cord, meaningful transcriptional analysis on these neurons is almost impossible to achieve from homogenized spinal cord tissue. A major challenge faced by scientists is to obtain good quality RNA from small amounts of starting material. In this paper, we used Laser Capture Microdissection (LCM) techniques to identify and isolate spinal cord motor neurons. The present analysis revealed that perfusion with paraformaldehyde (PFA) does not alter RNA quality. RNA integrity numbers (RINs) of tissue samples from rubrospinal tract (RST)-transected, intact spinal cord or from whole spinal cord homogenate were all above 8, which indicates intact, high-quality RNA. Levels of mRNA for brain-derived neurotrophic factor (BDNF) or for its tropomyosin receptor kinase B (TrkB) were not affected by rubrospinal tract (RST) transection, a surgical procedure that deprive motor neurons from one of their main supraspinal input. The isolation of pure populations of neurons with LCM techniques allows for robust transcriptional characterization that cannot be achieved with spinal cord homogenates. Such preparations of pure population of motor neurons will provide valuable tools to advance our understanding of the molecular mechanisms underlying spinal cord injury and neuromuscular diseases. In the near future, LCM techniques might be instrumental to the success of gene therapy for these debilitating conditions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Monitoring impacts of air pollution: PIXE analysis and histopathological modalities in evaluating relative risks of elemental contamination.

PubMed

Ejaz, Sohail; Camer, Gerry Amor; Anwar, Khaleeq; Ashraf, Muhammad

2014-04-01

Environmental toxicants invariably affect all biological organisms resulting to sufferings ranging from subclinical to debilitating clinical conditions. This novel research aimed to determine the toxic burdens of increased environmental elements in some vital organs/tissues of the wild animals (starling, owl, crow and pigeon), exposed to air polluted environment were assessed using particle induced X-ray emission and histopathological approaches. The presence of significantly elevated amounts of elemental toxicants namely: Aluminum (Al), Chlorine (Cl), Iron (Fe), Potassium (K), Magnesium (Mg), Manganese (Mn), Silicon (Si) and Vanadium (V) from the skin, muscle, lungs, liver and kidney of sampled animals were in concurrence with the observed histopathological changes. The skin of sampled starling, owl, pigeon and crow spotlighted highly significant increase (P < 0.001) in Al, Cl, Mg and Si. Muscle samples with myodegenerative lesions and mineral depositions highlighted substantial augmentation (P < 0.001) in the amount of Al, Fe, Mn, Si and V. The lungs of starling, owl, and pigeon were severely intoxicated (P < 0.001) with increased amount of Al, Fe, K, Mn and Si producing pulmonary lesions of congestion, edema, pneumonitis and mineral debris depositions. Liver samples revealed that the sampled animals were laden with Cl, Fe, Mg, Mn and V with histopathological profound degenerative changes and hepatic necrosis. Kidney sections presented severe tubular degenerative and necrotic changes that may be attributed to increased amounts of Cl and Fe. These current findings implied that the environmental/elemental toxicants and the accompanying lesions that were discerned in the organs/tissues of sampled birds may as well be afflicting people living within the polluted area. Further assessment to more conclusively demonstrate correlations of current findings to those of the populace within the area is encouraged.

Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004.

PubMed

Agrawal, Yuri; Carey, John P; Della Santina, Charles C; Schubert, Michael C; Minor, Lloyd B

2009-05-25

Balance dysfunction can be debilitating and can lead to catastrophic outcomes such as falls. The inner ear vestibular system is an important contributor to balance control. However, to our knowledge, the prevalence of vestibular dysfunction in the United States and the magnitude of the increased risk of falling associated with vestibular dysfunction have never been estimated. The objective of this study was to determine the prevalence of vestibular dysfunction among US adults, evaluate differences by sociodemographic characteristics, and estimate the association between vestibular dysfunction and risk of falls. We included data from the 2001-2004 National Health and Nutrition Examination Surveys, which were cross-sectional surveys of US adults aged 40 years and older (n = 5086). The main outcome measure was vestibular function as measured by the modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces. From 2001 through 2004, 35.4% of US adults aged 40 years and older (69 million Americans) had vestibular dysfunction. Odds of vestibular dysfunction increased significantly with age, were 40.3% lower in individuals with more than a high school education, and were 70.0% higher among people with diabetes mellitus. Participants with vestibular dysfunction who were clinically symptomatic (ie, reported dizziness) had a 12-fold increase in the odds of falling. Vestibular dysfunction, as measured by a simple postural metric, is common among US adults. Vestibular dysfunction significantly increases the likelihood of falls, which are among the most morbid and costly health conditions affecting older individuals. These data suggest the importance of diagnosing, treating, and potentially screening for vestibular deficits to reduce the burden of fall-related injuries and deaths in the United States.

Activating transcription factor 3 promotes loss of the acinar cell phenotype in response to cerulein-induced pancreatitis in mice.

PubMed

Fazio, Elena N; Young, Claire C; Toma, Jelena; Levy, Michael; Berger, Kurt R; Johnson, Charis L; Mehmood, Rashid; Swan, Patrick; Chu, Alphonse; Cregan, Sean P; Dilworth, F Jeffrey; Howlett, Christopher J; Pin, Christopher L

2017-09-01

Pancreatitis is a debilitating disease of the exocrine pancreas that, under chronic conditions, is a major susceptibility factor for pancreatic ductal adenocarcinoma (PDAC). Although down-regulation of genes that promote the mature acinar cell fate is required to reduce injury associated with pancreatitis, the factors that promote this repression are unknown. Activating transcription factor 3 (ATF3) is a key mediator of the unfolded protein response, a pathway rapidly activated during pancreatic insult. Using chromatin immunoprecipitation followed by next-generation sequencing, we show that ATF3 is bound to the transcriptional regulatory regions of >30% of differentially expressed genes during the initiation of pancreatitis. Of importance, ATF3-dependent regulation of these genes was observed only upon induction of pancreatitis, with pathways involved in inflammation, acinar cell differentiation, and cell junctions being specifically targeted. Characterizing expression of transcription factors that affect acinar cell differentiation suggested that acinar cells lacking ATF3 maintain a mature cell phenotype during pancreatitis, a finding supported by maintenance of junctional proteins and polarity markers. As a result, Atf3 -/- pancreatic tissue displayed increased tissue damage and inflammatory cell infiltration at early time points during injury but, at later time points, showed reduced acinar-to-duct cell metaplasia. Thus our results reveal a critical role for ATF3 as a key regulator of the acinar cell transcriptional response during injury and may provide a link between chronic pancreatitis and PDAC. © 2017 Fazio et al. This article is distributed by The American Society for Cell Biology under license from the author(s). Two months after publication it is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

A pilot study evaluating the safety and efficacy of modafinal for cancer-related fatigue.

PubMed

Blackhall, Leslie; Petroni, Gina; Shu, Jianfen; Baum, Lora; Farace, Elena

2009-05-01

Fatigue is a common symptom that lowers the quality of life of patients with cancer, affecting between 60% and 90% of patients. Relatively few options are available for the treatment of this debilitating condition. Modafinal, a psychostimulant developed for the treatment of narcolepsy, has been used to treat fatigue in other diseases such as multiple sclerosis, but little data support its use in cancer patients. The primary objective of this open-label pilot study was to evaluate the safety, and efficacy of modafinil in improving cancer-related fatigue (CRF) as measured by the Brief Fatigue Inventory (BFI). The effect of this agent on depression, quality of life, functional status, and cognitive function was also assessed. Modafinal was self-administered at a dose of 100 mg/d during weeks 1-2, and 200 mg during weeks 3-4. Assessments were performed at baseline, 2, and 4 weeks. BFI score was improved in 46% of patients at 2 weeks and 75% at 4 weeks (p = 0.025). Hospital Anxiety and Depression Scale scores declined at 2 and 4 weeks (p < 0.001). Most scales for neurocognitive function were unchanged. Score for all Functional Assessment of Cancer Therapy-Brain (FACT-BR) subscales (measuring quality of life), except social/family well-being, were improved (p < 0.05) at 2 and 4 weeks. Significant changes in Eastern Cooperative Oncology Group (ECOG) performance status were noted, with 40% of patients improving at least one level. Modafinil was well-tolerated with only one patient discontinuing treatment due to drug-related toxicity. In this pilot study modafinil was well-tolerated and effective for fatigue in patients with cancer. Improvements were also seen in mood, quality of life, and functional status.

Qualitative analysis of the impact of Oral Potentially Malignant Disorders on daily life activities.

PubMed

Tadakamadla, Jyothi; Kumar, Santhosh; Lalloo, Ratilal; Johnson, Newell W

2017-01-01

To evaluate the impact of Oral Potentially Malignant Disorders (OPMD) on daily life activities. Patients diagnosed with Oral Leukoplakia, Oral submucous fibrosis and Oral Lichen Planus attending the Oral Medicine clinic of Panineeya Institute of Dental Sciences & Research Centre, Hyderabad, India were invited to participate. Eighteen interviews and three focus groups were conducted in a non-clinical setting. Voice recordings were transcribed and translated from Telugu to English. Data coding was performed using the NVivo software. Sample size for this qualitative study comprised 32 patients. Four main themes emerged: (1) difficulties with diagnosis and knowledge about the condition, (2) physical impairment and functional limitations, (3) psychological and social wellbeing and (4) effects of treatment on daily life. In a majority of the patients, most of the interview time was spent discussing physical impairment and functional limitations. Patients also reported their mouth condition having a debilitating effect on their psychological well-being and social interactions. 'Physical impairment and functional limitations' was the most important theme for many of the patients. However, the impacts of OPMD also extended beyond physical impairment and functional limitations to aspects of daily living, notably psychological and social wellbeing.