A rare presentation of hepatocellular carcinoma in non-cirrhotic liver.

PubMed

Kabbage, Lamia; El Kouhen, Meryem; Taghy, Ahmed; Znati, Kaoutar; Kabbaj, Nawal

2017-01-01

Hepatocellular carcinoma is the most frequent type of liver malignancy. Most cases of hepatocellular carcinoma are secondary to either viral hepatitis (hepatitis B, C) or alcoholic cirrhosis. Liver cirrhosis due to any other causes is considered as a risk factor for development of hepatocellular carcinoma; however, hepatocellular carcinoma in non cirrhotic livers remains a rare condition. The present case report describes a 59-year-old woman patient admitted to explore right hypochondriac and epigastric pain, with no evidence of pre-existing liver disease and with a good general condition. The computed tomography was very suggestive of a gastro-intestinal stromal tumor. But, at laparotomy, a huge hepatic tumor was discovered. Histopathological study confirmed the presence of primary hepatocellular carcinoma. Hepatocellular carcinoma occurs more frequently on a cirrhotic liver. However, it can occur on a non cirrhotic liver and remains and extremely rare case.

Primary intestinal lymphangiectasia as a component of autoimmune polyglandular syndrome type I: a report of 2 cases.

PubMed

Makharia, Govind K; Tandon, Nikhil; Stephen, Neil de Jesus Rangel; Gupta, Siddhartha Datta; Tandon, Rakesh K

2007-01-01

Chronic diarrhea and steatorrhea occur frequently in patients with autoimmune polyglandular syndrome (APS) type I. Intestinal lymphangiectasia has been reported earlier as a cause of steatorrhea in a young girl with APS Type I. We describe 2 patients with APS Type I who were found to have intestinal lymphangiectasia, one of whom had symptomatic protein-losing enteropathy.

Abundance of wind scorpions (Solifugae: Eremobatidae) in riparian forests disturbed by grazing, fire, and flood in Central New Mexico, USA

Treesearch

D. Max Smith; Deborah M. Finch

2011-01-01

Historically, flood was the primary disturbance structuring riparian plant and animal communities in the southwestern United States. In many areas, however, livestock grazing and wildfire occur more frequently than flooding. Research has shown that changes in flood and fire frequency affect the composition of riparian surface-active arthropod communities (Bess et al....

[Circular migration in Indonesia].

PubMed

Mantra, I B

1979-12-01

The author examines circular migration in Indonesia, with primary focus on the 1970s. It is found that circular, or repeated return migration, generally occurs over short distances and for short periods and is more frequent than lifetime migration. The relationships between improvements in the national transport system, access to labor force opportunities in both the formal and informal sectors of the economy, and circular migration are discussed.

[Limb lymphedema as a first manifestation of primary intestinal lymphangiectasia (Waldmann's disease)].

PubMed

Boursier, V; Vignes, S

2004-05-01

Primary intestinal lymphangiectasia (Waldmann's disease) is characterized by protein-losing enteropathy occurring more frequently in childhood. Chronic diarrhea and diffuse edema are the main clinical manifestations. Peripheral lymphedema may also be associated. Lymphedema is usually present at the time of diagnosis or appears later in the course of the disease. We report the observation of a 31-year-old man suffering from an upper, lower limb and genital lymphedema many years before diagnosis of primary intestinal lymphangiectasia was established. Lower limb lymphoscintigraphy confirmed lymphedema and duodenal biopsies lymphangiectasia. Hypoproteinemia, lymphopenia and hypogammaglobulinemia were also noted. Treatment of lymphedema included low stretch bandaging and elastic stocking. No dietary management with a low-fat diet was added. Search for primary intestinal lymphangiectasia with biological parameters would be useful when primary lymphedema is present. Especially since primary intestinal lymphangiectasia may be complicated by occurrence of B cell lymphoma.

The prevalence of X-linked hypohidrotic ectodermal dysplasia (XLHED) in Denmark, 1995-2010.

PubMed

Nguyen-Nielsen, Mary; Skovbo, Stine; Svaneby, Dea; Pedersen, Lars; Fryzek, Jon

2013-05-01

X-linked hypohidrotic ectodermal dysplasia (XLHED) is characterised by hypohidrosis, sparse hair, and teeth abnormalities. Infants with XLHED have an increased risk of death by hyperpyrexia. XLHED is the most common form of hypohidrotic ectodermal dysplasia (HED); however, no population-based prevalence estimates are available. We aimed to: 1) estimate the prevalence of XLHED in the Danish population per January 1, 2011; 2) identify the most frequent age at time of diagnosis; and 3) quantify the most frequent clinical feature associated with XLHED. We conducted a nationwide cross-sectional study (1995-2010). We leveraged national medical registries and data from clinical departments to categorise XLHED cases into three groups: 1) Molecularly-confirmed XLHED; 2) Clinically-diagnosed HED (registered with ICD-10 Q 82.4); and 3) Possible HED (registered with sufficient clinical features based on a clinical algorithm that we designed). We identified 90 molecularly-confirmed XLHED, 146 clinically-diagnosed HED, and 988 possible HED cases between 1995 and 2010 (total n = 1224). The prevalence was 21.9 per 100,000 overall and 1.6 per 100,000 when restricting to molecularly-confirmed XLHED cases. The most frequent age at time of XLHED diagnosis occurred between the ages of 11 and 18 years. Teeth abnormalities occurred in 79% of all cases and 52% of molecularly-confirmed cases as a primary clinical marker. We present the first ever population-based prevalence estimates of XLHED and suggest that the prevalence of XLHED may be higher than previously estimated. Diagnosis occurs most frequently during adolescence and teeth abnormalities were the most frequent clinical marker of XLHED. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Headache in sports.

PubMed

Seifert, Tad

2014-09-01

Sports- and exercise-related headaches are not unusual. Despite their frequent occurrence in this context, there are little epidemiologic data concerning sports-related headache. The recent attention of concussive injuries and associated post-traumatic headache has renewed interest in the study of those headaches occurring after head trauma; however, any primary headache type can also occur in the setting of contact and/or collision sports. The nonspecific nature of headaches provides unique challenges to clinicians encountering this complaint. It is, therefore, imperative that physicians treating athletes are able to distinguish the various headache types and presentations often seen in this population.

Long-term results of 81 prevertebral subclavian artery angioplasties: a 26-year experience.

PubMed

Berger, Ludovic; Bouziane, Zacharie; Felisaz, Aurélien; Coffin, Olivier; Dugue, Audrey; Maiza, Dominique

2011-11-01

Long-term results of transluminal angioplasty (TLA) of the prevertebral subclavian artery (PVSA) are not well known. The aim of this work was to present a retrospective analysis of a consecutive series of 81 TLAs of the PVSA, with a mean follow-up of approximately 7 years (82 months). From January 1984 to May 2007, 81 TLAs of PVSA were consecutively performed in 72 patients (64% men; median age = 56.7 years) to treat 71 tight stenoses and 10 occlusions. In 58 cases, TLA was carried out under local anesthesia (71.6%), 65 times by femoral approach, and 16 times by humeral approach. A percutaneous approach was used 72 times (89%). A stent was placed in 18 cases (22.2%). Immediate technical success rate was 93%. One transient monoplegia was noticed after TLA and four puncture complications were observed, which occurred significantly more frequently with percutaneous humeral approach (p = 0.024). A recurrent stenosis occurred 28 times (34.6%) and was symptomatic in three cases. With a mean 82-month follow-up (3-299 months), primary patency at 10 years was 85.2% and primary assisted patency was 92.6%. No restenosis occurred after the 25th month of the follow-up. No restenosis factor was statistically predictive. TLA of the PVSA is a mildly invasive and efficient treatment. Early restenoses are frequent but remain accessible to a new TLA with stable long-term results. Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

Insomnia in women.

PubMed

Krystal, Andrew D

2003-01-01

Insomnia is a highly prevalent disorder that can lead to substantial impairments in quality of life and functional capacity. This condition occurs significantly more frequently in women than men. An important contributing factor is that insomnia can occur in association with hormonal changes that are unique to women, such as those of menopause or the late-luteal phase of the menstrual cycle. Another consideration is that women are more likely to suffer from major depression and anxiety disorders, which are also associated with insomnia. The reasons are unclear as are the reasons why women are at increased risk of primary insomnia. These conditions are frequently encountered in clinical practice and present a challenge to the practitioner because there is a striking lack of research data to serve as a guide. For example, there are no published studies to indicate how to safely and effectively manage insomnia that often occurs late in pregnancy. This article reviews the available literature related to these conditions with a focus on the epidemiologic data and diagnosis and treatment of insomnia and highlights the need for further research.

Free Radical Mechanisms of Xenobiotic Mammalian Cytotoxicities

DTIC Science & Technology

1991-06-30

injury process was mediated through biotransformation of the halocarbons to a free radical intermediate, similar to what happens in the liver . However...peroxidation) of antioxidant agents - is not limited to the liver , but also occurs in vascular cells as well. Unlike the liver , where most of the injury is...frequent mechanism of xenobiotic liver toxicity is biotransformation by cytochrome P,5o-enzymes to toxic free radical intermediates. The primary objective

Synchronous Occurance of Acute Myeloid Leukemia and Rhabdomyosarcoma.

PubMed

Jayasudha, A V; Nair, Rekha A; Renu, S; Binitha, R; Reghu, K S; Kusumakumary, P

2015-09-01

Metachronous primary distinct tumors are frequently and increasingly encountered in oncology clinical practice of recent times, but synchronous tumours are still a rarity. We report an unusual case of a 2 year old male child who had synchronous occurrence of rhabdomyosarcoma of pelvis and acute myeloid leukemia.Our search of literature suggests that this may be the first reported case of simultaneous occurrence of these two malignancies.

Fused primary first mandibular macromolar with a unique relation to its permanent successors: A rare tooth anomaly.

PubMed

Dhindsa, Abhishek; Garg, Shalini; Damle, S G; Opal, Shireen; Singh, Tavleen

2013-04-01

Dental anomalies of number and forms may occur in the primary and permanent dentition. Various terms have been used to describe dental twinning anomalies: Germination, fusion, concrescence, double teeth, conjoined teeth, twinned teeth, geminifusion, and vicinifusion. Fused tooth is a developmental anomaly that is seen more frequently in the primary than the permanent dentition. Double tooth involving deciduous anterior teeth is found mostly in the mandible. Very few cases of nonsyndromic double primary molar have been reported in the literature. The succeeding permanent tooth is often found missing congenitally in the same region. This article reports a very rare unilateral occurrence of an anomalous, primary mandibular first macromolar formed by fusion with a dysmorphic premolar like supernumerary tooth in deciduous dentition period. Instead of agenesis of succedaneous tooth, the double tooth has been succeeded by normally developing mandibular first premolar in the same region.

Tuberculous Otomastoiditis.

PubMed

Hand, Jonathan M; Pankey, George A

2016-12-01

Tuberculous otitis media and mastoiditis, or tuberculous otomastoiditis, is a rare but well-described infectious process occasionally affecting individuals in the United States but more frequently seen in countries where tuberculosis is endemic. Infection may be primary and occur through mucus aspirated through the Eustachian tube. Alternatively, organisms may secondarily infect the nasopharynx when expectorated from the lungs and, less frequently, may be hematogenously spread. Chronic otorrhea and hearing loss are common symptoms, and extensive perforation of the tympanic membranes and facial nerve paralysis are routinely described. Diagnosis is made by direct culture of Mycobacterium tuberculosis, although more recently, molecular techniques have been used. Successful treatment of tuberculous otomastoiditis routinely involves surgical intervention combined with prolonged antituberculosis therapy.

Equine recurrent uveitis: the viewpoint from the USA.

PubMed

Gilger, B C

2010-03-01

Equine recurrent uveitis (ERU) is a common disease in horses in the USA. There have been many advances in the treatment of ERU; however, frequent misdiagnosis of ERU occurs in cases of primary corneal or uveal disease. It is critical to remember that primary uveitis (i.e. one bout of inflammation) is a different disease to ERU, which is an immune mediated recurrent uveitis. Standard symptomatic anti-inflammatory therapy is effective to control most cases of ERU; however, some horses require advanced therapy, such as placement of drug delivery devices or removal of the vitreous, when they fail to respond to the standard therapy.

Hypermethylation of the TSLC1 Gene Promoter in Primary Gastric Cancers and Gastric Cancer Cell Lines

PubMed Central

Honda, Teiichiro; Waki, Takayoshi; Jin, Zhe; Sato, Kiyoshi; Motoyama, Teiichi; Kawata, Sumio; Kimura, Wataru; Nishizuka, Satoshi; Murakami, Yoshinori

2002-01-01

The TSLC1 (tumor suppressor in lung cancer–1) gene is a novel tumor suppressor gene on chromosomal region 11q23.2, and is frequently inactivated by concordant promoter hypermethylation and loss of heterozygosity (LOH) in non‐small cell lung cancer (NSCLC). Because LOH on 11q has also been observed frequently in other human neoplasms including gastric cancer, we investigated the promoter methylation status of TSLC1 in 10 gastric cancer cell lines and 97 primary gastric cancers, as well as the corresponding non‐cancerous gastric tissues, by bisulfite‐SSCP analysis followed by direct sequencing. Allelic status of the TSLC1 gene was also investigated in these cell lines and primary gastric cancers. The TSLC1 promoter was methylated in two gastric cancer cell lines, KATO‐III and ECC10, and in 15 out of 97 (16%) primary gastric cancers. It was not methylated in non‐cancerous gastric tissues, suggesting that this hypermethylation is a cancer‐specific alteration. KATO‐III and ECC10 cells retained two alleles of TSLC1, both of which showed hypermethylation, associated with complete loss of gene expression. Most of the primary gastric cancers with promoter methylation also retained heterozygosity at the TSLC1 locus on 11q23.2. These data indicate that bi‐allelic hypermethylation of the TSLC1 promoter and resulting gene silencing occur in a subset of primary gastric cancers. PMID:12716461

Shoulder dystocia in primary midwifery care in the Netherlands.

PubMed

Kallianidis, Athanasios F; Smit, Marrit; Van Roosmalen, Jos

2016-02-01

In the Netherlands, low-risk pregnancies are managed by midwives in primary care. Despite strict definitions of low risk, obstetric complications can occur. Midwives seldom encounter uncommon labour complications, but are sufficiently trained to manage these. We assessed neonatal and maternal outcome after management of shoulder dystocia in primary midwifery care. In this 2-year prospective cohort study from April 2008 to April 2010, primary-care midwives, who participated in an obstetric emergency course, reported all obstetric complications. Main outcome was neonatal and maternal outcome. In sixty-four cases of shoulder dystocia McRoberts was the first maneuver in 42/64 (65.6%) cases with a success rate of 23.8%. All-fours maneuver was most frequently used as the second maneuver (24/45; 53.3%). No neonatal mortality occurred, none of the infants suffered from hypoxic ischemic injury, two (3.1%) had transient brachial plexus injuries, two (3.1%) had fractured clavicles and one (1.6%) had a fractured humerus. Eight (12.5%) neonates were successfully resuscitated because of birth asphyxia. All infants fully recovered. In neonates with immediate adverse outcome significantly more maneuvers were used compared with those without adverse neonatal outcome (p = 0.02). Postpartum hemorrhage occurred in 2/64 (3.1%) women, deep vaginal lacerations in 2/64 (3.1%), perineal tears in 23/64 (35.9%). No anal sphincter injuries occurred. McRoberts and all-fours maneuvers are widely used by primary-care midwives in the management of shoulder dystocia. Low rates of adverse neonatal and maternal outcomes were observed in cases of shoulder dystocia up to 6 weeks postpartum. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

An update of neurological manifestations of vasculitides and connective tissue diseases: a literature review

PubMed Central

Bougea, Anastasia; Anagnostou, Evangelos; Spandideas, Nikolaos; Triantafyllou, Nikolaos; Kararizou, Evangelia

2015-01-01

Vasculitides comprise a heterogeneous group of autoimmune disorders, occurring as primary or secondary to a broad variety of systemic infectious, malignant or connective tissue diseases. The latter occur more often but their pathogenic mechanisms have not been fully established. Frequent and varied central and peripheral nervous system complications occur in vasculitides and connective tissue diseases. In many cases, the neurological disorders have an atypical clinical course or even an early onset, and the healthcare professionals should be aware of them. The purpose of this brief review was to give an update of the main neurological disorders of common vasculitis and connective tissue diseases, aiming at accurate diagnosis and management, with an emphasis on pathophysiologic mechanisms. PMID:26313435

Ketamine Patient Controlled Analgesia for Acute Pain in Trauma Patients: A Randomized, Active Comparator Controlled, Blinded, Pilot Trial

DTIC Science & Technology

2017-01-11

patient- controlled analgesia per the primary treating team. Four subjects in the ketamine group and one subject in the hydromorphone group withdrew...occurred more frequently in the ketamine group , although this was not statistically significant (40% vs. 0%, P=0.090). Ketamine patient- controlled ...breakthrough IV morphine equivalents between groups . 4.0 RESULTS 4.1 Participants Due to unanticipated barriers to enrollment, including a

Palatine tonsillar metastasis of a small pulmonary adenocarcinoma showing an invasive micropapillary carcinoma pattern and Pagetoid spread at the tonsil: a case suggesting retrograde lymphatic metastasis from bulky lymph node metastases of the neck.

PubMed

Tajima, Shogo; Koda, Kenji

2015-01-01

Metastasis rarely occurs in the palatine tonsils. Among primary pulmonary carcinoma subtypes, small cell carcinoma more frequently metastasizes to this site. Herein, we present an exceedingly rare case of a small pulmonary adenocarcinoma that metastasized to the cervical lymph nodes and the right palatine tonsil in a 62-year-old man. In spite of the small size of the primary site, such extensive metastasis may have occurred because of the invasive micropapillary carcinoma pattern seen in the metastatic sites. The manner of metastasis to the palatine tonsil was considered retrograde lymphatic metastasis originating from carcinoma cells in the cervical lymph nodes. Furthermore, Pagetoid spread was observed at the palatine tonsil. Although there have been only a few cases showing retrograde lymphatic metastasis and Pagetoid spread at the metastatic site, we should be careful when speculating about the primary site based on such metastatic sites, especially when dealing with a biopsy sample exhibiting Pagetoid spread.

Risperidone dosing in children and adolescents with autistic disorder: a double-blind, placebo-controlled study.

PubMed

Kent, Justine M; Kushner, Stuart; Ning, Xiaoping; Karcher, Keith; Ness, Seth; Aman, Michael; Singh, Jaskaran; Hough, David

2013-08-01

Efficacy and safety of 2 risperidone doses were evaluated in children and adolescents with autism. Patients (N = 96; 5-17 years), received risperidone (low-dose: 0.125 mg/day [20 to <45 kg], 0.175 mg/day [>45 kg] or high-dose: 1.25 mg/day [20 to <45 kg], 1.75 mg/day [>45 kg]) or placebo. Mean baseline (range 27-29) to endpoint change in Aberrant Behavior Checklist-Irritability (primary endpoint) was significantly greater in the high-dose-(-12.4 [6.5]; p < 0.001), but not low-dose (-7.4 [8.1]; p = 0.164) group, versus placebo (-3.5 [10.7]). Clinical Global Impressions-Severity and Children's Yale-Brown Obsessive Compulsive Scale scores improved significantly only in the high-dose group, consistent with ABC-I results. Somnolence, sedation and increased appetite occurred more frequently in high-versus low-dose groups. Overall, increased appetite occurred most frequently.

An analysis of aircraft accidents involving fires

NASA Technical Reports Server (NTRS)

Lucha, G. V.; Robertson, M. A.; Schooley, F. A.

1975-01-01

All U. S. Air Carrier accidents between 1963 and 1974 were studied to assess the extent of total personnel and aircraft damage which occurred in accidents and in accidents involving fire. Published accident reports and NTSB investigators' factual backup files were the primary sources of data. Although it was frequently not possible to assess the relative extent of fire-caused damage versus impact damage using the available data, the study established upper and lower bounds for deaths and damage due specifically to fire. In 12 years there were 122 accidents which involved airframe fires. Eighty-seven percent of the fires occurred after impact, and fuel leakage from ruptured tanks or severed lines was the most frequently cited cause. A cost analysis was performed for 300 serious accidents, including 92 serious accidents which involved fire. Personal injury costs were outside the scope of the cost analysis, but data on personnel injury judgements as well as settlements received from the CAB are included for reference.

The distribution and public health consequences of releases of chemicals intended for pool use in 17 states, 2001-2009.

PubMed

Anderson, Ayana R; Welles, Wanda Lizak; Drew, James; Orr, Maureen F

2014-05-01

To keep swimming pool water clean and clear, consumers purchase, transport, store, use, and dispose of large amounts of potentially hazardous chemicals. Data about incidents due to the use of these chemicals and the resultant public health impacts are limited. The authors analyzed pool chemical release data from 17 states that participated in the Agency for Toxic Substances and Disease Registry's chemical event surveillance system during 2001-2009. In 400 pool chemical incidents, 60% resulted in injuries. Of the 732 injured persons, 67% were members of the public and 50% were under 18 years old. Incidents occurred most frequently in private residences (39%), but incidents with the most injured persons (34%) occurred at recreational facilities. Human error (71.9%) was the most frequent primary contributing factor, followed by equipment failure (22.8%). Interventions designed to mitigate the public health impact associated with pool chemical releases should target both private pool owners and public pool operators.

Mature aggressive B-cell lymphoma across age groups - molecular advances and therapeutic implications.

PubMed

Lange, Jonas; Lenz, Georg; Burkhardt, Birgit

2017-02-01

Mature B-cell lymphoma represents the most common type of Non-Hodgkin lymphoma, and different subtypes prevail at different patient ages. Areas covered: We review recent data on differences and commonalities in mature B-cell lymphoma occurring in adult and pediatric patients, with a special emphasis on molecular advances and therapeutic implications. To this end, we will discuss knowledge on diffuse large B-cell lymphoma and Burkitt lymphoma/leukemia, which are the most frequent subtypes in adult and pediatric patients, respectively, and on primary mediastinal B-cell lymphoma, which is a subtype of mature B-cell lymphoma occurring mainly in adolescents and young adults with a female predominance. Expert commentary: Molecular profiling has revealed molecular alterations that can be used to further classify the subtypes of mature B-cell lymphoma. These new subgroups frequently respond differentially to targeted therapeutic strategies. Future clinical trials utilizing new drugs will address this issue by combining clinical data and response assessment with a molecular workup of the corresponding lymphomas.

Recurrent hypoglycaemia in type-1 diabetes mellitus may unravel the association with Addison's disease: a case report.

PubMed

Passanisi, Stefano; Timpanaro, Tiziana; Lo Presti, Donatella; Caruso-Nicoletti, Manuela

2014-09-12

Primary adrenocortical insufficiency or Addison's disease is caused by a progressive destruction of the adrenal cortex, resulting into a reduction of glucocorticoids, mineralocorticoids, and androgens. Autoimmune Addison's disease is the most common etiological form, accounting for about 80% of all cases. We describe the case of a 16-year-old Caucasian boy affected by type-1 diabetes mellitus and autoimmune thyroiditis, who experienced recurrent hypoglycaemia as presenting symptom of Addison's disease. Hypoglycaemia is not a common presenting feature of Addison's disease, both in patients with type-1 diabetes mellitus and in non-diabetic patients. However, hypoglycaemia may occur in association with primary and secondary glucocorticoid deficiency as a result of an enhanced insulin sensitivity. Hypoglycaemia is the most common acute complication of insulin therapy in patients with type-1 diabetes mellitus. Addison's disease has been described in approximately 0.5% of patients with type-1 diabetes mellitus, being more frequent in females and occurring in middle-aged patients. An association among type-1 diabetes mellitus, autoimmune thyroiditis, and Addison's disease is found in the "Schmidt's syndrome", a rare disorder that may occur in the paediatric age. Our case suggests that the presence of Addison's disease should be taken into consideration in patients with type-1 diabetes mellitus and frequent episodes of hypoglycaemia. We wish to highlight that there are no specific indications to screen for the association between Addison's disease and type-1 diabetes mellitus, although an early diagnosis of Addison's disease in diabetic patients would prevent the morbidity and potential mortality of this association.

Chemoprophylaxis and the epidemiological characteristics of re-emergent P. vivax malaria in the Republic of Korea.

PubMed Central

Kim, Changsoo; Shin, Dong Chun; Yong, Tai Soon; Oh, Dae Kyu; Kim, Rock Kwon; Park, Keeho; Suh, I. L.

2006-01-01

OBJECTIVE: In the Republic of Korea (ROK), soldiers stationed where there is a risk of contracting malaria have received antimalarial chemoprophylaxis since 1997. However, chemoprophylaxis may facilitate the development of drug resistance, and late primary attacks in individuals who have received chemoprophylaxis are becoming more frequent. We investigated the association between chemoprophylaxis and the epidemiological characteristics and effectiveness of treatment for re-emergent Plasmodium vivax malaria, using a nationwide malaria database. METHODS: Among soldiers at risk of malaria between 1999 and 2001, we reviewed all P. vivax malaria cases (1158) that occurred before 31 December 2003. Early and late primary attacks were defined as cases occurring 2 months after the last day of exposure to risk of malaria, respectively. FINDINGS: Of these cases, 634 (72.0%) had received chemoprophylaxis, and 324 (28.0%) had not. Cases occurred mostly in summer, with a peak in July-August. Stratification by chemoprophylaxis history revealed different times to onset. Early primary attacks were more prevalent in the group not receiving chemoprophylaxis, while in the group receiving chemoprophylaxis most cases were late primary attacks. Of the latter, 312 out of 461 (67.7%) did not take primaquine regularly. After treatment of the first attack, 14 (1.2%) of 1158 were re-treated; all re-treated cases were cured using the same doses and regimen used for the first treatment. CONCLUSION: In ROK, the increase in late primary episodes of re-emergent P. vivax malaria is associated with the use of antimalarial chemoprophylaxis. PMID:17128363

[Biological exposure-related injuries in workers in a health system of the health service of Galicia, Spain].

PubMed

Cores Calvo, Juan; Muñiz Saborido, José Ramón; González Iglesias, Marta Clara

2013-01-01

The objective of this study was to describe the factors involved in biological exposure-related injuries occurring in worker from a health system in Galicia, Spain. The study was conducted in a health system of the Health Service of Galicia, that included four hospitals and 72 primary care centers, with nearly 6000 workers. The study used occupational injury data available o in the injury registry of the Health Service of Galicia for the year 2011. We identified 194 biohazard-related injuries. Exposures, locations, devices, tasks and causes of these incidents were analysed. The majority of biological exposures occurred through needlestick injuries (82%). The areas where more injuries occurred were in inpatient wards (37%) and operating rooms (25%). The devices most frequently involved were suture needles (15%) and insulin needles (15%). The most frequently recorded causes were lack of training and information, together with lack of biosafety devices. Worker training and information should be promoted along with the implementation of biosafety devices, as the latter measure alone does not seem sufficient to reduce the number of injuries. Copyright belongs to the Societat Catalana de Seguretat i Medicina del Treball.

Primary stabbing headache.

PubMed

Pareja, Juan A; Sjaastad, Ottar

2010-01-01

Primary stabbing headache is characterized by transient, cephalic ultrashort stabs of pain. It is a frequent complaint with a prevalence of 35.2%, a female preponderance, and a mean age of onset of 28 years (Vågå study). Attacks are generally characterized by moderate to severe, jabbing or stabbing pain, lasting from a fraction of a second to 3s. Attack frequency is generally low, with one or a few attacks per day. The paroxysms generally occur spontaneously, during daytime. Most patients exhibit a sporadic pattern, with an erratic, unpredictable alternation between symptomatic and non-symptomatic periods. Paroxysms are almost invariably unilateral. Temporal and fronto-ocular areas are most frequently affected. Attacks tend to move from one area to another, in either the same or the opposite hemicranium. Jabs may be accompanied by a shock-like feeling and even by head movement - "jolts" -or vocalization. On rare occasions, conjunctival hemorrhage and monocular vision loss have been described as associated features. Primary stabbing headache may concur, synchronously or independently, with other primary headaches. In contrast to what is the case in adults, in childhood it is not usually associated with other headaches. Treatment is rarely necessary. Indomethacin, 75-150 mg daily, may seem to be of some avail. Celecoxib, nifedipine, melatonin, and gabapentin have been reported to be effective in isolated cases and small series of patients. The drug studies need corroboration. Copyright © 2011 Elsevier B.V. All rights reserved.

Therapeutic outcomes of transsphenoidal surgery in pediatric patients with craniopharyngiomas: a single-center study.

PubMed

Yamada, Shozo; Fukuhara, Noriaki; Yamaguchi-Okada, Mitsuo; Nishioka, Hiroshi; Takeshita, Akira; Takeuchi, Yasuhiro; Inoshita, Naoko; Ito, Junko

2018-03-30

OBJECTIVE The aim of this study was to analyze the outcomes of transsphenoidal surgery (TSS) in a single-center clinical series of pediatric craniopharyngioma patients treated with gross-total resection (GTR). METHODS The authors retrospectively reviewed the surgical outcomes for 65 consecutive patients with childhood craniopharyngiomas (28 girls and 37 boys, mean age 9.6 years) treated with TSS (45 primary and 20 repeat surgeries) between 1990 and 2015. Tumors were classified as subdiaphragmatic or supradiaphragmatic. Demographic and clinical characteristics, including extent of resection, complications, incidence of recurrence, pre- and postoperative visual disturbance, pituitary function, and incidence of diabetes insipidus (DI), as well as new-onset obesity, were analyzed and compared between the primary surgery and repeat surgery groups. RESULTS Of the 45 patients in the primary surgery group, 26 (58%) had subdiaphragmatic tumors and 19 had supradiaphragmatic tumors. Of the 20 patients in the repeat surgery group, 9 (45%) had subdiaphragmatic tumors and 11 had supradiaphragmatic tumors. The only statistically significant difference between the 2 surgical groups was in tumor size; tumors were larger (mean maximum diameter 30 mm) in the primary surgery group than in the repeat surgery group (25 mm) (p = 0.008). GTR was accomplished in 59 (91%) of the 65 cases; the GTR rate was higher in the primary surgery group than in the repeat surgery group (98% vs 75%, p = 0.009). Among the patients who underwent GTR, 12% experienced tumor recurrence, with a median follow-up of 7.8 years, and recurrence tended to occur less frequently in primary than in repeat surgery patients (7% vs 27%, p = 0.06). Of the 45 primary surgery patients, 80% had deteriorated pituitary function and 83% developed DI, whereas 100% of the repeat surgery patients developed these conditions. Among patients with preoperative visual disturbance, vision improved in 62% but worsened in 11%. Visual improvement was more frequent in primary than in repeat surgery patients (71% vs 47%, p < 0.001), whereas visual deterioration was less frequent following primary surgery than repeat surgery (4% vs 24%, p = 0.04). Among the 57 patients without preoperative obesity, new-onset postoperative obesity was found in 9% of primary surgery patients and 21% of repeat surgery patients (p = 0.34) despite aggressive resection, suggesting that hypothalamic dysfunction was rarely associated with GTR by TSS in this series. However, obesity was found in 25% of the repeat surgery patients preoperatively due to prior transcranial surgery. Although there were no perioperative deaths, there were complications in 12 cases (18%) (6 cases of CSF leaks, 3 cases of meningitis, 2 cases of transient memory disturbance, and 1 case of hydrocephalus). Postoperative CSF leakage appeared to be more common in repeat than in primary surgery patients (20% vs 4.4%, p = 0.2). CONCLUSIONS The results of TSS for pediatric craniopharyngioma in this case series suggest that GTR should be the goal for the first surgical attempt. GTR should be achievable without serious complications, although most patients require postoperative hormonal replacement. When GTR is not possible or tumor recurrence occurs after GTR, radiosurgery is recommended to prevent tumor regrowth or progression.

The long past and short history of the vocabulary of Anglophone psychology.

PubMed

Benjafield, John G

2012-02-01

How do particular words come to be part of the vocabulary of Anglophone psychology? The present study sampled 600 words with psychological senses from the Oxford English Dictionary, which not only gives the number of senses for each word but also the date and author for the earliest known occurrence of each sense. Analogous information for the same words was taken from PsycINFO. One can distinguish between words for which their psychological sense is the first to occur in the history of the written language (primary psychological words) and words for which their psychological sense only emerges after one or more other senses have become established in the written language (secondary psychological words). To use a distinction made famous by Ebbinghaus, secondary psychological words have both a past and a history in psychology, while primary psychological words only have a history. Secondary psychological words have more connections to other words and occur more frequently in PsycINFO than do primary psychological words. For secondary psychological words, it is possible to trace a process of metaphoric polysemy that provides a basis for the eventual occurrence of the psychological sense of a word. Some primary psychological words are now developing secondary, nonpsychological senses, showing that they are subject to the same metaphoric process as are any other words.

PubMed

Kelle, Bayram; Yıldız, Fatih; Paydas, Semra; Bagır, Emine Kılıc; Ergin, Melek; Kozanoglu, Erkan

2014-12-23

Hypertrophic osteoarthropathy (HOA) is a condition characterized by arthralgia/arthritis, clubbing, and periosteal reaction. Primary form of HOA is observed at early ages of life and is hereditary in nature. Secondary HOA is more frequently seen in clinical setting and occurs as a result of various disorders including inflammatory and malignant diseases. Regression in HOA may be seen after the treatment of underlying condition. In this report, we presented a case of HOA coexisted with myelofibrosis and reviewed the current literature. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

Metastases of breast cancer to a uterine leiomyoma.

PubMed

Ludovisi, Manuela; Moruzzi, Maria Cristina; Ferrandina, Gabriella; Scambia, Giovanni; Testa, Antonia Carla

2017-09-19

Metastases to the uterus occur very rarely, accounting for less than 10% of all cases of metastases involving the female genital tract; mammary and gastrointestinal carcinomas are the most frequent extragenital primary neoplasms metastasizing to the uterine corpus 1 . Very little data is available in the literature including 24 cases of breast cancer metastasized to a uterine leiomyoma 2 , as assessed at surgery (N = 16), and autoptic evaluation (n = 8). This article is protected by copyright. All rights reserved.

Comparison of implant component fractures in external and internal type: A 12-year retrospective study.

PubMed

Yi, Yuseung; Koak, Jai-Young; Kim, Seong-Kyun; Lee, Shin-Jae; Heo, Seong-Joo

2018-04-01

The aim of this study was to compare the fracture of implant component behavior of external and internal type of implants to suggest directions for successful implant treatment. Data were collected from the clinical records of all patients who received WARANTEC implants at Seoul National University Dental Hospital from February 2002 to January 2014 for 12 years. Total number of implants was 1,289 and an average of 3.2 implants was installed per patient. Information about abutment connection type, implant locations, platform sizes was collected with presence of implant component fractures and their managements. SPSS statistics software (version 24.0, IBM) was used for the statistical analysis. Overall fracture was significantly more frequent in internal type. The most frequently fractured component was abutment in internal type implants, and screw fracture occurred most frequently in external type. Analyzing by fractured components, screw fracture was the most frequent in the maxillary anterior region and the most abutment fracture occurred in the maxillary posterior region and screw fractures occurred more frequently in NP (narrow platform) and abutment fractures occurred more frequently in RP (regular platform). In external type, screw fracture occurred most frequently, especially in the maxillary anterior region, and in internal type, abutment fracture occurred frequently in the posterior region. placement of an external type implant rather than an internal type is recommended for the posterior region where abutment fractures frequently occur.

Investigation of suspected chronic fatigue syndrome/myalgic encephalopathy.

PubMed

Owe, Jone Furlund; Næss, Halvor; Gjerde, Ivar Otto; Bødtker, Jørn Eilert; Tysnes, Ole-Bjørn

2016-02-09

Chronic fatigue is a frequently occurring problem in both the primary and specialist health services. The Department of Neurology at Haukeland University Hospital has established a standard assessment for patients referred with suspected CFS/ME. This study reports diagnoses and findings upon assessment, and considers the benefit of supplementary examinations. Diagnoses and findings from examinations of 365 patients assessed for suspected CFS/ME are retrospectively reported. A total of 48 patients (13.2%) were diagnosed with CFS/ME, while a further 18 patients (4.9%) were diagnosed with post-infectious fatigue. Mental and behavioural disorders were diagnosed in 169 patients (46.3%), and these represented by far the largest group. Serious, but unrecognised somatic illness was discovered in two patients, while changes of uncertain significance were identified by MRI and lumbar puncture in a few patients. Fatigue is a frequently occurring symptom in the population. Thorough somatic and psychiatric investigation is necessary before referral to the specialist health services. Mental disorders and reactions to life crises are common and important differential diagnoses for CFS/ME. Long waiting times in the specialist health services may result in delayed diagnosis for these patients.

[Infectious mononucleosis--a "childhood disease" of great medical concern].

PubMed

Stock, Ingo

2013-10-01

Infectious mononucleosis is usually a benign self-limiting disease, which is caused by the Epstein-Barr virus (EBV), a member of the Herpes virus family. EBV virions have a double-stranded, linear DNA genome surrounded by a protein capsid. EBV is transmitted primarily through saliva, but transmission via blood and droplets also occurs. Infectious mononucleosis is the most frequent clinical manifestation of EBV infection and occurs during primary infection with the virus. With some exceptions, only children older than 10 years, adolescents and young adults are suffering from the disease. Primary EBV infection in children up to 10 years is usually asymptomatic or shows unspecific courses. After an incubation period of up to seven weeks, a sore throat, mild fever and swollen lymph nodes in the neck area are the first signs of symptomatic infection. Further course of the disease often leads to hepatitis and swelling of the spleen. The symptoms usually subside after a few weeks, but protracted courses and clinical active infection also occur. The Epstein-Barr virus is distributed worldwide. At least 90% of all adults are seropositive to EBV. The treatment of infectious mononucleosis is mainly symptomatic, a generally effective specific therapy does not exist. A vaccine is currently not available.

A 6-year-old girl with restricted upward gaze of her right eye.

PubMed

Tuli, Sanjeev; Tuli, Sonal

2012-08-01

Brown syndrome is an incomitant strabismus syndrome characterized by inability of the eye to elevate during adduction. • Primary Brown syndrome is thought to occur due to the inability of the superior oblique tendon to stretch.However, there are many secondary causes of this condition that must be ruled out. • Despite significant misalignment of the eyes during upgaze, patients with Brown syndrome usually do not have decreased vision or diplopia with primary gaze. • Unlike paralytic strabismus, forced duction tests demonstrate restriction and a Parks’ three-step test does not demonstrate a paralytic muscle. Spontaneous resolution is frequent, and surgical management typically is not indicated because of the high incidence of postoperative symptomatic superior oblique palsy.

Metastatic pheochromocytoma: clinical, genetic, and histopathologic characteristics

PubMed Central

Zelinka, Tomáš; Musil, Zdeněk; Dušková, Jaroslava; Burton, Deborah; Merino, Maria J; Milosevic, Dragana; Widimský, Jiří; Pacak, Karel

2011-01-01

Background Pheochromocytomas are tumors arising from chromaffin tissue located in the adrenal medulla associated with typical symptoms and signs which may occasionally develop metastases, which are defined as the presence of tumor cells at sites where these cells are not found. This retrospective analysis was focused on clinical, genetic, and histopathologic characteristics of primary metastatic versus primary benign pheochromocytomas. Materials and methods We identified 41 subjects with metastatic pheochromocytoma and 108 subjects with apparently benign pheochromocytoma. We assessed dimension and biochemical profile of the primary tumor, age at presentation, and time to develop metastases. Results Subjects with metastatic pheochromocytoma presented at a significantly younger age (41.4±14.7 vs. 50.2±13.7 years; P<0.001), with larger primary tumors (8.38±3.27 cm vs. 6.18±2.75 cm; P<0.001) and secreted more frequently norepinephrine (95.1% vs. 83.3 %; P=0.046) compared to subjects with apparently benign pheochromocytomas. No significant differences were found in the incidence of genetic mutations in both groups of subjects (25.7 % in the metastatic group and 14.7 % in the benign group; P=0.13). From available histopathologic markers of potential malignancy, only necrosis occurred more frequently in subjects with metastatic pheochromocytoma (27.6 % vs. 0 %; P<0.001). The median time to develop metastases was 3.6 years with the longest interval 24 years. Conclusions In conclusion, regardless of a genetic background, the size of a primary pheochromocytoma and age of its first presentation are two independent risk factors associated with the development of metastatic disease. PMID:21692797

Current practice of preconception care by primary caregivers in the Netherlands.

PubMed

van Voorst, Sabine; Plasschaert, Sophie; de Jong-Potjer, Lieke; Steegers, Eric; Denktaş, Semiha

2016-06-01

Over the past decade the value of preconception care (PCC) consultations has been acknowledged. Investments have been made to promote delivery and uptake of PCC consultations in the Dutch primary care setting. We assessed current activities, perceptions and prerequisites for delivery of PCC in primary care. A questionnaire was compiled and distributed by mail or e-mail among 1682 general practitioners (GPs) and 746 midwives in the Netherlands between 2013 and 2014. The questionnaire was completed by 449 GPs and 250 midwives. While GPs and midwives were frequently asked about preconception risks, explicit requests by patients for a PCC consultation were less frequent. Although caregivers gave information on preconception risk factors, only a minority recommended PCC in the form of a dedicated consultation. Such consultations occurred infrequently. Risk factor assessment varied between GPs and midwives. Respondents' perceptions of PCC consultations, however, were generally positive. A small proportion believed that PCC medicalised pregnancy, and recognised barriers in actively raising the topic of patients' pregnancy wishes. More training, staff, promotion of PCC and adequate reimbursement were prerequisites for future delivery. GPs differed in their opinion of whether they or midwives were primarily responsible for PCC consultations. Midwives, however, saw themselves as responsible for providing PCC consultations. Primary care is underserving prospective parents with regards to PCC consultations. Targets to increase delivery of systematic PCC are: (1) promotion during routine care; (2) increased use of tools; (3) increased collaboration among primary caregivers; (4) reduction of caregivers' negative perceptions; and (5) tailoring PCC consultations to suit women's preferences.

Headache associated with cough: a review

PubMed Central

2013-01-01

Headache only triggered by coughing is a rather uncommon condition. The aim of the present review is to present an overview of the diagnosis, clinical characteristics, pathophysiology and treatment of both primary and symptomatic cough headache and discuss other relevant headache disorders affected by coughing. The diagnosis of primary cough headache is made when headache is brought on and occurs only in association with coughing, straining or a Valsalva manoeuvre and in the absence of any abnormalities on neuro-imaging. In case an underlying pathology is identified as a cause of the headache, the diagnosis of symptomatic cough headache is made. The vast majority of these patients present with a Chiari malformation type I. Other frequently reported causes include miscellaneous posterior fossa pathology, carotid or vertebrobasilar disease and cerebral aneurysms. Consequently, diagnostic neuroimaging is key in the diagnosis of cough-related headache and guides treatment. Besides primary and symptomatic cough headache, several other both primary and secondary headache disorders exist where coughing acts as a trigger or aggravator of headache symptomatology. PMID:23687906

Primary Subcutaneous Synovial Sarcoma: First Reported Subcutaneous Case Showing TLE1 Immunoreactivity.

PubMed

Alegría-Landa, Victoria; Nájera, Laura; Massa, Dolores Suárez; Roustan, Gastón; Río, María Del; Kutzner, Heinz; Requena, Luis

2018-05-08

Synovial sarcoma (SS) accounts for 5%-10% of all soft tissue sarcomas. It is a well-defined soft tissue neoplasm with biphasic and monophasic histologic subtypes and unknown histogenesis. It usually occurs in the extremities, especially the thigh-knee region of young adults. Recurrences are frequent and distant metastasis developed in approximately half of the patients. SSs are characterized by a recurrent nonrandom chromosomal translocation, t(X; 18) (p11; q11), which is considered the primary genetic event in more than 90% of cases. Only 4 cases of cutaneous and subcutaneous SSs have been published in the literature so far. We report a case of primary subcutaneous SS in the forearm of a young woman and discuss the histopathologic differential diagnosis with other similar neoplasms. This is the first reported case of primary cutaneous SS showing immunoreactivity for TLE1 in the nuclei of neoplastic cells, supporting the use of this marker for diagnosis of this rare cutaneous neoplasm.

[Diagnosis of primary hyperlipoproteinemia in umbilical cord blood (author's transl)].

PubMed

Parwaresch, M R; Radzun, H J; Mäder, C

1977-10-01

The aim of the present investigation was to assay the frequency of primary dyslipoproteinemia in a random sample of one hundred newborns and to describe the minimal methodical requirements for sound diagnosis. After comparison of different methods total lipids were determined by gravimetry, cholesterol and triglycerides by enzymatic methods, nonesterified fatty acids by direct colorimetry; phospholipids were estimated indirectly. All measurements were applied to umbilical cord sera and to lipoprotein fractions separated by selective precipitation. The diagnosis of hyperlipoproteinemia type IV, which is the most frequent one in adults, is highly afflicted with pitfalls in the postnatal period. A primary hyper-alpha-liproteinemia occured in one case and type II-hyperlipoproteinemia in two cases, one of the parents being involved in each case. For mass screening triglycerides should be assayed in serum and cholesterol in precipitated and resolubilized LDL-fraction, for which the minimal requirements are described.

Primary sternum diffuse large B-cell lymphoma: A case report and review of the literature

PubMed Central

TONG, MENG-YING; ZHANG, XIAN; YU, ZHE; SUN, XIU-HUA; LI, SHUANG; ZHANG, YANG

2015-01-01

Primary bone lymphoma (PBL) is a rare disease, accounting for >1% of all cases of malignant lymphoma. Diffuse large B-cell lymphoma (DLBCL) is the most common histological type of PBL. The present study reported the case of a 68-year-old male with primary bone DLBCL, originally occurred in the sternum, which is a rare form of presentation. Computed tomography (CT), magnetic resonance imaging and bone emission CT were performed, followed by immunohistochemical analysis of a biopsy specimen, and the results were used to establish the diagnosis. At the time of diagnosis, no osseous involvement was observed. The clinical, radiological and histological features of PBL can mimic other medical conditions, thereby making the diagnosis difficult, and frequently leading to delays in treatment. The present study investigated the clinical features, management and prognosis of PBL, and reviewed previous relevant cases. PMID:26137117

A description of medication errors reported by pharmacists in a neonatal intensive care unit.

PubMed

Pawluk, Shane; Jaam, Myriam; Hazi, Fatima; Al Hail, Moza Sulaiman; El Kassem, Wessam; Khalifa, Hanan; Thomas, Binny; Abdul Rouf, Pallivalappila

2017-02-01

Background Patients in the Neonatal Intensive Care Unit (NICU) are at an increased risk for medication errors. Objective The objective of this study is to describe the nature and setting of medication errors occurring in patients admitted to an NICU in Qatar based on a standard electronic system reported by pharmacists. Setting Neonatal intensive care unit, Doha, Qatar. Method This was a retrospective cross-sectional study on medication errors reported electronically by pharmacists in the NICU between January 1, 2014 and April 30, 2015. Main outcome measure Data collected included patient information, and incident details including error category, medications involved, and follow-up completed. Results A total of 201 NICU pharmacists-reported medication errors were submitted during the study period. All reported errors did not reach the patient and did not cause harm. Of the errors reported, 98.5% occurred in the prescribing phase of the medication process with 58.7% being due to calculation errors. Overall, 53 different medications were documented in error reports with the anti-infective agents being the most frequently cited. The majority of incidents indicated that the primary prescriber was contacted and the error was resolved before reaching the next phase of the medication process. Conclusion Medication errors reported by pharmacists occur most frequently in the prescribing phase of the medication process. Our data suggest that error reporting systems need to be specific to the population involved. Special attention should be paid to frequently used medications in the NICU as these were responsible for the greatest numbers of medication errors.

Nitrogenase and Alkaline Phosphatase Activity in Wetland Metaphyton: Implications for Primary Production and CNP Composition

NASA Astrophysics Data System (ADS)

Scott, T.; Doyle, R.

2005-05-01

Longitudinal gradients of nutrient availability often occur along the flow path of water in freshwater wetlands. Differential removal efficiencies of water column nitrogen (N) and phosphorus (P) may increase the severity of nutrient deficiency and possibly change the nutrient that limits primary production. A previous study demonstrated that periphyton in the Lake Waco Wetlands (LWW), near Waco, Texas, USA, are generally more P limited near the inflow and become increasingly N limited as distance from the inflow increases. Therefore, spatial heterogeneity in nutrient availability likely influences both the structure and function of periphyton assemblages within this system. In this ongoing study, we are evaluating the relationships between metaphyton primary production, nitrogenase activity, alkaline phosphatase activity, and CNP stoichiometry in areas of differing nutrient limitation within the LWW. As expected, primary production is generally greatest in areas where nitrogenase and alkaline phosphatase activities are minimal. However, expected increases in C:N ratios in areas of greatest nutrient deficiency have not been frequently observed. Decreased primary production and increased enzyme mediated nutrient uptake appear to balance metaphyton nutrient content in these areas.

Integrating mental health into primary care in Sverdlovsk

PubMed Central

2009-01-01

Introduction Mental disorders occur as frequently in Russia as elsewhere, but the common mental disorders, especially depression, have gone largely unrecognised and undiagnosed by policlinic staff and area doctors. Methods This paper describes the impact and sustainability of a multi-component programme to facilitate the integration of mental health into primary care, by situation appraisal, policy dialogue, development of educational materials, provision of a training programme and the publication of standards and good practice guidelines to improve the primary care of mental disorders in the Sverdlovsk region of the Russian Federation. Results The multi-component programme has resulted in sustainable training about common mental disorders, not only of family doctors but also of other cadres and levels of professionals, and it has been well integrated with Sverdlovsk's overall programme of health sector reforms. Conclusion It is possible to facilitate the sustainable integration of mental health into primary care within the Russian context. While careful adaptation will be needed, the approach adopted here may also hold useful lessons for policy makers seeking to integrate mental health within primary care in other contexts and settings. PMID:22477885

Time dependence of risks and benefits in pediatric primary prevention implantable cardioverter-defibrillator therapy.

PubMed

DeWitt, Elizabeth S; Triedman, John K; Cecchin, Frank; Mah, Doug Y; Abrams, Dominic J; Walsh, Edward P; Gauvreau, Kimberlee; Alexander, Mark E

2014-12-01

Implantable cardioverter defibrillators (ICDs) used to prevent sudden cardiac arrest in children not only provide appropriate therapy in 25% of patients but also result in a significant incidence of inappropriate shocks and other device complications. ICDs placed for secondary prevention have higher rates of appropriate therapy than those placed for primary prevention. Pediatric patients with primary prevention ICDs were studied to determine time-dependent incidence of appropriate use and adverse events. A total of 140 patients aged <21 years (median age, 15 years) at first ICD implantation at Boston Children's Hospital (2000-2009) in whom devices were placed for primary prevention were retrospectively identified. Demographics and times to first appropriate shock; adverse events (including inappropriate shock, lead failure, reintervention, and complication); generator replacement and follow-up were noted. During mean follow-up of 4 years, appropriate shock occurred in 19% patients and first adverse event (excluding death/transplant) occurred in 36%. Risk of death or transplant was ≈1% per year and was not related to receiving appropriate therapy. Conditional survival analysis showed rates of appropriate therapy and adverse events decrease soon after implantation, but adverse events are more frequent than appropriate therapy throughout follow-up. Primary prevention ICDs were associated with appropriate therapy in 19% and adverse event in 36% in this cohort. The incidence of both first appropriate therapy and device-related adverse events decreased during longer periods of follow-up after implantation. This suggests that indications for continued device therapy in pediatric primary prevention ICD patients might be reconsidered after a period of nonuse. © 2014 American Heart Association, Inc.

Mucoepidermoid lung tumor appearing as an abscess on the scrotum.

PubMed

Szendroi, Attila; Majoros, Attila; Székely, Eszter; Szucs, Miklós; Romics, Imre

2009-01-01

The authors present the case of a 52-year-old man who had recurring scrotal abscesses resulting in oncotomy being carried out seven times within 2 years. Eventually, it was dissected out totally. Histology proved anaplastic cancer metastasis. The primary tumor was detected in the bronchia; moreover, metastases were found in other organs as well. The patient died 6 weeks after the first diagnosis. We intended to draw attention to frequently occurring scrotal inflammation and thus the underlying diseases. We emphasize the importance of histology examinations. (c) 2009 S. Karger AG, Basel.

The multiple genetic causes of central hypothyroidism.

PubMed

Persani, Luca; Bonomi, Marco

2017-03-01

An insufficient stimulation by thyrotropin (TSH) of an otherwise normal thyroid gland represents the cause of Central Hypothyrodism (CeH). CeH is about 1000-folds rarer than Primary Hypothyroidism and often represents a real challenge for the clinicians, mainly because they cannot rely on adequately sensitive parameters for diagnosis or management, as it occurs with circulating TSH in PH. Therefore, CeH diagnosis can be frequently missed or delayed in patients with a previously unknown pituitary involvement. A series of genetic defects have been described to account for isolated CeH or combined pituitary hormone defects (CPHDs) with variable clinical characteristics and degrees of severity. The recently identified candidate gene IGSF1 appears frequently involved. This review provides an updated illustration of the different genetic defects accounting for CeH. Copyright © 2017 Elsevier Ltd. All rights reserved.

Association between polymorphisms in renin-angiotensin system genes and primary ovarian insufficiency in Korean women.

PubMed

Jung, Yong Wook; Jeon, Young Joo; Park, Hye Mi; Lee, Bo Eun; Rah, Hyungchul; Lee, Woo Sik; Yoon, Tae Ki; Kim, Nam Keun

2013-05-01

The purpose of this study was to evaluate the relationship between angiotensin-converting enzyme (ACE; insertion/deletion), angiotensinogen (AGT M235T), and angiotensin II type 1 receptor (AT1R 1166A>C) and the prevalence of primary ovarian insufficiency (POI) in Korean women. A total of 133 women with POI and 238 controls were genotyped for polymorphic sites in each gene using polymerase chain reaction-restriction fragment length polymorphism analysis. ACE ID and ID + II variants occurred more frequently in women with POI than in controls (odds ratio [OR], 1.830; 95% CI, 1.040-3.221; P = 0.040; and OR, 1.797; 95% CI, 1.055-3.060; P = 0.031, respectively). The AT1R 1166AC genotype occurred more frequently in participants with POI than in controls (OR, 3.171; 95% CI, 1.562-6.436; P = 0.002). Comparing the combined genotype frequencies of ACE/AT1R revealed that the frequencies of ID/AA, ID/AC, and II/AC were higher in participants than in controls (OR, 1.916; 95% CI, 1.053-3.485; P = 0.043; OR, 3.544; 95% CI, 1.207-10.407; P = 0.036; and OR, 7.875; 95% CI, 2.224-27.881; P = 0.001, respectively). The TT/AC genotype for combined genotyping of AGT/AT1R was more frequently observed in the POI group than in the control group (OR, 3.472; 95% CI, 1.450-8.313; P = 0.006). In multifactor dimensionality reduction-based haplotype analysis, the I-T-C genotype of ACE/AGT/AT1R was a possible predisposing factor for POI (OR, 4.678; 95% CI, 1.721-12.717; P = 0.002). This study demonstrates that polymorphisms in the renin-angiotensin system are related to the prevalence of POI. Thus, these renin-angiotensin system genes may serve as a novel marker for predicting the development of POI.

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations.

PubMed

Zada, Gabriel; Cavallo, Luigi M; Esposito, Felice; Fernandez-Jimenez, Julio Cesar; Tasiou, Anastasia; De Angelis, Michelangelo; Cafiero, Tullio; Cappabianca, Paolo; Laws, Edward R

2010-10-01

In addition to difficulties with anesthetic and medical management, transsphenoidal operations in patients with longstanding acromegaly are associated with inherent intraoperative challenges because of anatomical variations that occur frequently in these patients. The object of this study was to review the overall safety profile and anatomical/technical challenges associated with transsphenoidal surgery in patients with acromegaly. The authors performed a retrospective analysis of 169 patients who underwent endoscopic transsphenoidal operations for growth hormone-secreting adenomas to assess the incidence of surgical complications. A review of frequently occurring anatomical challenges and operative strategies employed during each phase of the operation to address these particular issues was performed. Of 169 cases reviewed, there was no perioperative mortality. Internal carotid artery injury occurred in 1 patient (0.6%) with complex sinus anatomy, who remained neurologically intact following endovascular unilateral carotid artery occlusion. Other complications included: significant postoperative epistaxis (5 patients [3%]), transient diabetes insipidus (5 patients [3%]), delayed symptomatic hyponatremia (4 patients [2%]), CSF leak (2 patients [1%]), and pancreatitis (1 patient [0.6%]). Preoperative considerations in patients with acromegaly should include a cardiopulmonary evaluation and planning regarding intubation and other aspects of the anesthetic technique. During the nasal phase of the transsphenoidal operation, primary challenges include maintaining adequate visualization and hemostasis, which is frequently compromised by redundant, edematous nasal mucosa and bony hypertrophy of the septum and the nasal turbinates. During the sphenoid phase, adequate bony removal, optimization of working space, and correlation of imaging studies to intraoperative anatomy are major priorities. The sellar phase is frequently challenged by increased sellar floor thickness, distinct patterns of tumor extension and bony invasion, and anatomical variations in the caliber and course of the internal carotid artery. Specific operative techniques for addressing each of these intraoperative challenges are discussed. Transsphenoidal surgery in patients with longstanding acromegaly frequently poses greater challenges than operations for other types of sellar lesions, yet these challenges may be safely and effectively overcome with the anticipation of specific issues and implementation of various intraoperative techniques.

Dinitrogen-fixing cyanobacteria in microbial mats of two shallow coral reef ecosystems.

PubMed

Charpy, Loic; Palinska, Katarzyna A; Casareto, Beatriz; Langlade, Marie José; Suzuki, Yoshimi; Abed, Raeid M M; Golubic, Stjepko

2010-01-01

Dinitrogen-fixing organisms in cyanobacterial mats were studied in two shallow coral reef ecosystems: La Reunion Island, southwestern Indian Ocean, Sesoko (Okinawa) Island, and northwestern Pacific Ocean. Rapidly expanding benthic miniblooms, frequently dominated by a single cyanobacterial taxon, were identified by microscopy and molecular tools. In addition, nitrogenase activity by these blooms was measured in situ. Dinitrogen fixation and its contribution to mat primary production were calculated using (15)N(2) and (13)C methods. Dinitrogen-fixing cyanobacteria from mats in La Reunion and Sesoko showed few differences in taxonomic composition. Anabaena sp. among heterocystous and Hydrocoleum majus and Symploca hydnoides among nonheterocystous cyanobacteria occurred in microbial mats of both sites. Oscillatoria bonnemaisonii and Leptolyngbya spp. occurred only in La Reunion, whereas Hydrocoleum coccineum dominated in Sesoko. Other mats dominated by Hydrocoleum lyngbyaceum, Phormidium laysanense, and Trichocoleus tenerrimus occurred at lower frequencies. The 24-h nitrogenase activity, as measured by acetylene reduction, varied between 11 and 324 nmoles C(2)H(2) reduced microg(-1) Chl a. The highest values were achieved by heterocystous Anabaena sp. performed mostly during the day. Highest values for nonheterocystous cyanobacteria were achieved by H. coccineum mostly during the night. Daily nitrogen fixation varied from nine (Leptolyngbya) to 238 nmoles N(2) microg(-1) Chl day(-1) (H. coccineum). Primary production rates ranged from 1,321 (S. hydnoides) to 9,933 nmoles C microg(-1) Chl day(-1) (H. coccineum). Dinitrogen fixation satisfied between 5% and 21% of the nitrogen required for primary production.

Anesthetic implications of primary cardiac tumors in infants and children.

PubMed

Kussman, Barry D; Devavaram, Prabhakar; Hansen, Dolly D; Dinardo, James A; Forbess, Joseph M; Mehrota, Ramji; McGowan, Francis X

2002-10-01

To determine the degree of hemodynamic and airway compromise in infants and children undergoing anesthesia for primary cardiac tumors. Retrospective study. Tertiary-care, academic children's hospital. Patients <18 years old who had undergone anesthesia and surgery for resection or biopsy of a primary cardiac tumor (n = 25). None. Charts were reviewed for intraoperative complications, defined as (1) hypotension (20% decrease from baseline) during or after induction; (2) failure to gain airway control by insertion of an airway or endotracheal intubation, inability to ventilate after administration of a muscle relaxant, need for change in patient position, rigid bronchoscopy, or cardiopulmonary bypass for adequate oxygenation; and (3) new arrhythmias. Hypotension during induction occurred in 4 patients (16%), 3 of whom were hemodynamically unstable preoperatively. Hypotension after induction was found in 2 (8%) patients. Hypotension occurred more frequently in patients with obstruction to blood flow and arrhythmia (n = 3), obstruction to blood flow only (n = 1), and arrhythmia only (n = 1). No patient had airway difficulty related to the tumor, although one intrapericardial tumor mimicked an anterior mediastinal mass. New arrhythmias occurred in 3 (12%) patients. The subgroup of patients at greatest risk are patients with a combination of obstruction to blood flow and arrhythmias. Despite the alarming diagnosis, the intraoperative course tends to be fairly stable in most cases. Extensive pericardial tumors may produce the same airway concerns as anterior mediastinal masses, but airway complications do not seem to be a problem with intrachamber tumors. Copyright 2002, Elsevier Science (USA). All rights reserved.

Detecting Chemically Modified DNA Bases Using Surface Enhanced Raman Spectroscopy

PubMed Central

Barhoumi, Aoune; Halas, Naomi J.

2013-01-01

Post-translational modifications of DNA- changes in the chemical structure of individual bases that occur without changes in the DNA sequence- are known to alter gene expression. They are believed to result in frequently deleterious phenotypic changes, such as cancer. Methylation of adenine, methylation and hydroxymethylation of cytosine, and guanine oxidation are the primary DNA base modifications identified to date. Here we show it is possible to use surface enhanced Raman spectroscopy (SERS) to detect these primary DNA base modifications. SERS detection of modified DNA bases is label-free and requires minimal additional sample preparation, reducing the possibility of additional chemical modifications induced prior to measurement. This approach shows the feasibility of DNA base modification assessment as a potentially routine analysis that may be further developed for clinical diagnostics. PMID:24427449

Detecting Chemically Modified DNA Bases Using Surface Enhanced Raman Spectroscopy.

PubMed

Barhoumi, Aoune; Halas, Naomi J

2011-12-15

Post-translational modifications of DNA- changes in the chemical structure of individual bases that occur without changes in the DNA sequence- are known to alter gene expression. They are believed to result in frequently deleterious phenotypic changes, such as cancer. Methylation of adenine, methylation and hydroxymethylation of cytosine, and guanine oxidation are the primary DNA base modifications identified to date. Here we show it is possible to use surface enhanced Raman spectroscopy (SERS) to detect these primary DNA base modifications. SERS detection of modified DNA bases is label-free and requires minimal additional sample preparation, reducing the possibility of additional chemical modifications induced prior to measurement. This approach shows the feasibility of DNA base modification assessment as a potentially routine analysis that may be further developed for clinical diagnostics.

Peroperative Gastrograffin bowel lavage in gastroschisis.

PubMed

Cherian, Abraham; Hallows, Ruth M; Singh, Shalinder J; McCallion, William A; Stewart, Richard J

2006-10-01

The aim of the study was to evaluate potential benefits in the use of peroperative bowel lavage with Gastrograffin in neonates with gastroschisis. A retrospective analysis of newborns with gastroschisis was performed over a 10-year period in 2 centers in the United Kingdom. Two groups were studied wherein one had peroperative bowel lavage with Gastrograffin and the other did not. Data were collected on 116 patients of whom 93 were suitable for analysis. There were no statistically significant differences in primary closure rate, duration of ventilation, parenteral nutrition, or hospital stay. Intestinal obstruction occurred more frequently in the nonlavage group. Gastrograffin lavage peroperatively in gastroschisis offers no potential advantage in reducing ventilatory requirements, parenteral nutrition, and hospital stay. It also does not achieve greater primary closure rates, but may reduce the incidence of intestinal obstruction.

Emerging infectious diseases of wildlife: a critical perspective.

PubMed

Tompkins, Daniel M; Carver, Scott; Jones, Menna E; Krkošek, Martin; Skerratt, Lee F

2015-04-01

We review the literature to distinguish reports of vertebrate wildlife disease emergence with sufficient evidence, enabling a robust assessment of emergence drivers. For potentially emerging agents that cannot be confirmed, sufficient data on prior absence (or a prior difference in disease dynamics) are frequently lacking. Improved surveillance, particularly for neglected host taxa, geographical regions and infectious agents, would enable more effective management should emergence occur. Exposure to domestic sources of infection and human-assisted exposure to wild sources were identified as the two main drivers of emergence across host taxa; the domestic source was primary for fish while the wild source was primary for other taxa. There was generally insufficient evidence for major roles of other hypothesized drivers of emergence. Copyright © 2015 Elsevier Ltd. All rights reserved.

The chronology and sequence of eruption of human permanent teeth in Northern Ireland.

PubMed

Kochhar, R; Richardson, A

1998-12-01

To ascertain the average and range of ages and sequence of eruption of human permanent teeth, taking into account the effect of premature loss of primary antecedents. Longitudinal study. Caucasian subjects in Northern Ireland. Study casts at 6-monthly intervals from age 5 to 15 years of 276 children (146 males and 130 females) enrolled in the Belfast Growth Study. The mean and range of ages of eruption of each individual tooth were computed. Comparisons were made between the mean ages of eruption with and without premature loss of primary antecedents, between upper and lower arches, between right and left sides and between males and females. The sequence of eruption was also investigated. The means and ranges of eruption ages are reported. Premature loss of primary antecedents delayed eruption of permanent successors except for the upper premolars which were accelerated. The differences relating to the upper first premolar and lower canine were not statistically significant. Each lower tooth erupted before its upper counterpart except for the premolars. There was no significant difference in age of eruption between right and left sides. Females tended to erupt teeth before males with the exception of the second molars in both arches; however, the only differences to reach statistical significance related to upper and lower canines and upper lateral incisors. The most frequent orders of eruption were unique to the subject. These occurred in 22% of upper and 33% of lower arches. The classic sequences: first molar-central incisor-lateral incisor-first premolar-canine-second premolar-second molar (M1-I1-I2-PM1-C-PM2-M2) in the upper arch and I1-M1-I2-C-PM1-PM2-M2 in the lower arch occurred in only 16% of upper arches and 13% of lower arches. Males adhered to the textbook sequence (20% upper, 17% lower) more than females (12% upper, 8% lower). In the upper arch of females, the order M1-I1-I2-PM1-PM2-C-M2 in 10% of subjects was almost as frequent as the classic sequence. The ages, ranges and orders of eruption found in this study are more reliable than many which are frequently quoted on account of its longitudinal nature and the fact that the effect of premature loss of primary antecedents is taken into account. The exclusively Caucasian sample makes the data quite precise but limits applicability to patients of this ethnic origin.

Somatization among older primary care attenders.

PubMed

Sheehan, B; Bass, C; Briggs, R; Jacoby, R

2003-07-01

The importance of somatization among older primary care attenders is unclear. We aimed to establish the prevalence, persistence and associations of somatization among older primary care attenders, and the associations of frequent attendance. One hundred and forty primary care attenders over 65 years were rated twice, 10 months apart, on measures of somatization, psychiatric status, physical health and attendance. The syndrome of GMS hypochondriacal neurosis had a prevalence of 5% but was transient. Somatized symptoms and attributions were persistent and associated with depression, physical illness and perceived poor social support. Frequent attenders (top third) had higher rates of depression, physical illness and somatic symptoms, and lower perceived support. Somatization is common among older primary care attenders and has similar correlates to younger primary care somatizers. Psychological distress among older primary care attenders is associated with frequent attendance. Improved recognition should result in benefits to patients and services.

Welcome back? Frequent attenders to a pediatric primary care center.

PubMed

Klein, Melissa; Vaughn, Lisa M; Baker, Raymond C; Taylor, Trisha

2011-09-01

This study examines frequent attenders of a pediatric primary care clinic at a large urban children's hospital--who they are and their reasons for frequent attendance to the clinic. The literature suggests that some visits by frequent attenders may not be medically necessary, and these additional appointments may impair others' access to medical care within the same system. The key to eliminating excessive primary care visits is to determine if it is a problem in the primary care practice (quantify the problem), explore the reasons for the visits (from the patients' perspective), and then provide educational interventions that address the various causes for the extra visits and encourage the use of available resources, either ancillary services in the practice itself or resources and agencies available in the community (e.g. social service, legal aid).

Personal Characteristics and Experience of Primary Care Predicting Frequent Use of Emergency Department: A Prospective Cohort Study.

PubMed

Hudon, Catherine; Sanche, Steven; Haggerty, Jeannie L

2016-01-01

A small number of patients frequently using the emergency department (ED) account for a disproportionate amount of the total ED workload and are considered using this service inappropriately. The aim of this study was to identify prospectively personal characteristics and experience of organizational and relational dimensions of primary care that predict frequent use of ED. This study was conducted among parallel cohorts of the general population and primary care patients (N = 1,769). The measures were at baseline (T1), 12 (T2) and 24 months (T3): self-administered questionnaire on current health, health behaviours and primary care experience in the previous year. Use of medical services was confirmed using administrative databases. Mixed effect logistic regression modeling identified characteristics predicting frequent ED utilization. A higher likelihood of frequent ED utilization was predicted by lower socioeconomic status, higher disease burden, lower perceived organizational accessibility, higher number of reported healthcare coordination problems and not having a complete annual check-up, above and beyond adjustment for all independent variables. Personal characteristics such as low socioeconomic status and high disease burden as well as experience of organizational dimensions of primary care such as low accessibility, high healthcare coordination problems and low comprehensiveness of care are prospectively associated with frequent ED utilization. Interventions developed to prevent inappropriate ED visits, such as case management for example, should tailor low socioeconomic status and patients with high disease burden and should aim to improve experience of primary care regarding accessibility, coordination and comprehensiveness.

Epidemiology of Hymenolepis nana infections in primary school children in urban and rural communities in Zimbabwe.

PubMed

Mason, P R; Patterson, B A

1994-04-01

Fecal specimens were obtained on 3 occasions at 10-12 wk intervals from 315 children in 3 rural villages in Zimbabwe and from 351 children in the high-density suburbs of an adjacent small town. Specimens were examined qualitatively and quantitatively for eggs of Hymenolepis nana, and these were found in 142 (21%) children. Infections occurred more frequently in younger children in the urban area but in older children in rural areas. The prevalence in urban areas (24%) was higher than in rural areas (18%), and in urban areas infection correlated with low "hygiene scores" (determined by observation) and with the presence in the household of an infected sibling. The prevalence of infection in the 3 rural communities did not correlate with availability of water, number of households per toilet, with low "hygiene scores," or with the presence of an infected sibling. Treatment with a single oral dose of 15 mg/kg praziquantel cured 84% of the infected children. New or reinfections occurred more frequently in households that had an infected sibling in an urban but not rural setting. The study demonstrates distinct differences in the transmission of H. nana infection in rural and urban communities. The data suggest intrafamily transmission in urban areas, particularly in households with poor hygiene behavior, leading to primary infection early in life. In rural areas, the prevalence of infection and the incidence of reinfection were highest in children of school age, and there was little evidence for intrafamily transmission of the parasite.

Vertebral sclerosis in adults.

PubMed Central

Russell, A S; Percy, J S; Lentle, B C

1979-01-01

Narrowing of the intervertebral disc space with sclerosis of the adjacent vertebral bodies may occur as a consequence of infection, neoplasia, trauma, or rheumatic disease. Some patients have been described with backache and these radiological appearances without any primary cause being apparent. The lesions were almost always of 1 or, at most, 2 vertebrae and most frequently involved the inferior margin of L4. We describe 3 patients with far more extensive vertebral involvement and present the clinical, radiological, scintiscan, and histological findings. The only patient we have seen with the better known, isolated L4/5 lesion was shown on biopsy to have staphylococcal osteomyelitis. For this reason we would still recommend a biopsy of all such sclerotic vertebral lesions if they occur in the absence of other rheumatic disease. Images PMID:434941

Surveillance for waterborne disease outbreaks and other health events associated with recreational water --- United States, 2007--2008.

PubMed

Hlavsa, Michele C; Roberts, Virginia A; Anderson, Ayana R; Hill, Vincent R; Kahler, Amy M; Orr, Maureen; Garrison, Laurel E; Hicks, Lauri A; Newton, Anna; Hilborn, Elizabeth D; Wade, Timothy J; Beach, Michael J; Yoder, Jonathan S

2011-09-23

Since 1978, CDC, the U.S. Environmental Protection Agency, and the Council of State and Territorial Epidemiologists have collaborated on the Waterborne Disease and Outbreak Surveillance System (WBDOSS) for collecting and reporting data on waterborne disease outbreaks associated with recreational water. This surveillance system is the primary source of data concerning the scope and health effects of waterborne disease outbreaks in the United States. In addition, data are collected on other select recreational water--associated health events, including pool chemical--associated health events and single cases of Vibrio wound infection and primary amebic meningoencephalitis (PAM). Data presented summarize recreational water--associated outbreaks and other health events that occurred during January 2007--December 2008. Previously unreported data on outbreaks that have occurred since 1978 also are presented. The WBDOSS database includes data on outbreaks associated with recreational water, drinking water, water not intended for drinking (excluding recreational water), and water use of unknown intent. Public health agencies in the states, the District of Columbia, U.S. territories, and Freely Associated States are primarily responsible for detecting and investigating waterborne disease outbreaks and voluntarily reporting them to CDC using a standard form. Only data on outbreaks associated with recreational water are summarized in this report. Data on other recreational water--associated health events reported to CDC, the Agency for Toxic Substances and Disease Registry (ATSDR), and the U.S. Consumer Product Safety Commission (CPSC) also are summarized. A total of 134 recreational water--associated outbreaks were reported by 38 states and Puerto Rico for 2007--2008. These outbreaks resulted in at least 13,966 cases. The median outbreak size was 11 cases (range: 2--5,697 cases). A total of 116 (86.6%) outbreaks were associated with treated recreational water (e.g., pools and interactive fountains) and resulted in 13,480 (96.5%) cases. Of the 134 outbreaks, 81 (60.4%) were outbreaks of acute gastrointestinal illness (AGI); 24 (17.9%) were outbreaks of dermatologic illnesses, conditions, or symptoms; and 17 (12.7%) were outbreaks of acute respiratory illness. Outbreaks of AGI resulted in 12,477 (89.3%) cases. The etiology was laboratory-confirmed for 105 (78.4%) of the 134 outbreaks. Of the 105 outbreaks with a laboratory-confirmed etiology, 68 (64.8%) were caused by parasites, 22 (21.0%) by bacteria, five (4.8%) by viruses, nine (8.6%) by chemicals or toxins, and one (1.0%) by multiple etiology types. Cryptosporidium was confirmed as the etiologic agent of 60 (44.8%) of 134 outbreaks, resulting in 12,154 (87.0%) cases; 58 (96.7%) of these outbreaks, resulting in a total of 12,137 (99.9%) cases, were associated with treated recreational water. A total of 32 pool chemical--associated health events that occurred in a public or residential setting were reported to WBDOSS by Maryland and Michigan. These events resulted in 48 cases of illness or injury; 26 (81.3%) events could be attributed at least partially to chemical handling errors (e.g., mixing incompatible chemicals). ATSDR's Hazardous Substance Emergency Events Surveillance System received 92 reports of hazardous substance events that occurred at aquatic facilities. More than half of these events (55 [59.8%]) involved injured persons; the most frequently reported primary contributing factor was human error. Estimates based on CPSC's National Electronic Injury Surveillance System (NEISS) data indicate that 4,574 (95% confidence interval [CI]: 2,703--6,446) emergency department (ED) visits attributable to pool chemical--associated injuries occurred in 2008; the most frequent diagnosis was poisoning (1,784 ED visits [95% CI: 585--2,984]). NEISS data indicate that pool chemical--associated health events occur frequently in residential settings. A total of 236 Vibrio wound infections were reported to be associated with recreational water exposure; 36 (48.6%) of the 74 hospitalized vibriosis patients and six (66.7%) of the nine vibriosis patients who died had V. vulnificus infections. Eight fatal cases of PAM occurred after exposure to warm untreated freshwater. The 134 recreational water--associated outbreaks reported for 2007--2008 represent a substantial increase over the 78 outbreaks reported for 2005--2006 and the largest number of outbreaks ever reported to WBDOSS for a 2-year period. Outbreaks, especially the largest ones, were most frequently associated with treated recreational water and characterized by AGI. Cryptosporidium remains the leading etiologic agent. Pool chemical--associated health events occur frequently but are preventable. Data on other select recreational water--associated health events further elucidate the epidemiology of U.S. waterborne disease by highlighting less frequently implicated types of recreational water (e.g., oceans) and detected types of recreational water--associated illness (i.e., not AGI). CDC uses waterborne disease outbreak surveillance data to 1) identify the types of etiologic agents, recreational water venues, and settings associated with waterborne disease outbreaks; 2) evaluate the adequacy of regulations and public awareness activities to promote healthy and safe swimming; and 3) establish public health priorities to improve prevention efforts, guidelines, and regulations at the local, state, and federal levels.

Infantile spasms.

PubMed

Hrachovy, Richard A; Frost, James D

2013-01-01

Infantile spasms are a unique disorder of infancy and early childhood. The average age at onset of infantile spasms is 6 months and the average incidence of the disorder is approximately 0.31 per 1000 live births. Approximately one-quarter of patients will spontaneously stop having spasms within 1 year of onset. There are three main types of epileptic spasms: flexor, extensor, and mixed flexor-extensor. Spasms frequently occur in clusters and commonly occur upon arousal from sleep. The motor spasms are frequently confused with other normal and abnormal infant behaviors. Typically, the interictal EEG reveals hypsarrhythmia or one of its variants. A variety of ictal EEG patterns may be seen, the most common of which is a generalized slow-wave transient followed by an attenuation of the background activity in all regions. The primary treatment objective is to improve the EEG and stop the spasms as soon as possible and to avoid prolonged treatment durations with any form of therapy. Currently, there is no conclusive evidence that medical or surgical treatment of infantile spasms significantly alters long-term outcome. Although the pathophysiological mechanism underlying infantile spasms is unknown, several animal models of infantile spasms have been developed in recent years. Copyright © 2013 Elsevier B.V. All rights reserved.

Relationship Power, Sociodemographics, and Their Relative Influence on Sexual Agreements Among Gay Male Couples.

PubMed

Perry, Nicholas S; Huebner, David M; Baucom, Brian R; Hoff, Colleen C

2016-06-01

Men who have sex with men (MSM) in primary relationships engage in condomless sex both within and outside their relationships and a majority of HIV transmission risk may actually occur within primary relationships. Sexual agreements regarding non-monogamy are a critical component to understanding HIV prevention in male couples. Relationship factors have been associated with how sexual agreements function and power is one dyadic construct likely to affect couple's maintenance of non-monogamy agreements. Multilevel modeling was used in a cross-sectional study of gay male couples (N = 566 couples) to examine associations between partners' demographic characteristics traditionally used to define relationship power, a scale of decision-making power, and outcomes related to sexual agreements, including investment, agreement breaks, and break disclosure. Results indicated that decision-making power relative to one's partner was not associated with any agreement outcome, contrary to hypotheses. However, controlling for decision-making power, demographic bases of power were variably associated with sexual agreements' functioning. Younger partners were less invested in and more frequently broke their agreements. Lower-earning partners broke their agreements more frequently, but also disclosed breaks more often. White men in white-minority relationships broke their agreement more often than their partners. Concordant HIV-positive couples were less invested in their agreements and HIV-positive men disclosed breaks more frequently. HIV prevention efforts for same-sex couples must attend to the social, developmental, and cultural influences that affect their agreements around non-monogamy.

Clinical manifestations of neuroblastoma with head and neck involvement in children.

PubMed

Alvi, Sameer; Karadaghy, Omar; Manalang, Michelle; Weatherly, Robert

2017-06-01

The purpose of our study is to review our 15-year experience with pediatric patients who have been diagnosed with neuroblastoma, and to determine their most frequent head and neck manifestations and symptoms. Retrospective chart review of electronic medical record. An academic, tertiary care pediatric hospital. IRB approval from the Office of Research Integrity at Children's Mercy Hospital was obtained. The hospital tumor database was analyzed to identify patients with neuroblastoma, ganglioneuroblastoma, and esthesioneuroblastoma diagnosed between 1997 and 2012. We recorded the various clinical signs and symptoms these patients displayed at their initial presentation, focusing on patients with head and neck involvement. We then determined the relative incidence of these various findings. Our review yielded 118 patients diagnosed with neuroblastoma, ganglioneuroblastoma, or esthesioneuroblastoma over our 15 year study period. 7 of the 118 patients were diagnosed with primary tumors of the head and neck. Another 19 patients had metastatic head and neck involvement. For those with primary disease, presence of a neck mass and signs of Horner's syndrome were the most common findings. For metastatic disease, craniofacial bony metastasis was the most frequent finding in our study. Based on our data, there are a handful of findings that occur frequently in pediatric head and neck neuroblastoma. Any persistent neck mass, unexplained Horner's syndrome, or periorbital ecchymosis should be carefully evaluated. This study should serve as an aid for the otolaryngologist to be aware of the possible manifestations of this malignancy in children. Copyright © 2017 Elsevier B.V. All rights reserved.

Reinterventions after open and endovascular AAA repair.

PubMed

Malina, M

2015-04-01

Reinterventions seem to occur more frequently after endovascular aneurysm repair than after open surgical repair and are encountered in about 20% versus 10% of the cases, respectively. However, reinterventions following endovascular repair are predominantly endoluminal and early reinterventions are more frequent after open repair. The indications for reintervention after EVAR have changed over time. The incidence and type of reintervention depends on the complexity of the primary procedure, irrespective of whether it was open or endovascular. The use of a device outside instructions for use is associated with a higher complication rate but it may nevertheless be fully justified. Advanced stent-grafts such as fenestrated and branched devices require secondary procedures more often than a standard stent-graft. Similarly, more complex open repair, e.g. a bifurcated bypass, reimplantation of visceral arteries or a redo procedure, is also associated with more reinterventions than a simple tube graft. This manuscript presents some of the most common complications of open and endovascular aortic aneurysm repair and the reinterventions they require. Many of the complications are similar with both open and endovascular techniques. Limb thrombosis, infections and endoleaks are the most frequent indications for reintervention.

Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury: a clinical study.

PubMed

Picetti, Edoardo; Caspani, Maria Luisa; Iaccarino, Corrado; Pastorello, Giulia; Salsi, Pierpaolo; Viaroli, Edoardo; Servadei, Franco

2017-04-01

Intracranial pressure (ICP) monitoring represents an important tool in the management of traumatic brain injury (TBI). Although current information exists regarding ICP monitoring in secondary decompressive craniectomy (DC), little is known after primary DC following emergency hematoma evacuation. Retrospective analysis of prospectively collected data. Inclusion criteria were age ≥18 years and admission to the intensive care unit (ICU) for TBI and ICP monitoring after primary DC. Exclusion criteria were ICU length of stay (LOS) <1 day and pregnancy. Major objectives were: (1) to analyze changes in ICP/cerebral perfusion pressure (CPP) after primary DC, (2) to evaluate the relationship between ICP/CPP and neurological outcome and (3) to characterize and evaluate ICP-driven therapies after DC. A total of 34 patients were enrolled. Over 308 days of ICP/CPP monitoring, 130 days with at least one episode of intracranial hypertension (26 patients, 76.5%) and 57 days with at least one episode of CPP <60 mmHg (22 patients, 64.7%) were recorded. A statistically significant relationship was discovered between the Glasgow Outcome Scale (GOS) scores and mean post-decompression ICP (p < 0.04) and between GOS and CPP minimum (CPPmin) (p < 0.04). After DC, persisting intracranial hypertension was treated with: barbiturate coma (n = 7, 20.6%), external ventricular drain (EVD) (n = 4, 11.8%), DC diameter widening (n = 1, 2.9%) and removal of newly formed hematomas (n = 3, 8.8%). Intracranial hypertension and/or low CPP occurs frequently after primary DC; their occurence is associated with an unfavorable neurological outcome. ICP monitoring appears useful in guiding therapy after primary DC.

Frequent summer nuptial flights of ants provide a primary food source for bats

NASA Astrophysics Data System (ADS)

Levin, Eran; Yom-Tov, Yoram; Barnea, Anat

2009-04-01

In many ant species, nuptial flight tends to be short in time and assumed to be synchronous across a large area. Here, we report that, in the upper Jordan Valley, northern Israel, massive nuptial flights of Carpenter ants ( Camponotus sp.) occur frequently throughout the summer, and their alates form up to 90% of the diet of the greater mouse-tailed bat ( Rhinopoma microphyllum) during this period. This fat and protein-rich diet enables female bats to lactate during summer, and the large amount of fat that both sexes accumulate may serve as an energy source for their following winter hibernation and posthibernation mating in early spring (March-April). We suggest that the annual movement of these bats to the Mediterranean region of Israel may have evolved in order to enable them to exploit the extremely nutritious forms of ant alates when the bats’ energetic demands are highest.

Mechanical performance of aquatic rowing and flying.

PubMed

Walker, J A; Westneat, M W

2000-09-22

Aquatic flight, performed by rowing or flapping fins, wings or limbs, is a primary locomotor mechanism for many animals. We used a computer simulation to compare the mechanical performance of rowing and flapping appendages across a range of speeds. Flapping appendages proved to be more mechanically efficient than rowing appendages at all swimming speeds, suggesting that animals that frequently engage in locomotor behaviours that require energy conservation should employ a flapping stroke. The lower efficiency of rowing appendages across all speeds begs the question of why rowing occurs at all. One answer lies in the ability of rowing fins to generate more thrust than flapping fins during the power stroke. Large forces are necessary for manoeuvring behaviours such as accelerations, turning and braking, which suggests that rowing should be found in slow-swimming animals that frequently manoeuvre. The predictions of the model are supported by observed patterns of behavioural variation among rowing and flapping vertebrates.

Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction.

PubMed

de Nie, Karlijn F; Crama, N; Tilanus, Maurits A D; Klevering, B Jeroen; Boon, Camiel J F

2013-05-01

Primary vitreous floaters can be highly bothersome in some patients. In the case of persistently bothersome floaters, pars plana vitrectomy may be the most effective treatment. The aim of this study is to evaluate the incidence of complications, and patient satisfaction, after pars plana vitrectomy for disabling primary vitreous opacities. We included a total of 110 eyes that underwent pars plana vitrectomy between February 1998 and August 2010. Fifty-seven eyes (51.8%) underwent 20-gauge vitrectomy, whereas 53 eyes (48.2%) underwent 23-gauge vitrectomy. In a retrospective manner, we assessed intraoperative and postoperative complications. There was a considerable range of time between surgery and questionnaire (range: 4-136 months). Patient satisfaction was assessed by a questionnaire based on a modified NEI VFQ-25 questionnaire. A retinal detachment occurred in 10.9% of cases, and the incidence did not differ significantly between the 20-gauge and 23-gauge vitrectomy groups. In 4.5% of the eyes, a retinal detachment developed within the first 3 months, and 6.4% occurred later in the postoperative period. Cystoid macular edema occurred in 5.5%, and an epiretinal membrane was seen postoperatively in 3.6% of cases. Development of glaucoma requiring glaucoma surgery, a macular hole, and postoperative scotoma, each occurred in 0.9% of cases. No cases of endophthalmitis occurred. Eighty-five percent of patients were satisfied or very satisfied with the results of the vitrectomy. Eighty-four percent of all patients were completely cured from their troublesome vitreous floaters, and an additional 9.3% of patients were less troubled by vitreous floaters. Ten patients (9.3%) were dissatisfied, and six of these patients (5.6%) had a serious complication that resulted in permanent visual loss. Pars plana vitrectomy is an effective approach to treat primary vitreous floaters, resulting in a high rate of patient satisfaction. Postoperative complications may be more frequent than previously reported, so patients should be well-informed about the complication rate before reaching informed consent about this surgical intervention. Additional preventive measures should be considered to reduce this complication rate.

Multiple neoplasms among cervical cancer patients in the material of the lower Silesian cancer registry.

PubMed

Izmajłowicz, Barbara; Kornafel, Jan; Błaszczyk, Jerzy

2014-01-01

According to the definition by the International Agency for Research on Cancer (IARC), primary multiple neoplasms are two or more neoplasms of different histopathological build in one organ, or two or more tumors occurring in one patient, regardless of the time of their occurrence (synchronic - up to 6 months, metachronous - after 6 months), coming from an organ or a tissue and not being an infiltration from another neoplasm, a relapse or a metastasis. It was the aim of the study to analyze the frequency of the occurrence of multiple neoplasms among patients suffering from uterine cervix cancer, with a special interest in coexistent neoplasms, the time of their occurrence and total 5-year survivals. The data from the Lower Silesian Cancer Registry concerning the years 1984-2009 formed the material of the present study. 5.3% of all cervix neoplasms occurred as multiple cancers. Cervix neoplasms were 13.4% of multiple neoplasms. On average, cervical cancer occurred as a subsequent cancer in 6 patients yearly (60.7% of the occurrences of cervical cancer were in the period of 5 years following treatment for the first neoplasm). 5-year survival in patients suffering from primarily multiple cervix neoplasms constituted 57% and was convergent with the results for all patients suffering from cervical cancer. Cervical cancer as the first neoplasm occurred in 287 patients, on average in 11 patients annually. In the period of the first 5 years after the treatment of cervical cancer, there were 42.8% occurrences of other cancers. Cervical neoplasms most frequently coexisted with cancers of the breast, lung and large intestine. The frequency of the occurrence of multiple neoplasm among cervical cancer patients is increasing. Most frequently they coexist with other tobacco-related neoplasms, those related to HPV infections and with secondary post-radiation neoplasms. These facts should be taken into consideration during post-treatment observation and when directing diagnostic and prophylactic tests. Synchronic neoplasms require detailed diagnostics and planning of treatment by a team of specialists. The occurrence of primary multiple cervical neoplasms does not worsen the prognosis as compared to patients suffering exclusively from cervical cancer.

Osteomalacia as inaugural manifestation of Sjögren syndrome.

PubMed

Cherif, Eya; Ben Hassine, Lamia; Kaoueche, Zouleikha; Khalfallah, Narjess

2013-10-09

Osteomalacia is a relatively common condition, which is frequently underdiagnosed due to lack of clinical suspicion and non-specific symptoms. Osteomalacia can complicate tubulo-interstital nephritis. However, it occurs exceptionally as the first manifestation of Sjögren syndrome with renal involvement. It is a consequence of chronic metabolic acidosis and is associated with distal renal tubular acidosis. We report a 31-year-old woman hospitalised for a 1 year history of muscle weakness and joint and chest wall pains. Skeletal imagery showed Looser's zones in the left femoral neck. Investigations concluded to the diagnosis of primary Sjogren's syndrome.

Urbanisation and the incidence of eating disorders.

PubMed

van Son, Gabriëlle E; van Hoeken, Daphne; Bartelds, Aad I M; van Furth, Eric F; Hoek, Hans W

2006-12-01

The link between degree of urbanisation and a number of mental disorders is well established. Schizophrenia, psychosis and depression are known to occur more frequently in urban areas. In our primary care-based study of eating disorders, the incidence of bulimia nervosa showed a dose-response relation with degree of urbanisation and was five times higher in cities than in rural areas. Remarkably, anorexia nervosa showed no association with urbanisation. We conclude that urban life is a potential environmental risk factor for bulimia nervosa but not for anorexia nervosa. These findings provide a promising avenue for further research into the aetiology of eating disorders.

Thrombocytosis: a retrospective study of 165 dogs.

PubMed

Neel, Jennifer A; Snyder, Laura; Grindem, Carol B

2012-06-01

Thrombocytosis has been associated with various conditions, including inflammation, neoplasia, iron deficiency, splenectomy, and drug administration. The aim of this study was to characterize diseases and conditions associated with thrombocytosis in dogs. In this retrospective study, dogs with thrombocytosis (platelet count > 600 × 10(3) /μL) and complete medical records during a 1-year period were included, and breed, sex, age, CBC results, alkaline phosphatase and gamma-glutamyltransferase activities in some dogs, administration of glucocorticoids or vincristine, and primary diagnosis were evaluated. Thrombocytosis was found in 240 of 5342 dogs (4.6%), and 165 (3.1%) met inclusion criteria. Thrombocytosis was secondary in all dogs, and underlying diseases and conditions (n,%) were neoplasia (56, 33.9%), inflammation (55, 33.3%), miscellaneous disorders (26, 15.8%), neoplasia plus a second disease (13, 7.9%), endocrine diseases (8, 4.8%), and multiple diseases (7, 4.2%). In dogs with neoplasia, carcinomas (24) and round cell neoplasms (20), especially lymphoma and mast cell tumor, were the most frequent tumors. Inflammatory disorders consisted of immune-mediated disorders (11), neurologic diseases (8), infectious diseases (6), allergic disease (5), orthopedic diseases (4), gastrointestinal diseases (4), and miscellaneous conditions (17). Of the 165 dogs, 73 (44.2%) had received glucocorticoids (55) or vincristine (18) Marked (850-969 × 10(3) platelets/μL) or extreme ( ≥ 970 × 10(3) platelets/μL) thrombocytosis occurred in 24 (14.5%) dogs; 12 (50.0%) had neoplasia. Thromboembolism occurred in 13 (7.9%) dogs. Thrombocytosis in dogs occurred most frequently secondary to neoplastic and inflammatory diseases and was commonly associated with glucocorticoid and vincristine administration. Thromboembolic complications occurred in a small number of patients. Marked or extreme thrombocytosis was more likely to occur with neoplasia than with other conditions. © 2012 American Society for Veterinary Clinical Pathology.

Levetiracetam mitigates doxorubicin-induced DNA and synaptic damage in neurons.

PubMed

Manchon, Jose Felix Moruno; Dabaghian, Yuri; Uzor, Ndidi-Ese; Kesler, Shelli R; Wefel, Jeffrey S; Tsvetkov, Andrey S

2016-05-11

Neurotoxicity may occur in cancer patients and survivors during or after chemotherapy. Cognitive deficits associated with neurotoxicity can be subtle or disabling and frequently include disturbances in memory, attention, executive function and processing speed. Searching for pathways altered by anti-cancer treatments in cultured primary neurons, we discovered that doxorubicin, a commonly used anti-neoplastic drug, significantly decreased neuronal survival. The drug promoted the formation of DNA double-strand breaks in primary neurons and reduced synaptic and neurite density. Pretreatment of neurons with levetiracetam, an FDA-approved anti-epileptic drug, enhanced survival of chemotherapy drug-treated neurons, reduced doxorubicin-induced formation of DNA double-strand breaks, and mitigated synaptic and neurite loss. Thus, levetiracetam might be part of a valuable new approach for mitigating synaptic damage and, perhaps, for treating cognitive disturbances in cancer patients and survivors.

Recurrent left ventricular myxoma presenting as cerebrovascular accidents in a teenage girl.

PubMed

Vermeulen, Tom; Conraads, Viviane M; Vrints, Christiaan; Rodrigus, Inez E

2009-12-01

Myxoma cordis is the most frequent primary cardiac tumour in adults. Paediatric primary cardiac tumours are rare, the most common type being rhabdomyoma. Atrial and ventricular myxomas occur infrequently in the paediatric age group. Intracardiac myxomas are seen with an estimated incidence of 0.5 per million population per year. Approximately 70% of the affected patients are of female gender. Recurrences are rare (1.3%). Asymptomatic recurrences are observed in young patients who have a familial history of tumour or multifocal myxomas. Although rare, cardiac aetiology (atrial fibrillation, intracardiac thrombi, patent foramen ovale, myxoma, endocarditis) should be considered. In children presenting with central neurological symptoms, a cardiac aetiology has to be considered. We describe a rare case of an 18-year-old girl presenting with a recurrent left ventricular myxoma, accompanied by neurological deficits.

Levetiracetam mitigates doxorubicin-induced DNA and synaptic damage in neurons

PubMed Central

Manchon, Jose Felix Moruno; Dabaghian, Yuri; Uzor, Ndidi-Ese; Kesler, Shelli R.; Wefel, Jeffrey S.; Tsvetkov, Andrey S.

2016-01-01

Neurotoxicity may occur in cancer patients and survivors during or after chemotherapy. Cognitive deficits associated with neurotoxicity can be subtle or disabling and frequently include disturbances in memory, attention, executive function and processing speed. Searching for pathways altered by anti-cancer treatments in cultured primary neurons, we discovered that doxorubicin, a commonly used anti-neoplastic drug, significantly decreased neuronal survival. The drug promoted the formation of DNA double-strand breaks in primary neurons and reduced synaptic and neurite density. Pretreatment of neurons with levetiracetam, an FDA-approved anti-epileptic drug, enhanced survival of chemotherapy drug-treated neurons, reduced doxorubicin-induced formation of DNA double-strand breaks, and mitigated synaptic and neurite loss. Thus, levetiracetam might be part of a valuable new approach for mitigating synaptic damage and, perhaps, for treating cognitive disturbances in cancer patients and survivors. PMID:27168474

Do colorectal cancer patients diagnosed as an emergency differ from non-emergency patients in their consultation patterns and symptoms? A longitudinal data-linkage study in England

PubMed Central

Renzi, C; Lyratzopoulos, G; Card, T; Chu, T P C; Macleod, U; Rachet, B

2016-01-01

Background: More than 20% of colorectal cancers are diagnosed following an emergency presentation. We aimed to examine pre-diagnostic primary-care consultations and related symptoms comparing patients diagnosed as emergencies with those diagnosed through non-emergency routes. Methods: Cohort study of colorectal cancers diagnosed in England 2005 and 2006 using cancer registration data individually linked to primary-care data (CPRD/GPRD), allowing a detailed analysis of clinical information referring to the 5-year pre-diagnostic period. Results: Emergency diagnosis occurred in 35% and 15% of the 1029 colon and 577 rectal cancers. ‘Background' primary-care consultations (2–5 years before diagnosis) were similar for either group. In the year before diagnosis, >95% of emergency and non-emergency presenters had consulted their doctor, but emergency presenters had less frequently relevant symptoms (colon cancer: 48% vs 71% (P<0.001); rectal cancer: 49% vs 61% (P=0.043)). ‘Alarm' symptoms were recorded less frequently in emergency presenters (e.g., rectal bleeding: 9 vs 24% (P=0.002)). However, about 1/5 of emergency presenters (18 and 23% for colon and rectal cancers) had ‘alarm' symptoms the year before diagnosis. Conclusions: Emergency presenters have similar ‘background' consultation history as non-emergency presenters. Their tumours seem associated with less typical symptoms, however opportunities for earlier diagnosis might be present in a fifth of them. PMID:27537389

[Effect of autogenic training with cognitive and symbol therapy on the treatment of patients with primary headache].

PubMed

Zsombók, Terézia; Juhász, Gabriella; Gonda, Xénia; Vitrai, József; Bagdy, György

2005-01-01

Only a minor part of headaches are associated with an organic abnormality in the nervous system. In case of migraine and tension headache, the main provoking factor is psychological stress. Furthermore, these syndromes often occur together with depression and anxiety disorders, and when these comorbid conditions are present headache attacks tend to be more frequent, longer and stronger, causing an increase in the consumption of antimigraine agents, and at the same time increase the consumption of antidepressant and anxiolytic agents. Further to drugs, modified versions of Schultz-type autogenic training is also frequently used for anxiolysis. The aim of our research was to study the effect of the cognitive and symbol therapy enhanced autogenic training on headache and related drug consumption in three different types of primary headaches. Twenty five female patients with migraine, tension-type headache or mixed headache participated in an eight-month follow-up study. Headache frequency, analgesic, antimigraine and anxiolytic consumption were measured by means of a headache diary. During the first four months (observation phase) patients became familiar with using the diary, and in the second four months they participated in autogenic training. The data of the second, third and fourth months were considered as baseline data. Our method decreased headache frequency and drug consumption in all three headache groups. This means that the cognitive and symbol therapy enhanced autogenic training is an effective alternative for medications in the treatment of primary headaches.

A real-world cohort study on the quality of potassium and creatinine monitoring during initiation of mineralocorticoid receptor antagonists in patients with heart failure.

PubMed

Nilsson, Erik; De Deco, Pietro; Trevisan, Marco; Bellocco, Rino; Lindholm, Bengt; Lund, Lars H; Coresh, Josef; Carrero, Juan J

2018-05-02

Clinical heart failure (HF) guidelines recommend monitoring of creatinine and potassium throughout the initial weeks of mineralocorticoid receptor antagonists (MRAs) therapy. We here assessed the extent to which this occurs in our healthcare. Observational study in 2007-2010 HF patients starting MRA therapy in Stockholm, Sweden. Outcomes included potassium and creatinine laboratory testing before MRA initiation and in the early (days 1-10) and extended (days 11-90) post-initiation periods. Exclusion criteria considered death/hospitalization within 90 days, and lack of a second MRA dispense. Of 4,036 HF patients starting on MRA, 45% were initiated from a hospital, 24% from a primary care center and 30% from other private centers. Overall, 89% underwent pre-initiation testing, being more common among hospital (97%) than for primary care (74%) initiations. Only 24% were adequately monitored in all three recommended intervals, being again more frequent following hospital (33%) than private (21%) or primary care (17%) initiations. In multivariable analyses, adequate monitoring was more likely for hospital [odds ratio (OR), 95% confidence interval; 2.85, 2.34-3.56] initiations, and for patients with chronic kidney disease (OR 1.79, 1.30-2.43) and concomitant use of ACE (OR 1.27, 1.05-1.52), ARBs (OR 1.19, 1.01-1.40) or beta blockers (OR 1.65, 1.22-2.26). Age, sex and prescribing center explained a small portion of adequate monitoring (c-statistic, 0.63). Addition of comorbidities and medications improved prediction marginally (c-statistic, 0.65). Although serum potassium and creatinine monitoring before MRA initiation for HF is frequent, rates of post-initiation monitoring remain suboptimal, especially among primary care centers.

Frequent attendance in primary care: comparison and implications of different definitions

PubMed Central

Luciano, Juan V; Fernández, Ana; Pinto-Meza, Alejandra; Luján, Leila; Bellón, Juan A; García-Campayo, Javier; Peñarrubia, María T; Fernández, Rita; Sanavia, Marta; Blanco, María E; Haro, Josep M; Palao, Diego J; Serrano-Blanco, Antoni

2010-01-01

Background The diversity of definitions of frequent attendance in the literature hampers comparison of their precision, validity, and associated factors. Aim To examine different definitions of frequent attendance in order to identify the sociodemographic and clinical factors associated with frequent attendance in primary care, according to each definition. Design of study One-phase cross-sectional study. Setting Seventy-seven primary care centres in Catalonia, Spain. Method A total of 3815 primary care patients were interviewed between October 2005 and March 2006. Three definitions of frequent attendance were tested: (1) frequent attenders as the top 25% and the top 10% consulting patients; (2) frequent attenders as the top 25% and the top 10% consulting patients stratified by age and sex; and (3) frequent attenders as the top 25% and the top 10% consulting patients stratified by the presence of physical/mental conditions (patients with only mental disorders, with only chronic physical conditions, with comorbid conditions, and with no condition). Multilevel logistic regressions were used. Results The following factors were systematically related to frequent attender status: being on sick leave, being born outside of Spain, reporting mental health problems as the main reason for consulting, and having arthritis/rheumatism, or bronchitis. Major depression was related to frequent attendance in two of the three definitions. The factor ‘GP’ was related to frequent attendance when the top decile cut-off point was used. The models with a 10% cut-off point were more discriminative than those with a 25% cut-off point: the area under the receiver operating characteristic curve for models with a 25% cut-off and a 10% cut-off ranged between 0.71 (95% confidence interval [CI] = 0.70 to 0.73) and 0.75 (95% CI = 0.74 to 0.77) and between 0.79 (95% CI = 0.78 to 0.81) and 0.85 (95% CI = 0.83 to 0.86), respectively. Conclusion The way frequent attendance is defined is of crucial importance. It is recommended that a more discriminative definition of frequent attendance is used (the top 10%). PMID:20132693

Stage IV-S neuroblastoma. Results with definitive therapy

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

Stokes, S.H.; Thomas, P.R.; Perez, C.A.

1984-05-15

The results of management of 14 patients with Stage IV-S neuroblastoma are reported. The treatment policy, although not consistent over this time span, in general used a combination of radiotherapy and chemotherapy or infrequently one modality alone. Twelve of 14 (86%) survived more than 6 years. One patient, with a solitary mediastinal primary tumor, died of rapidly progressive disease at three months. The other death occurred in a 4.5-year-old presenting with hepatomegaly at diagnosis followed by skeletal dissemination 2.5 years later. Thirteen of the patients were younger than 1 year of age. Of the 11 patients that received radiotherapy, 4more » experienced mild asymptomatic scoliosis or kyphoscoliosis at 3 to 12 years after initial therapy. A review of the literature indicates that spontaneous regression in this tumor is very frequent; therefore, it is recommended that for the common presentation of massive hepatomegaly in an infant, close observation is warranted, unless life threatening complications occur. However, initial therapeutic intervention may be indicated in those patients with life threatening presentations. This data did not substantiate the necessity for complete surgical excision of the primary tumor, as has been suggested by others.« less

Bilateral phacomorphic angle-closure glaucoma in a highly myopic patient secondary to isolated spherophakia.

PubMed

Sowka, Joseph; Girgis, Nadine

2010-09-01

Angle closure most commonly occurs in older hyperopic patients as a result of primary relative pupil block. Less frequently, angle closure occurs in highly myopic patients with conditions other than primary relative pupil block. This report presents the diagnosis, pathophysiologic mechanism, and management of a patient with both high myopia and bilateral advanced phacomorphic angle-closure glaucoma caused by isolated spherophakia. A 40-year-old asymptomatic man with very high myopic astigmatism presented with chronic angle closure and an intraocular pressure of 42 mmHg in both eyes. Additionally there was a nonmyopic fundus and 24-mm axial length, with a clear crystalline lens protruding through the pupillary plane in each eye, confirmed by B-scan ultrasonography. Gonioscopy and A-scan and B-scan ultrasonography identified the pathogenesis of intraocular pressure elevation, angle closure, and high myopia to be lenticular in origin. Initial medical therapy and subsequent laser iridotomy relieved the pupil block angle closure and successfully lowered intraocular pressure. Angle closure can occur in highly myopic eyes. Careful gonioscopy and ultrasonography can lead to the correct diagnosis and tailored management for these eyes. Phacomorphic angle-closure glaucoma from spherophakia is associated with Weill-Marchesani syndrome as well as a few other uncommon syndromes. Isolated pseudophakia is a rarely reported cause of phacomorphic angle closure. Copyright 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.

Preattentive binding of auditory and visual stimulus features.

PubMed

Winkler, István; Czigler, István; Sussman, Elyse; Horváth, János; Balázs, Lászlo

2005-02-01

We investigated the role of attention in feature binding in the auditory and the visual modality. One auditory and one visual experiment used the mismatch negativity (MMN and vMMN, respectively) event-related potential to index the memory representations created from stimulus sequences, which were either task-relevant and, therefore, attended or task-irrelevant and ignored. In the latter case, the primary task was a continuous demanding within-modality task. The test sequences were composed of two frequently occurring stimuli, which differed from each other in two stimulus features (standard stimuli) and two infrequently occurring stimuli (deviants), which combined one feature from one standard stimulus with the other feature of the other standard stimulus. Deviant stimuli elicited MMN responses of similar parameters across the different attentional conditions. These results suggest that the memory representations involved in the MMN deviance detection response encoded the frequently occurring feature combinations whether or not the test sequences were attended. A possible alternative to the memory-based interpretation of the visual results, the elicitation of the McCollough color-contingent aftereffect, was ruled out by the results of our third experiment. The current results are compared with those supporting the attentive feature integration theory. We conclude that (1) with comparable stimulus paradigms, similar results have been obtained in the two modalities, (2) there exist preattentive processes of feature binding, however, (3) conjoining features within rich arrays of objects under time pressure and/or longterm retention of the feature-conjoined memory representations may require attentive processes.

Animal Models of Cancer-Associated Hypercalcemia

PubMed Central

Kohart, Nicole A.; Elshafae, Said M.; Breitbach, Justin T.; Rosol, Thomas J.

2017-01-01

Cancer-associated hypercalcemia (CAH) is a frequently-occurring paraneoplastic syndrome that contributes to substantial patient morbidity and occurs in both humans and animals. Patients with CAH are often characterized by markedly elevated serum calcium concentrations that result in a range of clinical symptoms involving the nervous, gastrointestinal and urinary systems. CAH is caused by two principle mechanisms; humorally-mediated and/or through local osteolytic bone metastasis resulting in excessive calcium release from resorbed bone. Humoral hypercalcemia of malignancy (HHM) is the most common mechanism and is due to the production and release of tumor-associated cytokines and humoral factors, such as parathyroid hormone-related protein (PTHrP), that act at distant sites to increase serum calcium concentrations. Local osteolytic hypercalcemia (LOH) occurs when primary or metastatic bone tumors act locally by releasing factors that stimulate osteoclast activity and bone resorption. LOH is a less frequent cause of CAH and in some cases can induce hypercalcemia in concert with HHM. Rarely, ectopic production of parathyroid hormone has been described. PTHrP-mediated hypercalcemia is the most common mechanism of CAH in human and canine malignancies and is recognized in other domestic species. Spontaneous and experimentally-induced animal models have been developed to study the mechanisms of CAH. These models have been essential for the evaluation of novel approaches and adjuvant therapies to manage CAH. This review will highlight the comparative aspects of CAH in humans and animals with a discussion of the available animal models used to study the pathogenesis of this important clinical syndrome. PMID:29056680

Cognitive behaviour therapy for long-term frequent attenders in primary care: a feasibility case series and treatment development study.

PubMed

Malins, Samuel; Kai, Joe; Atha, Christopher; Avery, Anthony; Guo, Boliang; James, Marilyn; Patel, Shireen; Sampson, Christopher; Stubley, Michelle; Morriss, Richard

2016-10-01

Most frequent attendance in primary care is temporary. Long-term frequent attendance may be suitable for psychological intervention to address health management and service use. To explore the feasibility and acceptability of cognitive behaviour therapy (CBT) for long-term frequent attendance in primary care and obtain preliminary evidence regarding clinical and cost effectiveness. A CBT case series was carried out in five GP practices in the East Midlands. Frequent attenders (FAs) were identified from case notes and invited by their practice for assessment, then offered CBT. Feasibility and acceptability were assessed by CBT session attendance and thematic analysis of semi-structured questionnaires. Clinical and cost effectiveness was assessed by primary care use and clinically important change on a range of health and quality of life instruments. Of 462 FAs invited to interview, 87 (19%) consented to assessment. Thirty-two (7%) undertook CBT over a median of 3 months. Twenty-four (75%) attended at least six sessions. Eighteen FAs (86%, n = 21) reported overall satisfaction with treatment. Patients reported valuing listening without judgement alongside support to develop coping strategies. Thirteen (54%, n = 24), achieved clinically important improvement on the SF-36 Mental-Component Scale at 6-month follow-up and improved quality of life, but no improvement on other outcomes. Primary care use reduced from a median of eight contacts in 3 months at baseline (n = 32) to three contacts in 3 months at 1 year (n = 18). CBT appears feasible and acceptable to a subset of long-term FAs in primary care who halved their primary care use. With improved recruitment strategies, this approach could contribute to decreasing GP workload and merits larger-scale evaluation. © British Journal of General Practice 2016.

Evidence of selective reporting bias in hematology journals: A systematic review

PubMed Central

Scheckel, Caleb; Hicks, Chandler; Nissen, Timothy; Leduc, Linda; Som, Mousumi; Vassar, Matt

2017-01-01

Introduction Selective reporting bias occurs when chance or selective outcome reporting rather than the intervention contributes to group differences. The prevailing concern about selective reporting bias is the possibility of results being modified towards specific conclusions. In this study, we evaluate randomized controlled trials (RCTs) published in hematology journals, a group in which selective outcome reporting has not yet been explored. Methods Our primary goal was to examine discrepancies between the reported primary and secondary outcomes in registered and published RCTs concerning hematological malignancies reported in hematology journals with a high impact factor. The secondary goals were to address whether outcome reporting discrepancies favored statistically significant outcomes, whether a pattern existed between the funding source and likelihood of outcome reporting bias, and whether temporal trends were present in outcome reporting bias. For trials with major outcome discrepancies, we contacted trialists to determine reasons for these discrepancies. Trials published between January 1, 2010 and December 31, 2015 in Blood; British Journal of Haematology; American Journal of Hematology; Leukemia; and Haematologica were included. Results Of 499 RCTs screened, 109 RCTs were included. Our analysis revealed 118 major discrepancies and 629 total discrepancies. Among the 118 discrepancies, 30 (25.4%) primary outcomes were demoted, 47 (39.8%) primary outcomes were omitted, and 30 (25.4%) primary outcomes were added. Three (2.5%) secondary outcomes were upgraded to a primary outcome. The timing of assessment for a primary outcome changed eight (6.8%) times. Thirty-one major discrepancies were published with a P-value and twenty-five (80.6%) favored statistical significance. A majority of authors whom we contacted cited a pre-planned subgroup analysis as a reason for outcome changes. Conclusion Our results suggest that outcome changes occur frequently in hematology trials. Because RCTs ultimately underpin clinical judgment and guide policy implementation, selective reporting could pose a threat to medical decision making. PMID:28570573

Paediatric acid-base disorders: A case-based review of procedures and pitfalls

PubMed Central

Carmody, J Bryan; Norwood, Victoria F

2013-01-01

Acid-base disorders occur frequently in paediatric patients. Despite the perception that their analysis is complex and difficult, a straightforward set of rules is sufficient to interpret even the most complex disorders – provided certain pitfalls are avoided. Using a case-based approach, the present article reviews the fundamental concepts of acid-base analysis and highlights common mistakes and oversights. Specific topics include the proper identification of the primary disorder; distinguishing compensatory changes from additional primary disorders; use of the albumin-corrected anion gap to generate a differential diagnosis for patients with metabolic acidosis; screening for mixed disorders with the delta-delta formula; recognizing the limits of compensation; use of the anion gap to identify ‘hidden’ acidosis; and the importance of using information from the history and physical examination to identify the specific cause of a patient’s acid-base disturbance. PMID:24381489

Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

PubMed Central

Kim, Young-Il

2015-01-01

Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated. PMID:25844339

Postprandial hypotension in older survivors of critical illness.

PubMed

Nguyen, Thu Anh Ngoc; Ali Abdelhamid, Yasmine; Weinel, Luke M; Hatzinikolas, Seva; Kar, Palash; Summers, Matthew J; Phillips, Liza K; Horowitz, Michael; Jones, Karen L; Deane, Adam M

2018-06-01

In older people postprandial hypotension occurs frequently; and is an independent risk factor for falls, cardiovascular events, stroke and death. The primary aim of this pilot study was to estimate the frequency of postprandial hypotension and evaluate the mechanisms underlying this condition in older survivors of an Intensive Care Unit (ICU). Thirty-five older (>65 years) survivors were studied 3 months after discharge. After an overnight fast, participants consumed a 300 mL drink containing 75 g glucose, labelled with 20 MBq 99m Tc-calcium phytate. Patients had concurrent measurements of blood pressure, heart rate, blood glucose and gastric emptying following drink ingestion. Proportion of participants is presented as percent (95% CI) and continuous variables as mean (SD). Postprandial hypotension was evident in 10 (29%; 95% CI 14-44), orthostatic hypotension in 2 (6%; 95% CI 0-13) and cardiovascular autonomic dysfunction in 2 (6%; 95% CI 0-13) participants. The maximal postprandial nadir for systolic blood pressure and diastolic blood pressures were -29 (14) mmHg and -18 (7) mmHg. In this cohort of older survivors of ICU postprandial hypotension occurred frequently . This suggests that postprandial hypotension is an unrecognised issue in older ICU survivors. Copyright © 2018. Published by Elsevier Inc.

Operative shoulder instability injury management in Australian Football League players: A case series.

PubMed

Bonacci, Jason; Manson, Brent; Bowe, Steven J; Gill, Stephen; Seward, Hugh; Hoy, Greg; Page, Richard

2017-11-27

The purpose of this study was to review the surgical management procedures of shoulder instability injuries in Australian Football League (AFL) players, and determine outcomes regarding return to sport and injury recurrence. Retrospective cohort study. Elite AFL players with shoulder instability resulting in surgery were assessed in a retrospective cohort design (72 players/77 shoulders). Type of initial injury, surgical management, return to sport and injury recurrence were obtained. The mean follow-up period post-surgery was 2.9 years. Return to sport outcomes were compared between arthroscopic and open surgery using a Kaplan-Meier survival analysis. Logistic regression modelling was used to determine associations between injury recurrence, type of injury, participant age and method of surgery. Shoulder instability injuries occurred most frequently during tackling (40%). Arthroscopic surgery was preferred for primary shoulder instability. Nine (16%) recurrences occurred in those who underwent arthroscopic surgery compared to two (9%) following open surgery. Return to the elite level was slightly but significantly (2 weeks, p=0.049) longer for open compared to arthroscopic surgery. Recurrence was 5 times more likely if the primary injury was a dislocation and more likely in players who were younger at the time of surgery. Tackling was the predominant mechanism for shoulder instability injuries in AFL players and arthroscopic surgery was more commonly performed for primary injuries. Sustaining a dislocation as the primary injury and younger age increased the likelihood of recurrent instability. Careful consideration should be given to the operative management of these individuals. Copyright © 2017. Published by Elsevier Ltd.

Unusual Intestinal Involvement by Paracoccidioidomycosis Diagnosed After Oral Manifestation.

PubMed

Neves-Silva, Rodrigo; Fernandes, Patrícia Maria; Santos-Silva, Alan Roger; Vargas, Pablo Agustin; de Souza Cavalcante, Ricardo; Lopes, Marcio Ajudarte

2018-02-16

Paracoccidioidomycosis is a common deep fungus infection in South America, particularly in Brazil. It is acquired through inhalation and primary involvement of lungs. Subsequently, dissemination may occur and oral mucosa is frequently affected and actually, in most of the cases the diagnosis is established because of the oral lesions. Thus, the role of the dentist is fundamental to correct diagnosis. However, the involvement of intestine is rarely reported. The current case describes a 36-year-old man who presented abdominal pain and intestinal constipation, being suspected and then confirmed as paracoccidioidomycosis after already be diagnosed with this disease by a dentist through oral manifestations.

Osteomalacia as inaugural manifestation of Sjögren syndrome

PubMed Central

Cherif, Eya; Ben Hassine, Lamia; Kaoueche, Zouleikha; Khalfallah, Narjess

2013-01-01

Osteomalacia is a relatively common condition, which is frequently underdiagnosed due to lack of clinical suspicion and non-specific symptoms. Osteomalacia can complicate tubulo-interstital nephritis. However, it occurs exceptionally as the first manifestation of Sjögren syndrome with renal involvement. It is a consequence of chronic metabolic acidosis and is associated with distal renal tubular acidosis. We report a 31-year-old woman hospitalised for a 1 year history of muscle weakness and joint and chest wall pains. Skeletal imagery showed Looser’s zones in the left femoral neck. Investigations concluded to the diagnosis of primary Sjogren's syndrome. PMID:24108773

Which anxiety disorders may differentiate attention deficit hyperactivity disorder, combined type with dysthymic disorder from attention deficit hyperactivity disorder, combined type alone?

PubMed

Vance, Alasdair; Harris, Katrina; Boots, Marilyn; Talbot, Jessica; Karamitsios, Mary

2003-10-01

Attention deficit hyperactivity disorder, combined type (ADHD-CT), dysthymic disorder, and anxiety disorders frequently co-occur in primary school age children, although there have been no published data describing their association. We investigated the association of anxiety, defined from a parent or child perspective, with primary school-age children with ADHD-CT with and without dysthymic disorder. One hundred and forty-six medication naïve children with ADHD-CT were studied. Two groups with and without dysthymic disorder were formed to compare parent and child reports of anxiety, using categorical and continuous measures of anxiety, using logistic regression. Separation anxiety disorder and social phobia were associated with primary school-age children with ADHD-CT and dysthymic disorder, compared to children with ADHD-CT without dysthymic disorder. The recognition of dysthymic disorder and anxiety disorders and their management in primary school-age children with ADHD-CT is generally poorly understood. The identification and elucidation of composite anxiety and depressive phenomena that may be systematically investigated through longitudinal studies of epidemiologically derived samples is needed in this particular group of children.

[Incidence, associated factors, and follow-up of hospital heart failure complicating acute anterior myocardial infarction successfully treated by primary angioplasty].

PubMed

Meimoun, P; M'barek, D; Dragomir, C; Luycx-Bore, A; Elmkies, F; Boulanger, J; Zemir, H; Martis, S; Neykova, A; Tzvetkov, B; Clerc, J

2013-11-01

Heart failure (HF) complicating acute myocardial infarction (AMI) is of poor prognosis and is often associated with patient's characteristics and success of reperfusion strategies. However, few data is available regarding the high-risk subgroup of patients with anterior AMI treated successfully by primary angioplasty. The aim of the study was to assess the incidence, associated factors, and the future of HF occurring during hospitalisation, in the setting of anterior AMI treated successfully by primary angioplasty. Eighty-five consecutive patients with anterior AMI treated successfully by primary angioplasty (final angiographic TIMI flow grade=3, without residual stenosis) were included. Clinical, biochemical, angiographic, and echocardiographic data were prospectively collected and compared between patients with (Killip 2 and 3) and without HF during hospitalisation. Fifteen patients had HF (18%) during hospitalisation and 70 did not. By comparison to patients without HF, patients with HF were more frequently diabetics, had troponin peak and CPK, leucocytes count, and fasting glucose higher, LVEF and wall motion score index in the left anterior descending territory (WMSi-lad) poorer, and a lower non-invasive coronary flow reserve (CFR) in the LAD 24hours after angioplasty (all, P<0.05). In multivariate analysis, fasting glucose, leucocytes count after angioplasty, CFR and WMSi-lad were independently associated with HF, even after adjusting with angiographic variables (all, P<0.05). At 6months, patients with HF had less recovery of LV function and higher frequency of adverse LV remodelling (58% versus 20%, P<0.01) by comparison to patients without HF. In conclusion, HF is not uncommon even after successful primary angioplasty for anterior AMI (nearly one patient out of 5), is associated with hyperglycaemia and inflammation, a poor microvascular reperfusion, and left ventricular systolic function, and is more frequently complicated by adverse LV remodelling and lack of LV recovery. Copyright © 2013. Published by Elsevier SAS.

[Would the Screening of Common Mental Disorders in Primary-Care Health Services Hyper-Frequent Patients Be Useful?].

PubMed

Rincón-Hoyos, Hernán G; López, Mérida R Rodríguez; Ruiz, Ana María Villa; Hernández, Carlos Augusto; Ramos, Martha Lucía

2012-12-01

Hyper-frequentation in health services is a problem for patients, their families and the institutions. This study is aimed at determining the frequency and characteristics of common mental disorders in hyper-frequent patients showing vague symptoms and signs at a primary healthcare service during the year 2007 in the city of Cali (Colombia). Cross sectional. The most frequent mental disorders in hyper-frequent patients were detected through a telephone interview which included several modules of the PRIME MD instrument. In general, healthcare service hyper-frequenters are working women, 38,7-year old in average. Basically, the consultation is due to cephalalgia but they also exhibit a high prevalence of common mental disorders (somatization, depression and anxiety) not easily diagnosed by physicians in primary care. Expenses for additional health activities generated by these patients are attributed basically to medical consultation and required procedures. Considering hyper-frequenters in health care services as a risk group in terms of common mental disorders involves screening as an efficient strategy to prevent abuse in service use and to improve satisfaction with the attention received. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Epidemiologic Characteristics of Injured School-age Patients Transported via Emergency Medical Services in Korea.

PubMed

Park, Hang A; Ahn, Ki Ok; Park, Ju Ok; Kim, Jungeun; Jeong, Seungmin; Kim, Meesook

2018-03-05

The purpose of this study was to identify the characteristics of injuries of school-aged children transported via emergency medical services (EMS) that occurred in schools by comparing with injuries that occurred outside of school. Data from the 119 EMS from 2012 to 2014 were analyzed. School and non-school injuries were analyzed in children 6 to 17 years of age. The epidemiologic characteristics were assessed according to school-age groups; low-grade primary (6-8 years), high-grade primary (9-13 years), middle (13-15 years) and high (15-17 years) school. Gender-stratified multivariable logistic regression analysis was conducted to estimate the risks of school injury in each age group. During the study period, a total of 167,104 children with injury were transported via 119 ambulances. Of these injuries, 13.3% occurred at schools. Boys accounted for 76.9% of school injuries and middle school children accounted for a significantly greater proportion (39.6%) of school injuries (P < 0.001). The most frequent mechanisms of injury at school were falls (43.8%). The peak times for school injury occurrence were lunch time (13:00-13:59) in all age groups. Multivariate regression identified the risky age groups as high-grade primary (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09-1.20) and middle school-aged boys (OR, 1.82; 95% CI, 1.74-1.90) and middle school-aged girls (OR, 1.30; 95% CI, 1.21-1.40). Notable epidemiologic differences exist between in- and out-of-school injuries. The age groups at risk for school injuries differ by gender. © 2018 The Korean Academy of Medical Sciences.

Epidemiologic Characteristics of Injured School-age Patients Transported via Emergency Medical Services in Korea

PubMed Central

2018-01-01

Background The purpose of this study was to identify the characteristics of injuries of school-aged children transported via emergency medical services (EMS) that occurred in schools by comparing with injuries that occurred outside of school. Methods Data from the 119 EMS from 2012 to 2014 were analyzed. School and non-school injuries were analyzed in children 6 to 17 years of age. The epidemiologic characteristics were assessed according to school-age groups; low-grade primary (6–8 years), high-grade primary (9–13 years), middle (13–15 years) and high (15–17 years) school. Gender-stratified multivariable logistic regression analysis was conducted to estimate the risks of school injury in each age group. Results During the study period, a total of 167,104 children with injury were transported via 119 ambulances. Of these injuries, 13.3% occurred at schools. Boys accounted for 76.9% of school injuries and middle school children accounted for a significantly greater proportion (39.6%) of school injuries (P < 0.001). The most frequent mechanisms of injury at school were falls (43.8%). The peak times for school injury occurrence were lunch time (13:00–13:59) in all age groups. Multivariate regression identified the risky age groups as high-grade primary (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09–1.20) and middle school-aged boys (OR, 1.82; 95% CI, 1.74–1.90) and middle school-aged girls (OR, 1.30; 95% CI, 1.21–1.40). Conclusion Notable epidemiologic differences exist between in- and out-of-school injuries. The age groups at risk for school injuries differ by gender. PMID:29495140

Complementary and Integrative Interventions for Chronic Neurologic Conditions Encountered in the Primary Care Office.

PubMed

Bega, Danny

2017-06-01

Chronic neurologic conditions are frequently managed in the primary care setting, and patients with these conditions are increasingly seeking nonconventional treatment options. This article provides a review and summary of the evidence for some of the most commonly studied and most frequently used complementary and integrative interventions for 3 conditions managed every day in primary care offices - diabetic neuropathy, migraine, and dementia. Copyright © 2017 Elsevier Inc. All rights reserved.

Experimental characterization of recurrent ovarian immature teratoma cells after optimal surgery.

PubMed

Tanaka, Tetsuji; Toujima, Saori; Utsunomiya, Tomoko; Yukawa, Kazunori; Umesaki, Naohiko

2008-07-01

Minimal optimal surgery without chemotherapy is often performed for patients with ovarian immature teratoma, which frequently occurs in young women who hope for future pregnancies. If tumors recur after the operation, anticancer drug chemotherapy is often administered, although few studies have highlighted differences between the recurrent and the primary tumor cells. Therefore, we have established experimental animal models of recurrent ovarian immature teratoma cells after optimal surgery and characterized the anticancer drug sensitivity and antigenicity of the recurrent tumors. Surgically-excised tumor cells of a grade II ovarian immature teratoma were cultured in vitro and transplanted into nude mice to establish stable cell lines. Differential drug sensitivity and antigenicity of the tumor cells were compared between the primary and the nude mouse tumors. Nude mouse tumor cells showed a normal 46XX karyotype. Cultured primary cells showed a remarkably high sensitivity to paclitaxel, docetaxel, adriamycin and pirarubicin, compared to peritoneal cancer cells obtained from a patient with ovarian adenocarcinomatous peritonitis. The drug sensitivity of teratoma cells to 5-fluorouracil, bleomycin or peplomycin was also significantly higher. However, there was no significant difference in sensitivity to platinum drugs between the primary teratoma and the peritoneal adenocarcinoma cells. As for nude mouse tumor cells, sensitivity to 12 anticancer drugs was significantly lower than that of the primary tumor cells, while there was little difference in sensitivity to carboplatin or peplomycin between the primary and nude mouse tumor cells. Flow cytometry showed that the expression of smooth muscle actin (SMA) significantly decreased in nude mouse tumor cells when compared to cultured primary cells. In conclusion, ovarian immature teratomas with normal karyotypes have a malignant potential to recur after minimal surgery. During nude mouse transplantation, SMA-overexpressing cells appeared to be selectively excluded and nude mouse tumor cells were less sensitive to the majority of anticancer drugs than the primary tumor cells. These results indicate that after optimal surgery for ovarian immature teratoma, recurrent cells can be more resistant to anticancer drugs than the primary tumors. Therefore, it is likely that adjuvant chemotherapy lowers the risk of ovarian immature teratomas recurring after optimal surgery. BEP and PBV regimens are frequently given to teratoma patients. However, paclitaxel/carboplatin or docetaxel/carboplatin, which are the most effective chemotherapy treatments for epithelial ovarian cancer patients, are considered to be an alternative regimen, especially in the prevention of reproductive toxicity.

A retrospective study on traumatic dental and soft-tissue injuries in preschool children in Zagreb, Croatia.

PubMed

Vuletić, Marko; Škaričić, Josip; Batinjan, Goran; Trampuš, Zdenko; Čuković Bagić, Ivana; Jurić, Hrvoje

2014-02-01

The purpose of this study was to analyze data according to gender, age, cause, number of traumatized teeth, time elapsed before treatment and type of tooth from the records of traumatized children. A retrospective study was conducted in the Department of Paediatric Dentistry at the University Dental Clinic in Zagreb, Croatia using the documentation of 128 patients (61 males and 67 females) aged 1 month to 6 years with injuries of primary teeth between February 2009 and January 2013. Trauma was seen in 217 primary teeth, which implies that the number of injured primary teeth was 1.69 per child. The maxillary central incisors were the most frequently affected teeth (81.1%), they were followed by maxillary lateral incisors, while the least affected were mandibular central incisors. Traumatic dental injuries involved periodontal tissue 2.82 times more frequently than hard dental and pulp tissue. The main cause of teeth injury was fall (67.2%) and the majority of injuries occurred at home (51.6%) (p<0.05). Of 128 patients who received treatment 71 (55.5%) also had soft-tissue injuries. The distribution of soft-tissue injuries by gender (35 males, 36 females) was not statistically significant. Comparing children with soft-tissue injuries and those without them, a statistically significant difference was found in the time of arrival (p<0.01). The results of this study showed the need of informing about preventive measures against falls at home and the methods of providing first aid in dental trauma injuries.

A retrospective study on traumatic dental and soft-tissue injuries in preschool children in Zagreb, Croatia

PubMed Central

Vuletić, Marko; Škaričić, Josip; Batinjan, Goran; Trampuš, Zdenko; Bagić, Ivana Čuković; Jurić, Hrvoje

2014-01-01

The purpose of this study was to analyze data according to gender, age, cause, number of traumatized teeth, time elapsed before treatment and type of tooth from the records of traumatized children. A retrospective study was conducted in the Department of Paediatric Dentistry at the University Dental Clinic in Zagreb. Croatia using the documentation of 128 patients (61 males and 67 females) aged 1 month to 6 years with injuries of primary teeth between February 2009 and January 2013. Trauma was seen in 217 primary teeth, which implies that the number of injured primary teeth was 1.69 per child. The maxillary central incisors were the most frequently affected teeth (81.1%), they were followed by maxillary lateral incisors, while the least affected were mandibular central incisors. Traumatic dental injuries involved periodontal tissue 2.82 times more frequently than hard dental and pulp tissue. The main cause of teeth injury was fall (67.2%) and the majority of injuries occurred at home (51.6%) (p<0.05). Of 128 patients who received treatment 71 (55.5%) also had soft-tissue injuries. The distribution of soft-tissue injuries by gender (35 males, 36 females) was not statistically significant. Comparing children with soft-tissue injuries and those without them, a statistically significant difference was found in the time of arrival (p<0.01). The results of this study showed the need of informing about preventive measures against falls at home and the methods of providing first aid in dental trauma injuries. PMID:24579964

Neural correlates of short-term memory in primate auditory cortex

PubMed Central

Bigelow, James; Rossi, Breein; Poremba, Amy

2014-01-01

Behaviorally-relevant sounds such as conspecific vocalizations are often available for only a brief amount of time; thus, goal-directed behavior frequently depends on auditory short-term memory (STM). Despite its ecological significance, the neural processes underlying auditory STM remain poorly understood. To investigate the role of the auditory cortex in STM, single- and multi-unit activity was recorded from the primary auditory cortex (A1) of two monkeys performing an auditory STM task using simple and complex sounds. Each trial consisted of a sample and test stimulus separated by a 5-s retention interval. A brief wait period followed the test stimulus, after which subjects pressed a button if the sounds were identical (match trials) or withheld button presses if they were different (non-match trials). A number of units exhibited significant changes in firing rate for portions of the retention interval, although these changes were rarely sustained. Instead, they were most frequently observed during the early and late portions of the retention interval, with inhibition being observed more frequently than excitation. At the population level, responses elicited on match trials were briefly suppressed early in the sound period relative to non-match trials. However, during the latter portion of the sound, firing rates increased significantly for match trials and remained elevated throughout the wait period. Related patterns of activity were observed in prior experiments from our lab in the dorsal temporal pole (dTP) and prefrontal cortex (PFC) of the same animals. The data suggest that early match suppression occurs in both A1 and the dTP, whereas later match enhancement occurs first in the PFC, followed by A1 and later in dTP. Because match enhancement occurs first in the PFC, we speculate that enhancement observed in A1 and dTP may reflect top–down feedback. Overall, our findings suggest that A1 forms part of the larger neural system recruited during auditory STM. PMID:25177266

Depression and Heart Diseases: Leading Health Problems.

PubMed

Raič, Matea

2017-12-01

Depression is the most common psychiatric disorder in the world population and the most frequent mental disorder in a primary health care. Unrecognized and untreated depression is associated with a poor outcome of treated chronic diseases which co-exist with depression. Depression and cardiovascular diseases are bidirectional related conditions, risks are for each other, and they often co-exist. Depression is a common disorder in cardiovascular patients with a prevalence of 20% to 45%, which is much more frequent than in the general population. In cardiac patients with acute myocardial infarction, depression occurs three times more often than in the general population. Depression has a direct effect on the pathophysiological changes of various organ systems, changing the values of blood pressure, heart rate, vasomotor tone, vascular resistance, blood viscosity and plasma volume. The potential mechanism for developing heart disease in depressed patients includes hypothalamic-pituitary-adrenal gland dysfunction, increased proinflammatory and prothrombotic factor activity, reduced omega-3 fatty acids, reduced heart rate variability, smoking, physical inactivity, reduced mood, self-esteem and self-efficacy.

Hypocalcemia and tetany caused by vitamin D deficiency in a child with intestinal lymphangiectasia.

PubMed

Lu, Ying-Yi; Wu, Jia-Feng; Ni, Yen-Hsuan; Peng, Steven Shinn-Forng; Shun, Chia-Tung; Chang, Mei-Hwei

2009-10-01

Primary intestinal lymphangiectasia is a rare disease of children, which is characterized by chronic diarrhea and complicated with malnutrition, including fat-soluble vitamin deficiency. We report a girl aged 4 years and 8 months who was diagnosed with the disease by endoscopic duodenal biopsy at 8 months of age. She presented initially with chronic diarrhea at 4 months of age. Generalized edema with hypoalbuminemia frequently occurred despite regular albumin supplements. Multiple vitamins initially were not supplied regularly. Episodes of tetany caused by hypocalcemia developed 4 years after the diagnosis of intestinal lymphangiectasia. Imaging study (long-bone X-ray and dual-energy X-ray absorptiometry) revealed low bone density. Complicated vitamin D deficiency [low serum 25-hydroxy vitamin D concentration (< 12.48 mmol/L, the detection limit)] and secondary hyperparathyroidism were confirmed via blood testing. Vitamin D supplementation for 3 months improved her bone density, secondary hyperparathyroidism and frequent tetany. Vitamin D status should be monitored in patients with intestinal lymphangiectasia.

Facial trauma.

PubMed

Peeters, N; Lemkens, P; Leach, R; Gemels B; Schepers, S; Lemmens, W

Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

[Treatment with nutrition and fluids in patients with non-curable cancer].

PubMed

Nordøy, Tone; Thoresen, Lene; Kvikstad, Anne; Svensen, Rune

2006-02-23

Patients with non-curable cancer represent a large and heterogeneous group in which malnutrition and weight loss is a frequent finding. This article is based on relevant literature and our own clinical experience. For every patient a thorough examination of possible underlying causes should be explored and corrected as soon as possible (secondary cachexia). However, in many patients primary cachexia is the cause, a catabolic condition where muscle protein and lipids are degraded and even aggressive nutrition will not reverse the process. This condition is very different from starvation. Metoclopramide, corticosteroids and gestagens can relieve symptoms as anorexia, chronic nausea and asthenia which frequently occur in patients with cachexia. Treatments that may maintain or increase muscle function and modulate inflammatory processes are new approaches, such as eicosapentaneoic acid, adenosine triphosphate, specific amino acids and nonsteroidal antiinflammatory drugs. Nutrition is an integrated part of supportive therapy to all cancer patients, unless expected survival is short. At this time in life, nutrition will not influence survival and focus should be on symptom control.

[The medical social aspects of ambulatory medical care to victims of road traffic accidents].

PubMed

Gorbunkov, V Ia; Bugaev, D A; Derevianko, D V

2012-01-01

The article discusses the issues of the organization of medical care to victims of road traffic accidents. The analysis of primary appealability of patients to the first-aid center of Stavropol and Novorossiysk during 2008-2010 is presented. The sampling consisted of 904 cases of this kind of trauma. It is established that among victims of road traffic accident appealed to first-aid centers the pedestrians consist the major part. The traumas of limbs are among the most frequently occurred cases. The victims with cranio-cerebral injuries are among those who appealed most frequently for medical aid. Besides that in most cases (63.4%) the victims with cranio-cerebral injuries were transported not to the neurologic surgery clinic but to the first-aid center This action increased the number of transport stages and duration of time gap before specialized medical care was applied. The conclusion is made concerning the need of further development of out-patient urgent medical care to victims of road traffic accidents.

Adenocarcinoma of the thymus, enteric type: report of 2 cases, and proposal for a novel subtype of thymic carcinoma.

PubMed

Moser, Bernhard; Schiefer, Ana Iris; Janik, Stefan; Marx, Alexander; Prosch, Helmut; Pohl, Wolfgang; Neudert, Barbara; Scharrer, Anke; Klepetko, Walter; Müllauer, Leonhard

2015-04-01

We report 2 cases of primary thymic adenocarcinoma with enteric differentiation. One carcinoma occurred in a 41-year-old man as a 7-cm-diameter cystic tumor and the other one in a 39-year-old woman as a 6-cm-diameter solid mass. Both tumors were located in the anterior mediastinum. Clinical staging did not reveal any extrathymic tumor. Histologically, the tumors were classified as adenocarcinoma, not otherwise specified, and a mucinous (colloid) carcinoma, respectively. Immunohistochemically, both tumors were positive for cytokeratin 20 (CK20), CDX2, and carcinoembryonic antigen, reflecting enteric differentiation. A review of the literature on 43 other cases of primary thymic adenocarcinomas suggested 11 further cases with enteric differentiation, as assessed by CK20 and/or CDX2 expression. We propose that thymic adenocarcinoma with enteric differentiation represents a novel subtype of thymic carcinoma. It is mostly of mucinous morphology and frequently associated with thymic cysts. The clinical outcome is variable. Recognition of primary thymic adenocarcinoma with enteric differentiation is helpful for the differentiation from metastatic disease, mainly from the gastrointestinal tract.

Primary effusion lymphoma-like lymphoma in a patient with inflammatory bowel disease.

PubMed

Nussinson, Elchanan; Shibli, Fahmi; Shahbari, Azmi; Rock, Wasseem; Elias, Mazen; Elmalah, Irit

2014-01-21

A 77-year-old man with inflammatory bowel disease (IBD) and who was treated with anti-tumor necrosis factor (TNF), 6-mercaptopurine and corticosteroids, presented with primary effusion lymphoma-like lymphoma (PEL-like lymphoma) with massive ascites. The patient's clinical course was complicated by acute renal insufficiency and hypotension, which led to death within 2 wk. In general, patients with IBD may have an increased risk for development of lymphoma, which is frequently associated with immunosuppressive and/or anti-TNF antibody therapies. PEL is a rare subset of lymphoma localized to serous body cavities, lacks tumor mass or nodal involvement, and is associated with infection by human herpes virus 8 (HHV-8). Primary neoplastic effusion may also be present in patients with large B-cell lymphoma without evidence of human immunodeficiency virus or HHV-8 infections. This type of lymphoma is classified as PEL-like lymphoma. Both PEL and PEL-like lymphoma types have been reported in patients undergoing immunosuppressive therapy, but to the best of our knowledge, the case described herein represents the first PEL-like lymphoma occurring in a patient with IBD.

Admission hyperglycemia predicts inhospital mortality and major adverse cardiac events after primary percutaneous coronary intervention in patients without diabetes mellitus.

PubMed

Ekmekci, Ahmet; Cicek, Gokhan; Uluganyan, Mahmut; Gungor, Baris; Osman, Faizel; Ozcan, Kazim Serhan; Bozbay, Mehmet; Ertas, Gokhan; Zencirci, Aycan; Sayar, Nurten; Eren, Mehmet

2014-02-01

Admission hyperglycemia is associated with high inhospital and long-term adverse events in patients that undergo primary percutaneous coronary intervention (PCI). We aimed to evaluate whether hyperglycemia predicts inhospital mortality. We prospectively analyzed 503 consecutive patients. The patients were divided into tertiles according to the admission glucose levels. Tertile I: glucose <118 mg/dL (n = 166), tertile II: glucose 118 to 145 mg/dL (n = 168), and tertile III: glucose >145 mg/dL (n = 169). Inhospital mortality was 0 in tertile I, 2 in tertile II, and 9 in tertile III (P < .02). Cardiogenic shock occurred more frequently in tertile III compared to tertiles I and II (10% vs 4.1% and 0.6%, respectively, P = .01). Multivariate logistic regression analysis revealed that patients in tertile III had significantly higher risk of inhospital major adverse cardiac events compared to patients in tertile I (odds ratio: 9.55, P < .02). Admission hyperglycemia predicts inhospital adverse cardiac events in mortality and acute ST-segment elevation myocardial infarction in patients that underwent primary PCI.

Primary effusion lymphoma-like lymphoma in a patient with inflammatory bowel disease

PubMed Central

Nussinson, Elchanan; Shibli, Fahmi; Shahbari, Azmi; Rock, Wasseem; Elias, Mazen; Elmalah, Irit

2014-01-01

A 77-year-old man with inflammatory bowel disease (IBD) and who was treated with anti-tumor necrosis factor (TNF), 6-mercaptopurine and corticosteroids, presented with primary effusion lymphoma-like lymphoma (PEL-like lymphoma) with massive ascites. The patient’s clinical course was complicated by acute renal insufficiency and hypotension, which led to death within 2 wk. In general, patients with IBD may have an increased risk for development of lymphoma, which is frequently associated with immunosuppressive and/or anti-TNF antibody therapies. PEL is a rare subset of lymphoma localized to serous body cavities, lacks tumor mass or nodal involvement, and is associated with infection by human herpes virus 8 (HHV-8). Primary neoplastic effusion may also be present in patients with large B-cell lymphoma without evidence of human immunodeficiency virus or HHV-8 infections. This type of lymphoma is classified as PEL-like lymphoma. Both PEL and PEL-like lymphoma types have been reported in patients undergoing immunosuppressive therapy, but to the best of our knowledge, the case described herein represents the first PEL-like lymphoma occurring in a patient with IBD. PMID:24574759

Relationship Between Peer Victimization and Posttraumatic Stress Among Primary School Children.

PubMed

Litman, Leib; Costantino, Giuseppe; Waxman, Richard; Sanabria-Velez, Caribel; Rodriguez-Guzman, Von Marie; Lampon-Velez, Anabelle; Brown, Richard; Cruz, Tomas

2015-08-01

Peer victimization is a common stressor experienced by children. Although peer victimization has been studied extensively, few studies have examined the potential link between peer victimization and posttraumatic stress disorder (PTSD), and no studies of which we are aware have examined this link among children in primary school. The paucity of studies examining the link between PTSD and peer victimization in primary school is surprising because peer victimization occurs more frequently and is more likely to be physical among 7- and 8-year-old children. This study assessed the relationship between peer victimization and PTSD in a sample of 358 elementary school children (ages 6-11 years). Results indicated that peer victimization accounted for 14.1% of PTSD symptom severity among boys and 10.1% among girls. Additionally, we found gender differences in the types of peer victimization that were most associated with PTSD symptom severity (d = 0.38). The long-term developmental consequences that may be associated with peer victimization-linked PTSD symptomatology are discussed. Copyright © 2015 International Society for Traumatic Stress Studies.

Adaptive immune responses to booster vaccination against yellow fever virus are much reduced compared to those after primary vaccination.

PubMed

Kongsgaard, Michael; Bassi, Maria R; Rasmussen, Michael; Skjødt, Karsten; Thybo, Søren; Gabriel, Mette; Hansen, Morten Bagge; Christensen, Jan Pravsgaard; Thomsen, Allan Randrup; Buus, Soren; Stryhn, Anette

2017-04-06

Outbreaks of Yellow Fever occur regularly in endemic areas of Africa and South America frequently leading to mass vaccination campaigns straining the availability of the attenuated Yellow Fever vaccine, YF-17D. The WHO has recently decided to discontinue regular booster-vaccinations since a single vaccination is deemed to confer life-long immune protection. Here, we have examined humoral (neutralizing antibody) and cellular (CD8 and CD4 T cell) immune responses in primary and booster vaccinees (the latter spanning 8 to 36 years after primary vaccination). After primary vaccination, we observed strong cellular immune responses with T cell activation peaking ≈2 weeks and subsiding to background levels ≈ 4 weeks post-vaccination. The number of antigen-specific CD8+ T cells declined over the following years. In >90% of vaccinees, in vitro expandable T cells could still be detected >10 years post-vaccination. Although most vaccinees responded to a booster vaccination, both the humoral and cellular immune responses observed following booster vaccination were strikingly reduced compared to primary responses. This suggests that pre-existing immunity efficiently controls booster inoculums of YF-17D. In a situation with epidemic outbreaks, one could argue that a more efficient use of a limited supply of the vaccine would be to focus on primary vaccinations.

Clinical characteristics of persistent frequent attenders in primary care: case-control study.

PubMed

Patel, Shireen; Kai, Joe; Atha, Christopher; Avery, Anthony; Guo, Boliang; James, Marilyn; Malins, Samuel; Sampson, Christopher; Stubley, Michelle; Morriss, Richard

2015-12-01

Most frequent attendance in primary care is temporary, but persistent frequent attendance is expensive and may be suitable for psychological intervention. To plan appropriate intervention and service delivery, there is a need for research involving standardized psychiatric interviews with assessment of physical health and health status. To compare the mental and physical health characteristics and health status of persistent frequent attenders (FAs) in primary care, currently and over the preceding 2 years, with normal attenders (NAs) matched by age, gender and general practice. Case-control study of 71 FAs (30 or more GP or practice nurse consultations in 2 years) and 71 NAs, drawn from five primary care practices, employing standardized psychiatric interview, quality of life, health anxiety and primary care electronic record review over the preceding 2 years. Compared to NAs, FAs were more likely to report a lower quality of life (P < 0.001), be unmarried (P = 0.03) and have no educational qualifications (P = 0.009) but did not differ in employment status. FAs experienced greater health anxiety (P < 0.001), morbid obesity (P = 0.02), pain (P < 0.001) and long-term pathological and ill-defined physical conditions (P < 0.001). FAs had more depression including dysthymia, anxiety and somatoform disorders (all P < 0.001). Persistent frequent attendance in primary care was associated with poor quality of life and high clinical complexity characterized by diverse and often persistent physical and mental multimorbidity. A brokerage model with GPs working in close liaison with skilled psychological therapists is required to manage such persistent complexity. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Frequent users of rural primary care: comparisons with randomly selected users.

PubMed

Mehl-Madrona, L E

1998-01-01

Frequent users of primary care have not been adequately characterized. The unique characteristics of this population was sought--why they come so often, what their care costs, and whether psychosocial factors play a role in their high utilization of health care. The billing system of a rural primary care clinic was used to find the frequency of visits for all patients attending the clinic for the previous 12 months. The 211 most frequent visitors were selected. A comparison group of 250 patients was drawn from the billing records using a random number generator. Charts were reviewed to compare diagnoses (by frequency), number of procedures, amount billed for care, amount received from those billings, number of psychotropic medications prescribed, and response to medication. A subgroup of each group was interviewed to confirm chart review findings and to inquire about personal reasons for coming to the clinic. Compared with patients who were random users, patients who were frequent users were more likely to come from the younger and older age groups, they averaged significantly more emergency department visits and visits to other specialists (P < 0.0001), and they had more mental health problems diagnosed (P < 0.01). Significantly more frequent users were insured by Medicaid and fewer were insured by Medicare. They had more detailed office visits and more laboratory tests. They received twice as much psychotherapy and had a higher percentage of problem-focused office visits. Chart audits and interviews of selected patients revealed that many nonmedical reasons were related to visits in addition to psychosocial stressors. Nonmedical factors are important among the most frequent users of a primary care clinic. Proposals to improve care for frequent users should consider the psychosocial needs of this population.

Recombination of Globally Circulating Varicella-Zoster Virus

PubMed Central

Depledge, Daniel P.; Kundu, Samit; Atkinson, Claire; Brown, Julianne; Haque, Tanzina; Hussaini, Yusuf; MacMahon, Eithne; Molyneaux, Pamela; Papaevangelou, Vassiliki; Sengupta, Nitu; Koay, Evelyn S. C.; Tang, Julian W.; Underhill, Gillian S.; Grahn, Anna; Studahl, Marie; Breuer, Judith; Bergström, Tomas

2015-01-01

ABSTRACT Varicella-zoster virus (VZV) is a human herpesvirus, which during primary infection typically causes varicella (chicken pox) and establishes lifelong latency in sensory and autonomic ganglia. Later in life, the virus may reactivate to cause herpes zoster (HZ; also known as shingles). To prevent these diseases, a live-attenuated heterogeneous vaccine preparation, vOka, is used routinely in many countries worldwide. Recent studies of another alphaherpesvirus, infectious laryngotracheitis virus, demonstrate that live-attenuated vaccine strains can recombine in vivo, creating virulent progeny. These findings raised concerns about using attenuated herpesvirus vaccines under conditions that favor recombination. To investigate whether VZV may undergo recombination, which is a prerequisite for VZV vaccination to create such conditions, we here analyzed 115 complete VZV genomes. Our results demonstrate that recombination occurs frequently for VZV. It thus seems that VZV is fully capable of recombination if given the opportunity, which may have important implications for continued VZV vaccination. Although no interclade vaccine-wild-type recombinant strains were found, intraclade recombinants were frequently detected in clade 2, which harbors the vaccine strains, suggesting that the vaccine strains have already been involved in recombination events, either in vivo or in vitro during passages in cell culture. Finally, previous partial and complete genomic studies have described strains that do not cluster phylogenetically to any of the five established clades. The additional VZV strains sequenced here, in combination with those previously published, have enabled us to formally define a novel sixth VZV clade. IMPORTANCE Although genetic recombination has been demonstrated to frequently occur for other human alphaherpesviruses, herpes simplex viruses 1 and 2, only a few ancient and isolated recent recombination events have hitherto been demonstrated for VZV. In the present study, we demonstrate that VZV also frequently undergoes genetic recombination, including strains belonging to the clade containing the vOKA strain. PMID:25926648

Monitoring of timely and delayed vaccinations: a nation-wide registry-based study of Norwegian children aged < 2 years.

PubMed

Riise, Øystein Rolandsen; Laake, Ida; Bergsaker, Marianne Adeleide Riise; Nøkleby, Hanne; Haugen, Inger Lise; Storsæter, Jann

2015-11-13

Delayed vaccinations increase the risk for vaccine preventable diseases (VPDs). Monitoring of delayed vaccinations by using a national immunisation registry has not been studied in countries recommending a two-dose (3 and 5 months of age) primary series of e.g., pertussis vaccine. Surveillance/monitoring of all vaccinations may improve vaccination programmes functioning. We obtained information from the Norwegian immunisation registry (SYSVAK) on all programme vaccinations received at age up to 730 days in children born in 2010 (n = 63,382). Timely vaccinations were received up to 7 days after the recommended age. Vaccinations were considered delayed if they were received more than one month after the recommended age in the schedule. In vaccinated children, timely administration of the subsequent three doses of pertussis and one dose of measles occurred in 73.8, 47.6, 53.6 and 43.5 % respectively. Delay for one or more programme vaccinations (diphtheria, tetanus, pertussis, polio, Haemophilus influenza type B, invasive pneumococcal disease, measles, mumps or rubella) was present in 28,336 (44.7 %) children. Among those who were delayed the mean duration was 139 days. The proportion of children that had vaccinations delayed differed among counties (range 37.4 %-57.8 %). Immigrant children were more frequently delayed 52.3 % vs. 43.1 %, RR 1.21 (95 % CI 1.19, 1.24). Children scheduled for vaccines in the summer holiday month (July) were more frequently delayed than others (1(st) dose pertussis vaccine 6.5 % vs. 3.9 % RR 1.65 (95 % CI 1.48, 1.85). Priming against pertussis (2(nd) dose), pneumococcal (2(nd) dose) and measles (1(st) dose) was delayed in 16.8, 18.6 and 29.3 % respectively. Vaccinations were frequently delayed. Delayed vaccinations differed among counties and occurred more frequently during the summer vacation (July) and in the immigrant population. Monitoring improves programme surveillance and may be used on an annual basis.

Myocardial infarction is a frequent cause of exercise-related resuscitated out-of-hospital cardiac arrest in a general non-athletic population.

PubMed

Søholm, Helle; Kjaergaard, Jesper; Thomsen, Jakob Hartvig; Bro-Jeppesen, John; Lippert, Freddy K; Køber, Lars; Wanscher, Michael; Hassager, Christian

2014-11-01

Performing exercise is shown to prevent cardiovascular disease, but the risk of an out-of-hospital cardiac arrest (OHCA) is temporarily increased during strenuous activity. We examined the etiology and outcome after successfully resuscitated OHCA during exercise in a general non-athletic population. Consecutive patients with OHCA were admitted with return of spontaneous circulation (ROSC) or on-going resuscitation at hospital arrival (2002-2011). Patient charts were reviewed for post-resuscitation data. Exercise was defined as moderate/vigorous physical activity. A total of 1393 OHCA-patients were included with 91(7%) arrests occurring during exercise. Exercise-related OHCA-patients were younger (60 ± 13 vs. 65 ± 15, p<0.001) and predominantly male (96% vs. 69%, p<0.001). The arrest was more frequently witnessed (94% vs. 86%, p=0.02), bystander CPR was more often performed (88% vs. 54%, p<0.001), time to ROSC was shorter (12 min (IQR: 5-19) vs. 15 (9-22), p=0.007) and the primary rhythm was more frequently shock-able (91% vs. 49%, p<0.001) compared to non-exercise patients. Cardiac etiology was the predominant cause of OHCA in both exercise and non-exercise patients (97% vs. 80%, p<0.001) and acute coronary syndrome was more frequent among exercise patients (59% vs. 38%, p<0.001). One-year mortality was 25% vs. 65% (p<0.001), and exercise was even after adjustment associated with a significantly lower mortality (HR=0.40 (95%CI: 0.23-0.72), p=0.002). OHCA occurring during exercise was associated with a significantly lower mortality in successfully resuscitated patients even after adjusting for confounding factors. Acute coronary syndrome was more common among exercise-related cardiac arrest patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

Elnahal, Shereef M., E-mail: selnaha1@jhmi.edu; Blackford, Amanda; Smith, Koren

Purpose: To describe radiation therapy cases during which voluntary incident reporting occurred; and identify patient- or treatment-specific factors that place patients at higher risk for incidents. Methods and Materials: We used our institution's incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient- and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios, and mixed-effect logistic regression models were used for group comparisons. Results:more » The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%), and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18 years) than in adult patients (37.7% vs 0.4%, P<.001). Patients with head and neck (16% vs 8%, P<.001) and breast (20% vs 15%, P=.03) primaries more frequently had incidents, whereas brain (18% vs 24%, P=.008) primaries were less frequent. Larger tumors (17% vs 10% had T4 lesions, P=.02), and cases on protocol (9% vs 5%, P=.005) or with intensity modulated radiation therapy/image guided intensity modulated radiation therapy (52% vs 43%, P=.001) were more likely to have incidents. Conclusions: We found several treatment- and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards, to minimize safety risks.« less

Frequency and nature of potentially harmful preventable problems in primary care from the patient's perspective with clinician review: a population-level survey in Great Britain.

PubMed

Stocks, Susan Jill; Donnelly, Ailsa; Esmail, Aneez; Beresford, Joanne; Luty, Sarah; Deacon, Richard; Danczak, Avril; Mann, Nicola; Townsend, David; Ashley, James; Gamble, Carolyn; Bowie, Paul; Campbell, Stephen M

2018-06-13

To estimate the frequency of patient-perceived potentially harmful problems occurring in primary care. To describe the type of problem, patient predictors of perceiving a problem, the primary care service involved, how the problem was discussed and patient suggestions as to how the problem might have been prevented. To describe clinician/public opinions regarding the likelihood that the patient-described scenario is potentially harmful. Population-level survey. Great Britain. A nationally representative sample of 3975 members of the public aged ≥15 years interviewed during April 2016. Counts of patient-perceived potentially harmful problems in the last 12 months, descriptions of patient-described scenarios and review by clinicians/members of the public. 3975 of 3996 participants in a nationally representative survey completed the relevant questions (99.5%). 300 (7.6%; 95% CI 6.7% to 8.4%) of respondents reported experiencing a potentially harmful preventable problem in primary care during the past 12 months and 145 (48%) discussed their concerns within primary care. This did not vary with age, gender or type of service used. A substantial minority (30%) of the patient-perceived problems occurred outside general practice, particularly the dental surgery, walk in clinic, out of hours care and pharmacy. Patients perceiving a potentially harmful preventable problem were eight times more likely to have 'no confidence and trust in primary care' compared with 'yes, definitely' (OR 7.9; 95% CI 5.9 to 10.7) but those who discussed their perceived-problem appeared to maintain higher trust and confidence. Generally, clinicians ranked the patient-described scenarios as unlikely to be potentially harmful. This study highlights the importance of actively soliciting patient's views about preventable harm in primary care as patients frequently perceive potentially harmful preventable problems and make useful suggestions for their prevention. Such engagement may also help to improve confidence and trust in primary care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Paediatric homoeopathy in general practice: where, when and why?

PubMed Central

Ekins-Daukes, Suzie; Helms, Peter J; Taylor, Michael W; Simpson, Colin R; McLay, James S

2005-01-01

Aims To investigate the extent of homoeopathic prescribing in primary care for childhood diseases and assess GP attitudes towards the use of homoeopathy in children. Methods Homoeopathic prescribing in primary care was assessed in 167 865 children aged 0–16 years for the year 1999–2000. Computerized prescribing data were retrieved from 161 representative general practices in Scotland. Medical attitudes towards homoeopathic prescribing to children were also assessed via a questionnaire survey. Results During the year 1999–2000 22% (36) of general practices prescribed homoeopathic medicines to 190 (1.1/1000 registered) children. The majority of such prescriptions were issued to children under 1 year of age (8.0/1000 registered children). The most frequently prescribed medicines were for common self-limiting infantile conditions such as colic, cuts and bruises, and teething. A total of 259 completed questionnaires were returned by GPs, giving a response rate of 75%. GPs who frequently prescribed homoeopathic medicines to children (more than 1 per month) were more likely to claim an interest in homoeopathy, have had a formal training and keep up to date in the discipline, and refer on to a homoeopath (P < 0.001 for all variables) than those GPs who prescribed less than once a month or never. The majority of GPs who prescribed homoeopathic medicines did so when conventional treatments had apparently failed (76%), while 94% also perceived homoeopathy to be safe. Frequent prescribers reported a more positive attitude towards homoeopathic medicines than those who prescribed less frequently. Non-prescribers reported a lack of proven efficacy and lack of training as the main reasons for not prescribing homoeopathic medicines (55% and 79%, respectively). However non-prescribers from within homoeopathic prescribing practices reported a more favourable attitude in general towards homoeopathy and less resistance towards prescribing in the future than non-prescribers from practices where none of the partners practiced homoeopathy. Conclusions In primary care paediatric prescribing of homoeopathic medicines most commonly occurs for self-limiting conditions in infants less than 1 year of age. Although the current level of homoeopathic prescribing is low, the widespread use in the community suggests that at least some knowledge of the main indications for homoeopathy and the preparations used would be of benefit to registered medical practitioners. PMID:15948942

Epidemiological, clinical and pathological features of primary cardiac hemangiosarcoma in dogs: a review of 51 cases.

PubMed

Yamamoto, Shinya; Hoshi, Katsuichiro; Hirakawa, Atsushi; Chimura, Syuuichi; Kobayashi, Masayuki; Machida, Noboru

2013-11-01

In the study presented here, we aimed to describe the epidemiological, clinical and pathological findings of 51 canine cases with histologically-verified diagnoses of primary cardiac hemangiosarcoma (HSA). The medical data for each dog, including signalment, presenting complaints, physical examination findings, results of various diagnostic testing performed and method of treatment, were checked. In addition, all 51 cases were re-examined pathologically. The tumor occurred most frequently in older Golden Retrievers, followed by Maltese dogs and Miniature Dachshunds. Mass lesions of HSA were found more commonly in the right auricle (RAu) (25/51) and right atrium (RA) (21/51), and the RA masses were significantly (P<0.001) larger than the RAu masses. The echocardiographic detection rate of masses in the RAu group (60%; 15/25) was significantly lower than that in the RA group (95%; 20/21). Survival time was significantly (P<0.05) longer for 5 dogs that received adjuvant chemotherapy after tumor resection than for 12 dogs that did not. In this series, the Maltese (9/51) and Miniature Dachshund (7/51), as well as the Golden Retriever, were represented more frequently than other breeds. The lower echocardiographic detection rate of RAu masses compared with RA masses may be related to tumor size and/or location. The significantly longer survival time for dogs receiving adjuvant chemotherapy indicates that postoperative chemotherapy could be useful for dogs with cardiac HSA.

Agreement between core laboratory and study investigators for imaging scores in a thrombectomy trial.

PubMed

Fahed, Robert; Ben Maacha, Malek; Ducroux, Célina; Khoury, Naim; Blanc, Raphaël; Piotin, Michel; Lapergue, Bertrand

2018-05-14

We aimed to assess the agreement between study investigators and the core laboratory (core lab) of a thrombectomy trial for imaging scores. The Alberta Stroke Program Early CT Score (ASPECTS), the European Collaborative Acute Stroke Study (ECASS) hemorrhagic transformation (HT) classification, and the Thrombolysis In Cerebral Infarction (TICI) scores as recorded by study investigators were compared with the core lab scores in order to assess interrater agreement, using Cohen's unweighted and weighted kappa statistics. There were frequent discrepancies between study sites and core lab for all the scores. Agreement for ASPECTS and ECASS HT classification was less than substantial, with disagreement occurring in more than one-third of cases. Agreement was higher on MRI-based scores than on CT, and was improved after dichotomization on both CT and MRI. Agreement for TICI scores was moderate (with disagreement occurring in more than 25% of patients), and went above the substantial level (less than 10% disagreement) after dichotomization (TICI 0/1/2a vs 2b/3). Discrepancies between scores assessed by the imaging core lab and those reported by study sites occurred in a significant proportion of patients. Disagreement in the assessment of ASPECTS and day 1 HT scores was more frequent on CT than on MRI. The agreement for the dichotomized TICI score (the trial's primary outcome) was substantial, with less than 10% of disagreement between study sites and core lab. NCT02523261, Post-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Sporotrichosis in cats: ABCD guidelines on prevention and management.

PubMed

Lloret, Albert; Hartmann, Katrin; Pennisi, Maria Grazia; Ferrer, Lluis; Addie, Diane; Belák, Sándor; Boucraut-Baralon, Corine; Egberink, Herman; Frymus, Tadeusz; Gruffydd-Jones, Tim; Hosie, Margaret J; Lutz, Hans; Marsilio, Fulvio; Möstl, Karin; Radford, Alan D; Thiry, Etienne; Truyen, Uwe; Horzinek, Marian C

2013-07-01

Sporotrichosis is an important subcutaneous fungal infection of humans and animals in some endemic tropical and subtropical areas. Among domestic species, cats are the most frequently infected. The primary mode of transmission is traumatic inoculation of fungal conidia from plants and soil. Contact with infected cats is the major mode of transmission to humans, especially in endemic areas like Brazil, where a large epidemic has occurred in the past decade. Most cases in cats are cutaneous, presenting as multiple ulcerated nodules and draining tracts in the skin. Lymphadenopathy, respiratory signs and systemic dissemination may also occur. Diagnosis is based on fungal detection by cytology and/or histology, and confirmation by culture. Treatment consists of at least 2 months' systemic antifungal therapy, with itraconazole as the first-choice agent. The prognosis is favourable provided there is good owner compliance and adverse drug effects do not occur. Contact with infected cats carries a high zoonotic risk. Cat owners travelling to endemic areas should be warned and advised to keep their cats indoors to prevent infection. Professionals must wear gloves when handling cats with skin nodules and ulcers and dealing with diagnostic samples.

Patient safety in out-of-hours primary care: a review of patient records.

PubMed

Smits, Marleen; Huibers, Linda; Kerssemeijer, Brian; de Feijter, Eimert; Wensing, Michel; Giesen, Paul

2010-12-10

Most patients receive healthcare in primary care settings, but relatively little is known about patient safety. Out-of-hours contacts are of particular importance to patient safety. Our aim was to examine the incidence, types, causes, and consequences of patient safety incidents at general practice cooperatives for out-of-hours primary care and to examine which factors were associated with the occurrence of patient safety incidents. A retrospective study of 1,145 medical records concerning patient contacts with four general practice cooperatives. Reviewers identified records with evidence of a potential patient safety incident; a physician panel determined whether a patient safety incident had indeed occurred. In addition, the panel determined the type, causes, and consequences of the incidents. Factors associated with incidents were examined in a random coefficient logistic regression analysis. In 1,145 patient records, 27 patient safety incidents were identified, an incident rate of 2.4% (95% CI: 1.5% to 3.2%). The most frequent incident type was treatment (56%). All incidents had at least partly been caused by failures in clinical reasoning. The majority of incidents did not result in patient harm (70%). Eight incidents had consequences for the patient, such as additional interventions or hospitalisation. The panel assessed that most incidents were unlikely to result in patient harm in the long term (89%). Logistic regression analysis showed that age was significantly related to incident occurrence: the likelihood of an incident increased with 1.03 for each year increase in age (95% CI: 1.01 to 1.04). Patient safety incidents occur in out-of-hours primary care, but most do not result in harm to patients. As clinical reasoning played an important part in these incidents, a better understanding of clinical reasoning and guideline adherence at GP cooperatives could contribute to patient safety.

Cardiopulmonary events during primary colonoscopy screening in an average risk population.

PubMed

Khalid-de Bakker, C A; Jonkers, D M; Hameeteman, W; de Ridder, R J; Masclee, A A; Stockbrügger, R W

2011-04-01

Large colorectal cancer screening studies using primary colonoscopy have reported a low risk of major complications. Studies on diagnostic and therapeutic colonoscopy have pointed to a frequent occurrence of(minor) cardiopulmonary events, and with the steady increase of colonoscopy screening, it is important to investigate their occurrence in colonoscopy screening. This study describes the frequency of bradycardia(pulse rate <60 min-1), hypotension (systolic blood pressure(SB P) <90 mmHg), hypoxaemia (blood oxygenation, SaO2<90%) and ECG changes during colonoscopy screening in an average-risk population (hospital personnel, n=214,mean age 54.0±3.8, 39.3% male), without significant comorbidity) and aims at identifying subject-related and/or endoscopic factors associated with their occurrence. All data were collected prospectively. During 214 consecutive primary screening colonoscopies under conscious sedation(midazolam and pethidine), on top of pulse rate and SaO2,blood pressure and a three-channel ECG were recorded every five minutes. No major complications or relevant ECG changes occurred. Hypoxaemia occurred in 119 (55.6%),hypotension in 19 (8.9%) and bradycardia in 12 subjects(5.6%). In multivariate analysis, the sedation level 3 increased the risk of hypoxaemia (OR 4.8, CI 1.7-13.7), and incomplete colonoscopy (OR 5.3, CI 1.6-18.1) was associated with hypotension. Subjects with bradycardia had a longer mean procedure time (38±12 vs. 29±12 min, p<0.05), which did not turn out as a risk factor in a multivariate analysis. Mainly procedure-related and not subject-related factors were found to be associated with the occurrence of cardiopulmonary events in primary colonoscopy screening in this relatively healthy screening population.

Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study.

PubMed

Mehta, Gautam U; Ding, Dale; Patibandla, Mohana Rao; Kano, Hideyuki; Sisterson, Nathaniel; Su, Yan-Hua; Krsek, Michal; Nabeel, Ahmed M; El-Shehaby, Amr; Kareem, Khaled A; Martinez-Moreno, Nuria; Mathieu, David; McShane, Brendan; Blas, Kevin; Kondziolka, Douglas; Grills, Inga; Lee, John Y; Martinez-Alvarez, Roberto; Reda, Wael A; Liscak, Roman; Lee, Cheng-Chia; Lunsford, L Dade; Vance, Mary Lee; Sheehan, Jason P

2017-11-01

Cushing disease (CD) due to adrenocorticotropic hormone-secreting pituitary tumors can be a management challenge. To better understand the outcomes of stereotactic radiosurgery (SRS) for CD and define its role in management. International, multicenter, retrospective cohort analysis. Ten medical centers participating in the International Gamma Knife Research Foundation. Patients with CD with >6 months endocrine follow-up. SRS using Gamma Knife radiosurgery. The primary outcome was control of hypercortisolism (defined as normalization of free urinary cortisol). Radiologic response and adverse radiation effects (AREs) were recorded. In total, 278 patients met inclusion criteria, with a mean follow-up of 5.6 years (0.5 to 20.5 years). Twenty-two patients received SRS as a primary treatment of CD. Mean margin dose was 23.7 Gy. Cumulative initial control of hypercortisolism was 80% at 10 years. Mean time to cortisol normalization was 14.5 months. Recurrences occurred in 18% with initial cortisol normalization. Overall, the rate of durable control of hypercortisolism was 64% at 10 years and 68% among patients who received SRS as a primary treatment. AREs included hypopituitarism (25%) and cranial neuropathy (3%). Visual deficits were related to treatment of tumor within the suprasellar cistern (P = 0.01), whereas both visual (P < 0.0001) and nonvisual cranial neuropathy (P = 0.02) were related to prior pituitary irradiation. SRS for CD is well tolerated and frequently results in control of hypercortisolism. However, recurrences can occur. SRS should be considered for patients with persistent hypercortisolism after pituitary surgery and as a primary treatment in those unfit for surgery. Long-term endocrine follow-up is essential after SRS. Copyright © 2017 Endocrine Society

Redo Laparoscopic Gastric Bypass: One-Step or Two-Step Procedure?

PubMed

Theunissen, Caroline M J; Guelinckx, Nele; Maring, John K; Langenhoff, Barbara S

2016-11-01

The adjustable gastric band (AGB) is a bariatric procedure that used to be widely performed. However, AGB failure-signifying band-related complications or unsatisfactory weight loss, resulting in revision surgery (redo operations)-frequently occurs. Often this entails a conversion to a laparoscopic Roux-en-Y gastric bypass (LRYGB). This can be performed as a one-step or two-step (separate band removal) procedure. Data were collected from patients operated from 2012 to 2014 in a single bariatric centre. We compared 107 redo LRYGB after AGB failure with 1020 primary LRYGB. An analysis was performed of the one-step vs. two-step redo procedures. All redo procedures were performed by experienced bariatric surgeons. No difference in major complication rate was seen (2.8 vs. 2.3 %, p = 0.73) between redo and primary LRYGB, and overall complication severity for redos was low (mainly Clavien-Dindo 1 or 2). Weight loss results were comparable for primary and redo procedures. The one-step and two-step redos were comparable regarding complication rates and readmissions. The operating time for the one-step redo LRYGB was 136 vs. 107.5 min for the two-step (median, p < 0.001), excluding the operating time of separate AGB removal (mean 61 min, range 36-110). Removal of a failed AGB and LRYGB in a one-step procedure is safe when performed by experienced bariatric surgeons. However, when erosion or perforation of the AGB occurs, we advise caution and would perform the redo LRYGB as a two-step procedure. Equal weights can be achieved at 1 year post redo LRYGB as after primary LRYGB procedures.

The types of the landslide by the heavy rain presumed from geographical and geological features in Japan

NASA Astrophysics Data System (ADS)

Doshida, S.

2014-12-01

Various types of a landslide, such as a deep-seated landslide, a shallow landslide, and a debris flow, exist. And the risk and the damage area of a landslide change greatly with the types. Therefore it is very important to guess the type of a landslide generated in the future, in order to decrease the damage of a landslide. In this research, I investigated and studied the landslide disaster which occurred in the typhoon No.12 disaster in 2011 and the northern Kyusyu-island heavy rain disaster 2012, in Japan. The purpose of the study presumes the types of a landslide generated in the future by analyzing geographical and geological features. 　Many deep-seated landslides and shallow landslides (debris flows) occurred by the typhoon No.12, 2011 in Japan. The precipitation exceeds 1,800 mm in four days in part regionally. Landslides occurred frequently in the Totsukawa area (Northern part) and Nachi-Katsuura area (Southern part), both area were the precipitation of about 1000 mm in four days. In the Totsukawa area, deep-seated landslides occurred frequently, and in Nachi-Katsuura area, shallow landslides (debris flows) occurred frequently. On the other hand, many deep-seated landslides and shallow landslides occurred by the northern Kyusyu-island heavy rain disaster 2012 in Japan too. Landslides occurred frequently in the Hoshino village area (Northern part) and Asodani area (Southern part). In both area, the total precipitation exceeds 500 mm and the hourly precipitation is about 80 mm. In the Hoshino village area, deep-seated landslides occurred frequently, and in Asodani area, shallow landslides occurred frequently. 　The result compared with the deep-seated landslide area (Totsukawa and Hoshino village) and the shallow landslide area (Nachi-Katsuura and Asodani), area of landslide is larger and number of landslide is fewer in the deep-seated landslide area. In the shallow landslide area, the slope is steeper and the drainage network is more developed. It is surmised that these geographical differentiations are the geographical features formed of the past landslide. Therefore, it is important to read and analyze the past landslide disaster hysteresis from geographical feature for specifying the type of a landslide.

Phosphatized algal-bacterial assemblages in Late Cretaceous phosphorites of the Voronezh Anteclise

NASA Astrophysics Data System (ADS)

Maleonkina, Svetlana Y.

2003-01-01

Late Cretaceous phosphogenesis of the Voronezh Anteclise has occurred during Cenomanian and Early Campanian. SEM studies show the presence of phosphatized algal-bacterial assemblages both in Cenomanian and Campanian phosphorites. In some Cenomanian nodular phosphorite samples revealed empty tubes 1 - 5 microns in diameter, which are most likely trichomes of cyanobacterial filaments. Other samples contained accumulations of spheres 0,5-3 microns, similar to coccoidal bacteria. Complicated tubular forms with variable diameter 2 - 5 microns occur on surface of some quartz grains in nodules. They are probably pseudomorphs after algae. We found similar formations in the Campanian phosphate grains. Frequently, grain represents a cyanobacterial mat, which is sometimes concentrically coated by phosphatic films. The films of some grains retain the primary structure, their concentric layers are formed by pseudomorphs after different bacterial types and obviously they represent oncolite. In other cases, the primary structure is unobservable because of recrystallization process erases them. Occasionally, the central part retains the coccoidal structure and the recrystallization affects only films. Besides the core of such oncolite can be represented not only by phosphatic grain, but also by grains of other minerals, such as quartz, glauconite and heavy minerals, which serve as a substrate for cyanobacterial colonies. Bacteria also could settle on cavity surfaces and interiors frames of sponge fragments, teeth and bones.

Avian pathogenic Escherichia coli bind fibronectin and laminin.

PubMed

Ramírez, Rosa María; Almanza, Yolanda; González, Rafael; García, Santos; Heredia, Norma

2009-04-01

Avian colisepticemia frequently occurs after respiratory tract damage, the primary site for infection allows bacteria to encounter an exposed basement membrane, where laminin and fibronectin are important components. We investigated the ability of an isolate of avian pathogenic Escherichia coli to bind fibronectin and laminin. Using Far-western dot blot analysis, we demonstrated the ability of this microorganism to bind basement membrane proteins fibronectin and laminin. Results from an ELISA-based approach indicate that the binding to these membrane proteins was bacterial-dose dependent. Furthermore, two specific E. coli polypeptides, of 32 kDa and 130 kDa, reacted with laminin and fibronectin, respectively. Further evaluation of these potential bacterial adhesins may provide insights into the pathogenesis of colibacillosis.

Do entheogen-induced mystical experiences boost the immune system? Psychedelics, peak experiences, and wellness.

PubMed

Roberts, T B

1999-01-01

Daily events that boost the immune system (as indicated by levels of salivary immunoglobulin A), some instances of spontaneous remission, and mystical experiences seem to share a similar cluster of thoughts, feelings, moods, perceptions, and behaviors. Entheogens--psychedelic drugs used in a religious context--can also produce mystical experiences (peak experiences, states of unitive consciousness, intense primary religious experiences) with the same cluster of effects. When this happens, is it also possible that such entheogen-induced mystical experiences strengthen the immune system? Might spontaneous remissions occur more frequently under such conditions? This article advances the so called "Emxis hypothesis"--that entheogen-induced mystical experiences influence the immune system.

Therapy of Acute Hypertension in Hospitalized Children and Adolescents

PubMed Central

Webb, Tennille N.; Shatat, Ibrahim F.

2014-01-01

Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently and in some cases, if not recognized and treated promptly, it can lead to hypertensive crisis with potentially significant morbidity and mortality. In contrast to adults, where acute HTN is most likely due to uncontrolled primary HTN, children and adolescents with acute HTN are more likely to have secondary HTN. This review will briefly cover evaluation of acute HTN and various age specific etiologies of secondary HTN and provide more in-depth discussion on treatment target, potential risks of acute HTN therapy, available pediatric data on intravenous and oral antihypertensive agents, and propose treatment schema including unique therapy of specific secondary HTN scenarios. PMID:24522943

Dynamic behaviour of the soft palate during nasal positive pressure ventilation under anaesthesia and paralysis: comparison between patients with and without obstructive sleep-disordered breathing.

PubMed

Okuyama, M; Kato, S; Sato, S; Okazaki, J; Kitamura, Y; Ishikawa, T; Sato, Y; Isono, S

2018-01-01

Difficult mask ventilation is common and is known to be associated with sleep-disordered breathing (SDB). It is our hypothesis that the incidence of expiratory retropalatal (RP) airway closure (primary outcome) during nasal positive pressure ventilation (PPV) is more frequent in patients with SDB (apnea hypopnea index ≥5 h -1 ) than non-SDB subjects. The severity of SDB was assessed before surgery using a portable sleep monitor. In anaesthetized and paralysed patients with (n=11) and without SDB (n=9), we observed the behaviour of the RP airway endoscopically during nasal PPV with the mouth closed and determined the dynamic RP closing pressure, which was defined as the highest airway pressure above which the RP airway closure was reversed. The static RP closing pressure was obtained during cessation of mechanical ventilation in patients with dynamic RP closure during nasal PPV. The expiratory RP airway closure accompanied by expiratory flow limitation occurred more frequently in SDB patients (9/11, 82%) than in non-SDB subjects (2/9, 22%; exact logistic regression analysis: P=0.022, odds ratio 3.6, 95% confidence interval 1.1-15.4). Receiver operating characteristic curve analyses indicated AHI >10h -1 and presence of habitual snoring as clinically useful predictors for the occurrence of RP closure during PPV. Dynamic RP closing pressure was greater than the static RP closing pressure by approximately 4-5 cm H 2 O. Valve-like dynamic RP closure that limits expiratory flow during nasal PPV occurs more frequently in SDB patients. Copyright © 2017. Published by Elsevier Ltd.

MR imaging of adult acute infectious encephalitis.

PubMed

Bertrand, A; Leclercq, D; Martinez-Almoyna, L; Girard, N; Stahl, J-P; De-Broucker, T

2017-05-01

Imaging is a key tool for the diagnosis of acute encephalitis. Brain CT scan must be urgently performed to rule out a brain lesion with mass effect that would contraindicate lumbar puncture. Brain MRI is less accessible than CT scan, but can provide crucial information with patients presenting with acute encephalitis. We performed a literature review on PubMed on April 1, 2015 with the search terms "MRI" and "encephalitis". We first described the various brain MRI abnormalities associated with each pathogen of acute encephalitis (HSV, VZV, other viral agents targeting immunocompromised patients or travelers; tuberculosis, listeriosis, other less frequent bacterial agents). Then, we identified specific patterns of brain MRI abnomalies that may suggest a particular pathogen. Limbic encephalitis is highly suggestive of HSV; it also occurs less frequently in encephalitis due to HHV6, syphillis, Whipple's disease and HIV primary infection. Rhombencephalitis is suggestive of tuberculosis and listeriosis. Acute ischemic lesions can occur in patients presenting with severe bacterial encephalitis, tuberculosis, VZV encephalitis, syphilis, and fungal infections. Brain MRI plays a crucial role in the diagnosis of acute encephalitis. It detects brain signal changes that reinforce the clinical suspicion of encephalitis, especially when the causative agent is not identified by lumbar puncture; it can suggest a particular pathogen based on the pattern of brain abnormalities and it rules out important differential diagnosis (vascular, tumoral or inflammatory causes). Copyright © 2017 Elsevier Masson SAS. All rights reserved.

A serological survey of leptospirosis in cattle of rural communities in the province of KwaZulu-Natal, South Africa.

PubMed

Hesterberg, U W; Bagnall, R; Bosch, B; Perrett, K; Horner, R; Gummow, B

2009-03-01

A serological survey of leptospirosis in cattle originating from rural communities of the province of KwaZulu-Natal (KZN) in South Africa was carried out between March 2001 and December 2003. The survey was designed as a 2-stage survey, using the local diptank as the primary sampling point. In total, 2021 animals from 379 diptanks in 33 magisterial districts were sampled and tested with the microscopic agglutination test (MAT). The apparent prevalence at district level was adjusted for clustering and diagnostic test sensitivity and specificity and displayed in maps. The prevalence of leptospirosis in cattle originating from communal grazing areas of KZN was found to be 19.4% with a 95% confidence interval of 14.8-24.1%. At district level the prevalence of leptospirosis varied from 0 to 63% of cattle. Bovine leptospirosis was found to occur in communal grazing areas throughout the province with the exception of 2 districts. The southeastern regions showed a higher prevalence than other areas of the province; while in some of the northern and western districts a lower prevalence was noted. Several serovars were detected by the MAT and although Leptospira interrogans serovar pomona occurred most frequently, serovars tarrasovi, bratislava, hardjo, canicola and icterohaemorrhagica were also frequently identified. The findings of the survey are discussed.

Dental anomalies in primary dentition and their corresponding permanent teeth.

PubMed

Gomes, R R; Fonseca, J A C; Paula, L M; Acevedo, A C; Mestrinho, H D

2014-05-01

The objectives of this paper are to estimate the prevalence of dental anomalies in primary dentition in a sample of 2- to 5-year-old Brazilian preschool children, determine their distribution, and investigate their occurrence in the succedaneous teeth of the sample compared with a control group of children with no dental anomalies in the primary dentition. The one-stage sample comprised 1,718 two to five-year-old children with fully erupted primary dentition clinically examined for dental anomalies. All children presenting dental anomalies underwent panoramic radiographs. Descriptive statistics were performed for the studied variables. A control group matched by sex and age was studied to compare the prevalence ratio for dental anomalies in the permanent dentition. The prevalence of dental anomalies in the primary dentition was 1.8 %, with no significant statistical difference between sexes. Double teeth were the most frequently observed. Dental anomalies on the succedaneous permanent teeth were diagnosed in 54.8 % of the children with affected primary dentition. The prevalence ratio (PR) for dental anomalies in the succedaneous permanent teeth was 17.1 (confidence interval (CI) 5.33-54.12) higher compared with the control group, higher in children with bilateral anomalies (PR = 31.2, CI 10.18-94.36). An association between anomalies of the permanent dentition and the presence of dental anomalies in primary teeth was observed, especially when they occur bilaterally. The results in the present study have a clinical relevance in the diagnosis of children with dental anomalies in primary dentition. Early identification of these anomalies can aid the dentist in planning dental treatment at the appropriate time.

Association of general psychological factors with frequent attendance in primary care: a population-based cross-sectional observational study.

PubMed

Hajek, André; Bock, Jens-Oliver; König, Hans-Helmut

2017-03-24

Whereas several studies have examined the association between frequent attendance in primary care and illness-specific psychological factors, little is known about the relation between frequent attendance and general psychological factors. Thus, the aim of this study was to investigate the association between being a frequent attender in primary care and general psychological factors. Data were used from a large, population-based sample of community-dwelling individuals aged 40 and above in Germany in 2014 (n = 7,446). Positive and negative affect, life satisfaction, optimism, self-esteem, self-efficacy, and self-regulation were included as general psychological factors. The number of self-reported GP visits in the past twelve months was used to quantify frequency of attendance; individuals with more than 9 visits (highest decile) were defined as frequent attenders. Multiple logistic regressions showed that being a frequent attender was positively associated with less life satisfaction [OR: 0.79 (0.70-0.89)], higher negative affect [OR: 1.38 (1.17-1.62)], less self-efficacy [OR: 0.74 (0.63-0.86)], less self-esteem [OR: 0.65 (0.54-0.79)], less self-regulation [OR: 0.74 (0.60-0.91)], and higher perceived stress [OR: 1.46 (1.28-1.66)], after adjusting for sociodemographic factors, morbidity and lifestyle factors. However, frequent attendance was not significantly associated with positive affect and self-regulation. The present study highlights the association between general psychological factors and frequent attendance. As frequent GP visits produce high health care costs and are potentially associated with increased referrals and use of secondary health care services, this knowledge might help to address these individuals with high needs.

General health status of residents of the Selebi Phikwe Ni-Cu mine area, Botswana.

PubMed

Ekosse, Georges

2005-10-01

Residents of the Selebi Phikwe area, Botswana where nickel-copper (Ni-Cu) is being exploited often exhibit symptoms of varied degrees of ailments, sicknesses and diseases. A need to investigate their general health status was therefore eminent. Primary data was obtained by means of a questionnaire and structured interviews conducted with individuals, health service providers, business enterprises and educational Institutions. The generated data revealed common ailments, sicknesses and diseases in the area with the four most frequent health complaints being frequent coughing headaches, influenza/common colds and rampant chest pains. Research findings indicated that residents had respiratory tract-related problems, suspected to be linked to the effects of air pollution caused by the emission of sulphur dioxide (SO2) from mining and smelting activities. Residents were frequently in contact with SO2 and related gases and fumes, mineral and silica dust generated from the mining processes. No clearly demarcating differences were noticed in the health status of residents living in the control site from those in the main study area. However, sites most affected were those close to where Ni-Cu is exploited. Environmental factors resulting from mining and smelting activities, among others, could be contributory to the negative health effects occurring at Selebi Phikwe.

A picture tells 1000 words: learning teamwork in primary care.

PubMed

Kelly, Martina; Bennett, Deirdre; O'Flynn, Siun; Foley, Tony

2013-04-01

Teamwork and patient centredness are frequently articulated concepts in medical education, but are not always explicit in the curriculum. In Ireland, recent government policy emphasises the importance of a primary care team approach to health care. We report on an appraisal of a newly introduced community-based student attachment, which focused on teamwork. To review students' experience of teamwork following a community clinical placement by examining student assignments: essays, poetry, music and art. Year-2 graduate-entry students (n = 45) spent 2 weeks with a primary care team. Attachments comprised placements with members of the primary care team, emphasising team dynamics, at the end of which students submitted a representative piece of work, which captured their learning. Essays (n = 22) were analysed using a thematic content analysis. Artwork consisted of painting, collage, photography, poetry and original music (n = 23). These were analysed using Gardner's entry points. Three core themes emerged in both written and visual work: patient centredness; communication; and an improved appreciation of the skills of other health care professionals. Students identified optimal team communication occurring when patient outcomes were prioritised. Metaphors relating to puzzles, hands and inter-connectedness feature strongly. The poems and artwork had a high impact when they were presented to tutors. Primary care team placements focus student attention on teamwork and patient centredness. Student artwork shows potential as a tool to evaluate student learning in medical education. © Blackwell Publishing Ltd 2013.

Re-aluminising the primary mirror of the South African Astronomical Observatory's 74-inch telescope

NASA Astrophysics Data System (ADS)

Crause, Lisa A.; Stoffels, John; Koorts, Willie; Christian, Brendt; de Water, Wilhelmina; Fransman, Timothy; Gibbons, Denville; Machete, Nelson; Sefako, Ramotholo R.; Taaibos, Sinethemba

2016-07-01

Telescope mirrors reside in harsh environments and thus require periodic re-aluminisation to maintain their reflectivity. The SAAO's Sutherland field station suffers from dust and frequent bouts of high humidity. Dust settling on the mirrors adheres to the upward-facing optical surfaces and is not removed by CO2 cleaning. The 74-inch primary mirror was unsuccessfully re-aluminised in April 2015. Parts of the mirror proved difficult to clean and the resulting coating included hazy, white patches in those problem areas. Cotton wool soaked with ferric chloride was used to strip small patches of coating, confirming that no optical surface damage had occurred. The 55 year-old aluminising equipment for the 74-inch required an extensive overhaul and the spruced up system was then used to re-coat the primary mirror in November 2015. We used the same de-ionised water, potassium hydroxide, sodium lauryl sulphate, cotton wool, safety gear and cleaning techniques employed by the mirror coating team at the neighbouring Southern African Large Telescope, as well as their Ocean Optics reflectometer to quantify the improvement in reflectivity. Measurements at 320 nm on different parts of the dirty primary ranged between 10 % and 70 %, while the new coating exceeded 95 % over the entire surface.

Suboptimal palliative sedation in primary care: an exploration.

PubMed

Pype, Peter; Teuwen, Inge; Mertens, Fien; Sercu, Marij; De Sutter, An

2018-02-01

Palliative sedation is a therapeutic option to control refractory symptoms in terminal palliative patients. This study aims at describing the occurrence and characteristics of suboptimal palliative sedations in primary care and at exploring the way general practitioners (GPs) experience suboptimal palliative sedation in their practice. We conducted a mixed methods study with a quantitative prospective survey in primary care and qualitative semi-structured interviews with GPs. The research team defined suboptimal palliative sedation as a time interval until deep sleep >1.5 h and/ or >2 awakenings after the start of the unconsciousness. Descriptive statistics were calculated on the quantitative data. Thematic analysis was used to analyse interview transcripts. We registered 63 palliative sedations in 1181 home deaths, 27 forms were completed. Eleven palliative sedations were suboptimal: eight due to the long time span until deep sleep; three due the number of unintended awakenings. GPs' interview analysis revealed two major themes: the shifting perception of failure and the burden of responsibility. Suboptimal palliative sedation occurs frequently in primary palliative care. Efficient communication towards family members is needed to prevent them from having unrealistic expectations and to prevent putting pressure on the GP to hasten the procedure. Sharing the burden of decision-making during the procedure with other health care professionals might diminish the heavy responsibility as perceived by GPs.

Tidal torques on infrequently colliding particle disks in binary systems and the truncation of the asteroid belt

NASA Technical Reports Server (NTRS)

Franklin, F. A.; Lecar, M.; Lin, D. N. C.; Papaloizou, J.

1980-01-01

Conditions leading to the truncation, at the 2:1 resonance, of a disk of infrequently colliding particles surrounding the primary of a binary system are studied numerically and analytically. Attention is given to the case in which the mass ratio, q, is sufficiently small (less than about 0.1) and the radius of the disk centered on the primary allowably larger, so that first-order orbit-orbit resonances between ring material and the secondary can lie within it. Collisions are found to be less frequent than q to the -2/3 power orbital periods (the period of the forced eccentricity at the 2:1 resonance), and truncation occurs and Kirkwood gaps are produced only if the particle eccentricity is less than some critical value, estimated to be of order q to the 5/9 power, or approximately 0.02 for the sun-Jupiter case having q equal to 10 to the -3rd power.

Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache.

PubMed

Silva, Ariovaldo Alberto da; Brandão, Karina Viana; Faleiros, Bruno Engler; Tavares, Rafael Mattos; Lara, Rodrigo Pinto; Januzzi, Eduardo; Carvalho, Anísio Bueno de; Carvalho, Eliane Maria Duarte de; Gomes, João Bosco Lima; Leite, Frederico Mota Gonçalves; Alves, Betania Mara Franco; Gómez, Rodrigo Santiago; Teixeira, Antônio Lúcio

2014-02-01

Clinical differentiation between the primary headaches and temporomandibular disorders (TMD) can be challenging. To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001). Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001). TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center.

Primary frontal sinus squamous cell carcinoma in three dogs treated with piroxicam combined with carboplatin or toceranib.

PubMed

de Vos, J; Ramos Vega, S; Noorman, E; de Vos, P

2012-09-01

In human medicine, primary frontal sinus squamous cell carcinoma (pFS-SCC) is not frequently reported. In veterinary medicine, frontal sinus SCC is exclusively described as an extension of nasal cavity SCC. To our knowledge, this is the first publication concerning canine pFS-SCC, diagnosed using histology or cytology and medical imaging, in three dogs. The tumours extended into the orbit or brain cavity, without nasal involvement. Treatment was initiated with piroxicam-carboplatin. Prolongation of carboplatin delivery with a low dose intensity was performed on dogs with a favourable initial response. Dog 1 achieved a complete remission (CR), but was euthanized 344 days after start of therapy. Dog 2, still alive 3 years after start of therapy and in CR, received 14 carboplatin deliveries. In dog 3, after changing the treatment protocol into piroxicam-toceranib, a significant tumour reduction occurred, but the dog was euthanized after 195 days because of a relapse. © 2011 Blackwell Publishing Ltd.

Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study.

PubMed

Liu, Dongbin; Cao, Feng; Liu, Jiafeng; Xu, Dahua; Wang, Yuehua; Li, Fei

2017-01-05

Primary closure following laparoscopic common bile duct exploration (LCBDE) has been widely adopted because of the efficacy and safety in treatment of common bile duct (CBD) stones. However, the risk factors for bile leakage, the most common complication after primary closure, has not been clarified yet. A retrospective cohort study of patients who underwent LCBDE with primary closure after choledochotomy between Feb. 2012 and Jun. 2016 was performed. Risk factors for bile leakage were identified by logistic regression inculding demographic factors, preoperative condition and surgical details. Between Feb. 2012 and Jun. 2016, a total of 265 LCBDE procedures were applied in our hospital and 141 patients with primary closure were included in this study. Bile leakage occurred in 11.3% (16/141) of these patients, and happened more frequently in patients with slender CBD (<1 vs ≥1 cm, 31.6% vs 7.0%, p = 0.04) and those managed by inexperienced surgeons (initial 70 cases vs later cases, 17.1% vs 5.6%, p = 0.04). After multivariable regression, the diameter of CBD [OR 95% CI, 3.799 (1.081-13.349), p = 0.04] and experience of surgeons [OR 95% CI, 4.228 (1.330-13.438), p = 0.03] were significantly related to bile leakage. Slender CBD and inexperienced surgeons were the high risk factors for bile leakage after primary closure following LCBDE.

Chronological shifts and changing causes of death after radiotherapy for early-stage oral cancer.

PubMed

Fujisawa, Rina; Shibuya, Hitoshi; Harata, Naoki; Yuasa-Nakagawa, Keiko; Toda, Kazuma; Hayashi, Keiji

2014-02-01

Following recent improvements in the curability of oral cancer, chronological shifts and changes in the causes of death after treatment have been observed. We conducted a review of the post-treatment causes of death following radiotherapy for oral cancers. The medical records of 966 patients with early-stage (stage I and II) oral cancer treated at our institute between 1980 and 2001 were reviewed, and the chronological shifts and changes in the causes of death after radiotherapy were assessed. Of the 966 patients enrolled in this study, 365 have died to date. Two hundred and eleven patients died of their primary malignancy; 193 of these deaths occurred within 5 years of treatment for the primary oral cancer. The second most frequent cause of death was second primary cancer (n = 90). Twenty-three patients with head and neck cancers and 18 patients with esophageal cancers died within 10 years of radiotherapy, and six patients with lung cancers died after more than 10 years. Within the first 5 years following treatment, the major cause of death was the primary oral cancer. After 5-10 years, a second primary cancer, such as head and neck cancer or esophageal cancer, became the leading cause of death. Over a 10-year period, the proportion of deaths from a second primary cancer in the lung was significant. We have demonstrated that there are chronological shifts and changes in the causes of death following treatment for early-stage oral cancer.

Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report.

PubMed

Lin, Tzu-Chieh; Tsai, Chung-Lin; Chang, Yao-Tien; Hu, Sung-Yuan

2018-06-07

Primary aortoduodenal fistula (ADF) is a rare cause of gastrointestinal (GI) bleeding and is difficult to diagnose as the clinical presentation is subtle. Clinicians should keep a high level of suspicion for an unknown etiology of GI bleeding, especially in older patients with or without abdominal aortic aneurysm (AAA). Computed tomographic angiography (CTA) can be used to detect primary ADF. Open surgery or endovascular aortic repair (EVAR) for ADF with bleeding will improve the survival rate. We report a rare case of AAA complicating ADF with massive GI bleeding in a 73-year-old Taiwanese man. He presented with abdominal pain and tarry stool for 5 days and an initial upper GI endoscopy at a rural hospital showed gastric ulcer only, but hypotension with tachycardia and a drop in hemoglobin of 9 g/dl from 12 g/dl occurred the next day. He was referred to our hospital for EVAR and primary closure of fistula defect due to massive GI bleeding with shock from ADF caused by AAA. Diagnosis was made by CTA of aorta. A timely and accurate diagnosis of primary ADF may be challenging due to insidious episodes of GI bleeding, which are frequently under-diagnosed until the occurrence of massive hemorrhage. Clinical physicians should keep a high index of awareness for primary ADF, especially in elderly patients with unknown etiology of upper GI bleeding with or without a known AAA.

[Frequent attendance: the primary care professional's perceptions on the influence of social factors and health care system organisation].

PubMed

Sandín-Vázquez, M; Conde-Espejo, P

2011-01-01

FREQUENT ATTENDANCE: The primary care professional's perceptions on the influence of social factors and health care system organisation. To find out the primary care (PC) professional's perceptions on the social factors and healthcare system organisation that influence frequent attendance. A qualitative study using semi-structured interviews in Primary Care Centres of six Health Areas in the Community of Madrid. Eighteen interviews were conducted, three per area (two physicians and one nurse). Structural sampling was carried out with regards to the variables that could influence the discourse: health area, occupation, sex and number of years worked. The transcriptions were analysed by two investigators and an agreement of interpretation was reached. Among the social factors, health professionals perceived as determining factors: the influence of the media and the medicalization of society, lack of health education and self-care abilities of the population and contextual factors of the patient (social, work and family). Among the health care organisation factors that could influence frequent attendance were, system saturation, appointment on demand, fear of potential lawsuits by the patient, chronic patients protocols, administrative consultations, professional behaviour, and poor coordination with specialised care. According to PC professionals, there are multiple environmental factors, both social and healthcare system organisational factors that encourage frequent attendance. Within the scope of health care system, organisational actions (such as teamwork and coordination with specialists) would help to manage demand. Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.

Worsening renal function and outcome in heart failure patients with preserved ejection fraction and the impact of angiotensin receptor blocker treatment.

PubMed

Damman, Kevin; Perez, Ana C; Anand, Inder S; Komajda, Michel; McKelvie, Robert S; Zile, Michael R; Massie, Barrie; Carson, Peter E; McMurray, John J V

2014-09-16

Worsening renal function (WRF) associated with renin-angiotensin-aldosterone system (RAAS) inhibition does not confer excess risk in heart failure patients with reduced ejection fraction (HFrEF). The goal of this study was to investigate the relationship between WRF and outcomes in heart failure patients with preserved ejection fraction (HFpEF) and the interaction with RAAS blockade. In 3,595 patients included in the I-PRESERVE (Irbesartan in Heart Failure With Preserved Ejection Fraction) trial, change in estimated glomerular filtration rate (eGFR) and development of WRF after initiation of irbesartan or placebo were examined. We examined the association between WRF and the first occurrence of cardiovascular death or heart failure hospitalization (primary outcome in this analysis) and the interaction with randomized treatment. Estimated GFR decreased early with irbesartan treatment and remained significantly lower than in the placebo group. WRF developed in 229 (6.4%) patients and occurred more frequently with irbesartan treatment (8% vs. 4%). Overall, WRF was associated with an increased risk of the primary outcome (adjusted hazard ratio [HR]: 1.43; 95% confidence interval [CI]: 1.10 to 1.85; p = 0.008). Although the risk related to WRF was greater in the irbesartan group (HR: 1.66; 95% CI: 1.21 to 2.28; p = 0.002) than with placebo (HR: 1.09; 95% CI: 0.66 to 1.79; p = 0.73), the interaction between treatment and WRF on outcome was not significant in an adjusted analysis. The incidence of WRF in HFpEF was similar to that previously reported in HFrEF but more frequent with irbesartan than with placebo. WRF after initiation of irbesartan treatment in HFpEF was associated with excess risk, in contrast to WRF occurring with RAAS blockade in HFrEF. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

A case report: a young waiter with Paget-Schroetter syndrome.

PubMed

Drakos, Nicholas; Gausche-Hill, Marianne

2013-03-01

Paget-Schroetter syndrome (PSS) is a rare presentation of primary axillary subclavian vein thrombosis that classically occurs in young men with a degree of underlying thoracic outlet syndrome after a period of upper extremity exertion. The primary complication of PSS is post-thrombotic syndrome, a result of chronic venous hypertension. To educate Emergency Physicians on this condition to potentiate timely diagnosis and appropriate disposition. A 29-year-old right-handed restaurant waiter presented with 3 days of non-painful, gradual-onset right upper extremity swelling with normal vital signs. The patient's history was otherwise notable for subjective fevers and a right forearm abrasion. Upon examination, the right upper extremity was neurovascularly intact and remarkable for uniform edema and erythema extending distally from the level of the mid-humerus. The primary differential diagnoses were deep venous thrombosis (DVT) vs. soft tissue infection. Venous phase contrast computed tomography did not reveal evidence of underlying soft tissue infection and was inconclusive regarding a DVT. Ultrasound demonstrated a right subclavian vein DVT. The patient was admitted and underwent thrombolysis, venolysis, and first rib resection and initiation of warfarin. PSS is a rare presentation of upper-extremity DVT occurring classically in patients without commonly recognized pro-thrombotic risk factors. PSS carries the potential of significant morbidity in the form of post-thrombotic syndrome and pulmonary embolism. Current literature suggests that optimal outcomes are achieved when treatment is initiated within 6 weeks of onset. The treatment paradigm calls for thrombolysis and, frequently, a first rib resection. Copyright © 2013 Elsevier Inc. All rights reserved.

Disentangling invasion processes in a dynamic shipping-boating network.

PubMed

Lacoursière-Roussel, Anaïs; Bock, Dan G; Cristescu, Melania E; Guichard, Frédéric; Girard, Philippe; Legendre, Pierre; McKindsey, Christopher W

2012-09-01

The relative importance of multiple vectors to the initial establishment, spread and population dynamics of invasive species remains poorly understood. This study used molecular methods to clarify the roles of commercial shipping and recreational boating in the invasion by the cosmopolitan tunicate, Botryllus schlosseri. We evaluated (i) single vs. multiple introduction scenarios, (ii) the relative importance of shipping and boating to primary introductions, (iii) the interaction between these vectors for spread (i.e. the presence of a shipping-boating network) and (iv) the role of boating in determining population similarity. Tunicates were sampled from 26 populations along the Nova Scotia, Canada, coast that were exposed to either shipping (i.e. ports) or boating (i.e. marinas) activities. A total of 874 individuals (c. 30 per population) from five ports and 21 marinas was collected and analysed using both mitochondrial cytochrome c oxidase subunit I gene (COI) and 10 nuclear microsatellite markers. The geographical location of multiple hotspot populations indicates that multiple invasions have occurred in Nova Scotia. A loss of genetic diversity from port to marina populations suggests a stronger influence of ships than recreational boats on primary coastal introductions. Population genetic similarity analysis reveals a dependence of marina populations on those that had been previously established in ports. Empirical data on marina connectivity because of boating better explains patterns in population similarities than does natural spread. We conclude that frequent primary introductions arise by ships and that secondary spread occurs gradually thereafter around individual ports, facilitated by recreational boating. © 2012 Blackwell Publishing Ltd.

Polythelia associated with disturbances of cardiac conduction.

PubMed

Máté, K; Horváth, J; Schmidt, J; Kulcsár, M; Erdei, M; Bálint, Z S; Nagy, M

1979-01-01

The authors examined three groups of persons (hospitalized patients, outpatients, and school girls) and conclude that in the cases of polythelia the cardiac conduction disturbances occur considerably more frequently than in persons without polythelia. When polythelia and conduction disturbances occur frequently in a family, the coexistence of both disorders is most probably of hereditary origin.

Use of complementary and alternative medicine by a sample of Turkish primary headache patients.

PubMed

Karakurum Göksel, Başak; Coşkun, Özlem; Ucler, Serap; Karatas, Mehmet; Ozge, Aynur; Ozkan, Secil

2014-01-01

Complementary and alternative medicine (CAM) is increasingly being used as adjunctive treatment in primary headache syndromes in many countries. In the Turkish population, no epidemiologic data have been reported about awareness and usage of these treatments in patients with headache. One hundred and ten primary headache patients attending three headache clinics completed a questionnaire regarding their headaches, the known modalities and the use and effect of CAM procedures for their headaches. The mean age of the patients was 34.7±9.6 years (32.8-36.5). Almost two-thirds of patients had completed high school and university, and one-third of patients were housewives. Migraine without aura (45.5%) was the most frequently diagnosed type of headache followed by migraine with aura (19.1%) and tension-type headache (18.2%). In 43.6% of the patients, headache frequency was 5-10 per month. The most frequently known CAM modalities were massage (74.5%), acupuncture (44.5%), yoga (31.8%), exercise (28.2%), psychotherapy (25.5%), and rosemary (23.6%). The most frequently used CAM treatments were massage (51%) and exercise (11%). Only massage was reported to be beneficial in one-third of the primary headache patients; the other modalities were not. Our findings suggest that the subgroup of primary headache patients in Turkey seek and use alternative treatments, frequently in combination with standard treatments. Neurologists should become more knowledgeable regarding CAM therapies; further randomized and controlled clinical researches with large sample sizes are needed.

Co-Occurrence of Language and Behavioural Change in Frontotemporal Lobar Degeneration.

PubMed

Harris, Jennifer M; Jones, Matthew; Gall, Claire; Richardson, Anna M T; Neary, David; du Plessis, Daniel; Pal, Piyali; Mann, David M A; Snowden, Julie S; Thompson, Jennifer C

2016-01-01

We aimed to evaluate the co-occurrence of language and behavioural impairment in patients with frontotemporal lobar degeneration (FTLD) spectrum pathology. Eighty-one dementia patients with pathological confirmation of FTLD were identified. Anonymized clinical records from patients' first assessment were rated for language and behavioural features from frontotemporal dementia consensus criteria, primary progressive aphasia (PPA) criteria and 1998 FTLD criteria. Over 90% of patients with FTLD pathology exhibited a combination of at least one behavioural and one language feature. Changes in language, in particular, were commonly accompanied by behavioural change. Notably, the majority of patients who displayed language features characteristic of semantic variant PPA exhibited 'early perseverative, stereotyped or compulsive/ritualistic behaviour'. Moreover, 'executive/generation deficits with relative sparing of memory and visuospatial functions' occurred in most patients with core features of non-fluent variant PPA. Behavioural and language symptoms frequently co-occur in patients with FTLD pathology. Current classifications, which separate behavioural and language syndromes, do not reflect this co-occurrence.

Impact of persistent, frequent regurgitation on quality of life in heartburn responders treated with acid suppression: a multinational primary care study.

PubMed

Kahrilas, P J; Howden, C W; Wernersson, B; Denison, H; Nuevo, J; Gisbert, J P

2013-05-01

In gastro-oesophageal reflux disease (GERD), heartburn responds well to acid suppression, but regurgitation is a common cause of incomplete treatment response. To assess the prevalence and burden of persistent, frequent regurgitation in primary care patients with GERD treated with acid suppression. We analysed observational data from 134 sites across six European countries in patients diagnosed with GERD. Within 3 months of the index visit, symptoms were assessed using the Reflux Disease Questionnaire, and their impact on sleep and work productivity with the Quality of Life in Reflux and Dyspepsia questionnaire and the Work Productivity and Activity Impairment Questionnaire, respectively. Patients provided information on concomitant over-the-counter (OTC) GERD medication use. Persistent, frequent (3-7 days/week) regurgitation was reported by 13.2% (153/1156) of GERD patients with no heartburn on acid suppression; the prevalence was very similar for patients with up to 2 days/week of ongoing mild heartburn. Among patients without heartburn, sleep disturbance of any type was reported by 50.7-60.1% with persistent, frequent regurgitation, compared with 38.1-51.1% and 14.4-19.2% of those with less frequent or no regurgitation respectively. Persistent, frequent regurgitation was associated with increased use of OTC medication and more hours of work missed, whether mild, infrequent heartburn was present or not. Frequent regurgitation, which persisted in 12-13% of patients with no or infrequent, mild heartburn on acid suppression, negatively affected sleep and work productivity, and increased use of OTC medication. Persistent, frequent regurgitation is problematic for primary care patients with GERD. © 2013 Blackwell Publishing Ltd.

Targetable genetic features of primary testicular and primary central nervous system lymphomas

PubMed Central

Chapuy, Bjoern; Roemer, Margaretha G. M.; Stewart, Chip; Tan, Yuxiang; Abo, Ryan P.; Zhang, Liye; Dunford, Andrew J.; Meredith, David M.; Thorner, Aaron R.; Jordanova, Ekaterina S.; Liu, Gang; Feuerhake, Friedrich; Ducar, Matthew D.; Illerhaus, Gerald; Gusenleitner, Daniel; Linden, Erica A.; Sun, Heather H.; Homer, Heather; Aono, Miyuki; Pinkus, Geraldine S.; Ligon, Azra H.; Ligon, Keith L.; Ferry, Judith A.; Freeman, Gordon J.; van Hummelen, Paul; Golub, Todd R.; Getz, Gad; Rodig, Scott J.; de Jong, Daphne; Monti, Stefano

2016-01-01

Primary central nervous system lymphomas (PCNSLs) and primary testicular lymphomas (PTLs) are extranodal large B-cell lymphomas (LBCLs) with inferior responses to current empiric treatment regimens. To identify targetable genetic features of PCNSL and PTL, we characterized their recurrent somatic mutations, chromosomal rearrangements, copy number alterations (CNAs), and associated driver genes, and compared these comprehensive genetic signatures to those of diffuse LBCL and primary mediastinal large B-cell lymphoma (PMBL). These studies identify unique combinations of genetic alterations in discrete LBCL subtypes and subtype-selective bases for targeted therapy. PCNSLs and PTLs frequently exhibit genomic instability, and near-uniform, often biallelic, CDKN2A loss with rare TP53 mutations. PCNSLs and PTLs also use multiple genetic mechanisms to target key genes and pathways and exhibit near-uniform oncogenic Toll-like receptor signaling as a result of MYD88 mutation and/or NFKBIZ amplification, frequent concurrent B-cell receptor pathway activation, and deregulation of BCL6. Of great interest, PCNSLs and PTLs also have frequent 9p24.1/PD-L1/PD-L2 CNAs and additional translocations of these loci, structural bases of immune evasion that are shared with PMBL. PMID:26702065

Health information management in the home: a human factors assessment.

PubMed

Zayas-Cabán, Teresa

2012-01-01

Achieving optimal health outcomes requires that consumers maintain myriad health data and understand how to utilize appropriate health information management applications. This case study investigated four families' health information management tasks in their homes. Four different families participated in the study: a single parent household; two nuclear family households; and an extended family household. A work system model known as the balance model was used as a guiding framework for data collection. Data collection consisted of three stages: (1) primary health information manager interviews; (2) family interviews; and (3) task observations. Overall, families reported 69 unique health information management tasks that took place in nine different locations, using 22 different information storage artifacts. Frequently occurring tasks related to health management or health coordination were conducted in public spaces. Less frequent or more time-consuming tasks, such as researching a health concern or storing medical history, were performed in private spaces such as bedrooms or studies. Similarities across households suggest potential foundational design elements that consumer health information technology application designers need to balance with tailored interventions to successfully support variations in individuals' health information management needs.

Source and long-term behavior of transuranic aerosols in the WIPP environment.

PubMed

Thakur, P; Lemons, B G

2016-10-01

Source and long-term behavior transuranic aerosols ((239+240)Pu, (238)Pu, and (241)Am) in the ambient air samples collected at and near the Waste Isolation Pilot Plant (WIPP) deep geologic repository site were investigated using historical data from an independent monitoring program conducted by the Carlsbad Environmental Monitoring and Research Center and an oversight monitoring program conducted by the management and operating contractor for WIPP at and near the facility. An analysis of historical data indicates frequent detections of (239+240)Pu and (241)Am, whereas (238)Pu is detected infrequently. Peaks in (239+240)Pu and (241)Am concentrations in ambient air generally occur from March to June timeframe, which is when strong and gusty winds in the area frequently give rise to blowing dust. Long-term measurements of plutonium isotopes (1985-2015) in the WIPP environment suggest that the resuspension of previously contaminated soils is likely the primary source of plutonium in the ambient air samples from WIPP and its vicinity. There is no evidence that WIPP is a source of environmental contamination that can be considered significant by any health-based standard.

Facial lacerations in children.

PubMed

Hwang, Kun; Huan, Fan; Hwang, Pil Joong; Sohn, In Ah

2013-03-01

The aim of this study was to evaluate the demographics and treatment of facial lacerations in pediatric patients. A retrospective record-based analysis was administered on 3783 patients (<15 years of age) presenting with facial lacerations from March 2002 to February 2011. Males were injured more frequently across all age groups (65.3%) and especially in the 13- to 15-year-old group (81.3%) (P = 0.012, Pearson χ). Overall, 48.9% of injuries occurred outdoors and 45.1% in homes. Only 6.0% occurred in schools or kindergartens. Injuries that occurred in schools or kindergarten increased with the age groups (from 2.3% for 0- to 3-year-olds to 19.1% for 13- to 15-year-olds). In the age groups younger than 12 years, injury occurred more frequently on the weekend. In the 13-to 15-year-old group, however, injury occurred more frequently on weekdays (odds ratio, 2.46). Injury occurred most frequently at the times of 7 to 9 PM and least frequently from midnight to 6 AM. The most frequent cause of injury in children was by being struck or by bumping something (32.5%), followed by slip-down (31.5%). Accidents involving furniture and stairs accounted for 9% each. Accidents caused by stairs decreased with age (from 10.2% for 0-3 years of age to 5.5% for 13-15 years of age, P = 0.000, Pearson χ). In a little less than half (47.2%) of the cases, parents accompanied their children at the time of injury. In the 13- to 15-year age group, only 17.9% of the children were accompanied by their parents. Foreheads (26.4%) took the brunt of most frequent injuries, followed by the eyelids (20.6%), eyebrows including the glabella (19.7%), and chin injuries (15.7%). Only 58 cases had associated injuries. Among 3783 cases of facial lacerations, 3745 patients did not have facial bone fractures or associated injuries and were managed under local anesthesia or through dressings only. A sound knowledge about the epidemiology of lacerations might be beneficial for the prevention of pediatric facial lacerations, which occurs more frequently than facial fractures. It is noteworthy that slip-down showed a peak in kindergarteners (4-6 years, 36.1%) and then decreased with age. The incidence of slip-down might be reduced if attention is paid when the kindergarteners are walking on steep stairs or steep flights of stairs. Injury at the educational institutions increases with the pupil's age, and therefore safety management in schools is important.

Retrospective Analysis of Opioid Medication Incidents Requiring Administration of Naloxone

PubMed Central

Neil, Katherine; Marcil, Allison; Kosar, Lynette; Dumont, Zack; Ruda, Lisa; McMillan, Kaitlyn

2013-01-01

Background: Opioid analgesics are high-alert medications known to cause adverse drug events. Objectives: The purpose of this study was to determine the cause of opioid incidents requiring administration of naloxone, an opioid reversal agent. The specific objectives were to determine the number of opioid incidents and the proportion of incidents documented through occurrence reporting and to characterize the incidents by phase in the medication-use process, by type of incident, and by drug responsible for toxic effects. Methods: A retrospective chart analysis was conducted using records from 2 acute care centres in the Regina Qu’Appelle Health Region. The study included inpatients who received naloxone for reversal of opioid toxicity resulting from licit, in-hospital opioid use. Cases were classified as preventable or nonpreventable. Preventable cases were analyzed to determine the phase of the medication-use process during which the incident occurred. These cases were also grouped thematically by the type of incident. The drug most likely responsible for opioid toxicity was determined for each case. The proportion of cases documented by occurrence reporting was also noted. Results: Thirty-six cases involving administration of naloxone were identified, of which 29 (81%) were deemed preventable. Of these 29 preventable cases, the primary medication incident occurred most frequently in the prescribing phase (23 [79%]), but multiple phases were often involved. The cases were grouped into 6 themes according to the type of incident. Morphine was the drug that most frequently resulted in toxic effects (18 cases [50%]). Only two of the cases (5.6%) were documented by occurrence reports. Conclusion: Preventable opioid incidents occurred in the acute care centres under study. A combination of medication safety initiatives involving multiple disciplines may be required to decrease the incidence of these events and to better document their occurrence. PMID:24159230

A high-throughput analysis of the IDH1(R132H) protein expression in pituitary adenomas.

PubMed

Casar-Borota, Olivera; Øystese, Kristin Astrid Berland; Sundström, Magnus; Melchior, Linea; Popovic, Vera

2016-08-01

Inactivating mutations of isocitrate dehydrogenase (IDH) 1 and 2, mitochondrial enzymes participating in the Krebs tricarboxylic acid cycle play a role in the tumorigenesis of gliomas and also less frequently in acute myeloid leukemia and other malignancies. Inhibitors of mutant IDH1 and IDH2 may potentially be effective in the treatment of the IDH mutation driven tumors. Mutations in the succinate dehydrogenase, the other enzyme complex participating in the Krebs cycle and electron transfer of oxidative phosphorylation occur in the paragangliomas, gastrointestinal stromal tumors, and occasionally in the pituitary adenomas. We aimed to determine whether the IDH1(R132H) mutation, the most frequent IDH mutation in human malignancies, occurs in pituitary adenomas. We performed immunohistochemical analysis by using a monoclonal anti-IDH1(R132H) antibody on the tissue microarrays containing specimens from the pituitary adenomas of different hormonal types from 246 patients. In positive samples, the status of the IDH1 gene was further examined by molecular genetic analyses. In all but one patient, there was no expression of mutated IDH1(R132H) protein in the tumor cells by immunohistochemistry. Only one patient with a recurring clinically non-functioning gonadotroph adenoma demonstrated IDH1(R132H)-immunostaining in both the primary tumor and the recurrence. However, no mutation in the IDH1 gene was detected using different molecular genetic analyses. IDH1(R132H) mutation occurs only exceptionally in pituitary adenomas and does not play a role in their pathogenesis. Patients with pituitary adenomas do not seem to be candidates for treatment with the inhibitors of mutant IDH1.

Paraheliotropic leaf movement in Siratro as a protective mechanism against drought-induced damage to primary photosynthetic reactions: damage by excessive light and heat.

PubMed

Ludlow, M M; Björkman, O

1984-11-01

Damage to primary photosynthetic reactions by drought, excess light and heat in leaves of Macroptilium atropurpureum Dc. cv. Siratro was assessed by measurements of chlorophyll fluorescence emission kinetics at 77 K (-196°C). Paraheliotropic leaf movement protected waterstressed Siratro leaves from damage by excess light (photoinhibition), by heat, and by the interactive effects of excess light and high leaf temperatures. When the leaves were restrained to a horizontal position, photoinhibition occurred and the degree of photoinhibitory damage increased with the time of exposure to high levels of solar radiation. Severe inhibition was followed by leaf death, but leaves gradually recovered from moderate damage. This drought-induced photoinhibitory damage seemed more closely related to low leaf water potential than to low leaf conductance. Exposure to leaf temperatures above 42°C caused damage to the photosynthetic system even in the dark and leaves died at 48°C. Between 42 and 48°C the degree of heat damage increased with the time of exposure, but recovery from moderate heat damage occurred over several days. The threshold temperature for direct heat damage increased with the growth temperature regime, but was unaffected by water-stress history or by current leaf water status. No direct heat damage occurred below 42°C, but in water-stressed plants photoinhibition increased with increasing leaf temperature in the range 31-42°C and with increasing photon flux density up to full sunglight values. Thus, water stress evidently predisposes the photosynthetic system to photoinhibition and high leaf temperature exacerbates this photoinhibitory damage. It seems probable that, under the climatic conditions where Siratro occurs in nature, but in the absence of paraheliotropic leaf movement, photoinhibitory damage would occur more frequently during drought than would direct heat damage.

Epidemiological, Clinical and Pathological Features of Primary Cardiac Hemangiosarcoma in Dogs: A Review of 51 Cases

PubMed Central

YAMAMOTO, Shinya; HOSHI, Katsuichiro; HIRAKAWA, Atsushi; CHIMURA, Syuuichi; KOBAYASHI, Masayuki; MACHIDA, Noboru

2013-01-01

ABSTRACT In the study presented here, we aimed to describe the epidemiological, clinical and pathological findings of 51 canine cases with histologically-verified diagnoses of primary cardiac hemangiosarcoma (HSA). The medical data for each dog, including signalment, presenting complaints, physical examination findings, results of various diagnostic testing performed and method of treatment, were checked. In addition, all 51 cases were re-examined pathologically. The tumor occurred most frequently in older Golden Retrievers, followed by Maltese dogs and Miniature Dachshunds. Mass lesions of HSA were found more commonly in the right auricle (RAu) (25/51) and right atrium (RA) (21/51), and the RA masses were significantly (P<0.001) larger than the RAu masses. The echocardiographic detection rate of masses in the RAu group (60%; 15/25) was significantly lower than that in the RA group (95%; 20/21). Survival time was significantly (P<0.05) longer for 5 dogs that received adjuvant chemotherapy after tumor resection than for 12 dogs that did not. In this series, the Maltese (9/51) and Miniature Dachshund (7/51), as well as the Golden Retriever, were represented more frequently than other breeds. The lower echocardiographic detection rate of RAu masses compared with RA masses may be related to tumor size and/or location. The significantly longer survival time for dogs receiving adjuvant chemotherapy indicates that postoperative chemotherapy could be useful for dogs with cardiac HSA. PMID:23811814

Reproductive biology of Echinopsis terscheckii (Cactaceae): the role of nocturnal and diurnal pollinators.

PubMed

Ortega-Baes, P; Saravia, M; Sühring, S; Godínez-Alvarez, H; Zamar, M

2011-01-01

The aim of this study was to analyse the reproductive biology of Echinopsis terscheckii, a species endemic to northwest Argentina that has nocturnal flowers. We expected that this species had a generalised pollination system, with moths and diurnal visitors as the primary pollinators. To test this, we studied the floral biology, breeding system and floral visitors of this species and the effectiveness of nocturnal and diurnal visitors. Floral biology was defined based on floral morphology, floral cycle and nectar production of the flowers. The breeding system and relative contributions of diurnal and nocturnal visitors to fruit and seed set were analysed through field experiments. E. terscheckii flowers opened at sunset and closed the following day. The peak of nectar production occurred at midnight. Flowers were determined to be self-incompatible. Moths, bees and birds were identified as floral visitors. Moths were the most frequent visitors at night, whereas bees were the most frequent visitors during the day. Fruit production by diurnal pollinators was less than that by nocturnal pollinators; among all floral visitors, moths were the most effective pollinators. We have demonstrated for the first time that moths are the primary pollinators of columnar cacti of the genus Echinopsis. Our results suggest that moths might be important pollinators of columnar cactus species with nocturnal flowers in the extra-tropical deserts of South America. © 2010 German Botanical Society and The Royal Botanical Society of the Netherlands.

Paragonimiasis: a common cause of persistent pleural effusion in Lao PDR.

PubMed

Vidamaly, Sisoupanh; Choumlivong, Khamla; Keolouangkhot, Valy; Vannavong, Nanthasane; Kanpittaya, Jaturat; Strobel, Michel

2009-10-01

Southeast Asia is the major endemic area for paragonimiasis. Diagnosis relies on identification of ova in the sputum, pleural fluid or tissue specimen, or serology. Low awareness, however, frequently results in the disease being overlooked. We report nine cases presenting as primary, massive and protracted pleural effusions. All patients had evidence of Paragonimus spp. in the pleural fluid; one discharged an adult worm through a chest tube during treatment with praziquantel. In three cases, resolution of symptoms and pleural effusions could not be achieved, despite repeated fluid evacuation procedures and courses of praziquantel, which contradicts the widely accepted statement of paragonimiasis being self-limited and easy to cure. The disease should be considered in any case of elusive pleural effusion occurring in endemic areas.

Biomarkers for CNS involvement in pediatric lupus

PubMed Central

Rubinstein, Tamar B; Putterman, Chaim; Goilav, Beatrice

2015-01-01

CNS disease, or central neuropsychiatric lupus erythematosus (cNPSLE), occurs frequently in pediatric lupus, leading to significant morbidity and poor long-term outcomes. Diagnosing cNPSLE is especially difficult in pediatrics; many current diagnostic tools are invasive and/or costly, and there are no current accepted screening mechanisms. The most complicated aspect of diagnosis is differentiating primary disease from other etiologies; research to discover new biomarkers is attempting to address this dilemma. With many mechanisms involved in the pathogenesis of cNPSLE, biomarker profiles across several modalities (molecular, psychometric and neuroimaging) will need to be used. For the care of children with lupus, the challenge will be to develop biomarkers that are accessible by noninvasive measures and reliable in a pediatric population. PMID:26079959

Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention.

PubMed

Morriss, Richard; Kai, Joe; Atha, Christopher; Avery, Anthony; Bayes, Sara; Franklin, Matthew; George, Tracey; James, Marilyn; Malins, Samuel; McDonald, Ruth; Patel, Shireen; Stubley, Michelle; Yang, Min

2012-07-06

The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6-22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention.

An Analysis of the Most Frequently Occurring Words in Spoken American English.

ERIC Educational Resources Information Center

Plant, Geoff

1999-01-01

A study analyzed frequency of occurrence of consonants, vowels, and diphthongs, syllabic structure of the words, and segmental structure of the 311 monosyllabic words of 500 words that occur most frequently in English. Three mannerisms of articulation accounted for nearly 75 percent of all consonant occurrences: stops, semi-vowels, and nasals.…

Paediatric team handover: a time to learn?

PubMed

Bradley, Stephen; Egan, John P; Henning, Marcus

2018-06-08

Paediatric team handovers provide medical professionals and students with the opportunity to exchange clinically relevant information about patients. This study explored the extent to which learning opportunities existed and were utilised within paediatric team handovers in New Zealand secondary hospitals. We undertook a qualitative, two-site case study within two paediatric departments in 2014 and 2015, and interviewed 29 participants, including medical students, junior doctors and consultants. We conducted a thematic analysis using a general inductive approach. Participants' narratives revealed that safe transfer of pertinent patient information between clinicians was the primary function of team handover. They described learning as an additional key component. Most learning opportunities were reported to be informal and opportunistic, related to the specific patients whose care was discussed within each handover. Handover team members indicated that implicit learning occurred as a feature of their handover experience. Learning opportunities exist within team handovers and the associated learning frequently occurs either opportunistically or implicitly. Adoption of a reflective approach to learning opportunities is likely to result in improved educational experiences for handover participants, particularly medical students and junior doctors. Handover represents a clinical event within which valuable workplace learning occurs.

[Parvovirus B19 infection after kidney transplantation].

PubMed

Brodin-Sartorius, Albane; Mekki, Yahia; Bloquel, Bénédicte; Rabant, Marion; Legendre, Christophe

2012-02-01

Prevalence for human parvovirus B19 infection is estimated to be between 2% and 30% in renal transplant recipients. In post-transplant settings, parvovirus B19 infection may occur either as a primary infection or a reactivation. Parvovirus transmission most commonly occurs through respiratory tract but may also result from graft or blood packs contamination. Co-infections with HHV-6 and CMV viruses are frequent. The hallmark symptom is anemia, more rarely pancytopenia and hemophagocytic syndrome. In respect to renal involvement, parvovirus B19 infection has been associated with graft dysfunction in 10% of cases. Both thrombotic microangiopathies and collapsing glomerulopathies have been reported concomitantly with parvovirus B19 infection but the causal link remains unclear. Other complications are seldomly reported, including hepatitis, encephalitis, and myocarditis. Diagnosis is based on pre and post-transplant serological status. In addition, the management of parvovirus B19 infection in immunocompromised patients requires quantitative assessment of blood viral load by PCR. The treatment relies primarily on reduction of immunosuppression combined with intravenous immunoglobulin infusions. Relapses occur in 30% of cases. Copyright © 2011 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

Comparison of the basin-scale effect of dredging operations and natural estuarine processes on suspended sediment concentration

USGS Publications Warehouse

Schoellhamer, D.H.

2002-01-01

Suspended sediment concentration (SSC) data from San Pablo Bay, California, were analyzed to compare the basin-scale effect of dredging and disposal of dredged material (dredging operations) and natural estuarine processes. The analysis used twelve 3-wk to 5-wk periods of mid-depth and near-bottom SSC data collected at Point San Pablo every 15 min from 1993-1998. Point San Pablo is within a tidal excursion of a dredged-material disposal site. The SSC data were compared to dredging volume, Julian day, and hydrodynamic and meteorological variables that could affect SSC. Kendall's ??, Spearman's ??, and weighted (by the fraction of valid data in each period) Spearman's ??w correlation coefficients of the variables indicated which variables were significantly correlated with SSC. Wind-wave resuspension had the greatest effect on SSC. Median water-surface elevation was the primary factor affecting mid-depth SSC. Greater depths inhibit wind-wave resuspension of bottom sediment and indicate greater influence of less turbid water from down estuary. Seasonal variability in the supply of erodible sediment is the primary factor affecting near-bottom SSC. Natural physical processes in San Pablo Bay are more areally extensive, of equal or longer duration, and as frequent as dredging operations (when occurring), and they affect SSC at the tidal time scale. Natural processes control SSC at Point San Pablo even when dredging operations are occurring.

Epilepsy and headaches: Further evidence of a link.

PubMed

Çilliler, Asli Ece; Güven, Hayat; Çomoğlu, Selim Selçuk

2017-05-01

Epilepsy and primary headaches are two of the most common neurologic conditions that share some common clinical characteristics, and can affect individuals of all age groups around the world. In recent years, the underlying pathophysiologic mechanisms potentially common to both headaches and epileptic seizures have been the subject of scrutiny. The objective of this study was to determine the frequencies and types of headaches in patients with epilepsy, and evaluate any temporal relationship with epileptic seizures. Demographic data, epilepsy durations, seizure frequencies, seizure types and antiepileptic medications used were captured of 349 patients who were followed up at our epilepsy outpatient clinic. Patients who experienced headaches were grouped based on the type of headaches and on whether their headaches occurred in the preictal, postictal or interictal period. Three hundred forty-nine patients (190 females, 159 males) were enrolled in the study. The patients' average age was 30.9±13.1 years, and average epilepsy duration was 13.5±10.9 years. The types of epileptic seizures were partial in 19.8% of patients, generalized in 57.9%, and secondary generalized in 20.3% of patients. Some 43.6% of the patients did not experience headaches, and 26.9% had migraine and 17.2% tension-type headaches. Headaches could not be classified in 12.3% of patients. The headaches occurred preictally in 9.6%, postictally in 41.6% and interictally in 8.6% of patients. The ratio of headaches was lower in male patients compared with females, and females experienced migraine-type headaches more frequently compared with males (p=0.006). Migraine-type headaches were less frequent a mong patients who experienced less than one seizure per year, but more frequent (p=0.017) among those who experienced more than one seizure per month, but less than one seizure per week. Migraine-type headaches were significantly more frequent (p=0.015) among patients receiving polytherapy compared with patients receiving monotherapy. The results of this study suggest that headaches, particularly migraine-type headaches, were frequently experienced by patients with epilepsy, postictal headaches were more common, and the frequency of migraine attacks could be linked with seizure frequency and the type of treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Mind wandering while reading easy and difficult texts.

PubMed

Feng, Shi; D'Mello, Sidney; Graesser, Arthur C

2013-06-01

Mind wandering is a phenomenon in which attention drifts away from the primary task to task-unrelated thoughts. Previous studies have used self-report methods to measure the frequency of mind wandering and its effects on task performance. Many of these studies have investigated mind wandering in simple perceptual and memory tasks, such as recognition memory, sustained attention, and choice reaction time tasks. Manipulations of task difficulty have revealed that mind wandering occurs more frequently in easy than in difficult conditions, but that it has a greater negative impact on performance in the difficult conditions. The goal of this study was to examine the relation between mind wandering and task difficulty in a high-level cognitive task, namely reading comprehension of standardized texts. We hypothesized that reading comprehension may yield a different relation between mind wandering and task difficulty than has been observed previously. Participants read easy or difficult versions of eight passages and then answered comprehension questions after reading each of the passages. Mind wandering was reported using the probe-caught method from several previous studies. In contrast to the previous results, but consistent with our hypothesis, mind wandering occurred more frequently when participants read difficult rather than easy texts. However, mind wandering had a more negative influence on comprehension for the difficult texts, which is consistent with the previous data. The results are interpreted from the perspectives of the executive-resources and control-failure theories of mind wandering, as well as with regard to situation models of text comprehension.

SIDECACHE: Information access, management and dissemination framework for web services.

PubMed

Doderer, Mark S; Burkhardt, Cory; Robbins, Kay A

2011-06-14

Many bioinformatics algorithms and data sets are deployed using web services so that the results can be explored via the Internet and easily integrated into other tools and services. These services often include data from other sites that is accessed either dynamically or through file downloads. Developers of these services face several problems because of the dynamic nature of the information from the upstream services. Many publicly available repositories of bioinformatics data frequently update their information. When such an update occurs, the developers of the downstream service may also need to update. For file downloads, this process is typically performed manually followed by web service restart. Requests for information obtained by dynamic access of upstream sources is sometimes subject to rate restrictions. SideCache provides a framework for deploying web services that integrate information extracted from other databases and from web sources that are periodically updated. This situation occurs frequently in biotechnology where new information is being continuously generated and the latest information is important. SideCache provides several types of services including proxy access and rate control, local caching, and automatic web service updating. We have used the SideCache framework to automate the deployment and updating of a number of bioinformatics web services and tools that extract information from remote primary sources such as NCBI, NCIBI, and Ensembl. The SideCache framework also has been used to share research results through the use of a SideCache derived web service.

Resiliency: Planning Ahead for Disasters - Continuum Magazine | NREL

Science.gov Websites

a proactive approach to lessen the impacts of climate change as disasters occur more frequently and approach to lessen the impacts of climate change as disasters occur more frequently and with greater climate change. A photo of the silhouette of three men in construction uniforms as the walk toward the

Dental anomalies in 14 patients with IP: clinical and radiological analysis and review.

PubMed

Santa-Maria, Fernanda D; Mariath, Luiza Monteavaro; Poziomczyk, Cláudia S; Maahs, Marcia A P; Rosa, Rafael F M; Zen, Paulo R G; Schüller-Faccini, Lavínia; Kiszewski, Ana Elisa

2017-06-01

Current knowledge on dental anomalies in patients with incontinentia pigmenti (IP) has been obtained by examining case reports; however, an overall characterization of such alterations remains lacking. The objective of this study was to determine the frequency, type and location of dental alterations in IP using a case series. Fourteen patients (9 children and 5 adults) with a clinical diagnosis of IP who presented dental anomalies were included in this study. All patients were administered a clinical questionnaire, dental examination and radiological investigation. In the present case series, agenesis of primary dentition was present in 60 % of patients and agenesis of permanent tooth was present in 92.8 % of patients. Most cases were missing at least 6 teeth. Second molar agenesis was present in 13 patients (92.8 %). Anomalies in dental crowns occurred in 71.4 % of cases, and the central incisor was most frequently affected. Two adult patients still had primary teeth. Malocclusion was found in 10 patients (71.4 %). High-arched palate was observed in 7 (50 %) patients. Patients with IP present alterations in both primary and permanent dentition. Because the agenesis of permanent teeth is more common, primary teeth are not always replaced. In addition, the durability of primary dentition appears to be greater in IP. This study shows that patients with IP experience significant loss of teeth, especially in permanent dentition, and have an increased risk of high-arched palate compared to the general population. Prophylactic care of primary teeth in IP is relevant for improving functional and aesthetic outcomes until dental prostheses are implanted.

Assessing Lightning and Wildfire Hazard by Land Properties and Cloud to Ground Lightning Data with Association Rule Mining in Alberta, Canada

PubMed Central

Cha, DongHwan; Wang, Xin; Kim, Jeong Woo

2017-01-01

Hotspot analysis was implemented to find regions in the province of Alberta (Canada) with high frequency Cloud to Ground (CG) lightning strikes clustered together. Generally, hotspot regions are located in the central, central east, and south central regions of the study region. About 94% of annual lightning occurred during warm months (June to August) and the daily lightning frequency was influenced by the diurnal heating cycle. The association rule mining technique was used to investigate frequent CG lightning patterns, which were verified by similarity measurement to check the patterns’ consistency. The similarity coefficient values indicated that there were high correlations throughout the entire study period. Most wildfires (about 93%) in Alberta occurred in forests, wetland forests, and wetland shrub areas. It was also found that lightning and wildfires occur in two distinct areas: frequent wildfire regions with a high frequency of lightning, and frequent wild-fire regions with a low frequency of lightning. Further, the preference index (PI) revealed locations where the wildfires occurred more frequently than in other class regions. The wildfire hazard area was estimated with the CG lightning hazard map and specific land use types. PMID:29065564

Assessing Lightning and Wildfire Hazard by Land Properties and Cloud to Ground Lightning Data with Association Rule Mining in Alberta, Canada.

PubMed

Cha, DongHwan; Wang, Xin; Kim, Jeong Woo

2017-10-23

Hotspot analysis was implemented to find regions in the province of Alberta (Canada) with high frequency Cloud to Ground (CG) lightning strikes clustered together. Generally, hotspot regions are located in the central, central east, and south central regions of the study region. About 94% of annual lightning occurred during warm months (June to August) and the daily lightning frequency was influenced by the diurnal heating cycle. The association rule mining technique was used to investigate frequent CG lightning patterns, which were verified by similarity measurement to check the patterns' consistency. The similarity coefficient values indicated that there were high correlations throughout the entire study period. Most wildfires (about 93%) in Alberta occurred in forests, wetland forests, and wetland shrub areas. It was also found that lightning and wildfires occur in two distinct areas: frequent wildfire regions with a high frequency of lightning, and frequent wild-fire regions with a low frequency of lightning. Further, the preference index (PI) revealed locations where the wildfires occurred more frequently than in other class regions. The wildfire hazard area was estimated with the CG lightning hazard map and specific land use types.

Which DSM validated tools for diagnosing depression are usable in primary care research? A systematic literature review.

PubMed

Nabbe, P; Le Reste, J Y; Guillou-Landreat, M; Munoz Perez, M A; Argyriadou, S; Claveria, A; Fernández San Martín, M I; Czachowski, S; Lingner, H; Lygidakis, C; Sowinska, A; Chiron, B; Derriennic, J; Le Prielec, A; Le Floch, B; Montier, T; Van Marwijk, H; Van Royen, P

2017-01-01

Depression occurs frequently in primary care. Its broad clinical variability makes it difficult to diagnose. This makes it essential that family practitioner (FP) researchers have validated tools to minimize bias in studies of everyday practice. Which tools validated against psychiatric examination, according to the major depression criteria of DSM-IV or 5, can be used for research purposes? An international FP team conducted a systematic review using the following databases: Pubmed, Cochrane and Embase, from 2000/01/01 to 2015/10/01. The three databases search identified 770 abstracts: 546 abstracts were analyzed after duplicates had been removed (224 duplicates); 50 of the validity studies were eligible and 4 studies were included. In 4 studies, the following tools were found: GDS-5, GDS-15, GDS-30, CESD-R, HADS, PSC-51 and HSCL-25. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value were collected. The Youden index was calculated. Using efficiency data alone to compare these studies could be misleading. Additional reliability, reproducibility and ergonomic data will be essential for making comparisons. This study selected seven tools, usable in primary care research, for the diagnosis of depression. In order to define the best tools in terms of efficiency, reproducibility, reliability and ergonomics for research in primary care, and for care itself, further research will be essential. Copyright © 2016. Published by Elsevier Masson SAS.

Thirty-day unplanned hospital readmission in ovarian cancer patients undergoing primary or interval cytoreductive surgery: systematic literature review.

PubMed

Clark, Rachel M; Rice, Laurel W; Del Carmen, Marcela G

2018-06-18

Thirty-day readmission rate has been proposed as metric of quality and remains an ongoing clinical concern in the primary treatment of patients with advanced-stage ovarian epithelial ovarian cancer. We conducted a review of the literature to identify rates, risk factors, and predictors for 30-day readmission in this population. A 10-year period MEDLINE (PubMed) search of English literature studies published between January 01, 2008-January 01, 2018 was performed to identify appropriate studies for review. Thirty -day readmission rates for ovarian cancer patients undergoing primary treatment ranged from 2.5-19.3%. Neoadjuvant chemotherapy and interval cytoreductive surgery (NACT-ICS) surgery was associated with lower readmission rates, when compared to primary debulking surgery (PDS). The most frequently reported adverse events resulting in readmission include inpatient management of ileus/small bowel obstruction, wound-related complications, and thromboembolic events. Readmission predictors included the presence of other medical comorbidities, re-operation, and major complications occurring after initial hospital discharge. Some studies reported lower rates of readmission and survival in patients treated by NACT-ICS. Policies and programs should be designed to measure short- and long-term outcomes in this patient population to avoid bias in assigning patients to NACT-ICS to maintain low 30-day readmission rates. Copyright © 2018 Elsevier Inc. All rights reserved.

Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.

PubMed

Goyder, Clare R; Jones, Caroline H D; Heneghan, Carl J; Thompson, Matthew J

2015-12-01

Because of the difficulties inherent in diagnosis in primary care, it is inevitable that diagnostic errors will occur. However, despite the important consequences associated with diagnostic errors and their estimated high prevalence, teaching and research on diagnostic error is a neglected area. To ascertain the key learning points from GPs' experiences of diagnostic errors and approaches to clinical decision making associated with these. Secondary analysis of 36 qualitative interviews with GPs in Oxfordshire, UK. Two datasets of semi-structured interviews were combined. Questions focused on GPs' experiences of diagnosis and diagnostic errors (or near misses) in routine primary care and out of hours. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. Learning points include GPs' reliance on 'pattern recognition' and the failure of this strategy to identify atypical presentations; the importance of considering all potentially serious conditions using a 'restricted rule out' approach; and identifying and acting on a sense of unease. Strategies to help manage uncertainty in primary care were also discussed. Learning from previous examples of diagnostic errors is essential if these events are to be reduced in the future and this should be incorporated into GP training. At a practice level, learning points from experiences of diagnostic errors should be discussed more frequently; and more should be done to integrate these lessons nationally to understand and characterise diagnostic errors. © British Journal of General Practice 2015.

Metastasis of colon cancer to the thyroid gland: a case diagnosed on fine-needle aspirate by a combined cytological, immunocytochemical, and molecular approach.

PubMed

Cozzolino, Immacolata; Malapelle, Umberto; Carlomagno, Chiara; Palombini, Lucio; Troncone, Giancarlo

2010-12-01

Fine-needle aspiration (FNA) with cytological evaluation reliably diagnoses primary and secondary thyroid neoplasms. However, identifying the primary origin of a metastatic process involving the thyroid gland is challenging. In particular, metastasis of colon cancer to the thyroid gland is very rare. In this case report, a right lobe solid thyroid nodule in a 66-year-old male was aspirated. FNA cytology showed necrosis and atypical tall columnar cells; since, the patient at age 60 had undergone surgery for a sigmoid-rectal cancer metastasizing to the liver and subsequently to the lung, a suspicion of metastasis from colon cancer was raised. This was corroborated by cell-block immunocytochemistry showing a cytokeratin (CK) 7 negative/CK20-positive staining pattern; thyreoglobulin and TTF-1 were both negative. Since KRAS codon 12/13 mutations frequently occur in colon cancer, whereas they are extremely uncommon in primary thyroid tumors, DNA was extracted from the aspirated cells, and KRAS mutational analysis was carried out. The codon 12 G12D mutation was found; the same mutation was evident in the primary cancer of the colon and in its liver and lung metastasis. Thus, a combined cytological, immunocytochemical and molecular approach unquestionably correlated metastatic adenocarcinoma cells aspirated from the thyroid to a colo-rectal origin. © 2010 Wiley-Liss, Inc.

Sleep and Epilepsy: Strange Bedfellows No More.

PubMed

St Louis, Erik K

2011-09-01

Ancient philosophers and theologians believed that altered consciousness freed the mind to prophesy the future, equating sleep with seizures. Only recently has the bidirectional influences of epilepsy and sleep upon one another received more substantive analysis. This article reviews the complex and increasingly recognized interrelationships between sleep and epilepsy. NREM sleep differentially activates interictal epileptiform discharges during slow wave (N3) sleep, while ictal seizure events occur more frequently during light NREM stages N1 and N2. The most commonly encountered types of sleep-related epilepsies (those with preferential occurrence during sleep or following arousal) include frontal and temporal lobe partial epilepsies in adults, and benign epilepsy of childhood with centrotemporal spikes (benign rolandic epilepsy) and juvenile myoclonic epilepsy in children and adolescents. Comorbid sleep disorders are frequent in patients with epilepsy, particularly obstructive sleep apnea in refractory epilepsy patients which may aggravate seizure burden, while treatment with nasal continuous positive airway pressure often improves seizure frequency. Distinguishing nocturnal events such as NREM parasomnias (confusional arousals, sleep walking, and night terrors), REM parasomnias including REM sleep behavior disorder, and nocturnal seizures if frequently difficult and benefits from careful history taking and video-EEG-polysomnography in selected cases. Differentiating nocturnal seizures from primary sleep disorders is essential for determining appropriate therapy, and recognizing co-existent sleep disorders in patients with epilepsy may improve their seizure burden and quality of life.

Epidemiology and prognosis of candidaemia in elderly patients.

PubMed

Ramos-Martínez, Antonio; Vicente-López, Natalia; Sánchez-Romero, Isabel; Padilla, Belén; Merino-Amador, Paloma; Garnacho-Montero, José; Ruiz-Camps, Isabel; Montejo, Miguel; Salavert, Miguel; Mensa, José; Cuenca-Estrella, Manuel

2017-12-01

The aim of the study was to analyse the epidemiology and prognosis of candidaemia in elderly patients. We performed a comparison of clinical presentation of candidaemia according to age and a study of hazard factors within a prospective programme performed in 29 hospitals. One hundred and seventy-six episodes occurred in elderly patients (>75 years), 227 episodes in middle-aged patients (61-75 years) and 232 episodes in younger patients (16-60 years). Central venous catheter, parenteral nutrition, neutropenia, immunosuppressive therapy and candidaemia caused by Candida parapsilosis were less frequent in elderly patients. These patients received inadequate antifungal therapy (57.3%) more frequently than middle-aged and younger patients (40.5% P < .001). Mortality during the first week (20%) and 30 days (42%) was higher in elderly patients. The variables independently associated with mortality in elderly patients during the first 7 days were acute renal failure (OR: 2.64), Pitt score (OR: 1.57) and appropriate antifungal therapy (OR: 0.132). Primary candidaemia (OR: 2.93), acute renal failure (OR: 3.68), Pitt score (OR: 1.38), appropriate antifungal therapy (OR: 0.3) and early removal of the central catheter (OR: 0.47) were independently associated with 30-day mortality.In conclussion, inadequate antifungal treatment is frequently prescribed to elderly patients with candidaemia and is related with early and late mortality. © 2017 Blackwell Verlag GmbH.

Occurrence and persistence of fungicides in bed sediments and suspended solids from three targeted use areas in the United States

USGS Publications Warehouse

Smalling, Kelly L.; Reilly, Timothy J.; Sandstrom, Mark W.; Kuivila, Kathryn

2013-01-01

To document the environmental occurrence and persistence of fungicides, a robust and sensitive analytical method was used to measure 34 fungicides and an additional 57 current-use pesticides in bed sediments and suspended solids collected from areas of intense fungicide use within three geographic areas across the United States. Sampling sites were selected near or within agricultural research farms using prophylactic fungicides at rates and types typical of their geographic location. At least two fungicides were detected in 55% of the bed and 83% of the suspended solid samples and were detected in conjunction with herbicides and insecticides. Six fungicides were detected in all samples including pyraclostrobin (75%), boscalid (53%), chlorothalonil (41%) and zoxamide (22%). Pyraclostrobin, a strobilurin fungicide, used frequently in the United States on a variety of crops, was detected more frequently than p,p′-DDE, the primary degradate of p,p′-DDT, which is typically one of the most frequently occurring pesticides in sediments collected within highly agricultural areas. Maximum fungicide concentrations in bed sediments and suspended solids were 198 and 56.7 μg/kg dry weight, respectively. There is limited information on the occurrence, fate, and persistence of many fungicides in sediment and the environmental impacts are largely unknown. The results of this study indicate the importance of documenting the persistence of fungicides in the environment and the need for a better understanding of off-site transport mechanisms, particularly in areas where crops are grown that require frequent treatments to prevent fungal diseases.

Antibody deficiency in patients with frequent exacerbations of Chronic Obstructive Pulmonary Disease (COPD).

PubMed

McCullagh, Brian N; Comellas, Alejandro P; Ballas, Zuhair K; Newell, John D; Zimmerman, M Bridget; Azar, Antoine E

2017-01-01

Chronic Obstructive Pulmonary Disease is the third leading cause of death in the US, and is associated with periodic exacerbations, which account for the largest proportion of health care utilization, and lead to significant morbidity, mortality, and worsening lung function. A subset of patients with COPD have frequent exacerbations, occurring 2 or more times per year. Despite many interventions to reduce COPD exacerbations, there is a significant lack of knowledge in regards to their mechanisms and predisposing factors. We describe here an important observation that defines antibody deficiency as a potential risk factor for frequent COPD exacerbations. We report a case series of patients who have frequent COPD exacerbations, and who were found to have an underlying primary antibody deficiency syndrome. We also report on the outcome of COPD exacerbations following treatment in a subset with of these patients with antibody deficiency. We identified patients with COPD who had 2 or more moderate to severe exacerbations per year; immune evaluation including serum immunoglobulin levels and pneumococcal IgG titers was performed. Patients diagnosed with an antibody deficiency syndrome were treated with either immunoglobulin replacement therapy or prophylactic antibiotics, and their COPD exacerbations were monitored over time. A total of 42 patients were identified who had 2 or more moderate to severe COPD exacerbations per year. Twenty-nine patients had an underlying antibody deficiency syndrome: common variable immunodeficiency (8), specific antibody deficiency (20), and selective IgA deficiency (1). Twenty-two patients had a follow-up for at least 1 year after treatment of their antibody deficiency, which resulted in a significant reduction of COPD exacerbations, courses of oral corticosteroid use and cumulative annual dose of oral corticosteroid use, rescue antibiotic use, and hospitalizations for COPD exacerbations. This case series identifies antibody deficiency as a potentially treatable risk factor for frequent COPD exacerbations; testing for antibody deficiency should be considered in difficult to manage frequently exacerbating COPD patients. Further prospective studies are warranted to further test this hypothesis.

Antibody deficiency in patients with frequent exacerbations of Chronic Obstructive Pulmonary Disease (COPD)

PubMed Central

McCullagh, Brian N.; Comellas, Alejandro P.; Ballas, Zuhair K.; Newell, John D.; Zimmerman, M. Bridget

2017-01-01

Chronic Obstructive Pulmonary Disease is the third leading cause of death in the US, and is associated with periodic exacerbations, which account for the largest proportion of health care utilization, and lead to significant morbidity, mortality, and worsening lung function. A subset of patients with COPD have frequent exacerbations, occurring 2 or more times per year. Despite many interventions to reduce COPD exacerbations, there is a significant lack of knowledge in regards to their mechanisms and predisposing factors. We describe here an important observation that defines antibody deficiency as a potential risk factor for frequent COPD exacerbations. We report a case series of patients who have frequent COPD exacerbations, and who were found to have an underlying primary antibody deficiency syndrome. We also report on the outcome of COPD exacerbations following treatment in a subset with of these patients with antibody deficiency. We identified patients with COPD who had 2 or more moderate to severe exacerbations per year; immune evaluation including serum immunoglobulin levels and pneumococcal IgG titers was performed. Patients diagnosed with an antibody deficiency syndrome were treated with either immunoglobulin replacement therapy or prophylactic antibiotics, and their COPD exacerbations were monitored over time. A total of 42 patients were identified who had 2 or more moderate to severe COPD exacerbations per year. Twenty-nine patients had an underlying antibody deficiency syndrome: common variable immunodeficiency (8), specific antibody deficiency (20), and selective IgA deficiency (1). Twenty-two patients had a follow-up for at least 1 year after treatment of their antibody deficiency, which resulted in a significant reduction of COPD exacerbations, courses of oral corticosteroid use and cumulative annual dose of oral corticosteroid use, rescue antibiotic use, and hospitalizations for COPD exacerbations. This case series identifies antibody deficiency as a potentially treatable risk factor for frequent COPD exacerbations; testing for antibody deficiency should be considered in difficult to manage frequently exacerbating COPD patients. Further prospective studies are warranted to further test this hypothesis. PMID:28212436

Exploring the relationship between frequent internet use and health and social care resource use in a community-based cohort of older adults: an observational study in primary care

PubMed Central

Round, Jeff; Morris, Stephen; Kharicha, Kalpa; Ford, John; Manthorpe, Jill; Iliffe, Steve; Goodman, Claire; Walters, Kate

2017-01-01

Objectives Given many countries’ ageing populations, policymakers must consider how to mitigate or reduce health problems associated with old age, within budgetary constraints. Evidence of use of digital technology in delaying the onset of illness and reducing healthcare service use is mixed, with no clear consensus as yet. Our aim was to investigate the relationship between frequent internet use and patterns of health or social care resource use in primary care attendees who took part in a study seeking to improve the health of older adults. Methods Participants recruited from primary care, aged >65 and living in semirural or urban areas in the south of England, were followed up at 3 and 6 months after completing a comprehensive questionnaire with personalised feedback on their health and well-being. We performed logistic regression analyses to investigate relationships between frequent internet use and patterns of service use, controlling for confounding factors, and clustering by general practitioner practice. Four categories of service use data were gathered: use of primary National Health Service (NHS) care; secondary NHS care; other community health and social care services; and assistance with washing, shopping and meals. Results Our results show, in this relatively healthy population, a positive relationship (OR 1.72, 95% CI 1.33 to 2.23) between frequent internet use and use of any other community-based health services (physiotherapist, osteopath/chiropractor, dentist, optician/optometrist, counselling service, smoking cessation service, chiropodist/podiatrist, emergency services, other non-specific health services) and no relationship with the other types of care. No causal relationship can be postulated due to the study’s design. Conclusions No observed relationship between frequent internet use and primary or secondary care use was found, suggesting that older adults without internet access are not disadvantaged regarding healthcare use. Further research should explore how older people use the internet to access healthcare and the impact on health. PMID:28733300

Indications for laboratory tests in primary care: assessment of the most frequent indications and requests with blank clinical information

PubMed Central

Salinas, Maria; López-Garrigós, Maite; Flores, Emilio; Leiva-Salinas, Maria; Esteban, Patricia; Ahumada, Miguel; Leiva-Salinas, Carlos

2016-01-01

Introduction The aim of this work is twofold. Firstly, to study the temporal evolution in the number of laboratory requests from primary care without clinical indication, and to analyse the number of such requests before and after the implementation of an automated requesting procedure. Secondly, to investigate what are the most frequent clinical indications that prompted laboratory testing. Materials and methods This is a retrospective observational study conducted from January 2009 to December 2015. We counted the requests without clinical question, calculated the number of such requests per total number of requests and listed the most frequent indications. Results The number of tests requests with a blank clinical indication was significantly higher in 2009 when compared to 2015 (80% vs. 20%; P < 0.001). For every year in this 7-year period, dyslipidemia, essential hypertension and diabetes were the most prevalent diagnoses that prompted a laboratory test in primary care, accounting for more than 20% of all indications. Conclusions The number of primary care requests without patient clinical question has decreased after the implementation of an automated requesting procedure. Disorders of lipid metabolism, essential hypertension and diabetes mellitus were the most prevalent diagnoses that prompted a laboratory test in primary care. PMID:27812310

Evaluation of anxiety and depression prevalence in patients with primary severe hyperhidrosis*

PubMed Central

Bragança, Gleide Maria Gatto; Lima, Sonia Oliveira; Pinto, Aloisio Ferreira; Marques, Lucas Menezes; de Melo, Enaldo Vieira; Reis, Francisco Prado

2014-01-01

BACKGROUND Primary hyperhidrosis (PH) can lead to mood changes due to the inconveniences it causes. OBJECTIVE This study aimed to examine the existence of anxiety and depression in patients with severe primary hyperhidrosis who sought treatment at a medical office. METHODS The questionnaire "Hospital Anxiety and Depression Scale" was used for 197 individuals, in addition to the chi square test and Fisher exact test, p <0.05. RESULTS There was an increased prevalence of anxiety (49.6%) but not of depression (11.2%) among patients with PH, with no link to gender, age or amount of affected areas. Palmar and plantar primary hyperhidrosis were the most frequent but when associated with the presence of anxiety, the most frequent were the axillary (p = 0.02) and craniofacial (p = 0.02) forms. There was an association between patients with depression and anxiety (p = 0.001). CONCLUSIONS the involvement of Primary hyperhidrosis was responsible for a higher prevalence of anxiety than that described among the general population and patients with other chronic diseases. Depression had a low prevalence rate, while mild and moderate forms were the most common and frequently associated with anxiety. The degree of anxiety was higher in mild and moderate types than in the severe form. PMID:24770497

Loss of steroid hormone receptors is common in malignant pleural and peritoneal effusions of breast cancer patients treated with endocrine therapy

PubMed Central

Schrijver, Willemijne A.M.E.; Schuurman, Karianne; van Rossum, Annelot; Peeters, Ton; Ter Hoeve, Natalie

2017-01-01

Discordance in estrogen receptor alpha (ERα), progesterone receptor (PR), androgen receptor (AR) and human epidermal growth factor receptor 2 (HER2) status between primary breast cancers and solid distant metastases (“conversion”) has been reported previously. Even though metastatic spread to the peritoneal and pleural cavities occurs frequently and is associated with high mortality, the rate of receptor conversion and the prognostic implications thereof remain elusive. We therefore determined receptor conversion in 91 effusion metastases (78 pleural, 13 peritoneal effusions) of 69 patients by immunohistochemistry (IHC) and in situ hybridization. Data were coupled to clinical variables and treatment history. ERα, PR and AR receptor status converted from positive in the primary tumor to negative in the effusion metastases or vice versa in 25-30%, 30-35% and 46-51% of cases for the 1% and 10% thresholds for positivity, respectively. 19-25% of patients converted clinically relevant from “ERα+ or PR+” to ERα-/PR- and 3-4% from ERα-/PR- to “ERα+ or PR+”. For HER2, conversion was observed in 6% of cases. Importantly, receptor conversion for ERα (p = 0.058) and AR (p < 0.001) was more often seen in patients adjuvantly treated with endocrine therapy. Analogous to this observation, HER2-loss was more frequent in patients adjuvantly treated with trastuzumab (p < 0.001). Alike solid distant metastases, receptor conversion for ERα, PR, AR and HER2 is a frequent phenomenon in peritoneal and pleural effusion metastases. Adjuvant endocrine and trastuzumab therapy imposes an evolutionary selection pressure on the tumor, leading to receptor loss in effusion metastases. Determination of receptor status in malignant effusion specimens will facilitate endocrine treatment decision-making at this lethal state of the disease, and is hence recommended whenever possible. PMID:28903441

An overview of financial sources being utilized to support Zika Virus published research

PubMed Central

Elias, Vanessa

2017-01-01

Background Since its initial detection in Brazil in 2015, Zika Virus (ZIKV) has spread rapidly throughout most of the Caribbean and South, Central and North America. An upsurge in congenital syndrome associated with ZIKV and Guillain-Barre Syndrome (GBS) has been associated with the increase in ZIKV. This amplification in numbers led to the need for funded research initiatives focusing on various countries globally and on specific experimental types. Objectives To determine the financial institutions involved in the production of primary research into the ZIKV epidemic. This research also intends to draw attention to the investigative areas that are dominating, experimental types being conducted and the geographical areas that are producing the bulk of the research utilizing available funds. Methods A cross sectional search of published primary research was conducted using Pan American Health Organization (PAHO) Zika platform and PubMed between January 2007 and October 2016. Titles, abstract and full articles were assed and one researcher extracted data. Information was crossed checked by a second researcher to ensure accuracy. Findings 268 articles were included and investigations occurred across 48 countries with Brazil and USA dominating the research. Applied Research and Laboratory based studies were most frequently utilized. 38.1% of articles did not report financial sources. Public institutions were the major known contributors. Other financiers included private, non-profits and mixed funders exclusive of public sources. 156 individual financial bodies assisted with National Institute of Health being most frequently mentioned followed by The National Council for Scientific and Technological Development (CNPq) and the Institut Pasteur. Virus, vectors and reservoirs was most frequently used (99/268, 36.9%) followed by clinical management (70/268, 26.1%) and epidemiology (46/268, 17.2%). Interpretation The evidence suggests international efforts to fund ZIKV research and a need to foster collaborative and synchronized priority setting for resource allocation. PMID:28817610

An overview of financial sources being utilized to support Zika Virus published research.

PubMed

Goodridge, Keisha; Reveiz, Ludovic; Elias, Vanessa

2017-01-01

Since its initial detection in Brazil in 2015, Zika Virus (ZIKV) has spread rapidly throughout most of the Caribbean and South, Central and North America. An upsurge in congenital syndrome associated with ZIKV and Guillain-Barre Syndrome (GBS) has been associated with the increase in ZIKV. This amplification in numbers led to the need for funded research initiatives focusing on various countries globally and on specific experimental types. To determine the financial institutions involved in the production of primary research into the ZIKV epidemic. This research also intends to draw attention to the investigative areas that are dominating, experimental types being conducted and the geographical areas that are producing the bulk of the research utilizing available funds. A cross sectional search of published primary research was conducted using Pan American Health Organization (PAHO) Zika platform and PubMed between January 2007 and October 2016. Titles, abstract and full articles were assed and one researcher extracted data. Information was crossed checked by a second researcher to ensure accuracy. 268 articles were included and investigations occurred across 48 countries with Brazil and USA dominating the research. Applied Research and Laboratory based studies were most frequently utilized. 38.1% of articles did not report financial sources. Public institutions were the major known contributors. Other financiers included private, non-profits and mixed funders exclusive of public sources. 156 individual financial bodies assisted with National Institute of Health being most frequently mentioned followed by The National Council for Scientific and Technological Development (CNPq) and the Institut Pasteur. Virus, vectors and reservoirs was most frequently used (99/268, 36.9%) followed by clinical management (70/268, 26.1%) and epidemiology (46/268, 17.2%). The evidence suggests international efforts to fund ZIKV research and a need to foster collaborative and synchronized priority setting for resource allocation.

Estimation of phytoplankton production from space: current status and future potential of satellite remote sensing.

PubMed

Joint; Groom

2000-07-30

A new generation of ocean colour satellites is now operational, with frequent observation of the global ocean. This paper reviews the potential to estimate marine primary production from satellite images. The procedures involved in retrieving estimates of phytoplankton biomass, as pigment concentrations, are discussed. Algorithms are applied to SeaWiFS ocean colour data to indicate seasonal variations in phytoplankton biomass in the Celtic Sea, on the continental shelf to the south west of the UK. Algorithms to estimate primary production rates from chlorophyll concentration are compared and the advantages and disadvantage discussed. The simplest algorithms utilise correlations between chlorophyll concentration and production rate and one equation is used to estimate daily primary production rates for the western English Channel and Celtic Sea; these estimates compare favourably with published values. Primary production for the central Celtic Sea in the period April to September inclusive is estimated from SeaWiFS data to be 102 gC m(-2) in 1998 and 93 gC m(-2) in 1999; published estimates, based on in situ incubations, are ca. 80 gC m(-2). The satellite data demonstrate large variations in primary production between 1998 and 1999, with a significant increase in late summer in 1998 which did not occur in 1999. Errors are quantified for the estimation of primary production from simple algorithms based on satellite-derived chlorophyll concentration. These data show the potential to obtain better estimates of marine primary production than are possible with ship-based methods, with the ability to detect short-lived phytoplankton blooms. In addition, the potential to estimate new production from satellite data is discussed.

Fluoroscopic removal of retrievable self-expandable metal stents in patients with malignant oesophageal strictures: Experience with a non-endoscopic removal system.

PubMed

Kim, Pyeong Hwa; Song, Ho-Young; Park, Jung-Hoon; Zhou, Wei-Zhong; Na, Han Kyu; Cho, Young Chul; Jun, Eun Jung; Kim, Jun Ki; Kim, Guk Bae

2017-03-01

To evaluate clinical outcomes of fluoroscopic removal of retrievable self-expandable metal stents (SEMSs) for malignant oesophageal strictures, to compare clinical outcomes of three different removal techniques, and to identify predictive factors of successful removal by the standard technique (primary technical success). A total of 137 stents were removed from 128 patients with malignant oesophageal strictures. Primary overall technical success and removal-related complications were evaluated. Logistic regression models were constructed to identify predictive factors of primary technical success. Primary technical success rate was 78.8 % (108/137). Complications occurred in six (4.4 %) cases. Stent location in the upper oesophagus (P=0.004), stricture length over 8 cm (P=0.030), and proximal granulation tissue (P<0.001) were negative predictive factors of primary technical success. If granulation tissue was present at the proximal end, eversion technique was more frequently required (P=0.002). Fluoroscopic removal of retrievable SEMSs for malignant oesophageal strictures using three different removal techniques appeared to be safe and easy. The standard technique is safe and effective in the majority of patients. The presence of proximal granulation tissue, stent location in the upper oesophagus, and stricture length over 8 cm were negative predictive factors for primary technical success by standard extraction and may require a modified removal technique. • Fluoroscopic retrievable SEMS removal is safe and effective. • Standard removal technique by traction is effective in the majority of patients. • Three negative predictive factors of primary technical success were identified. • Caution should be exercised during the removal in those situations. • Eversion technique is effective in cases of proximal granulation tissue.

Visual Information Present in Infragranular Layers of Mouse Auditory Cortex.

PubMed

Morrill, Ryan J; Hasenstaub, Andrea R

2018-03-14

The cerebral cortex is a major hub for the convergence and integration of signals from across the sensory modalities; sensory cortices, including primary regions, are no exception. Here we show that visual stimuli influence neural firing in the auditory cortex of awake male and female mice, using multisite probes to sample single units across multiple cortical layers. We demonstrate that visual stimuli influence firing in both primary and secondary auditory cortex. We then determine the laminar location of recording sites through electrode track tracing with fluorescent dye and optogenetic identification using layer-specific markers. Spiking responses to visual stimulation occur deep in auditory cortex and are particularly prominent in layer 6. Visual modulation of firing rate occurs more frequently at areas with secondary-like auditory responses than those with primary-like responses. Auditory cortical responses to drifting visual gratings are not orientation-tuned, unlike visual cortex responses. The deepest cortical layers thus appear to be an important locus for cross-modal integration in auditory cortex. SIGNIFICANCE STATEMENT The deepest layers of the auditory cortex are often considered its most enigmatic, possessing a wide range of cell morphologies and atypical sensory responses. Here we show that, in mouse auditory cortex, these layers represent a locus of cross-modal convergence, containing many units responsive to visual stimuli. Our results suggest that this visual signal conveys the presence and timing of a stimulus rather than specifics about that stimulus, such as its orientation. These results shed light on both how and what types of cross-modal information is integrated at the earliest stages of sensory cortical processing. Copyright © 2018 the authors 0270-6474/18/382854-09$15.00/0.

Frequent users of the Royal Flying Doctor Service primary clinic and aeromedical services in remote New South Wales: a quality study.

PubMed

Garne, David L; Perkins, David A; Boreland, Frances T; Lyle, David M

To examine activity patterns of the Royal Flying Doctor Service of Australia (RFDS) in far western New South Wales and to determine whether frequent use of RFDS services, particularly emergency evacuations, is a useful indicator of patients who may benefit from care planning and review. We conducted a retrospective audit of the RFDS South Eastern Section's Broken Hill patient database. Patients with a residential address in the study area who had accessed at least one RFDS medical service between 1 July 2000 and 30 June 2005 were included in the study. Number of evacuations, clinic consultations and remote consultations; clinic usage by frequent evacuees; number of primary diagnoses recorded for frequent evacuees; number of frequent users who might benefit from multidisciplinary care or specialist shared care. Between July 2000 and June 2005, the number of residents requiring evacuation or remote consultations declined by 26% and 19%, respectively, and the number of residents accessing clinics declined by 6%. (Over the same period, the population of the study area fell by about 24%.) Of the 78 patients who were identified as frequent users of the evacuation service (> or = 3 evacuations/year), 34 had three or more primary diagnoses recorded; 15 were infrequent or non-users of the clinics (< or = 3 attendances/year); 53 may have benefited from multidisciplinary care, and 41 from specialist shared care. Simple, practical clinical review systems can help health care organisations in rural and remote communities to achieve better outcomes by identifying patients who may benefit from planned care.

Interprofessional Communication Patterns During Patient Discharges: A Social Network Analysis.

PubMed

Pinelli, Vincent A; Papp, Klara K; Gonzalo, Jed D

2015-09-01

Optimal care delivery requires timely, efficient, and accurate communication among numerous providers and their patients, especially during hospital discharge. Little is known about communication patterns during this process. Our aim was to assess the frequency and patterns of communication between patients and providers during patient discharges from a hospital-based medicine unit. On the day of the patient's discharge, the patient and all healthcare providers involved in the discharge were interviewed using structured questions related to information exchange during the discharge process. Each interview identified the frequency and method of communication between participants, including synchronous (e.g., face-to-face) and asynchronous (e.g., through electronic medical record) routes. Communication patterns were visually diagramed using social network analysis. Forty-six patients were screened for inclusion in the network analysis. Of those, seven patients who were fully oriented and able to complete an interview and all providers who participated in their care during the discharge were selected for inclusion in the analysis. In all, 72 healthcare professionals contributing to the discharge process were interviewed, including physicians, nurses, therapists, pharmacists, care coordinators, social workers, and nutritionists. Patients' mean age was 63, length-of-stay was 7.8 days, and most (86 %) were discharged to home. On average, 11 roles were involved with each discharge. The majority of communication was synchronous (562 events vs. 469 asynchronous events, p = 0.004). Most communication events occurred between the primary nurse and patient and the care coordinator and primary nurse (mean 3.9 and 2.3 events/discharge, respectively). Participants identified intern physicians as most important in the discharge process, followed by primary nurses and care coordinators. In patients being discharged from the medicine service, communication was more frequently synchronous, and occurred between intern physicians, primary nurses, and patients. Potential improvements in coordinating patients' discharges are possible by reorganizing systems to optimize efficient communication.

Cervical lymph node metastasis in adenoid cystic carcinoma of the major salivary glands.

PubMed

2017-02-01

To verify the prevalence of cervical lymph node metastasis in adenoid cystic carcinoma of major salivary glands, and to establish recommendations for elective neck treatment. A search was conducted of the US National Library of Medicine database. Appropriate articles were selected from the abstracts, and the original publications were obtained to extract data. Among 483 cases of major salivary gland adenoid cystic carcinoma, a total of 90 (18.6 per cent) had cervical metastasis. The prevalence of positive nodes from adenoid cystic carcinoma was 14.5 per cent for parotid gland, 22.5 per cent for submandibular gland and 24.7 per cent for sublingual gland. Cervical lymph node metastasis occurred more frequently in patients with primary tumour stage T3-4 adenoid cystic carcinoma, and was usually located in levels II and III in the neck. Adenoid cystic carcinoma of the major salivary glands is associated with a significant prevalence of cervical node metastasis, and elective neck treatment is indicated for T3 and T4 primary tumours, as well as tumours with other histological risk factors.

A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use

PubMed Central

Pope, Charlene A.; Davis, Boyd H.; Wine, Leticia; Nemeth, Lynne S.; Axon, Robert N.

2018-01-01

Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving. PMID:29482411

Acro-osteolysis as an indicator of severity in systemic sclerosis.

PubMed

Arana-Ruiz, Juan Carlos; Amezcua-Guerra, Luis Manuel

2016-01-01

Systemic sclerosis is a rare disease that predominantly affects women. The Medsger severity scale has been used to assess the severity, but it requires expensive and poorly accessible studies and it does not include complications such acrosteolysis, calcinosis, pericardial disease or hypothyroidism that occur on a relatively frequent basis in this disease. There is no study that considers if comorbidities, such as primary biliary cirrhosis, are related to gravity. To determine the correlation between severity and the presence of such complications. 40 patients with systemic sclerosis, dividing them into tertiles according to severity were studied. Dichotomous variables were described using percentages, while dimensional by averages+SD. Statistical inference was performed using chi square test or Kruskal-Wallis test with Dunn post-test, as appropriate. A significance at P<.05 was set. Of all the complications studied there were only differences in severity with acrosteolysis. Within comorbidities, primary biliary cirrhosis is not associated with gravity. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Recent advances in metastasis research.

PubMed

Molloy, Tim; van 't Veer, Laura J

2008-02-01

Advances in the early prediction, detection, and treatment of metastatic disease has improved the outlook in cancer patients in recent decades, however, metastasis remains the major cause of death in affected individuals. Metastasis occurs in a series of discreet biological steps in which a single, frequently clinically occult micrometastatic cell travels from the primary tumor to a distant location, where it lodges, grows, and ultimately results in the patient's death. Recent work has provided many new insights in the mechanisms and biology behind metastatic spread. This short review surveys some of the most important recent developments that have helped increase our understanding of the three broad phases of metastasis - the genesis of the metastatic cell through the loss of local constraints in the primary tumor microenvironment, dissemination of the cell to a distant organ while avoiding immune surveillance, and finally lodging and growth of the overt metastasis. These studies are providing mounting evidence that the interactions between tumor and normal cells and tissues are critical for disease progression - a paradigm that will provide a fertile area for future research.

[(Over-)flowing bone: the rare disease of melorheostosis: clinical presentation and therapeutic concepts demonstrated by three cases].

PubMed

Hesse, E; Brand, J; Bastian, L; Krettek, C; Meller, R

2008-07-01

Melorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.

Common Child and Adolescent Cutaneous Infestations and Fungal Infections.

PubMed

Alter, Sherman J; McDonald, Megan B; Schloemer, Julie; Simon, Ryan; Trevino, Julian

2018-01-01

Cutaneous infections and infestations are common among children and adolescents. Ectoparasitic infestations affect individuals across the globe. Head lice, body lice, scabies, and infestations with bed bugs are seen in individuals who reside in both resource poor areas and in developed countries. Superficial cutaneous and mucosal candida infections occur throughout the life cycle. Dermatophyte infections of keratin-containing skin and skin structures result in tinea capitis (scalp), tinea corporis (body), tinea pedis (foot), and tinea unguium (nails). Less frequent endemic fungal infections such as blastomycosis, coccidiodomycosis, and histoplasmosis may present with skin findings. This article will describe the epidemiology and transmission of these conditions as well as their clinical manifestations. The approach to diagnosis will be addressed as well as primary prevention and current therapies. Copyright © 2018 Mosby, Inc. All rights reserved.

Riga-Fede disease: a histological study and case report.

PubMed

Taghi, Azizi; Motamedi, Mohammad Hosein Kalantar

2009-01-01

Acute traumatic ulcerations and granulomas of the oral mucosa may result from physical damage via sharp foodstuffs, accidental biting, or talking. Most ulcerations heal within days. Others become chronic, reactive, and exophytic. A histopathologically unique type of chronic traumatic ulceration is the traumatic ulcerative granuloma with stromal eosinophilia (TUGSE). TUGSE exhibits a deep "pseudoinvasive" inflammatory reaction. This lesion may occur under the tongue in infants as a result of chronic mucosal trauma caused by mandibular anterior primary teeth during nursing and is termed Riga-Fede disease (RFD). The clinical presentation many resemble squamous cell carcinoma causing concern. RFD, although not uncommon, is not frequently reported. Thus, dental practitioners are unfamiliar with such lesions. We present a large Riga-Fede lesion in an infant along with the clinical management.

Gouty involvement of the patella and extensor mechanism of the knee mimicking aggressive neoplasm. A case series.

PubMed

Kester, Christopher; Wallace, Matthew T; Jelinek, James; Aboulafia, Albert

2018-06-01

Gout is a common inflammatory crystal deposition disease that occurs in many joints throughout the body. Active gout is most often associated with painful synovitis causing searing joint pains, but gout can also produce large masses of space-occupying deposits called tophi. Tophi are most frequently seen in juxta-articular locations with or without bony erosion and are often misdiagnosed as degenerative joint disease. Soft tissue deposits and tendon involvement are also known manifestations of gout, but can present with indeterminate and alarming findings on imaging. We present three cases of tophaceous gout mimicking aggressive neoplasms in the extensor mechanism of the knee. All cases presented as extensor tendon masses eroding into the patella, with imaging findings initially concerning for primary musculoskeletal malignancy.

Retinoblastoma in the adolescent. Unusual clinical and histopathology findings.

PubMed

Hernández-Ayuso, I; Ríos y Valles-Valles, D; Lome-Maldonado, C; Gómez-Leal, A; Rodríguez-Martínez, H A; Rodríguez-Reyes, A A

2016-03-01

A 17-year- old male with 2years history of an intraocular mass and progressive visual loss of the left eye. Spontaneous sclera rupture occurred during enucleation. Microscopic evaluation with H-E, PAS and immunohistochemistry (NSE, GAFP, SYN, CD99) revealed a small blue round cell malignant neoplasm with extensive necrosis and apoptosis. The optic nerve, ciliary body, choroid, anterior chamber, and sclera were infiltrated. SYN was positive and CD99 was negative in neoplastic cells, consistent with a poorly differentiated retinoblastoma. Retinoblastoma is the most frequent primary intraocular malignant tumour in childhood, but occasionally older patients can be affected. Immunohistochemistry is mandatory in poorly differentiated retinoblastomas. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Giant and thrombosed left ventricular aneurysm

PubMed Central

de Agustin, Jose Alberto; de Diego, Jose Juan Gomez; Marcos-Alberca, Pedro; Rodrigo, Jose Luis; Almeria, Carlos; Mahia, Patricia; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; de Isla, Leopoldo Perez

2015-01-01

Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention. PMID:26225205

Fibrolamellar variant of hepatocellular carcinoma.

PubMed

Chun, Yun Shin; Zimmitti, Giuseppe

2013-01-01

The fibrolamellar variant of hepatocellular carcinoma is a rare primary liver cancer occurring in adolescents and young adults without chronic liver disease or known risk factors. Histologically, it is defined by lamellar bands of fibrosis surrounding well-differentiated tumor cells. Radiologic imaging typically demonstrates a large, solitary mass with calcifications and a central scar. Lymph node metastases in the porta hepatis are frequently diagnosed upon presentation. More patients with fibrolamellar carcinoma are candidates for surgical resection than those with conventional hepatocellular carcinoma, owing to their young age and absence of cirrhosis. The most important prognostic factor is surgical resection, which results in 5-year overall survival rates ranging between 50 and 76 %. Despite complete surgical resection, relapse rates are high, and novel therapies are needed to prevent and treat recurrent disease.

Imaging and histology in the diagnosis of multiple papillary fibroelastomas in a patient with hypertrophic obstructive cardiomyopathy. Case report.

PubMed

Ionescu, Alin Alexandru; Radulescu, Bogdan; Herlea, Vlad; Miclea, Ioan; Parepa, Irinel; Bubenek, Serban; Popescu, Bogdan Alexandru; Ginghina, Carmen; Jurcut, Ruxandra

2017-11-29

Papillary fibroelastomas (PFEs) are one of the most frequent primary cardiac tumors and occur more often in patients with hypertrophic obstructive cardiomyopathy (HOCM). PFEs have been linked to an increased risk of neurological events. We report a case of a 59-year-old woman with HOCM in whom echocardiography (transthoracic and transesophageal, using 2D and 3D techniques) revealed multiple masses in various locations in the left cardiac chambers. Surgical excision of the cardiac tumors and aortic valve replacement was performed and the pathologic report confirmed the diagnosis of PFEs. Patient followup using ultrasonography is crucial since recurrence is a possibility. Current cardiac ultrasound techniques are essential for diagnosing and for guiding the management of these conditions.

A Matter of Trust: Patient Barriers to Primary Medication Adherence

ERIC Educational Resources Information Center

Polinski, J. M.; Kesselheim, A. S.; Frolkis, J. P.; Wescott, P.; Allen-Coleman, C.; Fischer, M. A.

2014-01-01

Primary medication adherence occurs when a patient properly fills the first prescription for a new medication. Primary adherence only occurs about three-quarters of the time for antihypertensive medications. We assessed patients' barriers to primary adherence and attributes of patient-provider discussions that might improve primary adherence…

GNAQ and GNA11 mutations occur in 9.5% of mucosal melanoma and are associated with poor prognosis.

PubMed

Sheng, Xinan; Kong, Yan; Li, Yiqian; Zhang, Qiannan; Si, Lu; Cui, Chuanliang; Chi, Zhihong; Tang, Bixia; Mao, Lili; Lian, Bin; Wang, Xuan; Yan, Xieqiao; Li, Siming; Dai, Jie; Guo, Jun

2016-09-01

Mucosal melanoma (MM) is a rare subtype of melanoma in Caucasians with extremely poor prognosis, and therapy strategy has not been clearly established for MM. We aimed to investigate the genetic aberrations possibly applicable in targeted therapy of MM. We examined the somatic mutations of GNAQ and GNA11 (GNAQ/11, encoding the guanine nucleotide-binding alpha subunits) in MM and evaluated their correlation to clinicopathologic features of MM. This study collected samples from primary lesions of 284 MM patients. Tissue samples were analysed for mutations in exons 4 and 5 of GNAQ/11 in genomic DNA by polymerase chain reaction amplification and Sanger sequencing. Correlations of GNAQ/11 mutations to clinicopathologic features and prognosis of MM were evaluated. The overall mutation frequency of GNAQ/11 in MM was 9.5% (27 in 284), with a frequency of 4.6% and 4.9% for GNAQ and GNA11 mutations, respectively. The mutations in exon 5 of GNAQ/11 occurred exclusively in codon 209. GNAQ(Q209L) was the most prevalent variation (92.3% of missense GNAQ mutations). GNAQ/11 mutations were not significantly associated with age, gender, ulceration, and primary anatomic site. The median overall survival for MM patients with GNAQ mutations (16.0 versus 26.0 months, P = 0.031) or GNA11 mutations (15.0 versus 26.0 months, P = 0.039) were significantly shorter than those for patients with wild-type GNAQ and GNA11, respectively. Our study suggests that GNAQ and GNA11 mutations occur frequently in MM and may be a prognostic factor for MM. Our data implicate that GNAQ/11 may be potential targets for targeted therapy of MM. Copyright © 2016 Elsevier Ltd. All rights reserved.

[A comparative study of aggression towards Primary Care and Hospital Health professionals in a Madrid health area (2009-2014)].

PubMed

de-San-Segundo, M; Granizo, J J; Camacho, I; Martínez-de-Aramayona, M J; Fernández, M; Sánchez-Úriz, M Á

2017-03-01

The aim of this paper is perform an analysis on the incidents and attacks against medical personnel that occurred in the area covered by the Prevention Service Group, comparing the results in Primary Care (PC) with Hospital Care (HC). The information available in the database of the regional Madrid Register of Aggressions Conflict Health Worker between 2009 and 2014 was analysed. This included a total of 8,056 workers, of whom 1,605 were from PC. A total of 1,262 incidents have been reported, of which 61.2% took place in HC and 38.8% in PC (32.2 notifications/100,000 inhabitants, or 12.88 incidents/100 hospital workers compared to 168.98 notifications/100,000 inhabitants, or 30.53 incidents/100 PC workers). Nurses in CP have a higher incidence of assaults (47.4%), while in HC it is the physicians (53.1%) (P<.001). In PC the aggressor is usually the patient (56.9%), while in HC it is the relative or companion (45.3%) (P<.001). HC aggressions occur more frequently in emergency departments (35.5%) compared with 63.9% in PC, where they occur in the consulting room (P<.001). Although it is difficult to make comparisons with previous studies due to methodological differences, a higher incidence of aggression in PC is observed compared with HC. It is necessary to establish improvements in Madrid Register of Aggressions and Conflicts, designed to optimise data quality and use them for preventive purposes. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Antibiotic resistance pattern of Helicobacter pylori strains isolated in Italy during 2010-2016.

PubMed

Fiorini, Giulia; Zullo, Angelo; Saracino, Ilaria Maria; Pavoni, Matteo; Vaira, Dino

2018-04-24

Bacterial resistance toward the most used antibiotics is increasing in Helicobacter pylori strains worldwide. Emergence of multidrug resistance significantly affects the efficacy of standard therapy regimens. Therefore, monitoring for primary antimicrobial resistance is essential for H. pylori management in clinical practice. H. pylori isolates obtained from patients consecutively observed in a single center were tested for primary resistance by using E-test method. Bacterial strains showing MIC values >0.5, >8 and >1 mg/L toward clarithromycin, metronidazole and levofloxacin, respectively, were considered resistant. The trend of antibiotic prevalence, either single or combined, during 2010-2016 was assessed. Antibiotic susceptibility data were available in 1424 (82.3%) out of 1730 tested patients. The overall resistance for all the three antibiotics showed an increasing trend from 2010 to 2013 (clarithromycin: from 19% to 35.6%; metronidazole: from 33.6% to 45.3%; levofloxacin: from 19% to 29.7%; p < .001), when a plateau until 2016 was observed (clarithromycin: 35.9%; metronidazole: 40.2%; levofloxacin: 29.3%). A similar trend occurred for clarithromycin-metronidazole combined resistance rate (2010: 11.4%; 2013: 28.2%; 2016: 21.9%). Our data suggest that prevalence of primary resistance in H. pylori isolates toward the most frequently used antibiotics probably reached a plateau in the last years.

HLA class I polymorphisms are associated with development of infectious mononucleosis upon primary EBV infection

PubMed Central

McAulay, Karen A.; Higgins, Craig D.; Macsween, Karen F.; Lake, Annette; Jarrett, Ruth F.; Robertson, Faye L.; Williams, Hilary; Crawford, Dorothy H.

2007-01-01

Infectious mononucleosis (IM) is an immunopathological disease caused by EBV that occurs in young adults and is a risk factor for Hodgkin lymphoma (HL). An association between EBV-positive HL and genetic markers in the HLA class I locus has been identified, indicating that genetic differences in the HLA class I locus may alter disease phenotypes associated with EBV infection. To further determine whether HLA class I alleles may affect development of EBV-associated diseases, we analyzed 2 microsatellite markers and 2 SNPs located near the HLA class I locus in patients with acute IM and in asymptomatic EBV-seropositive and -seronegative individuals. Alleles of both microsatellite markers were significantly associated with development of IM. Specific alleles of the 2 SNPs were also significantly more frequent in patients with IM than in EBV-seronegative individuals. IM patients possessing the associated microsatellite allele had fewer lymphocytes and increased neutrophils relative to IM patients lacking the allele. These patients also displayed higher EBV titers and milder IM symptoms. The results of this study indicate that HLA class I polymorphisms may predispose patients to development of IM upon primary EBV infection, suggesting that genetic variation in T cell responses can influence the nature of primary EBV infection and the level of viral persistence. PMID:17909631

Negotiating complementary and alternative medicine use in primary care visits with older patients

PubMed Central

Koenig, Christopher J.; Ho, Evelyn Y.; Yadegar, Vivien; Tarn, Derjung M.

2013-01-01

Objective To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits. Methods Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning. Results Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician–patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment. Conclusion Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions. Practice implications Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use. PMID:22483672

HLA class I polymorphisms are associated with development of infectious mononucleosis upon primary EBV infection.

PubMed

McAulay, Karen A; Higgins, Craig D; Macsween, Karen F; Lake, Annette; Jarrett, Ruth F; Robertson, Faye L; Williams, Hilary; Crawford, Dorothy H

2007-10-01

Infectious mononucleosis (IM) is an immunopathological disease caused by EBV that occurs in young adults and is a risk factor for Hodgkin lymphoma (HL). An association between EBV-positive HL and genetic markers in the HLA class I locus has been identified, indicating that genetic differences in the HLA class I locus may alter disease phenotypes associated with EBV infection. To further determine whether HLA class I alleles may affect development of EBV-associated diseases, we analyzed 2 microsatellite markers and 2 SNPs located near the HLA class I locus in patients with acute IM and in asymptomatic EBV-seropositive and -seronegative individuals. Alleles of both microsatellite markers were significantly associated with development of IM. Specific alleles of the 2 SNPs were also significantly more frequent in patients with IM than in EBV-seronegative individuals. IM patients possessing the associated microsatellite allele had fewer lymphocytes and increased neutrophils relative to IM patients lacking the allele. These patients also displayed higher EBV titers and milder IM symptoms. The results of this study indicate that HLA class I polymorphisms may predispose patients to development of IM upon primary EBV infection, suggesting that genetic variation in T cell responses can influence the nature of primary EBV infection and the level of viral persistence.

Negotiating complementary and alternative medicine use in primary care visits with older patients.

PubMed

Koenig, Christopher J; Ho, Evelyn Y; Yadegar, Vivien; Tarn, Derjung M

2012-12-01

To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits. Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning. Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician-patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment. Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions. Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

System hazards in managing laboratory test requests and results in primary care: medical protection database analysis and conceptual model.

PubMed

Bowie, Paul; Price, Julie; Hepworth, Neil; Dinwoodie, Mark; McKay, John

2015-11-27

To analyse a medical protection organisation's database to identify hazards related to general practice systems for ordering laboratory tests, managing test results and communicating test result outcomes to patients. To integrate these data with other published evidence sources to inform design of a systems-based conceptual model of related hazards. A retrospective database analysis. General practices in the UK and Ireland. 778 UK and Ireland general practices participating in a medical protection organisation's clinical risk self-assessment (CRSA) programme from January 2008 to December 2014. Proportion of practices with system risks; categorisation of identified hazards; most frequently occurring hazards; development of a conceptual model of hazards; and potential impacts on health, well-being and organisational performance. CRSA visits were undertaken to 778 UK and Ireland general practices of which a range of systems hazards were recorded across the laboratory test ordering and results management systems in 647 practices (83.2%). A total of 45 discrete hazard categories were identified with a mean of 3.6 per practice (SD=1.94). The most frequently occurring hazard was the inadequate process for matching test requests and results received (n=350, 54.1%). Of the 1604 instances where hazards were recorded, the most frequent was at the 'postanalytical test stage' (n=702, 43.8%), followed closely by 'communication outcomes issues' (n=628, 39.1%). Based on arguably the largest data set currently available on the subject matter, our study findings shed new light on the scale and nature of hazards related to test results handling systems, which can inform future efforts to research and improve the design and reliability of these systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Bone Metastasis in Prostate Cancer: Recurring Mitochondrial DNA Mutation Reveals Selective Pressure Exerted by the Bone Microenvironment

PubMed Central

Arnold, Rebecca S.; Fedewa, Stacey A.; Goodman, Michael; Osunkoya, Adeboye O.; Kissick, Haydn T.; Morrissey, Colm; True, Lawrence D.; Petros, John A.

2015-01-01

Background Cancer progression and metastasis occurs such that cells with acquired mutations enhancing growth and survival (or inhibiting cell death) increase in number, a concept that has been recognized as analogous to Darwinian evolution of species since Peter C. Nowell’s description in 1976. Selective forces include those intrinsic to the host (including metastatic site) as well as those resulting from anti-cancer therapies. By examining the mutational status of multiple tumor sites within an individual patient some insight may be gained into those genetic variants that enhance site-specific metastasis. By comparing these data across multiple individuals, recurrent patterns may identify alterations that are fundamental to successful site-specific metastasis. Methods We sequenced the mitochondrial genome in 10 prostate cancer patients with bone metastases enrolled in a rapid autopsy program. Patients had late stage disease and received androgen ablation and frequently other systemic therapies. For each of 9 patients, 4 separate tissues were sequenced: the primary prostate cancer, a soft tissue metastasis, a bone metastasis and an uninvolved normal tissue that served as the non-cancerous control. An additional (10th) patient had no primary prostate available for sequencing but had both metastatic sites (and control DNA) sequenced. We then examined the number and location of somatically acquired mitochondrial DNA (mtDNA) mutations in the primary and two metastatic sites in each individual patient. Finally, we compared patients with each other to determine any common patterns of somatic mutation. Results Somatic mutations were significantly more numerous in bone compared to either the primary tumor or soft tissue metastases. A missense mutation at nucleotide position (np) 10398 (A10398G; Thr114Ala) in the respiratory complex I gene ND3 was the most common (7 of 10 patients) and was detected only in bone. Other notable somatic mutations that occurred in more than one patient include a tRNA Arg mutation at np 10436 and a tRNA Thr mutation at np 15928. The tRNA Arg mutation was restricted to bone metastases and occurred in three of 10 patients (30%). Somatic mutation at 15928 was not restricted to bone and also occurred in three patients. Conclusions Mitochondrial genomic variation was greater in metastatic sites than the primary tumor and bone metastases had statistically significantly greater numbers of somatic mutations than either the primary or the soft tissue metastases. The genome was not mutated randomly. At least one mutational “hot-spot” was identified at the individual base level (nucleotide position 10398 in bone metastases) indicating a pervasive selective pressure for bone metastatic cells that had acquired the 10398 mtDNA mutation. Two additional recurrent mutations (tRNA Arg and tRNA Thr) support the concept of bone site-specific “survival of the fittest” as revealed by variation in the mitochondrial genome and selective pressure exerted by the metastatic site. PMID:25952970

Bone metastasis in prostate cancer: Recurring mitochondrial DNA mutation reveals selective pressure exerted by the bone microenvironment.

PubMed

Arnold, Rebecca S; Fedewa, Stacey A; Goodman, Michael; Osunkoya, Adeboye O; Kissick, Haydn T; Morrissey, Colm; True, Lawrence D; Petros, John A

2015-09-01

Cancer progression and metastasis occur such that cells with acquired mutations enhancing growth and survival (or inhibiting cell death) increase in number, a concept that has been recognized as analogous to Darwinian evolution of species since Peter C. Nowell's description in 1976. Selective forces include those intrinsic to the host (including metastatic site) as well as those resulting from anti-cancer therapies. By examining the mutational status of multiple tumor sites within an individual patient some insight may be gained into those genetic variants that enhance site-specific metastasis. By comparing these data across multiple individuals, recurrent patterns may identify alterations that are fundamental to successful site-specific metastasis. We sequenced the mitochondrial genome in 10 prostate cancer patients with bone metastases enrolled in a rapid autopsy program. Patients had late stage disease and received androgen ablation and frequently other systemic therapies. For each of 9 patients, 4 separate tissues were sequenced: the primary prostate cancer, a soft tissue metastasis, a bone metastasis and an uninvolved normal tissue that served as the non-cancerous control. An additional (10th) patient had no primary prostate available for sequencing but had both metastatic sites (and control DNA) sequenced. We then examined the number and location of somatically acquired mitochondrial DNA (mtDNA) mutations in the primary tumor and two metastatic sites in each individual patient. Finally, we compared patients with each other to determine any common patterns of somatic mutation. Somatic mutations were significantly more numerous in the bone compared to either the primary tumor or soft tissue metastases. A missense mutation at nucleotide position (n.p.) 10398 (A10398G; Thr114Ala) in the respiratory complex I gene ND3 was the most common (7 of 10 patients) and was detected only in the bone. Other notable somatic mutations that occurred in more than one patient include a tRNA Arg mutation at n.p. 10436 and a tRNA Thr mutation at n.p. 15928. The tRNA Arg mutation was restricted to bone metastases and occurred in three of 10 patients (30%). Somatic mutation at 15928 was not restricted to the bone and also occurred in three patients. Mitochondrial genomic variation was greater in metastatic sites than in the primary tumor and bone metastases had statistically significantly greater numbers of somatic mutations than either the primary or the soft tissue metastases. The genome was not mutated randomly. At least one mutational "hot-spot" was identified at the individual base level (nucleotide position 10398 in bone metastases) indicating a pervasive selective pressure for bone metastatic cells that had acquired the 10398 mtDNA mutation. Two additional recurrent mutations (tRNA Arg and tRNA Thr) support the concept of bone site-specific "survival of the fittest" as revealed by variation in the mitochondrial genome and selective pressure exerted by the metastatic site. Published by Elsevier Inc.

Comparison of the discontinuation rates and side-effect profiles of pilocarpine and cevimeline for xerostomia in primary Sjögren's syndrome.

PubMed

Noaiseh, Ghaith; Baker, Joshua F; Vivino, Frederick B

2014-01-01

There are currently no head-to-head comparisons of sialagogues for Primary Sjögren's syndrome (pSS). We compared the tolerability and side effect profile of pilocarpine and cevimeline in patients with pSS and determined clinical, laboratory and pathological variables associated with therapeutic failure. We retrospectively reviewed the use of pilocarpine and cevimeline in 118 patients with pSS who fulfilled the 2002 American European Consensus Group criteria in a University-based setting. Clinical, laboratory and pathological baseline variables were collected. Failure of therapy was defined as the clinician or patient's decision to stop treatment either due to lack of efficacy or side effects. Cevimeline was associated with lower failure rates compared to pilocarpine among first-time users: 27% vs. 47% (p=0.02), and all users: 32% vs. 61% (p<0.001). Severe sweating was the most frequent side effect leading to cessation of therapy and occurred more frequently in pilocarpine (25%) than cevimeline (11%) users (p=0.02). Patients who previously failed one secretagogue were less likely to discontinue treatment with the other agent, 52% of first-time users vs. 27% of second-time users (p=0.004). Only ANA positivity was associated with failure: [59% vs. 38%] (p=0.03). pSS patients were more likely to continue cevimeline than pilocarpine long-term due to fewer reported side effects with cevimeline. Therapeutic failure of one secretagogue did not predict similar results with the other since second time users were more likely to continue long-term treatment.

Factors affecting the loss of MED12-mutated leiomyoma cells during in vitro growth.

PubMed

Bloch, Jeannine; Holzmann, Carsten; Koczan, Dirk; Helmke, Burkhard Maria; Bullerdiek, Jörn

2017-05-23

Uterine leiomyomas (UL) are the most prevalent symptomatic human tumors at all and somatic mutations of the gene encoding mediator subcomplex 12 (MED12) constitute the most frequent driver mutations in UL. Recently, a rapid loss of mutated cells during in vitro growth of UL-derived cell cultures was reported, resulting in doubts about the benefits of UL-derived cell cultures. To evaluate if the rapid loss of MED12-mutated cells in UL cell cultures depends on in vitro passaging, we set up cell cultures from nine UL from 40-50 year old Caucasian patients with at least one UL. Cultured UL cells were investigated for loss of MED12-mutated cells. Genetic characterization of native tumor samples and adjacent myometrium was done by array analysis. "Aged" primary cultures without passaging were compared to cells of three subsequent passages. Comparative analyses of the mutated/non-mutated ratios between native tissue, primary cells, and cultured tumor cells revealed a clear decrease of MED12-mutated cells. None of the tumors showed gross alterations of the array profiles, excluding the presence of gross genomic imbalances besides the MED12 mutations as a reason for the intertumoral variation in the loss of MED12-mutated cells. Albeit at a lesser rate, loss of MED12-mutated cells from cell cultures of UL occurs even without passaging thus indicating the requirement of soluble factors or matrix components lacking in vitro. Identification of these factors can help to understand the mechanisms of the growth of the most frequent type of uterine leiomyomas and to decipher novel drug targets.

Randomized controlled trial comparing impact on platelet reactivity of twice-daily with once-daily aspirin in people with Type 2 diabetes.

PubMed

Bethel, M A; Harrison, P; Sourij, H; Sun, Y; Tucker, L; Kennedy, I; White, S; Hill, L; Oulhaj, A; Coleman, R L; Holman, R R

2016-02-01

Reduced aspirin efficacy has been demonstrated in people with Type 2 diabetes. Because increased platelet reactivity and/or turnover are postulated mechanisms, we examined whether higher and/or more frequent aspirin dosing might reduce platelet reactivity more effectively. Participants with Type 2 diabetes (n = 24) but without known cardiovascular disease were randomized in a three-way crossover design to 2-week treatment periods with aspirin 100 mg once daily, 200 mg once daily or 100 mg twice daily. The primary outcome was platelet reactivity, assessed using the VerifyNow(™) ASA method. Relationships between platelet reactivity and aspirin dosing were examined using generalized linear mixed models with random subject effects. Platelet reactivity decreased from baseline with all doses of aspirin. Modelled platelet reactivity was more effectively reduced with aspirin 100 mg twice daily vs. 100 mg once daily, but not vs. 200 mg once daily. Aspirin 200 mg once daily did not differ from 100 mg once daily. Aspirin 100 mg twice daily was also more effective than once daily as measured by collagen/epinephrine-stimulated platelet aggregation and urinary thromboxane levels, with a similar trend measured by serum thromboxane levels. No episodes of bleeding occurred. In Type 2 diabetes, aspirin 100 mg twice daily reduced platelet reactivity more effectively than 100 mg once daily, and numerically more than 200 mg once daily. Clinical outcome trials evaluating primary cardiovascular disease prevention with aspirin in Type 2 diabetes may need to consider using a more frequent dosing schedule. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

Molecular Characterization of Indolent Prostate Cancer

DTIC Science & Technology

2013-10-01

SUPPLEMENTARY NOTES 14. ABSTRACT Indolent prostate cancers that pose very low risk to aged men occur frequently and may be detected at biopsy, leading...Introduction Indolent prostate cancers that pose very low risk to aged men occur frequently and may be detected at biopsy, leading to the...cancer at the time of biopsy detection and thus meeting the entry criteria for active surveillance. The scope of the proposed research is: 1) to

Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention

PubMed Central

2012-01-01

Background The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. Methods/design A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6–22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. Discussion The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention. PMID:22607525

Value of surgery in patients with negative imaging and sporadic Zollinger-Ellison syndrome.

PubMed

Norton, Jeffrey A; Fraker, Douglas L; Alexander, H Richard; Jensen, Robert T

2012-09-01

To address the value of surgery in patients with sporadic Zollinger-Ellison syndrome (ZES) with negative imaging studies. Medical control of acid hypersecretion in patients with sporadic ZES is highly effective. This has led to these patients frequently not being sent to surgery, especially if preoperative imaging studies are negative, due, in large part, to existence of almost no data on the success of surgery in this group. Fifty-eight prospectively studied patients with sporadic ZES (17% of total studied) had negative imaging studies, and their surgical outcome was compared with 117 patients with positive imaging results. Thirty-five patients had negative imaging studies in the pre-somatostatin receptor scintigraphy (SRS) era, and 23 patients in the post-SRS era. Patients with negative imaging studies had long disease histories before surgery [mean ± SEM (from onset) = 7.9 ± 1 [range, -0.25 to 35 years]) and 25% were followed for 2 or more years from diagnosis. At surgery, gastrinoma was found in 57 of 58 patients (98%). Tumors were small (mean = 0.8 cm, 60% <1 cm). The most common primary sites were duodenal 64%, pancreatic 17%, and lymph node (10%). Fifty percent had a primary-only, 41% primary + lymph node, and 7% had liver metastases. Thirty-five of 58 patients (60%) were cured immediately postoperatively, and at last follow-up [mean = -9.4 years; range, 0.2-22 years], 27 patients (46%) remained cured. During follow-up, 3 patients died, each had liver metastases at surgery. In comparison to positive imaging patients, those with negative imaging studies had lower preoperative fasting gastrin levels; had a longer delay before surgery; more frequently had a small duodenal tumor; less frequently had a pancreatic tumor, multiple tumors, or developed a new lesion postoperatively; and had a longer survival. Sporadic ZES patients with negative imaging studies are not rare even in the post-SRS period. An experienced surgeon can find gastrinoma in almost every patient (98%) and nearly one half (46%) are cured, a rate similar to patients with positive imaging findings. Because liver metastases were found in 7%, which may have been caused by a long delay in surgery and all the disease-related deaths occurred in this group, surgery should be routinely undertaken early in ZES patients despite negative imaging studies.

Value of Surgery In Patients With Negative Imaging And Sporadic Zollinger-Ellison Syndrome (ZES)

PubMed Central

Norton, Jeffrey A.; Fraker, Douglas L.; Alexander, H. Richard; Jensen, Robert T

2012-01-01

Objectives To address the value of surgery in sporadic Zollinger-Ellison syndrome (ZES) patients with negative imaging studies. Background Medical control of acid hypersecretion in patients with sporadic Zollinger-Ellison syndrome (ZES) is highly effective. This has led to these patients frequently not sent to surgery, especially if preoperative imaging studies are negative, due in large part because almost no data exists on the success of surgery in this group. Methods 58 prospectively studied sporadic ZES patients (17% of total studied) had negative imaging studies and their surgical outcome was compared to 117 patients with positive imaging results. Results 35 patients had negative imaging in the pre-somatostatin receptor scintigraphy era (SRS) and 23 in the post-SRS era. The image negative patients had long disease histories prior to surgery (mean±SEM, from onset=7.9±1[range −0.25-35 yrs]) and 25% were followed ≥2yrs from diagnosis. At surgery, gastrinoma was found in 57/58 patients (98%). Tumors were small (mean=0.8cm, 60% < 1 cm). The most common primary sites were: duodenal 64%, pancreatic 17%, and lymph node (LN)(10%). 50% had a primary only, 41% primary + LN, and 7% had liver metastases. 35/58(60%) were cured immediately postoperatively and at last follow-up [mean-9.4yrs, range 0.2-22yrs], 27 patients (46%) remained cured. During follow-up 3 patients died, each was found to have liver metastases at surgery. In comparison to the image positive patients, those with negative imaging had lower preop fasting gastrin levels; a longer delay prior to surgery; more frequently had a small duodenal tumors; less frequently had a pancreatic tumor, multiple tumors or developed a new lesion postoperatively and had a longer survival. Conclusions Imaging negative sporadic ZES patients are not rare even in the post-SRS period. An experienced surgeon can find gastrinoma in almost every patient (98%) and nearly one-half (46%) are cured, a rate similar to imaging positive tumor patients. Because liver metastases were found in 7%, which may have been caused by a long delay in surgery and all the disease-related deaths occurred in this group, surgery should be routinely undertaken early in ZES patients despite negative imaging studies. PMID:22868363

Reduced CO2 fertilization effect in temperate C3 grasslands under more extreme weather conditions

NASA Astrophysics Data System (ADS)

Obermeier, W. A.; Lehnert, L. W.; Kammann, C. I.; Müller, C.; Grünhage, L.; Luterbacher, J.; Erbs, M.; Moser, G.; Seibert, R.; Yuan, N.; Bendix, J.

2017-02-01

The increase in atmospheric greenhouse gas concentrations from anthropogenic activities is the major driver of recent global climate change. The stimulation of plant photosynthesis due to rising atmospheric carbon dioxide concentrations ([CO2]) is widely assumed to increase the net primary productivity (NPP) of C3 plants--the CO2 fertilization effect (CFE). However, the magnitude and persistence of the CFE under future climates, including more frequent weather extremes, are controversial. Here we use data from 16 years of temperate grassland grown under `free-air carbon dioxide enrichment’ conditions to show that the CFE on above-ground biomass is strongest under local average environmental conditions. The observed CFE was reduced or disappeared under wetter, drier and/or hotter conditions when the forcing variable exceeded its intermediate regime. This is in contrast to predictions of an increased CO2 fertilization effect under drier and warmer conditions. Such extreme weather conditions are projected to occur more intensely and frequently under future climate scenarios. Consequently, current biogeochemical models might overestimate the future NPP sink capacity of temperate C3 grasslands and hence underestimate future atmospheric [CO2] increase.

Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use

PubMed Central

Kinoshita, Yoshikazu; Ishimura, Norihisa; Ishihara, Shunji

2018-01-01

Proton pump inhibitors (PPIs) potently inhibit gastric acid secretion and are widely used for treatment of acid-related diseases including gastroesophageal reflux disease and secondary prevention of aspirin/NSAID-induced ulcers. Although clinically important adverse effects of PPIs can occur, just as with other drugs, those are not frequently observed during or after administration. Thus, PPIs are regarded as relatively safe and considered to be clinically beneficial. Recently, PPIs have become frequently administered to patients with functional gastrointestinal diseases or primary prevention of drug-related gastroduodenal damage, even though their beneficial effects for those conditions have not been fully confirmed. PPIs tend to be given for conditions in which the necessity of the drug has not been clarified, thus otherwise rare adverse effects are presented as clinically relevant. Although several PPI-related adverse effects have been reported, their clinical relevance is not yet clear, since the evidence reported in those studies is not at a high enough level, as the majority are based on retrospective observational studies and the reported hazard ratios are low. It is important to administer PPIs only for patients who will gain a substantial clinical benefit and to continue to investigate their adverse effects with high quality prospective studies. PMID:29605975

Psychodermatology: A Guide to Understanding Common Psychocutaneous Disorders

PubMed Central

Jafferany, Mohammad

2007-01-01

Objective: This review focuses on classification and description of and current treatment recommendations for psychocutaneous disorders. Medication side effects of both psychotropic and dermatologic drugs are also considered. Data Sources: A search of the literature from 1951 to 2004 was performed using the MEDLINE search engine. English-language articles were identified using the following search terms: skin and psyche, psychiatry and dermatology, mind and skin, psychocutaneous, and stress and skin. Data Synthesis: The psychotropic agents most frequently used in patients with psychocutaneous disorders are those that target anxiety, depression, and psychosis. Psychiatric side effects of dermatologic drugs can be significant but can occur less frequently than the cutaneous side effects of psychiatric medications. In a majority of patients presenting to dermatologists, effective management of skin conditions requires consideration of associated psychosocial factors. For some dermatologic conditions, there are specific demographic and personality features that commonly associate with disease onset or exacerbation. Conclusions: More than just a cosmetic disfigurement, dermatologic disorders are associated with a variety of psychopathologic problems that can affect the patient, his or her family, and society together. Increased understanding of biopsychosocial approaches and liaison among primary care physicians, psychiatrists, and dermatologists could be very useful and highly beneficial. PMID:17632653

[Some neurologic and psychiatric complications in endocrine disorders: the thyroid gland].

PubMed

Aszalós, Zsuzsa

2007-02-18

Thyroid hormones are of primary importance for the perinatal development of the central nervous system, and for normal function of the adult brain. These hormones primarily regulate the transcription of specific target genes. They increase the cortical serotonergic neurotransmission, and play an important role in regulating central noradrenergic and GABA function. Thyroid deficiency during the perinatal period results in mental retardation. Hypothyroidism of the adults causes most frequently dementia and depression. Other less common clinical pictures include myxoedema coma, dysfunction of cerebellum and cranial nerves. Hypothyroidism also increases predisposition of stroke. Peripheral diseases frequently include polyneuropathy, carpal tunnel syndrome, myalgic state, and rarely myokymia. Nearly all the hyperthyroid patients show minor psychiatric signs, and infrequently psychosis, dementia, confusion state, depression, apathetic thyrotoxicosis, thyrotoxic crisis, seizures, pyramidal signs, or chorea occur. The peripheral complications may be indicated by chronic thyrotoxic myopathy, infiltrative ophthalmopathy, myasthenia gravis, periodic hypokalemic paralysis and polyneuropathy. Generalized resistance to thyroid hormone was confirmed in a number of patients with attention deficit-hyperactivity disorder. Significantly elevated antithyroid antibody titers characterize Hashimoto's encephalopathy. This condition is a rare, acute - subacute, serious, life threatening, but steroid-responsive, relapsing-remitting, autoimmune disease.

Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use.

PubMed

Kinoshita, Yoshikazu; Ishimura, Norihisa; Ishihara, Shunji

2018-04-30

Proton pump inhibitors (PPIs) potently inhibit gastric acid secretion and are widely used for treatment of acid-related diseases including gastroesophageal reflux disease and secondary prevention of aspirin/NSAID-induced ulcers. Although clinically important adverse effects of PPIs can occur, just as with other drugs, those are not frequently observed during or after administration. Thus, PPIs are regarded as relatively safe and considered to be clinically beneficial. Recently, PPIs have become frequently administered to patients with functional gastrointestinal diseases or primary prevention of drug-related gastroduodenal damage, even though their beneficial effects for those conditions have not been fully confirmed. PPIs tend to be given for conditions in which the necessity of the drug has not been clarified, thus otherwise rare adverse effects are presented as clinically relevant. Although several PPI-related adverse effects have been reported, their clinical relevance is not yet clear, since the evidence reported in those studies is not at a high enough level, as the majority are based on retrospective observational studies and the reported hazard ratios are low. It is important to administer PPIs only for patients who will gain a substantial clinical benefit and to continue to investigate their adverse effects with high quality prospective studies.

Adolescent women's daily academic behaviors, sexual behaviors, and sexually related emotions.

PubMed

Hensel, Devon J; Sorge, Brandon H

2014-12-01

Emerging literature suggests that the emotional and behavioral experience in young women's romantic/sexual relationships may link to their academic success. However, existing studies' reliance on retrospective and/or global measures prevents detailed understanding of how and when specific academic experiences link to specific relationship experiences and whether these associations could vary over different school days. Adolescent women (N = 387; 14-17 years at enrollment) were recruited from primary care adolescent clinics for a longitudinal cohort study of sexual relationships and sexual behavior. Participants provided daily diary information on academic behaviors, sexual emotions, and sexual behaviors. Chi-square and generalized estimating equation ordinal logistic or linear regression, respectively, assessed prevalence of sexual behaviors or differences in sexual emotions when academic behaviors did and did not occur. Young women's weekday reports of skipping school or failing a test were significantly linked to more frequent vaginal sex, less frequent condom use, and different levels of sexual emotions, on that same day. Our findings provide evidence that the emotional and behavioral experiences in young women's romantic/sexual relationships may impact young women's reaction to academic events. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Primary gastrointestinal lymphoma: a review of 21 cases.

PubMed

Kaufman, Z; Eliashiv, A; Shpitz, B; Witz, M; Griffel, B; Dinbar, A

1984-05-01

A retrospective study of 21 patients who had suffered from gastrointestinal lymphoma was carried out. Gastric involvement was more common than involvement of the small or large intestine and carried a better prognosis. Gastrointestinal lymphoma generally occurs most frequently during the fourth to seventh decades of life. In our study, however, five lymphomas occurred in patients under 20 years of age. Clinical symptoms were nonspecific, and abdominal mass was found in only 15% of the patients on clinical examination. All patients were explored, 17 underwent resection, and 4 laparotomy and biopsy. Five-year survival was much better for patients who had undergone resection. Survival was inversely proportionate to the extent of nodal spread. Multiple lesions on the same organ yielded a 5-year survival of 20%, while a single lesion offered a 55% chance of 5-year survival. Diffuse histiocytic lymphoma was the commonest type, followed by the poorly differentiated lymphocytic type. A longer survival rate was present in the lymphocytic type. However, the highest survival rate was in those patients in whom definite resections of the lesion were performed followed by radiation and chemotherapy, especially for gastric tumor.

Activation of the MAPK pathway is a common event in uveal melanomas although it rarely occurs through mutation of BRAF or RAS.

PubMed

Zuidervaart, W; van Nieuwpoort, F; Stark, M; Dijkman, R; Packer, L; Borgstein, A-M; Pavey, S; van der Velden, P; Out, C; Jager, M J; Hayward, N K; Gruis, N A

2005-06-06

In contrast to cutaneous melanoma, there is no evidence that BRAF mutations are involved in the activation of the mitogen-activated protein kinase (MAPK) pathway in uveal melanoma, although there is increasing evidence that this pathway is activated frequently in the latter tumours. In this study, we performed mutation analysis of the RAS and BRAF genes in a panel of 11 uveal melanoma cell lines and 19 primary uveal melanoma tumours. In addition, Western blot and immunohistochemical analyses were performed on downstream members of the MAPK pathway in order to assess the contribution of each of these components. No mutations were found in any of the three RAS gene family members and only one cell line carried a BRAF mutation (V599E). Despite this, mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK), ERK and ELK were constitutively activated in all samples. These data suggest that activation of the MAPK pathway is commonly involved in the development of uveal melanoma, but occurs through a mechanism different to that of cutaneous melanoma.

Activation of the MAPK pathway is a common event in uveal melanomas although it rarely occurs through mutation of BRAF or RAS

PubMed Central

Zuidervaart, W; van Nieuwpoort, F; Stark, M; Dijkman, R; Packer, L; Borgstein, A-M; Pavey, S; van der Velden, P; Out, C; Jager, M J; Hayward, N K; Gruis, N A

2005-01-01

In contrast to cutaneous melanoma, there is no evidence that BRAF mutations are involved in the activation of the mitogen-activated protein kinase (MAPK) pathway in uveal melanoma, although there is increasing evidence that this pathway is activated frequently in the latter tumours. In this study, we performed mutation analysis of the RAS and BRAF genes in a panel of 11 uveal melanoma cell lines and 19 primary uveal melanoma tumours. In addition, Western blot and immunohistochemical analyses were performed on downstream members of the MAPK pathway in order to assess the contribution of each of these components. No mutations were found in any of the three RAS gene family members and only one cell line carried a BRAF mutation (V599E). Despite this, mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK), ERK and ELK were constitutively activated in all samples. These data suggest that activation of the MAPK pathway is commonly involved in the development of uveal melanoma, but occurs through a mechanism different to that of cutaneous melanoma. PMID:15928660

Biochemical abnormalities in neonatal seizures.

PubMed

Sood, Arvind; Grover, Neelam; Sharma, Roshan

2003-03-01

The presence of seizure does not constitute a diagnoses but it is a symptom of an underlying central nervous system disorder due to systemic or biochemical disturbances. Biochemical disturbances occur frequently in the neonatal seizures either as an underlying cause or as an associated abnormality. In their presence, it is difficult to control seizure and there is a risk of further brain damage. Early recognition and treatment of biochemical disturbances is essential for optimal management and satisfactory long term outcome. The present study was conducted in the department of pediatrics in IGMC Shimla on 59 neonates. Biochemical abnormalities were detected in 29 (49.15%) of cases. Primary metabolic abnormalities occurred in 10(16.94%) cases of neonatal seizures, most common being hypocalcaemia followed by hypoglycemia, other metabolic abnormalities include hypomagnesaemia and hyponateremia. Biochemical abnormalities were seen in 19(38.77%) cases of non metabolic seizure in neonates. Associated metabolic abnormalities were observed more often with Hypoxic-ischemic-encephalopathy (11 out of 19) cases and hypoglycemia was most common in this group. No infant had hyponateremia, hyperkelemia or low zinc level.

Uncoupling of Satellite DNA and Centromeric Function in the Genus Equus

PubMed Central

Magnani, Elisa; Bertoni, Livia; Attolini, Carmen; Khoriauli, Lela; Raimondi, Elena; Giulotto, Elena

2010-01-01

In a previous study, we showed that centromere repositioning, that is the shift along the chromosome of the centromeric function without DNA sequence rearrangement, has occurred frequently during the evolution of the genus Equus. In this work, the analysis of the chromosomal distribution of satellite tandem repeats in Equus caballus, E. asinus, E. grevyi, and E. burchelli highlighted two atypical features: 1) several centromeres, including the previously described evolutionary new centromeres (ENCs), seem to be devoid of satellite DNA, and 2) satellite repeats are often present at non-centromeric termini, probably corresponding to relics of ancestral now inactive centromeres. Immuno-FISH experiments using satellite DNA and antibodies against the kinetochore protein CENP-A demonstrated that satellite-less primary constrictions are actually endowed with centromeric function. The phylogenetic reconstruction of centromere repositioning events demonstrates that the acquisition of satellite DNA occurs after the formation of the centromere during evolution and that centromeres can function over millions of years and many generations without detectable satellite DNA. The rapidly evolving Equus species gave us the opportunity to identify different intermediate steps along the full maturation of ENCs. PMID:20169180

Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease

PubMed Central

Walker, Craig M; Bunch, Frank T; Cavros, Nick G; Dippel, Eric J

2015-01-01

Peripheral arterial disease (PAD) is frequently diagnosed after permanent damage has occurred, resulting in a high rate of morbidity, amputation, and loss of life. Early and ongoing diagnosis and treatment is required for this progressive disease. Lifestyle modifications can prevent or delay disease progression and improve symptoms. Limb-sparing endovascular interventions can restore circulation based on appropriate diagnostic testing to pinpoint vascular targets, and intervention must occur as early as possible to ensure optimal clinical outcomes. An algorithm for the diagnosis and management of PAD was developed to enable a collaborative approach between the family practice and primary care physician or internist and various specialists that may include a diabetologist, endocrinologist, smoking cessation expert, hypertension and lipid specialist, endovascular interventionalist, vascular surgeon, orthopedist, neurologist, nurse practitioner, podiatrist, wound healing expert, and/or others. A multidisciplinary team working together has the greatest chance of providing optimal care for the patient with PAD and ensuring ongoing surveillance of the patient’s overall health, ultimately resulting in better quality of life and increased longevity for patients with PAD. PMID:26203234

Characteristics of renal papillae in kidney stone formers.

PubMed

Marien, Tracy P; Miller, Nicole L

2016-12-01

The mechanism of kidney stone formation is not well understood. In order to better understand the pathophysiology for specific kidney stone compositions and systemic diseases associated with kidney stones, endoscopic papillary mapping studies with concurrent biopsies have been conducted. This review will summarize the findings of these studies and proposed mechanisms for thirteen disease processes associated with kidney stones. A review of the literature was performed identifying thirteen studies that endoscopically mapped and biopsied renal papillae of different stone formers. These studies characterized renal papillae based on amount of Randall's plaque, Bellini's duct pathology, papillary contour changes, presence of attached stones, pitting, and frequently papillary and cortical biopsies. The groups studied and reviewed here are kidney stone formers who have a history of idiopathic calcium oxalate stone formation, cystinuria, brushite stones, gastric bypass, ileostomy, small bowel resection, primary hyperparathyroidism, distal renal tubular acidosis (dRTA), primary hyperoxaluria, idiopathic calcium phosphate stone formation, medullary sponge kidney (MSK), uric acid stones, and struvite stones. A proposed standardized scoring system for papillary pathology was also reviewed. The series showed various degrees and types of changes to the renal papillae and corresponding histopathologic changes for each type of stone former reviewed. Those with predominantly alone Randall's plaque pathology had less tissue damage versus those with extensive Bellini's duct lesions who had more interstitial fibrosis and cortical pathology. Randall's plaques are associated with stone formers who have low urinary volume, high urinary calcium, and acidic urine and thus are frequently seen in those with brushite stones, primary hyperparathyroidism, small bowel resection, and idiopathic calcium phosphate stone formers. Bellini's duct plugging and pathology is theorized to occur via free solution crystallization, ductal obstruction, inflammation, cellular injury, fibrosis, and acidification defects. Ureteroscopic manifestations of stone disease can vary from normal appearing papillae to significantly diseased appearing papillae. Some diseases have very characteristic papillary changes. Further studies are necessary to fully elucidate the mechanisms of stone formation in patients with nephrolithiasis.

Sexual Orientation Disclosure in Primary Care Settings by Gay, Bisexual, and Other Men Who Have Sex with Men in a Canadian City.

PubMed

Coleman, Todd A; Bauer, Greta R; Pugh, Daniel; Aykroyd, Gloria; Powell, Leanne; Newman, Rob

2017-02-01

Sexual orientation affects individuals' health histories and is fundamental to providers' understanding of patients as a whole. Gay, bisexual, and other men who have sex with men (GB-MSM) are vulnerable to certain health conditions, including HIV. The aim of this exploratory analysis was to examine factors associated with sexual orientation disclosure and communication with providers about GB-MSM health issues and to discuss implications. We conducted a cross-sectional internet survey of GB-MSM (n = 202) in London-Middlesex, Ontario, Canada; analyses were limited to those with a regular primary care provider (n = 173). Blockwise regression models explored demographic, psychosocial, and healthcare-related factors associated with sexual orientation disclosure and physician-patient communication about GB-MSM-related health. Just over seventy-one percent (71.1%) of participants reported that their primary care provider (PCP) knew their sexual orientation, and 44.5% had talked to them about GB-MSM health. Overt negative comments or being refused care based on sexual orientation occurred infrequently, although 26.6% reported their provider had assumed they were heterosexual. Being married to or living common-law with another man, more frequent experiences of homosexual prejudice, and higher quality assessment of provider's communication skills were associated with the PCP knowing respondents' sexual orientation. Greater internalized homonegativity was associated with not talking to a PCP about GB-MSM-related health issues. More frequent experiences of homosexual prejudice, higher assessment of provider communication, and having prior negative experiences with a PCP were significantly associated with talking to a PCP about GB-MSM health. The majority of our sample disclosed their sexual orientation; however, not all patients voluntarily disclose. Medical training and education in Canada, where specific rights protections exist for sexual orientation minority populations, should emphasize awareness of essential patient health information. Training should include information about GB-MSM health and building a foundation on how to speak with GB-MSM patients nonjudgmentally.

Primary care nurses' communication and its influence on patient talk during motivational interviewing.

PubMed

Östlund, Ann-Sofi; Wadensten, Barbro; Häggström, Elisabeth; Lindqvist, Helena; Kristofferzon, Marja-Leena

2016-11-01

The aim of this study was to describe what verbal behaviours/kinds of talk occur during recorded motivational interviewing sessions between nurses in primary care and their patients. The aim was also to examine what kinds of nurse talk predict patient change talk, neutral talk and/or sustain talk. Motivational interviewing is a collaborative conversational style. It has been shown to be effective, in addressing health behaviours such as diet, exercise, weight loss and chronic disease management. In Sweden, it is one of the approaches to disease prevention conversations with patients recommended in the National Guidelines for Disease Prevention. Research on the mechanisms underlying motivational interviewing is growing, but research on motivational interviewing and disease prevention has also been called for. A descriptive and predictive design was used. Data were collected during 2011-2014. Fifty audio-recorded motivational interviewing sessions between 23 primary care nurses and 50 patients were analysed using Motivational Interviewing Sequential Code for Observing Process Exchanges. The frequency of specific kinds of talk and sequential analysis (to predict patient talk from nurse talk) were computed using the software Generalized Sequential Querier 5. The primary care nurses and patients used neutral talk most frequently. Open and negative questions, complex and positive reflections were significantly more likely to be followed by change talk and motivational interviewing-inconsistent talk, positive questions and negative reflections by sustain talk. To increase patients' change talk, primary care nurses need to use more open questions, complex reflections and questions and reflections directed towards change. © 2016 John Wiley & Sons Ltd.

Genomic evolution and chemoresistance in germ-cell tumours.

PubMed

Taylor-Weiner, Amaro; Zack, Travis; O'Donnell, Elizabeth; Guerriero, Jennifer L; Bernard, Brandon; Reddy, Anita; Han, G Celine; AlDubayan, Saud; Amin-Mansour, Ali; Schumacher, Steven E; Litchfield, Kevin; Turnbull, Clare; Gabriel, Stacey; Beroukhim, Rameen; Getz, Gad; Carter, Scott L; Hirsch, Michelle S; Letai, Anthony; Sweeney, Christopher; Van Allen, Eliezer M

2016-11-30

Germ-cell tumours (GCTs) are derived from germ cells and occur most frequently in the testes. GCTs are histologically heterogeneous and distinctly curable with chemotherapy. Gains of chromosome arm 12p and aneuploidy are nearly universal in GCTs, but specific somatic genomic features driving tumour initiation, chemosensitivity and progression are incompletely characterized. Here, using clinical whole-exome and transcriptome sequencing of precursor, primary (testicular and mediastinal) and chemoresistant metastatic human GCTs, we show that the primary somatic feature of GCTs is highly recurrent chromosome arm level amplifications and reciprocal deletions (reciprocal loss of heterozygosity), variations that are significantly enriched in GCTs compared to 19 other cancer types. These tumours also acquire KRAS mutations during the development from precursor to primary disease, and primary testicular GCTs (TGCTs) are uniformly wild type for TP53. In addition, by functional measurement of apoptotic signalling (BH3 profiling) of fresh tumour and adjacent tissue, we find that primary TGCTs have high mitochondrial priming that facilitates chemotherapy-induced apoptosis. Finally, by phylogenetic analysis of serial TGCTs that emerge with chemotherapy resistance, we show how TGCTs gain additional reciprocal loss of heterozygosity and that this is associated with loss of pluripotency markers (NANOG and POU5F1) in chemoresistant teratomas or transformed carcinomas. Our results demonstrate the distinct genomic features underlying the origins of this disease and associated with the chemosensitivity phenotype, as well as the rare progression to chemoresistance. These results identify the convergence of cancer genomics, mitochondrial priming and GCT evolution, and may provide insights into chemosensitivity and resistance in other cancers.

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

Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Raab, Udo, E-mail: udo.raab@klinikum-ingolstadt.de; Lazarus, Friedrich, E-mail: friedrich.lazarus@klinikum-ingolstadt.de

PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft wasmore » the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.« less

Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care.

PubMed

Thompson, Sandra C; Haynes, Emma; Woods, John A; Bessarab, Dawn C; Dimer, Lynette A; Wood, Marianne M; Sanfilippo, Frank M; Hamilton, Sandra J; Katzenellenbogen, Judith M

2016-01-01

The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and inside the clinic for prevention and management of disease. A toolkit of proactive and holistic opportunities for interventions is proposed.

Stimulus-specific adaptation in a recurrent network model of primary auditory cortex

PubMed Central

2017-01-01

Stimulus-specific adaptation (SSA) occurs when neurons decrease their responses to frequently-presented (standard) stimuli but not, or not as much, to other, rare (deviant) stimuli. SSA is present in all mammalian species in which it has been tested as well as in birds. SSA confers short-term memory to neuronal responses, and may lie upstream of the generation of mismatch negativity (MMN), an important human event-related potential. Previously published models of SSA mostly rely on synaptic depression of the feedforward, thalamocortical input. Here we study SSA in a recurrent neural network model of primary auditory cortex. When the recurrent, intracortical synapses display synaptic depression, the network generates population spikes (PSs). SSA occurs in this network when deviants elicit a PS but standards do not, and we demarcate the regions in parameter space that allow SSA. While SSA based on PSs does not require feedforward depression, we identify feedforward depression as a mechanism for expanding the range of parameters that support SSA. We provide predictions for experiments that could help differentiate between SSA due to synaptic depression of feedforward connections and SSA due to synaptic depression of recurrent connections. Similar to experimental data, the magnitude of SSA in the model depends on the frequency difference between deviant and standard, probability of the deviant, inter-stimulus interval and input amplitude. In contrast to models based on feedforward depression, our model shows true deviance sensitivity as found in experiments. PMID:28288158

Combined elevated temperature and soil waterlogging stresses inhibit cell elongation by altering osmolyte composition of the developing cotton (Gossypium hirsutum L.) fiber.

PubMed

Chen, Yinglong; Wang, Haimiao; Hu, Wei; Wang, Shanshan; Wang, Youhua; Snider, John L; Zhou, Zhiguo

2017-03-01

Soil waterlogging events and high temperature conditions occur frequently in the Yangtze River Valley, yet the effects of these co-occurring stresses on fiber elongation have received little attention. In the current study, the combined effect of elevated temperature (ET) and soil waterlogging (SW) more negatively affected final fiber length (reduced by 5.4%-11.3%) than either stress alone by altering the composition of osmotically active solutes (sucrose, malate, and K + ), where SW had the most pronounced effect. High temperature accelerated early fiber development, but limited the duration of elongation, thereby limiting final fiber length. Treatment of ET alone altered fiber sucrose content mainly through decreased source strength and the expression of the sucrose transporter gene GhSUT-1, making sucrose availability the primary determinant of final fiber length under ET. Waterlogging stress alone decreased source strength, down-regulated GhSUT-1 expression and enhanced SuSy catalytic activity for sucrose reduction. Waterlogging treatment alone also limited fiber malate production by down-regulating GhPEPC-1 & -2. However, combined elevated temperature and waterlogging limited primary cell wall synthesis by affecting GhCESAs genes and showed a negative impact on all three major osmotic solutes through the regulation of GhSUT-1, GhPEPC-1 & -2 and GhKT-1 expression and altered SuSy activity, which functioned together to produce a shorter fiber length. Copyright © 2017 Elsevier B.V. All rights reserved.

ATG-Fresenius treatment and low-dose tacrolimus: results of a randomized controlled trial in liver transplantation.

PubMed

Benítez, C E; Puig-Pey, I; López, M; Martínez-Llordella, M; Lozano, J J; Bohne, F; Londoño, M C; García-Valdecasas, J C; Bruguera, M; Navasa, M; Rimola, A; Sánchez-Fueyo, A

2010-10-01

We report the results of a prospective randomized controlled trial in liver transplantation assessing the efficacy and safety of antithymocyte globulin (ATG-Fresenius) plus tacrolimus monotherapy at gradually decreasing doses. Patients were randomized to either: (a) standard-dose tacrolimus plus steroids;or (b) peritransplant ATG-Fresenius plus reduced-dose tacrolimus monotherapy followed by weaning of tacrolimus starting 3 months after transplantation. The primary end-point was the achievement of very low-dose tacrolimus (every-other-day or once daily dose with <5 ng/mL trough levels) at 12 months after transplantation. Acute rejection occurring during the first 3 months after transplantation was more frequent in the ATG group (52.4% vs. 25%). Moreover, late acute rejection episodes occurred in all recipients in whom weaning was attempted and no recipients reached the primary end-point. This motivated the premature termination of the trial. Tacrolimus trough levels were lower in the ATG-Fresenius group but no benefits in terms of improved renal function, lower metabolic complications or increased prevalence of tolerance-related biomarkers were observed. In conclusion, the use of ATG-Fresenius and tacrolimus at gradually decreasing doses was associated with a high rate of rejection, did not allow for the administration of very low doses of tacrolimus and failed to provide detectable clinical benefits. ClinicalTrials.gov identifier: NCT00436722. © 2010 The Authors Journal compilation © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

Sex difference in survival of patients treated by surgical resection for esophageal cancer.

PubMed

Hidaka, Hideki; Hotokezaka, Masayuki; Nakashima, Shinya; Uchiyama, Shuichiro; Maehara, Naoki; Chijiiwa, Kazuo

2007-10-01

Squamous cell carcinoma accounts for most of the esophageal cancers in Japan and is often related to excessive smoking and drinking. Although esophageal cancer occurs far more frequently in men than in women, it is not certain whether there are sex-specific differences in morbidity and mortality after surgical resection of the esophagus. We conducted a study to determine the influence of sex on the short- and long-term results of surgical resection in patients with esophageal cancer. There were 295 patients with a newly diagnosed primary malignant neoplasm of the esophagus treated at our University hospital between January 1978 and December 2005. There were 185 patients (166 men, 19 women; age range 39-86 years) who underwent surgical resection for primary esophageal malignant neoplasms. Survival rates were calculated according to the Kaplan-Meier method and tested with the log-rank test. Cox proportional hazards model was used to assess independent predictors of survival. The cumulative amount of alcohol consumed and number of cigarettes smoked were significantly higher in men than in women. Postoperative complications occurred in 101 men (60.8%) and 9 women (47.4%), but significant sex differences in postoperative morbidity and mortality were not observed. Overall survival was significantly better for women than for men. Postoperative morbidity and mortality do not appear to differ between men and women with esophageal cancer treated by surgical resection. Long-term survival after surgical resection of the esophagus appears to be significantly better for women than for men.

Double-balloon endoscopy as the primary method for small-bowel video capsule endoscope retrieval.

PubMed

Van Weyenberg, Stijn J B; Van Turenhout, Sietze T; Bouma, Gerd; Van Waesberghe, Jan Hein T M; Van der Peet, Donald L; Mulder, Chris J J; Jacobs, Maarten A J M

2010-03-01

Capsule retention in the small bowel is a known complication of small-bowel video capsule endoscopy. Surgery is the most frequently used method of capsule retrieval. To determine the incidence and causes of capsule retention and to describe double-balloon endoscopy (DBE) as the primary technique used for capsule retrieval. Retrospective analysis of all video capsule studies was performed at our center, and evaluation of the outcome of DBE was the first method used to retrieve entrapped video capsules. Tertiary referral center. A total of 904 patients who underwent small-bowel video capsule endoscopy. Capsule retrieval by DBE. The number of patients in whom capsule retention occurred and the number of patients in whom an entrapped capsule could be retrieved by using DBE. Capsule retention occurred in 8 patients (incidence 0.88%; 95% CI, 0.41%-1.80%) and caused acute small-bowel obstruction in 6 patients. All retained capsules were successfully removed during DBE. Five patients underwent elective surgery to treat the underlying cause of capsule retention. One patient required emergency surgery because of multiple small-bowel perforations. Retrospective design. In our series, the incidence of capsule retention was low. DBE is a reliable method for removing retained capsules and might prevent unnecessary surgery. If surgery is required, preoperative capsule retrieval allows preoperative diagnosis, adequate staging in case of malignancy, and optimal surgical planning. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Hypogonadism in DM1 and its relationship to erectile dysfunction.

PubMed

Antonini, Giovanni; Clemenzi, Alessandro; Bucci, Elisabetta; De Marco, Emanuela; Morino, Stefania; Di Pasquale, Antonella; Latino, Pamela; Ruga, Gilda; Lenzi, Andrea; Vanacore, Nicola; Radicioni, Antonio F

2011-07-01

Myotonic dystrophy type 1 (DM1) is characterized by both a premature appearance of age-related phenotypes and multiple organ involvement, which affects skeletal and smooth muscle as well as the eye, heart, central nervous system, and endocrine system. Although erectile dysfunction (ED) is a frequent complaint in patients with DM1, it has not been investigated in great depth. Hypogonadism, which is reported to be one of the physical causes of ED in the general population, frequently occurs in DM1. We planned this case-control study to evaluate the relationship between hypogonadism, as defined by the sexual hormone profile (FSH, LH, testosterone (T) and prolactin) and ED, as assessed by means of an internationally validated self-administered questionnaire (IIEF). DM1 patients had significantly increased mean levels of both gonadotropins (FSH and LH) (p < 0.0001) and a reduced mean level of T (p < 0.0001) when compared to controls. Twelve patients were eugonadic (normal LH, T, and FSH), while 18 displayed hormonal evidence of hypogonadism, characterized by tubular failure (increased FSH) in all the subjects and associated with interstitial failure in 14 subjects: seven with primary hypogonadism (increased LH and reduced T) and seven with compensated hypogonadism (increased LH and normal T). Patients with hormonal evidence of interstitial failure had a larger CTG expansion (p = 0.008), longer disease duration (p = 0.013), higher grade of disease (p = 0.004) and lower erectile function score (p = 0.02) than eugonadic patients. Impotence occurred in 13/14 hypogonadic patients with interstitial failure and in 5/12 eugonadic patients (p = 0.017, OR = 18.2).

Tight versus standard blood pressure control in patients with hypertension with and without cardiovascular disease.

PubMed

Reboldi, Gianpaolo; Angeli, Fabio; de Simone, Giovanni; Staessen, Jan A; Verdecchia, Paolo

2014-03-01

An excessive blood pressure (BP) reduction might be dangerous in high-risk patients with cardiovascular disease. In the Studio Italiano Sugli Effetti CARDIOvascolari del Controllo della Pressione Arteriosa SIStolica (Cardio-Sis), 1111 nondiabetic patients with systolic BP ≥150 mm Hg were randomly assigned to a systolic BP target <140 mm Hg (standard control) or <130 mm Hg (tight control). We stratified patients by absence (n=895) or presence (n=216) of established cardiovascular disease at entry. Antihypertensive treatment was open-label and tailored to each patient's needs. After 2-year follow-up, the primary end point of the study, electrocardiographic left ventricular hypertrophy, occurred less frequently in the tight than in the standard control group in the patients without (10.8% versus 15.2%) and with (14.1% versus 23.5%) established cardiovascular disease (P for interaction=0.82). The main secondary end point, a composite of cardiovascular events and all-cause death, occurred less frequently in the tight than in the standard control group both in patients without (1.47 versus 3.68 patient-years; P=0.016) and with (7.87 versus 11.22 patient-years; P=0.049) previous cardiovascular disease. In a multivariable Cox model, allocation to tight BP control reduced the risk of cardiovascular events to a similar extent in patients with or without overt cardiovascular disease at randomization (P for interaction=0.43). In conclusion, an intensive treatment aimed to lower systolic BP<130 mm Hg reduced left ventricular hypertrophy and improved clinical outcomes to a similar extent in patients with hypertension and without established cardiovascular disease.

Respiratory symptoms amongst females in a fishing settlement in the Niger Delta, Nigeria

PubMed Central

Akani, Alexander B.; Okokon, Ita B.

2011-01-01

Abstract Background Approximately half of the earth's population in the rural areas of developing countries uses energy obtained from biomass burning, which is harmful to people. Objectives This study is aimed at determining which respiratory symptoms can be associated with biomass burning amongst fish smokers in the Oyorokoto fishing settlement. Method A community-based, cross-sectional questionnaire, which employed a modified cluster sampling technique, was used. Results A total of 300 subjects were recruited for the study, of which 210 (70%) were fish smokers. The mean age was 31.46 ± 13.03 years, with the majority (42.0%) having only primary school education. The prevalence of respiratory symptoms amongst the subjects was 86.7%, the most frequent of which were catarrh (30.48%) and a cough (28.57%). The respiratory symptom occurring least frequently was breathlessness (2.38%). The symptoms most often experienced during fish smoking were those of catarrh (75.5%) and sneezing (73.0%), whereas breathlessness occurred the least, in only 7 (3.3%) of the participants. Sneezing stopped in 64.2% of the subjects after fish smoking had ceased. Most of the fish smoking took place indoors. Conclusion Health promotion featuring preventive interventions, such as the wearing of face-masks and the use of modern fish smoking methods, which is associated with fewer health risks, is essential to improving the quality of life of fish smokers. The government's provision of certain social services, including better education opportunities for the young, is advocated, and should be especially targeted at improving the lot of the girl child.

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

28 CFR 79.22 - Criteria for eligibility for claims relating to certain specified diseases contracted after...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., provided onset occurred at least five years after first exposure; (4) Primary cancer of the thyroid, provided onset occurred at least five years after first exposure; (5) Primary cancer of the male or female breast, provided onset occurred at least five years after first exposure; (6) Primary cancer of the...

28 CFR 79.22 - Criteria for eligibility for claims relating to certain specified diseases contracted after...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., provided onset occurred at least five years after first exposure; (4) Primary cancer of the thyroid, provided onset occurred at least five years after first exposure; (5) Primary cancer of the male or female breast, provided onset occurred at least five years after first exposure; (6) Primary cancer of the...

28 CFR 79.22 - Criteria for eligibility for claims relating to certain specified diseases contracted after...

Code of Federal Regulations, 2012 CFR

2012-07-01

..., provided onset occurred at least five years after first exposure; (4) Primary cancer of the thyroid, provided onset occurred at least five years after first exposure; (5) Primary cancer of the male or female breast, provided onset occurred at least five years after first exposure; (6) Primary cancer of the...

28 CFR 79.22 - Criteria for eligibility for claims relating to certain specified diseases contracted after...

Code of Federal Regulations, 2014 CFR

2014-07-01

..., provided onset occurred at least five years after first exposure; (4) Primary cancer of the thyroid, provided onset occurred at least five years after first exposure; (5) Primary cancer of the male or female breast, provided onset occurred at least five years after first exposure; (6) Primary cancer of the...

28 CFR 79.22 - Criteria for eligibility for claims relating to certain specified diseases contracted after...

Code of Federal Regulations, 2013 CFR

2013-07-01

..., provided onset occurred at least five years after first exposure; (4) Primary cancer of the thyroid, provided onset occurred at least five years after first exposure; (5) Primary cancer of the male or female breast, provided onset occurred at least five years after first exposure; (6) Primary cancer of the...

The Opinions of Primary School Teachers' Candidates towards Material Preparation and Usage

ERIC Educational Resources Information Center

Genc, Zeynep

2016-01-01

Instruction materials help students to acquire more memorable information. Instruction materials have an important effect on providing more permanent and simple way of learning in every step of education. Instruction materials are the most frequently used by primary school teachers. Primary school teachers should support their lectures with…

Providing Perinatal Mental Health Services in Pediatric Primary Care

ERIC Educational Resources Information Center

Talmi, Ayelet; Stafford, Brian; Buchholz, Melissa

2009-01-01

After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and…

Prevalence and Predictors of Change in Adult-Child Primary Caregivers

ERIC Educational Resources Information Center

Szinovacz, Maximiliane E.; Davey, Adam

2013-01-01

Family caregiving research is increasingly contextual and dynamic, but few studies have examined prevalence and predictors of change in primary caregivers, those with the most frequent contact with healthcare professionals. We identified prevalence and predictors of 2-year change in primary adult-child caregivers. Data pooled from the 1992-2000…

Family physician-patient relationship and frequent attendance of primary and specialist health care: Results from a German population-based cohort study.

PubMed

Dinkel, Andreas; Schneider, Antonius; Schmutzer, Gabriele; Brähler, Elmar; Häuser, Winfried

2016-07-01

To investigate the association between the quality of the family physician-patient relationship and frequent attendance of primary and specialist health care. Cross-sectional survey of a representative German population sample (N=2.266). Family physician-patient relationship was assessed with the Patient Doctor Relationship Questionnaire (PDRQ-9). Determinants of frequent attendance were analyzed using logistic regression. Frequent attendance of family physicians was associated with lower income (OR 1.43, 95% CI 1.02-2.00), not being in paid work (OR 1.58, CI 1.08-2.30), psychological distress (OR 1.14, CI 1.07-1.22), somatic symptoms (OR 1.07, CI 1.04-1.11), and physical comorbidity (OR 1.54, CI 1.36-1.74) in the multivariate analysis. Frequent attendance of specialists was related to psychological distress (OR 1.12, CI 1.04-1.20), somatic symptoms (OR 1.08, CI 1.04-1.11), and physical comorbidity (OR 1.69, CI 1.48-1.93) in the multivariate analysis. Quality of the relationship was associated with frequent attendance only in the univariate analyses. A stronger relationship with the family physician was not associated with reduced contact with specialists. The quality of the family physician-patient relationship is not independently associated with frequent attendance. Family physicians should be aware that need factors, i.e. symptom burden and physical comorbidities, are main drivers of frequent attendance. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Communicating with Clinicians: The Experiences of Surrogate Decision Makers for Hospitalized Older Adults

PubMed Central

Torke, Alexia M.; Petronio, Sandra; Purnell, Christianna E.; Sachs, Greg A.; Helft, Paul R.; Callahan, Christopher M.

2012-01-01

Background/Objectives When hospitalized older adults have impaired cognition, family members or other surrogates must communicate with clinicians to provide information and make medical decisions for the patient. The present study describes communication experiences of surrogates who recently made a major medical decision for a hospitalized older adult. Design Semi-structured interviews about a recent hospitalization. Setting Two hospitals both affiliated with 1 large medical school: an urban, public hospital; and a university-affiliated tertiary referral hospital. Participants Surrogates were eligible if they had recently made a major medical decision for a hospitalized patient aged 65 or older and were available for an interview within 1 month (2-5 months if the patient died). Measurements Interviews were audio-recorded, transcribed, and analyzed using methods of grounded theory. Results We interviewed 35 surrogates. They were 80% female, 44% white and 56% African American. Three primary themes emerged. We found the Nature of Surrogate/Clinician Relationships was best characterized as a relationship with a “team” of clinicians rather than individual clinicians due to frequent staff changes and multiple clinicians. Surrogates reported their Communication Needs, including frequent communication, information, and emotional support. Surrogates valued communication from any member of the clinical team, including nurses, social workers, and physicians. Third, surrogates described Trust and Mistrust, which were formed largely through surrogates’ communication experiences. Conclusion In the hospital, surrogates form relationships with a “team” of clinicians rather than with individuals. Yet effective communication and expressions of emotional support frequently occur and are highly valued by surrogates. Future interventions should focus on meeting surrogates’ needs for frequent communication, high levels of information and emotional support. PMID:22881864

Utilization of health services and prescription patterns among lupus patients followed by primary care physicians and rheumatologists in Puerto Rico.

PubMed

Molina, María J; Mayor, Angel M; Franco, Alejandro E; Morell, Carlos A; López, Miguel A; Vilá, Luis M

2008-01-01

To examine the utilization of health services and prescription patterns among patients with systemic lupus erythematosus (SLE) followed by primary care physicians and rheumatologists in Puerto Rico. The insurance claims submitted by physicians to a health insurance company of Puerto Rico in 2003 were examined. The diagnosis of lupus was determined by using the International Classification of Diseases, Ninth Revision, code for SLE (710.0). Of 552,733 insured people, 665 SLE patients were seen by rheumatologists, and 92 were followed by primary care physicians. Demographic features, selected co-morbidities, healthcare utilization parameters, and prescription patterns were examined. Fisher exact test, chi2 test, and analysis of variances were used to evaluate differences between the study groups. SLE patients followed by rheumatologists had osteopenia/osteoporosis diagnosed more frequently than did patients followed by primary care physicians. The frequency of high blood pressure, diabetes mellitus, hypercholesterolemia, coronary artery disease, and renal disease was similar for both groups. Rheumatologists were more likely to order erythrocyte sedimentation rate, anti-dsDNA antibodies, and serum complements. No differences were observed for office or emergency room visits, hospitalizations, and utilization of routine laboratory tests. Rheumatologists prescribed hydroxychloroquine more frequently than did primary care physicians. The use of nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, glucocorticoids, azathioprine, cyclophosphamide, and methotrexate was similar for both groups. Overall, the utilization of health services and prescription patterns among SLE patients followed by primary care physicians and rheumatologists in Puerto Rico are similar. However, rheumatologists ordered SLE biomarkers of disease activity and prescribed hydroxychloroquine more frequently than did primary care physicians.

Exploring the relationship between frequent internet use and health and social care resource use in a community-based cohort of older adults: an observational study in primary care.

PubMed

Clarke, Caroline S; Round, Jeff; Morris, Stephen; Kharicha, Kalpa; Ford, John; Manthorpe, Jill; Iliffe, Steve; Goodman, Claire; Walters, Kate

2017-07-21

Given many countries' ageing populations, policymakers must consider how to mitigate or reduce health problems associated with old age, within budgetary constraints. Evidence of use of digital technology in delaying the onset of illness and reducing healthcare service use is mixed, with no clear consensus as yet. Our aim was to investigate the relationship between frequent internet use and patterns of health or social care resource use in primary care attendees who took part in a study seeking to improve the health of older adults. Participants recruited from primary care, aged >65 and living in semirural or urban areas in the south of England, were followed up at 3 and 6 months after completing a comprehensive questionnaire with personalised feedback on their health and well-being. We performed logistic regression analyses to investigate relationships between frequent internet use and patterns of service use, controlling for confounding factors, and clustering by general practitioner practice. Four categories of service use data were gathered: use of primary National Health Service (NHS) care; secondary NHS care; other community health and social care services; and assistance with washing, shopping and meals. Our results show, in this relatively healthy population, a positive relationship (OR 1.72, 95% CI 1.33 to 2.23) between frequent internet use and use of any other community-based health services (physiotherapist, osteopath/chiropractor, dentist, optician/optometrist, counselling service, smoking cessation service, chiropodist/podiatrist, emergency services, other non-specific health services) and no relationship with the other types of care. No causal relationship can be postulated due to the study's design. No observed relationship between frequent internet use and primary or secondary care use was found, suggesting that older adults without internet access are not disadvantaged regarding healthcare use. Further research should explore how older people use the internet to access healthcare and the impact on health. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Patient and Physician Characteristics Associated with the Provision of Weight Loss Counseling in Primary Care

PubMed Central

Dutton, Gareth R.; Herman, Katharine G.; Tan, Fei; Goble, Mary; Dancer-Brown, Melissa; Van Vessem, Nancy; Ard, Jamy D.

2013-01-01

Background A variety of physician and patient characteristics may influence whether weight loss counseling occurs in primary care encounters. Objectives This study utilized a cross-sectional survey of primary care patients, which examined patient characteristics, physician characteristics, and characteristics of the physician-patient relationship associated with weight loss counseling and recommendations provided by physicians. Participants Participants (N=143, mean age=46.8 years, mean BMI=36.9 kg/m2, 65% Caucasian) were overweight and obese primary care patients participating in a managed care weight loss program. Measures Participants completed self-report surveys in the clinic prior to the initial weight loss session. Surveys included items assessing demographic/background characteristics, weight, height, and a health care questionnaire evaluating whether their physician had recommended weight loss, the frequency of their physicians’ weight loss counseling, and whether their physician had referred them for obesity treatment. Results Patient BMI and physician sex were most consistently associated with physicians’ weight loss counseling practices. Patients seen by female physicians were more likely to be told that they should lose weight, received more frequent obesity counseling, and were more likely to have been referred for obesity treatment by their physician. Length and frequency of physician-patient contacts were unrelated to the likelihood of counseling. Conclusions These findings add to previous evidence suggesting possible differences in the weight loss counseling practices of male and female physicians, although further research is needed to understand this potential difference between physicians. PMID:24743007

Metastases from distant primary tumours on the head and neck: clinical manifestation and diagnostics of 91 cases.

PubMed

Baum, Sven Holger; Mohr, Christopher

2018-06-01

The aim of this study was to evaluate which primary tumours metastasize on the head and neck region, identify the kind of clinical manifestation, the types of diagnostics that should be performed, and prove that the therapy appears possible and useful. As many as 91 patients with a distant metastasis on the head and neck were enrolled in this retrospective clinical study from January 2004 to September 2016. All the patients were evaluated for clinical symptoms, primary tumour, localization, diagnostics, and surgical procedure. A total of 31 patients had asymptomatic swelling, 27 patients had symptomatic swelling, and nine experienced isolated pain without swelling. Most other symptoms were organ-specific. The most frequent localizations were the orbit (44 metastases), mandible (19), neck region (9), and skin (7). The most common primary tumours were breast carcinoma (44), bronchial carcinoma (12), and renal carcinoma (9). A biopsy was performed on 38 patients, a partial resection was done on 28 patients, extirpation on six patients, and a radical resection on 19 patients. Distant metastases on the head and neck are rare and, therefore, pose a challenge for the oncologist and other involved disciplines. Most distant metastases occur within the first five years. Late metastases, especially in breast carcinoma, are still possible after 20 years. A surgical examination should be carried out if the findings are not clear due to multiple differential diagnoses. In particular, surgical options under palliative aspects should be examined.

DNA copy number gains at loci of growth factors and their receptors in salivary gland adenoid cystic carcinoma.

PubMed

Vékony, Hedy; Ylstra, Bauke; Wilting, Saskia M; Meijer, Gerrit A; van de Wiel, Mark A; Leemans, C René; van der Waal, Isaäc; Bloemena, Elisabeth

2007-06-01

Adenoid cystic carcinoma (ACC) is a malignant salivary gland tumor with a high mortality rate due to late, distant metastases. This study aimed at unraveling common genetic abnormalities associated with ACC. Additionally, chromosomal changes were correlated with patient characteristics and survival. Microarray-based comparative genomic hybridization was done to a series of 18 paraffin-embedded primary ACCs using a genome-wide scanning BAC array. A total of 238 aberrations were detected, representing more gains than losses (205 versus 33, respectively). Most frequent gains (>60%) were observed at 9q33.3-q34.3, 11q13.3, 11q23.3, 19p13.3-p13.11, 19q12-q13.43, 21q22.3, and 22q13.33. These loci harbor numerous growth factor [fibroblast growth factor (FGF) and platelet-derived growth factor (PDGF)] and growth factors receptor (FGFR3 and PDGFRbeta) genes. Gains at the FGF(R) regions occurred significantly more frequently in the recurred/metastasized ACCs compared with indolent ACCs. Furthermore, patients with 17 or more chromosomal aberrations had a significantly less favorable outcome than patients with fewer chromosomal aberrations (log-rank = 5.2; P = 0.02). Frequent DNA copy number gains at loci of growth factors and their receptors suggest their involvement in ACC initiation and progression. Additionally, the presence of FGFR3 and PDGFRbeta in increased chromosomal regions suggests a possible role for autocrine stimulation in ACC tumorigenesis.

Hemostatic findings of pleural fluid in dogs and the association between pleural effusions and primary hyperfibrino(geno)lysis: A cohort study of 99 dogs

PubMed Central

Drigo, Michele; Piek, Christine J.; Simioni, Paolo; Caldin, Marco

2018-01-01

The primary objective of this study was to determine if activation of coagulation and fibrinolysis occurs in canine pleural effusions. Thirty-three dogs with pleural effusions of different origin were studied. Pleural effusion fibrinogen concentrations were significantly lower, while pleural fibrin-fibrinogen degradation products (FDPs) and D-dimer concentrations were significantly higher than those in plasma (P < 0.001 for all comparisons). These results show that, in canine pleural fluids, there is evidence of coagulation activation and fibrinolysis. The secondary aims of the current study were to determine if primary hyperfibrinolysis ([PHF] i.e., elevated plasma FDPs with a normal D-dimer concentrations), occurs in dogs with pleural effusion, and whether the presence of a concurrent inflammatory process may have activated the hemostatic cascade, with its intrinsically linked secondary hyperfibrinolysis, masking the concurrent PHF. The previously 33 selected dogs with pleural effusion (group 1) were compared to two control groups of 33 healthy (group 2) and 33 sick dogs without pleural effusion (group 3). Serum fibrinogen, FDPs, D-dimer, C-reactive protein (CRP), fibrinogen/CRP ratio, and frequency of PHF were determined. Fibrinogen, FDPs, D-dimer and CRP concentrations in group 1 were significantly increased compared to group 2 (P < 0.001 for all comparisons). FDPs and CRP concentrations in group 1 were also significantly increased compared to group 3 (P = 0.001 and P < 0.001, respectively). The fibrinogen/CRP ratio was significantly decreased in group 1 compared to groups 2 and 3 (P < 0.001 for both comparison). The frequency of PHF was significantly higher in group 1 compared to groups 2 (P = 0.004), but not compared to group 3. These results support the hypothesis that PHF occurs significantly more often in dogs with pleural effusion compared to healthy dogs. Nevertheless, the decrease in the fibrinogen/CRP ratio in group 1 compared to group 3, considering the higher FDPs and similar D-dimer concentrations, would suggest that PHF is also more frequent in dogs with pleural effusion compared to sick control dogs, and that this phenomenon is hidden due to concurrent secondary hyperfibrinolysis. PMID:29462172

Hemostatic findings of pleural fluid in dogs and the association between pleural effusions and primary hyperfibrino(geno)lysis: A cohort study of 99 dogs.

PubMed

Zoia, Andrea; Drigo, Michele; Piek, Christine J; Simioni, Paolo; Caldin, Marco

2018-01-01

The primary objective of this study was to determine if activation of coagulation and fibrinolysis occurs in canine pleural effusions. Thirty-three dogs with pleural effusions of different origin were studied. Pleural effusion fibrinogen concentrations were significantly lower, while pleural fibrin-fibrinogen degradation products (FDPs) and D-dimer concentrations were significantly higher than those in plasma (P < 0.001 for all comparisons). These results show that, in canine pleural fluids, there is evidence of coagulation activation and fibrinolysis. The secondary aims of the current study were to determine if primary hyperfibrinolysis ([PHF] i.e., elevated plasma FDPs with a normal D-dimer concentrations), occurs in dogs with pleural effusion, and whether the presence of a concurrent inflammatory process may have activated the hemostatic cascade, with its intrinsically linked secondary hyperfibrinolysis, masking the concurrent PHF. The previously 33 selected dogs with pleural effusion (group 1) were compared to two control groups of 33 healthy (group 2) and 33 sick dogs without pleural effusion (group 3). Serum fibrinogen, FDPs, D-dimer, C-reactive protein (CRP), fibrinogen/CRP ratio, and frequency of PHF were determined. Fibrinogen, FDPs, D-dimer and CRP concentrations in group 1 were significantly increased compared to group 2 (P < 0.001 for all comparisons). FDPs and CRP concentrations in group 1 were also significantly increased compared to group 3 (P = 0.001 and P < 0.001, respectively). The fibrinogen/CRP ratio was significantly decreased in group 1 compared to groups 2 and 3 (P < 0.001 for both comparison). The frequency of PHF was significantly higher in group 1 compared to groups 2 (P = 0.004), but not compared to group 3. These results support the hypothesis that PHF occurs significantly more often in dogs with pleural effusion compared to healthy dogs. Nevertheless, the decrease in the fibrinogen/CRP ratio in group 1 compared to group 3, considering the higher FDPs and similar D-dimer concentrations, would suggest that PHF is also more frequent in dogs with pleural effusion compared to sick control dogs, and that this phenomenon is hidden due to concurrent secondary hyperfibrinolysis.

Changing pattern and etiology of maxillofacial fractures during the civil uprising in Western Libya

PubMed Central

Elarabi, Mohammed S.

2018-01-01

Background The purpose of the present study was to evaluate changing pattern in characteristics of maxillofacial fractures and concomitant injuries in Western Libya During revolution and to assess the association between mechanism of injury and fracture patterns. Material and Methods A retrospective review of medical records and radiographs of 187 patients treated for maxillofacial fractures from January 2010 to December 2012 was performed, there were 326 fractures in 187 patients. Results The male: female ratio was 6:1. Most fractures occurred in patients aged 11 to 40 years, and few injuries occurred in patients aged > 50 years. Most fractures occurred from motor vehicle accidents, and other most frequent causes included assault, gunshot, and fall injuries. Most maxillofacial fractures involved the mandible, zygomatic complex, or maxilla. Most mandibular fractures occurred at the parasymphysis, angle, or condyle. Associated injuries most frequently involved the head, chest, and extremities. Most patients were treated with open reduction (132 patients [71%]), and 26 patients (14%) were treated nonoperatively. There were 21 complications (11%). Conclusions In summary, motor vehicle accidents were the most frequent cause of maxillofacial fracture in western Libya, possibly because of the lack of seat belt legislation. Interpersonal violence was a less frequent cause of maxillofacial fracture, possibly because of the religious restriction on alcohol consumption. Key words:Tauma, mandible, zygomatic complex, maxilla, treatment, complications. PMID:29476683

Clinician Beliefs and Attitudes Regarding Use of Respiratory Protective Devices and Surgical Masks for Influenza

PubMed Central

Pillai, Satish K.; Beekmann, Susan E.; Babcock, Hilary M.; Pavia, Andrew T.; Koonin, Lisa M.; Polgreen, Philip M.

2015-01-01

While influenza transmission is thought to occur primarily by droplet spread, the role of airborne spread remains uncertain. Understanding the beliefs and attitudes of infectious disease physicians regarding influenza transmission and respiratory and barrier protection preferences can provide insights into workplace decisions regarding respiratory protection planning. Physicians participating in the Infectious Diseases Society of America’s Emerging Infections Network were queried in November 2013 to determine beliefs and attitudes on influenza transmission. A subset of physicians involved in their facility’s respiratory protection decision making were queried about respirator and surgical mask choices under various pandemic scenarios; availability of, and challenges associated with, respirators in their facility; and protective strategies during disposable N95 shortages. The majority of 686 respondents (98%) believed influenza transmission occurs frequently or occasionally via droplets; 44% of respondents believed transmission occurs via small particles frequently (12%) or occasionally (32%). Among the subset of respondents involved in respiratory protection planning at their facility, over 90% preferred surgical masks during provision of non-aerosol-generating patient care for seasonal influenza. However, for the same type of care during an influenza pandemic, two-thirds of respondents opted for disposable N95 filtering facepiece respirators. In settings where filtering facepiece (disposable) N95 respirators were in short supply, preferred conservation strategies included extended use and reuse of disposable N95s. Use of reusable (elastomeric facepiece) respirator types was viewed less favorably. While respondents identified droplets as the primary mode of influenza transmission, during a high-severity pandemic scenario there was increased support for devices that reduced aerosol-based transmission. Use of potentially less familiar respirator types may partially relieve shortages of disposable N95s but also may require significant education efforts so that clinicians are aware of the characteristics of alternative personal protective equipment. PMID:26173092

Incidence and Risk Factors for Health-Care Associated Infections after Hip Operation.

PubMed

Hessels, Amanda J; Agarwal, Mansi; Liu, Jianfang; Larson, Elaine L

2016-12-01

Hip operation reduces pain and improves mobility and quality of life for more than 300,000 people annually, most of whom are more than 65 years old. Substantial increases in surgical volume are projected between 2005 and 2030 in primary total (174%) and revision (137%) procedures. This projection demands that the impact of increasing age on the relative risk of health-care associated infections (HAI) after hip surgical procedures be assessed. Our aim was to examine the incidence and risk factors of HAI among patients who underwent hip operations between 2006 and 2012. This secondary analysis included data from patients 18 years old or older and having a hip prosthesis procedure in three New York City hospitals between 2006 and 2012. Procedures were categorized as total or partial hip replacements or revision and re-surfacing procedures. Outcomes of interest were blood stream infections (BSI), urinary tract infections (UTI), or surgical site infections (SSI). Patients in whom an infection developed during the hospital visit in which the hip procedure occurred were counted as cases. Of 2021 patients, approximately 11% (n = 218) had an HAI. There was no difference in infection rates by admission year despite an increase in surgical volume. SSI was associated with younger age, previous hospitalization, and hip revision surgical procedure whereas UTI and BSI were associated with older age, greater co-morbidity, longer pre-operative length of stay and intensive care unit stay, (p < 0.05). HAI after hip operation affected approximately one in 10 patients over a 7-year period in three high-volume hospitals. SSI occurred least frequently, predominantly among patients who underwent revision surgery (without previous SSI), were younger, and had a history of previous hospitalization. Infections such as BSI and UTI, although rare, occurred more frequently and in patients with more co-morbidities, longer pre-operative length of stay, and who required higher level care. Further research to understand these unexpected findings and target interventions is warranted.

Addressing Adult Innumeracy via an Interventionist Approach to Mathematics Aversion in Pre-Service Primary Teachers

ERIC Educational Resources Information Center

Klinger, Christopher M.

2011-01-01

Student primary teachers tend to have pervasive and frequently severe negative attitudes, low mathematics self-efficacy beliefs, and anxiety of mathematics that are more extreme than those of any other undergraduate student group. If unaddressed, such mathematics aversion will be carried into primary school classrooms, presenting a tangible and…

Playing wind instruments as a potential aetiologic cofactor in external cervical resorption: two case reports.

PubMed

Gunst, V; Huybrechts, B; De Almeida Neves, A; Bergmans, L; Van Meerbeek, B; Lambrechts, P

2011-03-01

To present two cases of external cervical resorption (ECR) on maxillary incisors, in which the primary aetiologic factor is suggested to be pressure trauma by frequently playing wind instruments. The exact aetiological spectrum of ECR is still poorly understood. For resorption to occur, a defect in the cementum layer (trigger) is a likely prerequisite. Whilst the mechanism for continuation (stimulus) is still unclear, knowledge of potential predisposing factors is important in assessing patients at risk. Pressure generated by playing wind instruments could present an aetiological factor in ECR because it affects the cervical region of the root surface. The cases that are presented may confirm this hypothesis and the extent of resorption defects is shown by cone-beam computer tomography (CT) and micro-focus CT imaging techniques. © 2010 International Endodontic Journal.

Squamous cell lung carcinoma presenting as melena: a case report and review of the literature.

PubMed

Azar, Ibrahim; Koutroumpakis, Efstratios; Patel, Raina; Mehdi, Syed

2017-10-03

Lung cancer has a predilection to widely metastasize to the liver, bone, brain and adrenal glands. Metastasis of primary lung tumors to the stomach is infrequent, with only sporadic cases reported. Most cases are asymptomatic and diagnosed post-mortem on autopsy. The incidence of symptomatic gastrointestinal metastases is extremely rare. Herein, we describe a case of gastric metastasis by squamous cell lung carcinoma, presenting as melena and diagnosed by esophagogastroduodenoscopy. To the best of our knowledge, only twenty other cases in the English literature have reported symptomatic gastric metastasis of lung cancer diagnosed by endoscopic biopsy. A brief review of the literature shows gastric metastasis of lung cancer to have a predilection to occur most frequently in male smokers with the most common type of tumor likely to be squamous cell carcinoma.

Hepatic alveolar echinococcosis: correlative US and CT study

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

Didier, D.; Weiler, S.; Rohmer, P.

1985-01-01

A total of 24 cases of hepatic alveolar echinococcosis (HAE) due to Echinococcus multilocularis was assessed by US and CT. The diagnosis was confirmed in all cases by immunologic and histologic study. Both US and CT patterns of HAE showed changes of liver morphology in both contour and size. Abnormal areas of parenchyma were nodular or in fields, irregular, heterogeneous, and basically echogenic. Clustered microcalcifications were encountered within the abnormal parenchymal fields in 50% of cases, and necrotized zones occurred in 40% of cases. Dilatation of intrahepatic bile ducts was commonly seen, especially on US; hilar involvement was frequent. Follow-upmore » by both techniques can display increases of primary lesions, occurrence of new foci, and local or regional extensions. Precise evaluations of the lesions arising from correlative use of US and CT permits adequate therapeutic management.« less

Pediatric Miller Fisher Syndrome Complicating an Epstein-Barr Virus Infection.

PubMed

Communal, Céline; Filleron, Anne; Baron-Joly, Sandrine; Salet, Randa; Tran, Tu-Anh

2016-10-01

Miller Fisher syndrome, a variant of Guillain-Barré syndrome, is an acute inflammatory demyelinating polyradiculoneuropathy that may occur weeks after a bacterial or viral infection. Campylobacter jejuni and Haemophilus influenzae are frequently reported etiological agents. We describe a boy with Miller Fisher syndrome following Epstein-002DBarr virus primary infectious mononucleosis. He presented with bilateral dysfunction of several cranial nerves and hyporeflexia of the limbs but without ataxia. Miller Fisher syndrome was confirmed by the presence of anti-GQ1b antibodies in a blood sample. Epstein-Barr virus was identified by polymerase chain reaction and serology. Epstein-Barr virus should be considered as a Miller Fisher syndrome's causative agent. The physiopathology of this condition may involve cross-reactive T-cells against Epstein-Barr virus antigens and gangliosides. Copyright © 2016 Elsevier Inc. All rights reserved.

Using observed warming to identify hazards to Mozambique maize production

USGS Publications Warehouse

Funk, Christopher C.; Harrison, Laura; Eilerts, Gary

2011-01-01

New Perspectives on Crop Yield Constraints because of Climate Change. Climate change impact assessments usually focus on changes to precipitation because most global food production is from rainfed cropping systems; however, other aspects of climate change may affect crop growth and potential yields.A recent (2011) study by the University of California, Santa Barbara (UCSB) Climate Hazards Group, determined that climate change may be affecting Mozambique's primary food crop in a usually overlooked, but potentially significant way (Harrison and others, 2011). The study focused on the direct relation between maize crop development and growing season temperature. It determined that warming during the past three decades in Mozambique may be causing more frequent crop stress and yield reductions in that country's maize crop, independent of any changes occurring in rainfall. This report summarizes the findings and conclusions of that study.

Plasma membrane disruption: repair, prevention, adaptation

NASA Technical Reports Server (NTRS)

McNeil, Paul L.; Steinhardt, Richard A.

2003-01-01

Many metazoan cells inhabit mechanically stressful environments and, consequently, their plasma membranes are frequently disrupted. Survival requires that the cell rapidly repair or reseal the disruption. Rapid resealing is an active and complex structural modification that employs endomembrane as its primary building block, and cytoskeletal and membrane fusion proteins as its catalysts. Endomembrane is delivered to the damaged plasma membrane through exocytosis, a ubiquitous Ca2+-triggered response to disruption. Tissue and cell level architecture prevent disruptions from occurring, either by shielding cells from damaging levels of force, or, when this is not possible, by promoting safe force transmission through the plasma membrane via protein-based cables and linkages. Prevention of disruption also can be a dynamic cell or tissue level adaptation triggered when a damaging level of mechanical stress is imposed. Disease results from failure of either the preventive or resealing mechanisms.

Portfolio of prospective clinical trials including brachytherapy: an analysis of the ClinicalTrials.gov database.

PubMed

Cihoric, Nikola; Tsikkinis, Alexandros; Miguelez, Cristina Gutierrez; Strnad, Vratislav; Soldatovic, Ivan; Ghadjar, Pirus; Jeremic, Branislav; Dal Pra, Alan; Aebersold, Daniel M; Lössl, Kristina

2016-03-22

To evaluate the current status of prospective interventional clinical trials that includes brachytherapy (BT) procedures. The records of 175,538 (100 %) clinical trials registered at ClinicalTrials.gov were downloaded on September 2014 and a database was established. Trials using BT as an intervention were identified for further analyses. The selected trials were manually categorized according to indication(s), BT source, applied dose rate, primary sponsor type, location, protocol initiator and funding source. We analyzed trials across 8 available trial protocol elements registered within the database. In total 245 clinical trials were identified, 147 with BT as primary investigated treatment modality and 98 that included BT as an optional treatment component or as part of the standard treatment. Academic centers were the most frequent protocol initiators in trials where BT was the primary investigational treatment modality (p < 0.01). High dose rate (HDR) BT was the most frequently investigated type of BT dose rate (46.3 %) followed by low dose rate (LDR) (42.0 %). Prostate was the most frequently investigated tumor entity in trials with BT as the primary treatment modality (40.1 %) followed by breast cancer (17.0 %). BT was rarely the primary investigated treatment modality for cervical cancer (6.8 %). Most clinical trials using BT are predominantly in early phases, investigator-initiated and with low accrual numbers. Current investigational activities that include BT mainly focus on prostate and breast cancers. Important questions concerning the optimal usage of BT will not be answered in the near future.

Exposure of Medical Students to Pharmaceutical Marketing in Primary Care Settings: Frequent and Influential

ERIC Educational Resources Information Center

Sarikaya, Ozlem; Civaner, Murat; Vatansever, Kevser

2009-01-01

It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient-physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts.…

Genetics Home Reference: blepharophimosis, ptosis, and epicanthus inversus syndrome

MedlinePlus

... features. Type I is also associated with an early loss of ovarian function (primary ovarian insufficiency) in women, which causes their menstrual periods to become less frequent and eventually stop before age 40. Primary ovarian insufficiency can lead to difficulty ...

Frequent ultraviolet brightenings observed in a solar active region with solar maximum mission

NASA Technical Reports Server (NTRS)

Porter, J. G.; Toomre, J.; Gebbie, K. B.

1984-01-01

Observations of the temporal behavior of ultraviolet emission from bright points within an active region of the sun are reported. Frequent and rapid brightenings in Si IV and O IV line emission are seen. The observations suggest that intermittent heating events of modest amplitude are occurring at many sites within an active region. By selecting the brightest site at any given time within an active region and then sampling its behavior in detail within a 120 s interval, it is found that about two-thirds of the samples show variations of the Si IV line intensity. The brightenings typically last about 40-60 s; intensity increases of about 20-100 percent are frequently observed. The results suggest that heating due to magnetic field reconnection within an active region is proceeding almost stochastically. Events involving only a modest release of energy occur the most frequently.

RNA editing differently affects protein-coding genes in D. melanogaster and H. sapiens.

PubMed

Grassi, Luigi; Leoni, Guido; Tramontano, Anna

2015-07-14

When an RNA editing event occurs within a coding sequence it can lead to a different encoded amino acid. The biological significance of these events remains an open question: they can modulate protein functionality, increase the complexity of transcriptomes or arise from a loose specificity of the involved enzymes. We analysed the editing events in coding regions that produce or not a change in the encoded amino acid (nonsynonymous and synonymous events, respectively) in D. melanogaster and in H. sapiens and compared them with the appropriate random models. Interestingly, our results show that the phenomenon has rather different characteristics in the two organisms. For example, we confirm the observation that editing events occur more frequently in non-coding than in coding regions, and report that this effect is much more evident in H. sapiens. Additionally, in this latter organism, editing events tend to affect less conserved residues. The less frequently occurring editing events in Drosophila tend to avoid drastic amino acid changes. Interestingly, we find that, in Drosophila, changes from less frequently used codons to more frequently used ones are favoured, while this is not the case in H. sapiens.

Targeted next generation sequencing of mucosal melanomas identifies frequent NF1 and RAS mutations.

PubMed

Cosgarea, Ioana; Ugurel, Selma; Sucker, Antje; Livingstone, Elisabeth; Zimmer, Lisa; Ziemer, Mirjana; Utikal, Jochen; Mohr, Peter; Pfeiffer, Christiane; Pföhler, Claudia; Hillen, Uwe; Horn, Susanne; Schadendorf, Dirk; Griewank, Klaus G; Roesch, Alexander

2017-06-20

Mucosal melanoma represents ~1% of all melanomas, frequently having a poor prognosis due to diagnosis at a late stage of disease. Mucosal melanoma differs from cutaneous melanoma not only in terms of poorer clinical outcome but also on the molecular level having e.g. less BRAF and more frequent KIT mutations than cutaneous melanomas. For the majority of mucosal melanomas oncogenic driver mutations remain unknown. In our study, 75 tumor tissues from patients diagnosed with mucosal melanoma were analyzed, applying a targeted next generation sequencing panel covering 29 known recurrently mutated genes in melanoma. NF1 and RAS mutations were identified as the most frequently mutated genes occurring in 18.3% and 16.9% of samples, respectively. Mutations in BRAF were identified in 8.4% and KIT in 7.0% of tumor samples. Our study identifies NF1 as the most frequently occurring driver mutation in mucosal melanoma. RAS alterations, consisting of NRAS and KRAS mutations, were the second most frequent mutation type. BRAF and KIT mutations were rare with frequencies below 10% each. Our data indicate that in mucosal melanomas RAS/NF1 alterations are frequent, implying a significant pathogenetic role for MAPK and potentially PI3K pathway activation in these tumors.

Targeted next generation sequencing of mucosal melanomas identifies frequent NF1 and RAS mutations

PubMed Central

Cosgarea, Ioana; Ugurel, Selma; Sucker, Antje; Livingstone, Elisabeth; Zimmer, Lisa; Ziemer, Mirjana; Utikal, Jochen; Mohr, Peter; Pfeiffer, Christiane; Pföhler, Claudia; Hillen, Uwe; Horn, Susanne; Schadendorf, Dirk

2017-01-01

Purpose Mucosal melanoma represents ~1% of all melanomas, frequently having a poor prognosis due to diagnosis at a late stage of disease. Mucosal melanoma differs from cutaneous melanoma not only in terms of poorer clinical outcome but also on the molecular level having e.g. less BRAF and more frequent KIT mutations than cutaneous melanomas. For the majority of mucosal melanomas oncogenic driver mutations remain unknown. Experimental Design and Results In our study, 75 tumor tissues from patients diagnosed with mucosal melanoma were analyzed, applying a targeted next generation sequencing panel covering 29 known recurrently mutated genes in melanoma. NF1 and RAS mutations were identified as the most frequently mutated genes occurring in 18.3% and 16.9% of samples, respectively. Mutations in BRAF were identified in 8.4% and KIT in 7.0% of tumor samples. Conclusions Our study identifies NF1 as the most frequently occurring driver mutation in mucosal melanoma. RAS alterations, consisting of NRAS and KRAS mutations, were the second most frequent mutation type. BRAF and KIT mutations were rare with frequencies below 10% each. Our data indicate that in mucosal melanomas RAS/NF1 alterations are frequent, implying a significant pathogenetic role for MAPK and potentially PI3K pathway activation in these tumors. PMID:28380455

Drought, tree mortality, and wildfire in forests adapted to frequent fire

Treesearch

Scott L Stephens; Brandon M Collins; Christopher J Fettig; Mark A Finney; Chad M Hoffman; Eric E Knapp; Malcolm P North; Hugh Safford; Rebecca B Wayman

2018-01-01

Massive tree mortality has occurred rapidly in frequent-fire-adapted forests of the Sierra Nevada, California. This mortality is a product of acute drought compounded by the long-established removal of a key ecosystem process: frequent, low- to moderate-intensity fire. The recent tree mortality has many implications for the future of these forests and the ecological...

Pesticides detected in urban streams in King County, Washington, 1998-2003

USGS Publications Warehouse

Frans, Lonna M.

2004-01-01

The U.S. Geological Survey and the King County Department of Natural Resources collected water samples from 14 sites on urban streams in King County during storms and during base flow between 1998 and 2003. The samples were analyzed for the presence of 155 pesticides and pesticide transformation products. Thirty-nine of the compounds were detected at least once during the study: 20 herbicides, 9 insecticides, 2 fungicides, 6 pesticide transformation products, and 2 other types of compounds. The most widespread compound was 4-nitrophenol, which was detected at all 14 sampling sites. The most frequently detected compound was pentachlorophenol, a fungicide, which occurred in more than 80 percent of the samples. The most frequently detected herbicides were prometon, trichlopyr, 2,4-D, and MCPP, and the most frequently detected insecticides were diazinon and carbaryl. All of the most frequently detected herbicides and insecticides were sold for homeowner use over the timeframe of this study. More compounds were detected during storms than during base flow, and were detected more frequently and typically at high concentrations during storms. Seven compounds were detected only during storms. Most of the compounds that were detected during storms occurred more frequently during spring storms than during autumn storms.

Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients.

PubMed

Isaacs, Albert M; Bezchlibnyk, Yarema B; Yong, Heather; Koshy, Dilip; Urbaneja, Geberth; Hader, Walter J; Hamilton, Mark G

2016-09-01

OBJECTIVE The efficacy of endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus has been extensively reported in the literature. However, ETV-related long-term outcome data are lacking for the adult hydrocephalus population. The objective of the present study was to assess the role of ETV as a primary or secondary treatment for hydrocephalus in adults. METHODS The authors performed a retrospective chart review of all adult patients (age ≥ 18 years) with symptomatic hydrocephalus treated with ETV in Calgary, Canada, over a span of 20 years (1994-2014). Patients were dichotomized into a primary or secondary ETV cohort based on whether ETV was the initial treatment modality for the hydrocephalus or if other CSF diversion procedures had been previously attempted respectively. Primary outcomes were subjective patient-reported clinical improvement within 12 weeks of surgery and the need for any CSF diversion procedures after the initial ETV during the span of the study. Categorical and actuarial data analysis was done to compare the outcomes of the primary versus secondary ETV cohorts. RESULTS A total of 163 adult patients with symptomatic hydrocephalus treated with ETV were identified and followed over an average of 98.6 months (range 0.1-230.4 months). All patients presented with signs of intracranial hypertension or other neurological symptoms. The primary ETV group consisted of 112 patients, and the secondary ETV consisted of 51 patients who presented with failed ventriculoperitoneal (VP) shunts. After the initial ETV procedure, clinical improvement was reported more frequently by patients in the primary cohort (87%) relative to those in the secondary ETV cohort (65%, p = 0.001). Additionally, patients in the primary ETV group required fewer reoperations (p < 0.001), with cumulative ETV survival time favoring this primary ETV cohort over the course of the follow-up period (p < 0.001). Fifteen patients required repeat ETV, with all but one experiencing successful relief of symptoms. Patients in the secondary ETV cohort also had a higher incidence of complications, with one occurring in 8 patients (16%) compared with 2 in the primary ETV group (2%; p = 0.010), although most complications were minor. CONCLUSIONS ETV is an effective long-term treatment for selected adult patients with hydrocephalus. The overall ETV success rate when it was the primary treatment modality for adult hydrocephalus was approximately 87%, and 99% of patients experience symptomatic improvement after 2 ETVs. Patients in whom VP shunt surgery fails prior to an ETV have a 22% relative risk of ETV failure and an almost eightfold complication rate, although mostly minor, when compared with patients who undergo a primary ETV. Most ETV failures occur within the first 7 months of surgery in patients treated with primary ETV, but the time to failure is more prolonged in patients who present with failed previous shunts.

Does frequent residential mobility in early years affect the uptake and timeliness of routine immunisations? An anonymised cohort study.

PubMed

Hutchings, Hayley A; Evans, Annette; Barnes, Peter; Healy, Melanie A; James-Ellison, Michelle; Lyons, Ronan A; Maddocks, Alison; Paranjothy, Shantini; Rodgers, Sarah E; Dunstan, Frank

2016-04-04

There are conflicting findings regarding the impact of residential mobility on immunisation status. Our aim was to determine whether there was any association between residential mobility and take up of immunisations and whether they were delayed in administration. We carried out a cohort analysis of children born in Wales, UK. Uptake and time of immunisation were collected electronically. We defined frequent movers as those who had moved: 2 or more times in the period prior to the final scheduled on-time date (4 months) for 5 in 1 vaccinations; and 3 or more times in the period prior to the final scheduled on-time date (12 months) for MMR, pneumococcal and meningitis C vaccinations. We defined immunisations due at 2-4 months delayed if they had not been given by age 1; and those due at 12-13 months as delayed if they had not been given by age 2. Uptake rates of routine immunisations and whether they were given within the specified timeframe were high for both groups. There was no increased risk (odds ratios (95% confidence intervals) between frequent movers compared to non-movers for the uptake of: primary MMR 1.08 (0.88-1.32); booster Meningitis C 1.65 (0.93-2.92); booster pneumococcal 1.60 (0.59-4.31); primary 5 in 1 1.28 (0.92-1.78); and timeliness: primary MMR 0.92 (0.79-1.07); booster Meningitis C 1.26 (0.77-2.07); booster pneumococcal 1.69 (0.23-12.14); and primary 5 in 1 1.04 (0.88-1.23). Findings suggest that children who move home frequently are not adversely affected in terms of the uptake of immunisations and whether they were given within a specified timeframe. Both were high and may reflect proactive behaviour in the primary healthcare setting to meet Government coverage rates for immunisation. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

RESPECT-Mil: feasibility of a systems-level collaborative care approach to depression and post-traumatic stress disorder in military primary care.

PubMed

Engel, Charles C; Oxman, Thomas; Yamamoto, Christopher; Gould, Darin; Barry, Sheila; Stewart, Patrice; Kroenke, Kurt; Williams, John W; Dietrich, Allen J

2008-10-01

U.S. military ground forces report high rates of war-related traumatic stressors, posttraumatic stress disorder (PTSD), and depression following deployment in support of recent armed conflicts in Iraq and Afghanistan. Affected service members do not receive needed mental health services in most cases, and they frequently report stigma and significant structural barriers to mental health services. Improvements in primary care may help address these issues, and evidence supports the effectiveness of a systems-level collaborative care approach. To test the feasibility of systems-level collaborative care for PTSD and depression in military primary care. We named our collaborative care model "Re-Engineering Systems of Primary Care for PTSD and Depression in the Military" (RESPECT-Mil). Key elements of RESPECT-Mil care include universal primary care screening for PTSD and depression, brief standardized primary care diagnostic assessment for those who screen positive, and use of a nurse "care facilitator" to ensure continuity of care for those with unmet depression and PTSD treatment needs. The care facilitator assists primary care providers with follow-up, symptom monitoring, and treatment adjustment and enhances the primary care interface with specialty mental health services. We report assessments of feasibility of RESPECT-Mil implementation in a busy primary care clinic supporting Army units undergoing frequent Iraq, Afghanistan, and other deployments. Thirty primary care providers (family physicians, physician assistants, and nurse practitioners) were trained in the model and in the care of depression and PTSD. The clinic screened 4,159 primary care active duty patient visits: 404 screens (9.7%) were positive for depression, PTSD, or both. Sixty-nine patients participated in collaborative care for 6 weeks or longer, and the majority of these patients experienced clinically important improvement in PTSD and depression. Even although RESPECT-Mil participation was voluntary for providers, only one refused participation. No serious adverse events were noted. Collaborative care is an evidence-based approach to improving the quality of primary care treatment of anxiety and depression. Our version of collaborative care for PTSD and depression, RESPECT-Mil, is feasible, safe, and acceptable to military primary care providers and patients, and participating patients frequently showed clinical improvements. Efforts to implement and evaluate collaborative care approaches for mental disorders in populations at high risk for psychiatric complications of military service are warranted.

Investigating light curve modulation via kernel smoothing. II. New additional modes in single-mode OGLE classical Cepheids

NASA Astrophysics Data System (ADS)

Süveges, Maria; Anderson, Richard I.

2018-04-01

Detailed knowledge of the variability of classical Cepheids, in particular their modulations and mode composition, provides crucial insight into stellar structure and pulsation. However, tiny modulations of the dominant radial-mode pulsation were recently found to be very frequent, possibly ubiquitous in Cepheids, which makes secondary modes difficult to detect and analyse, since these modulations can easily mask the potentially weak secondary modes. The aim of this study is to re-investigate the secondary mode content in the sample of OGLE-III and -IV single-mode classical Cepheids using kernel regression with adaptive kernel width for pre-whitening, instead of using a constant-parameter model. This leads to a more precise removal of the modulated dominant pulsation, and enables a more complete survey of secondary modes with frequencies outside a narrow range around the primary. Our analysis reveals that significant secondary modes occur more frequently among first overtone Cepheids than previously thought. The mode composition appears significantly different in the Large and Small Magellanic Clouds, suggesting a possible dependence on chemical composition. In addition to the formerly identified non-radial mode at P2 ≈ 0.6…0.65P1 (0.62-mode), and a cluster of modes with near-primary frequency, we find two more candidate non-radial modes. One is a numerous group of secondary modes with P2 ≈ 1.25P1, which may represent the fundamental of the 0.62-mode, supposed to be the first harmonic of an l ∈ {7, 8, 9} non-radial mode. The other new mode is at P2 ≈ 1.46P1, possibly analogous to a similar, rare mode recently discovered among first overtone RR Lyrae stars.

Strategies for multivessel revascularization in patients with diabetes.

PubMed

Farkouh, Michael E; Domanski, Michael; Sleeper, Lynn A; Siami, Flora S; Dangas, George; Mack, Michael; Yang, May; Cohen, David J; Rosenberg, Yves; Solomon, Scott D; Desai, Akshay S; Gersh, Bernard J; Magnuson, Elizabeth A; Lansky, Alexandra; Boineau, Robin; Weinberger, Jesse; Ramanathan, Krishnan; Sousa, J Eduardo; Rankin, Jamie; Bhargava, Balram; Buse, John; Hueb, Whady; Smith, Craig R; Muratov, Victoria; Bansilal, Sameer; King, Spencer; Bertrand, Michel; Fuster, Valentin

2012-12-20

In some randomized trials comparing revascularization strategies for patients with diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than percutaneous coronary intervention (PCI). We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approach for patients with diabetes and multivessel coronary artery disease. In this randomized trial, we assigned patients with diabetes and multivessel coronary artery disease to undergo either PCI with drug-eluting stents or CABG. The patients were followed for a minimum of 2 years (median among survivors, 3.8 years). All patients were prescribed currently recommended medical therapies for the control of low-density lipoprotein cholesterol, systolic blood pressure, and glycated hemoglobin. The primary outcome measure was a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. From 2005 through 2010, we enrolled 1900 patients at 140 international centers. The patients' mean age was 63.1±9.1 years, 29% were women, and 83% had three-vessel disease. The primary outcome occurred more frequently in the PCI group (P=0.005), with 5-year rates of 26.6% in the PCI group and 18.7% in the CABG group. The benefit of CABG was driven by differences in rates of both myocardial infarction (P<0.001) and death from any cause (P=0.049). Stroke was more frequent in the CABG group, with 5-year rates of 2.4% in the PCI group and 5.2% in the CABG group (P=0.03). For patients with diabetes and advanced coronary artery disease, CABG was superior to PCI in that it significantly reduced rates of death and myocardial infarction, with a higher rate of stroke. (Funded by the National Heart, Lung, and Blood Institute and others; FREEDOM ClinicalTrials.gov number, NCT00086450.).

Neuromuscular exercises prevent severe knee injury in adolescent team handball players.

PubMed

Achenbach, Leonard; Krutsch, Volker; Weber, Johannes; Nerlich, Michael; Luig, Patrick; Loose, Oliver; Angele, Peter; Krutsch, Werner

2017-10-20

Team handball is associated with a high risk of severe knee injury that needs to be reduced, particularly at the youth level. The purpose of this study was to show how an injury-prevention programme effectively reduces severe knee injury in adolescent team handball players. Of 23 adolescent handball teams of both sexes, 13 were randomly allocated into the intervention group (168 players) and 10 into the control group (111 players). Players of the intervention group regularly participated in an injury-prevention programme for one season. Handball exposure and sustained injuries were documented for both groups on a monthly basis. The primary outcome parameter of the injury-prevention programme was the incidence of severe knee injury. Of the 279 included players, 68 (24%) sustained 82 injuries yielding an overall incidence of 1.85 injuries per 1000 h handball exposure (intervention group: 50 injuries/incidence: 1.90/1000 h; control group: 32 injuries/incidence: 1.78/1000 h). Knee injury was the second most frequent injury in adolescent team handball. The primary outcome parameter, severe knee injury occurred significantly more often in the control group [mean age (SD) 15.1 (1.0), injury incidence 0.33/1000 h] than in the intervention group [mean age (SD) 14.9 (0.9), injury incidence 0.04/1000 h]. The odds ratio was 0.11 (95% CI 0.01-0.90), p = 0.019. Other injuries to the lower extremities showed no significant difference between the two groups. Frequent neuromuscular exercises prevent severe knee injury in adolescent team handball players and should thus be included in the practical routine as well as in the education of team coaches.

Primary and secondary prevention of breast cancer.

PubMed

Kolak, Agnieszka; Kamińska, Marzena; Sygit, Katarzyna; Budny, Agnieszka; Surdyka, Dariusz; Kukiełka-Budny, Bożena; Burdan, Franciszek

2017-12-23

Breast cancer is the most common cancer among women and is the second cancer frequently occurring worldwide of newly-diagnosed cancers. There is much evidence showing the influence of life style and environmental factors on the development of mammary gland cancer (high-fat diet, alcohol consumption, lack of physical exercise), the elimination of which (primary prevention) may contribute to a decrease in morbidity and mortality. Secondary prevention, comprising diagnostic tests (e.g. mammography, ultrasonography, magnetic resonance imaging, breast self-examination, as well as modern and more precise imaging methods) help the early detection of tumours or lesions predisposing to tumours. The aim of this study paper is to review current knowledge and reports regarding primary and secondary prevention of breast cancer. It is estimated that nearly 70% of malign tumours are caused by environmental factors, whereas in breast cancer this percentage reaches 90-95%. There are national programmes established in many countries to fight cancer, where both types of prevention are stressed as serving to decrease morbidity and mortality due to cancers. Cancer prevention is currently playing a key role in the fight against the disease. Behaviour modification, as well as greater awareness among women regarding breast cancer, may significantly contribute towards reducing the incidence of this cancer. Another important aspect is the number of women undergoing diagnostic tests, which still remains at an unsatisfactory level.

Functional connectivity of neural motor networks is disrupted in children with developmental coordination disorder and attention-deficit/hyperactivity disorder

PubMed Central

McLeod, Kevin R.; Langevin, Lisa Marie; Goodyear, Bradley G.; Dewey, Deborah

2014-01-01

Developmental coordination disorder (DCD) and attention deficit/hyperactivity disorder (ADHD) are prevalent childhood disorders that frequently co-occur. Evidence from neuroimaging research suggests that children with these disorders exhibit disruptions in motor circuitry, which could account for the high rate of co-occurrence. The primary objective of this study was to investigate the functional connections of the motor network in children with DCD and/or ADHD compared to typically developing controls, with the aim of identifying common neurophysiological substrates. Resting-state fMRI was performed on seven children with DCD, 21 with ADHD, 18 with DCD + ADHD and 23 controls. Resting-state connectivity of the primary motor cortex was compared between each group and controls, using age as a co-factor. Relative to controls, children with DCD and/or ADHD exhibited similar reductions in functional connectivity between the primary motor cortex and the bilateral inferior frontal gyri, right supramarginal gyrus, angular gyri, insular cortices, amygdala, putamen, and pallidum. In addition, children with DCD and/or ADHD exhibited different age-related patterns of connectivity, compared to controls. These findings suggest that children with DCD and/or ADHD exhibit disruptions in motor circuitry, which may contribute to problems with motor functioning and attention. Our results support the existence of common neurophysiological substrates underlying both motor and attention problems. PMID:24818082

[Redo urethroplasty with buccal mucosa].

PubMed

Rosenbaum, C M; Ernst, L; Engel, O; Dahlem, R; Fisch, M; Kluth, L A

2017-10-01

Urethral strictures can occur on the basis of trauma, infections, iatrogenic-induced or idiopathic and have a great influence on the patient's quality of life. The current prevalence rate of male urethral strictures is 0.6% in industrialized western countries. The favored form of treatment has experienced a transition from less invasive interventions, such as urethrotomy or urethral dilatation, to more complex open surgical reconstruction. Excision and primary end-to-end anastomosis and buccal mucosa graft urethroplasty are the most frequently applied interventions with success rates of more than 80%. Risk factors for stricture recurrence after urethroplasty are penile stricture location, the length of the stricture (>4 cm) and prior repeated endoscopic therapy attempts. Radiation-induced urethral strictures also have a worse outcome. There are various therapy options in the case of stricture recurrence after a failed urethroplasty. In the case of short stricture recurrences, direct vision urethrotomy shows success rates of approximately 60%. In cases of longer or more complex stricture recurrences, redo urethroplasty should be the therapy of choice. Success rates are higher than after urethrotomy and almost comparable to those of primary urethroplasty. Patient satisfaction after redo urethroplasty is high. Primary buccal mucosa grafting involves a certain rate of oral morbidity. In cases of a redo urethroplasty with repeated buccal mucosa grafting, oral complications are only slightly higher.

Children and adolescents referred for treatment of anxiety disorders: differences in clinical characteristics.

PubMed

Waite, Polly; Creswell, Cathy

2014-01-01

Reports of the clinical characteristics of children and adolescents with anxiety disorders are typically based on community populations or from clinical samples with exclusion criterion applied. Little is known about the clinical characteristics of children and adolescents routinely referred for treatment for anxiety disorders. Furthermore, children and adolescents are typically treated as one homogeneous group although they may differ in ways that are clinically meaningful. A consecutive series of children (n=100, aged 6-12 years) and adolescents (n=100, aged 13-18 years), referred to a routine clinical service, were assessed for anxiety and comorbid disorders, school refusal and parental symptoms of psychopathology. Children with a primary anxiety disorder were significantly more likely to be diagnosed with separation anxiety disorder than adolescents. Adolescents with a primary anxiety disorder had significantly higher self and clinician rated anxiety symptoms and had more frequent primary diagnoses of social anxiety disorder, diagnoses and symptoms of mood disorders, and irregular school attendance. Childhood and adolescence were considered categorically as distinct, developmental periods; in reality changes would be unlikely to occur in such a discrete manner. The finding that children and adolescents with anxiety disorders have distinct clinical characteristics has clear implications for treatment. Simply adapting treatments designed for children to make the materials more 'adolescent-friendly' is unlikely to sufficiently meet the needs of adolescents. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Children's Ideas about "Metals." Learning in Science Project (Primary). Working Paper No. 112.

ERIC Educational Resources Information Center

Biddulph, Fred; Osborne, Roger

The topic of metals is frequently taught in primary schools. However, when metals are suggested as one of a series of topics for study, students often initially show little enthusiasm for the topic. To determine the ideas that children have about metals the Learning in Science Project (Primary)--LISP(P)--interviewed thirty-eight 9- to 10-year-old…

Atrial septal defect (ASD)

MedlinePlus

... any symptoms, or symptoms may not occur until middle age or later. Symptoms that do occur may begin at any time after birth through childhood. They can include: Difficulty breathing ( dyspnea ) Frequent respiratory ...

Norovirus: Food Handlers

MedlinePlus

... of norovirus illness occur in nursing homes, hospitals, restaurants, cruise ships, schools, banquet halls, summer camps, and ... outbreaks occur in the food service settings like restaurants. Infected food workers are frequently the source of ...

An atypical case of successful resuscitation of an accidental profound hypothermia patient, occurring in a temperate climate.

PubMed

Coleman, E; Doddakula, K; Meeke, R; Marshall, C; Jahangir, S; Hinchion, J

2010-03-01

Cases of accidental profound hypothermia occur most frequently in cold, northern climates. We describe an atypical case, occurring in a temperate climate, where a hypothermic cardiac-arrested patient was successfully resuscitated using extracorporeal circulation (ECC).

Contrasting breast cancer molecular subtypes across serial tumor progression stages: biological and prognostic implications

PubMed Central

Kimbung, Siker; Kovács, Anikó; Danielsson, Anna; Bendahl, Pär-Ola; Lövgren, Kristina; Stolt, Marianne Frostvik; Tobin, Nicholas P.; Lindström, Linda; Bergh, Jonas; Einbeigi, Zakaria; Fernö, Mårten; Hatschek, Thomas; Hedenfalk, Ingrid

2015-01-01

The relevance of the intrinsic subtypes for clinical management of metastatic breast cancer is not comprehensively established. We aimed to evaluate the prevalence and prognostic significance of drifts in tumor molecular subtypes during breast cancer progression. A well-annotated cohort of 304 women with advanced breast cancer was studied. Tissue microarrays of primary tumors and synchronous lymph node metastases were constructed. Conventional biomarkers were centrally assessed and molecular subtypes were assigned following the 2013 St Gallen guidelines. Fine-needle aspirates of asynchronous metastases were transcriptionally profiled and subtyped using PAM50. Discordant expression of individual biomarkers and molecular subtypes was observed during tumor progression. Primary luminal-like tumors were relatively unstable, frequently adopting a more aggressive subtype in the metastases. Notably, loss of ER expression and a luminal to non-luminal subtype conversion was associated with an inferior post-recurrence survival. In addition, ER and molecular subtype assessed at all tumor progression stages were independent prognostic factors for post-recurrence breast cancer mortality in multivariable analyses. Our results demonstrate that drifts in tumor molecular subtypes may occur during tumor progression, conferring adverse consequences on outcome following breast cancer relapse. PMID:26375671

Atypical extraspinal musculoskeletal tuberculosis in immunocompetent patients: part II, tuberculous myositis, tuberculous bursitis, and tuberculous tenosynovites.

PubMed

Abdelwahab, Ibrahim Fikry; Bianchi, Stefano; Martinoli, Carlo; Klein, Michael; Hermann, George

2006-12-01

Tuberculosis involving the soft tissue from adjacent bone or joint is well recognized. However, primary tuberculous pyomyositis, tuberculous bursitis, and tuberculous tenosynovitis are rare entities constituting 1% of skeletal tuberculosis. Tuberculous tenosynovitis involves most commonly the tendon sheaths of the hand and wrist, and tuberculous bursitis occurs most commonly around the hip. The greater trochanteric bursa and the greater trochanter are the most frequent sites of tuberculous bursitis. Cases of primary tuberculous pyomyositis and tenosynovitis of the tendons of the ankle and foot are seldom reported in the radiology literature. All imaging modalities-plain radiography, bone scan, computed tomography, and magnetic resonance imaging (MRI)--provide information that is helpful in determining therapy. MRI in particular, with its multiplanar capabilities and superb contrast of soft tissue, can demonstrate the extent of the soft tissue mass and access the adjacent bones and joints. However, MRI has no diagnostic specificity in regard to tuberculosis, and in nonendemic areas, biopsy is strongly recommended. All patients in this review were permanent residents of North America or Western Europe and were immunocompetent. Examples of atypical presentations of the above entities are demonstrated.

[Bilateral ovarian Burkitt's lymphoma. A case presentation].

PubMed

Briseño-Hernández, Andrés Alejandro; Quezada-López, Deissy Roxana; Castañeda-Chávez, Agar; Dassaejv Macías-Amezcua, Michel; Pintor-Belmontes, Julio Cesar

2014-01-01

Burkitt lymphoma, is described as an aggressive form of non-Hodgkin lymphoma of B cells which occurs most often in children and young adults, ovarian lymphoma can appear as a primary lesion or more commonly referred to as a metastasis. Primary ovarian lesions are rare manifestations corresponding to 0.5% of non-Hodgkin lymphoma and 1.5% of ovarian tumors. Clinic case: 31 years old female with general weakness, march incapacity, dyspnea, hyporexia, fever, diaphoresis, weight loss of 20 kg, flat abs with abdominal pain; Ca125 610 U/ml. Abdominal computed tomography shows a solid aspect tumor which affects the right pelvic cavity. Bilateral ovarian tumors were removed. Microscopically, both lesions show a "starry sky" pattern composed by a monotonous infiltration of lymphocytes mixed with large and clear macrophages, several atypical mitoses, and necrosis and hemorrhage areas. Immunohistochemistry was positive for CD10, CD20, and negative for CD3 and high Ki67 proliferation index. Bilateral ovarian Burkitt's lymphoma was diagnosed. Bilateral ovarian Burkitt's lymphoma is a rare entity, with a variability of presentations, the abdominal pain and abdominal tumors are the most frequent. The patient's prognosis at short term is poor, therefore it's necessary to know this entity and make an early diagnosis.

The retinoblastoma gene is frequently altered leading to loss of expression in primary breast tumours.

PubMed

Varley, J M; Armour, J; Swallow, J E; Jeffreys, A J; Ponder, B A; T'Ang, A; Fung, Y K; Brammar, W J; Walker, R A

1989-06-01

We have analysed the organisation of the retinoblastoma (RB1) gene in 77 primary breast carcinomas, in metastatic tissue derived from 16 of those primary tumours, and in a variety of benign breast lesions. Expression of RB1 was also assessed in most samples by immunohistochemical detection of the RB1 protein in tissue sections. Structural abnormalities to RB1 were detected in DNA from 15/77 (19%) of primary breast carcinomas examined. Where DNA was available from metastatic tissue derived from such primary tumours, the same aberration could be detected. No alterations were seen in benign breast lesions. 16/56 (29%) of tumours examined for expression by immunohistochemical methods showed a proportion of tumour cells to be completely negative for the RB1 protein. All tumours in which a structural alteration to RB1 was detected had a proportion of negative cells, except for one case where all cells were positive. Several primary tumour samples were identified where there was no detectable structural change to the gene, but there was loss of expression in some tumour cells. The data presented here demonstrate that changes to the RB1 gene leading to loss of expression of both alleles are frequent in primary human breast tumours.

[Persistent diarrhea in the returned traveler].

PubMed

de Saussure, P; Hadengue, A

2006-05-10

Persistent diarrhea in a returned traveler is a frequent presenting complaint and may result from three etiologic groups: persistant infections, non-infectious post-gastroenteritis processes (in particular postinfectious irritable bowel syndrome) and appearance of an unrelated cause of chronic diarrhea. This article reviews the most frequent diseases involved and provides management guidelines for primary care physicians.

Hassles on Campus.

ERIC Educational Resources Information Center

Elliott, Timothy R.; And Others

1989-01-01

Examined frequently occurring hassles among college students (n=366) at rural university, suburban community college, and urban university. Identified several stressful hassles that were common across settings. Most frequently reported hassle (troublesome thoughts about future) was common among both males and females. Men reported more problems…

Bladder and bowel dysfunctions in 1748 children referred to pelvic physiotherapy: clinical characteristics and locomotor problems in primary, secondary, and tertiary healthcare settings.

PubMed

van Engelenburg-van Lonkhuyzen, Marieke L; Bols, Esther M J; Benninga, Marc A; Verwijs, Wim A; de Bie, Rob A

2017-02-01

The aims of this study are to evaluate in a pragmatic cross-sectional study, the clinical characteristics of childhood bladder and/or bowel dysfunctions (CBBD) and locomotor problems in the primary through tertiary health care setting. It was hypothesized that problems would increase, going from primary to tertiary healthcare. Data were retrieved from patient-records of children (1-16 years) presenting with CBBD and visiting pelvic physiotherapists. Prevalence's of dysfunctions were compared between healthcare settings and gender using ANOVA and chi-square test. Agreement between physicians' diagnoses and parent-reported symptoms was evaluated (Cohen's Kappa). One thousand seventy hundred forty-eight children (mean age 7.7 years [SD 2.9], 48.9% boys) were included. Daytime urinary incontinence (P = 0.039) and enuresis (P < 0.001) were more diagnosed in primary healthcare, whereas constipation (P < 0.001) and abdominal pain (P = 0.009) increased from primary to tertiary healthcare. All parent-reported symptoms occurred more frequently than indicated by the physicians. Poor agreement between physicians' diagnoses and parent-reported symptoms was found (k = 0.16). Locomotor problems prevailed in all healthcare settings, motor skills (P = 0.041) and core stability (P = 0.015) significantly more in tertiary healthcare. Constipation and abdominal pain (physicians' diagnoses) and the parent-reported symptoms hard stools and bloating increased from primary to tertiary healthcare. Discrepancies exist between the prevalence's of physicians' diagnoses and parent-reported symptoms. Locomotor problems predominate in all healthcare settings. What is Known: • Childhood bladder and/or bowel dysfunctions (CCBD) are common. • Particularly tertiary healthcare characteristics of CBBD are available What is New: • Characteristics of CBBD referred to pelvic physiotherapy are comparable in primary, secondary, and tertiary healthcare settings. • Concomitant CBBD appeared to be more prevalent than earlier reported. • Discrepancies exist between referring physicians' diagnoses and parent-reported symptoms.

[Frequent attendance in a Primary Health Care District].

PubMed

Menéndez Granados, Nicolás; Vaquero Abellán, Manuel; Toledano Estepa, Manuel; Pérez Díaz, Manuel Modesto; Redondo Pedraza, Rosa

2017-10-09

To describe the distribution of frequent attenders (FA) through the different primary care practices in Cordoba-Guadalquivir Health District (Córdoba, Spain). An ecological study was performed, including data from 2011 to 2015. Defining FA as those subjects who made12 or more appointments per year; independently analysed for nursing, general practice and paediatrics. Prevalence of frequent attendance and FA/professional ratio were used as dependent variables. Demographic characteristics from district population, number of health professionals and use of general facilities were also examinated. Aiming to understand FA distribution, primary health settings were classified according to facility size and environmental location (urban, suburban and rural). The mean prevalence for FA was 10.86% (0.5 SE) for nursing; general practice 21.70% (0.7 SE) and for paediatrics 16.96% (0.7 SE). FA/professional ratios for the different professional categories were: 101.07 (5.0 SE) for nursing, 239.74 (9.0 SE) for general practice and 159.54 (9.8 SE) for paediatrics. A major part of primary health care users make a high number of consultations. From this group, women overuse nursing and general practitioner services more compared to men. A higher prevalence of FAs was observed in smaller settings, in rural areas. Although taking the FAs:professional ratio as the bar, medium-size practices are more highly overused. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Renal manifestations of primary mitochondrial disorders

PubMed Central

Finsterer, Josef; Scorza, Fulvio

2017-01-01

The aim of the present review was to summarize and discuss previous findings concerning renal manifestations of primary mitochondrial disorders (MIDs). A literature review was performed using frequently used databases. The study identified that primary MIDs frequently present as mitochondrial multiorgan disorder syndrome (MIMODS) at onset or in the later course of the MID. Occasionally, the kidneys are affected in MIDs. Renal manifestations of MIDs include renal insufficiency, nephrolithiasis, nephrotic syndrome, renal cysts, renal tubular acidosis, Bartter-like syndrome, Fanconi syndrome, focal segmental glomerulosclerosis, tubulointerstitial nephritis, nephrocalcinosis, and benign or malign neoplasms. Among the syndromic MIDs, renal involvement has been most frequently reported in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome, Kearns-Sayre syndrome, Leigh syndrome and mitochondrial depletion syndromes. Only in single cases was renal involvement also reported in chronic progressive external ophthalmoplegia, Pearson syndrome, Leber's hereditary optic neuropathy, coenzyme-Q deficiency, X-linked sideroblastic anemia and ataxia, myopathy, lactic acidosis, and sideroblastic anemia, pyruvate dehydrogenase deficiency, growth retardation, aminoaciduria, cholestasis, iron overload, lactacidosis, and early death, and hyperuricemia, pulmonary hypertension, renal failure in infancy and alkalosis syndrome. The present study proposes that the frequency of renal involvement in MIDs is probably underestimated. Diagnosis of renal involvement follows general guidelines and treatment is symptomatic. Thus, renal manifestations of primary MIDs require recognition and appropriate management, as they determine the outcome of MID patients. PMID:28515908

Safety and survival in an earthquake

USGS Publications Warehouse

,

1969-01-01

Many earth scientists in this country and abroad are focusing their studies on the search for means of predicting impending earthquakes, but, as yet, an accurate prediction of the time and place of such an event cannot be made. From past experience, however, one can assume that earthquakes will continue to harass mankind and that they will occur most frequently in the areas where they have been relatively common in the past. In the United States, earthquakes can be expected to occur most frequently in the western states, particularly in Alaska, California, Washington, Oregon, Nevada, Utah, and Montana. The danger, however, is not confined to any one part of the country; major earthquakes have occurred at widely scattered locations.

Self-reported Stress Problems among Teachers in Hong Kong

NASA Astrophysics Data System (ADS)

Chan, Alan H. S.; Chen, K.; Chong, Elaine Y. L.

2010-10-01

The present study was developed to comprehensively investigate the occupational health problems among teachers of primary and secondary schools in Hong Kong. A random sample of 1,710 respondents was generated from the database of Hong Kong Professional Teachers' Union (HKPTU) members. A self-administrated questionnaire was designed and sent by mail to the teachers of primary and secondary schools in HK. The results indicated that comparing with one year and five years ago, 91.6% and 97.3% of the responding teachers reported an increase of perceived stress level, respectively. Heavy workload and time pressure, education reforms, external school review, pursuing further education, and managing students' behaviour and learning were the most frequently reported sources of work stress. The four most frequently reported stress management activities were sleeping, talking to neighbors and friends, self-relaxing, and watching television, while the least frequently reported activity was doing more exercises or sports.

Frequency Analysis of Failure Scenarios from Shale Gas Development.

PubMed

Abualfaraj, Noura; Gurian, Patrick L; Olson, Mira S

2018-04-29

This study identified and prioritized potential failure scenarios for natural gas drilling operations through an elicitation of people who work in the industry. A list of twelve failure scenarios of concern was developed focusing on specific events that may occur during the shale gas extraction process involving an operational failure or a violation of regulations. Participants prioritized the twelve scenarios based on their potential impact on the health and welfare of the general public, potential impact on worker safety, how well safety guidelines protect against their occurrence, and how frequently they occur. Illegal dumping of flowback water, while rated as the least frequently occurring scenario, was considered the scenario least protected by safety controls and the one of most concern to the general public. In terms of worker safety, the highest concern came from improper or inadequate use of personal protective equipment (PPE). While safety guidelines appear to be highly protective regarding PPE usage, inadequate PPE is the most directly witnessed failure scenario. Spills of flowback water due to equipment failure are of concern both with regards to the welfare of the general public and worker safety as they occur more frequently than any other scenario examined in this study.

Frequency Analysis of Failure Scenarios from Shale Gas Development

PubMed Central

Abualfaraj, Noura; Olson, Mira S.

2018-01-01

This study identified and prioritized potential failure scenarios for natural gas drilling operations through an elicitation of people who work in the industry. A list of twelve failure scenarios of concern was developed focusing on specific events that may occur during the shale gas extraction process involving an operational failure or a violation of regulations. Participants prioritized the twelve scenarios based on their potential impact on the health and welfare of the general public, potential impact on worker safety, how well safety guidelines protect against their occurrence, and how frequently they occur. Illegal dumping of flowback water, while rated as the least frequently occurring scenario, was considered the scenario least protected by safety controls and the one of most concern to the general public. In terms of worker safety, the highest concern came from improper or inadequate use of personal protective equipment (PPE). While safety guidelines appear to be highly protective regarding PPE usage, inadequate PPE is the most directly witnessed failure scenario. Spills of flowback water due to equipment failure are of concern both with regards to the welfare of the general public and worker safety as they occur more frequently than any other scenario examined in this study. PMID:29710821

Japanese Encephalitis: Frequently Asked Questions

MedlinePlus

... the vaccine, what should I do? What is Japanese encephalitis? Japanese encephalitis (JE) is a potentially severe ... cause inflammation of the brain (encephalitis). Where does Japanese encephalitis occur? JE occurs in Asia and parts ...

Epidemiology of biological-exposure incidents among Spanish healthcare workers.

PubMed

Monge, V; Mato, G; Mariano, A; Fernández, C; Fereres, J

2001-12-01

To determine the frequency and the epidemiological characteristics of biological-exposure incidents occurring among healthcare personnel. Prospective surveillance study. Participating Spanish primary-care and specialty centers from January 1994 to December 1997. 70 centers in 1994, 87 in 1995, 97 in 1996, and 104 in 1997. Absolute and relative frequencies were calculated for several variables (position held, area of care, type of injuring object, activity, etc) and for the different categories of each variable. There were 20,235 registered incidents. Annual incidence rates were as follows: 1994, 51 per 1,000; 1995, 58 per 1,000, 1996, 54 per 1,000; and 1997, 59 per 1,000. Mean age of accident victims was as follows: 1994, 35.68 (standard deviation [SD], 16.26); 1995, 33.6 (SD, 11.9); 1996,38.2 (SD, 17.27); and 1997, 36.7 (SD, 16.33) years. Of the 20,235 incidents, 15,860 (80.7%) occurred to women; 50% (9,833) accidents were among nursing staff. The type of incident most frequently reported was percutaneous injury (81.1%). The highest frequency of accidents was seen in medical and surgical areas (28% and 25.6%, respectively). Blood and blood products were the most commonly involved material (87.6%). Administration of intramuscular or intravenous medication was the activity associated with the highest accident rate (20.3%). The most frequent immediate action in response was rinsing and disinfecting (65.6%). The incident registry was highly stable in terms of incidence rates over the observation period and served to highlight the large number of incidents recorded each year. The potential implications of the results are the need to explore reasons for increased exposures in certain areas, with the aim of focusing prevention efforts, and, similarly, to establish the factors associated with diminished incidence rates to model successful measures.

Resident responses to after-hours otolaryngology patient phone calls: An overlooked aspect of residency training?

PubMed

Lehmann, Ashton E; Kozin, Elliott D; Sethi, Rosh K V; Wong, Kevin; Lin, Brian M; Gray, Stacey T; Cunningham, Michael J

2018-05-01

Otolaryngology residents are often responsible for triaging after-hours patient calls. However, residents receive little training on this topic. Data are limited on the clinical content, reporting, and management of otolaryngology patient calls. This study aimed to characterize the patient concerns residents handle by phone and their subsequent management and reporting. Retrospective review. Five hundred consecutive after-hours patient calls in a tertiary pediatric hospital were reviewed. Data collected included patient and caller demographics, clinical concerns, surgical history, recommendations, and subsequent emergency department (ED) visits. On average, 3.7 calls occurred per shift, 2.8 on weekday and 5.9 on weekend shifts. Mean patient age was 6.6 years. Mothers (71%) called most frequently. The majority of calls were postoperative (64.2%). Of postoperative calls, most occurred within 3 days of surgery (52.3%). Most calls were for surgical site bleeding (19.9%). Residents recommended ED evaluation for 17.2% of calls, of which 20.9% returned to the primary institution ED. ED evaluation was recommended more frequently for postoperative patients (P = .040), particularly following adenotonsillectomy (51.2%) or surgical site bleeding (18.6%). With respect to documentation, 32.8% of medical record numbers were absent, 11.8% had name errors, and 2.2% of patients could not be identified. This is the first study to analyze the management and reporting of patient calls by otolaryngology residents. A wide array of clinical concerns are triaged by phone conversations. The study has implications for both resident and patient education. 4. Laryngoscope, 128:E163-E170, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

[Profiles of high-frequency users of primary care services and associations with depressive anxiety disorders in Cali, Colombia].

PubMed

Rodriguez-Lopez, Mérida; Arrivillaga, Marcela; Holguín, Jorge; León, Hoover; Ávila, Alfonso; Hernández, Carlos; Rincón-Hoyos, Hernán G

2016-01-01

To determine the profiles of highly frequent users of primary care services and the associations of these profiles with depressive anxiety disorders in Cali, Colombia. A case-control study, high-frequency cases were defined as those involving patients with a percentile >75 with regard to the frequency of spontaneous use of outpatient facilities in the last 12 months; controls were defined as those with a percentile <25. A multiple correspondence analysis was used to describe patient profiles, and the influences of depression and anxiety on frequent attendance was determined via logistic regression. Among the 780 participating patients, differences in the profiles among frequent users and controls were related to predisposing factors such as sex, age, and education, capacity factors such as the time required to visit the institution and the means of transport used, and need factors such as health perceptions, social support, family function, and the presence of anxiety or depressive disorders. A depression or anxiety disorder was found to associate positively with frequent attendance (adjusted odds ratio [aOR]: 1.99, 95% confidence interval [CI]: 1.19-3.31) and a referral system (aOR: 1.61, 95% CI: 1.01-2.76), but negatively with mild or no family dysfunction (aOR: 0.79; 95% CI: 0.48-0.88) after adjusting for age, sex, ethnicity, and health service-providing institutions. The profiles of high-frequency patients differ from control patients with respect to factors related to capacity, need, and willingness; in particular, the latter were independently associated with frequent attendance. Notably, the presence of an anxious or depressive disorder doubled the risk of highfrequency attendance at a primary care facility.

Catatonia in DSM-5.

PubMed

Tandon, Rajiv; Heckers, Stephan; Bustillo, Juan; Barch, Deanna M; Gaebel, Wolfgang; Gur, Raquel E; Malaspina, Dolores; Owen, Michael J; Schultz, Susan; Tsuang, Ming; van Os, Jim; Carpenter, William

2013-10-01

Although catatonia has historically been associated with schizophrenia and is listed as a subtype of the disorder, it can occur in patients with a primary mood disorder and in association with neurological diseases and other general medical conditions. Consequently, catatonia secondary to a general medical condition was included as a new condition and catatonia was added as an episode specifier of major mood disorders in DSM-IV. Different sets of criteria are utilized to diagnose catatonia in schizophrenia and primary mood disorders versus neurological/medical conditions in DSM-IV, however, and catatonia is a codable subtype of schizophrenia but a specifier for major mood disorders without coding. In part because of this discrepant treatment across the DSM-IV manual, catatonia is frequently not recognized by clinicians. Additionally, catatonia is known to occur in several conditions other than schizophrenia, major mood disorders, or secondary to a general medical condition. Four changes are therefore made in the treatment of catatonia in DSM-5. A single set of criteria will be utilized to diagnose catatonia across the diagnostic manual and catatonia will be a specifier for both schizophrenia and major mood disorders. Additionally, catatonia will also be a specifier for other psychotic disorders, including schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, and substance-induced psychotic disorder. A new residual category of catatonia not otherwise specified will be added to allow for the rapid diagnosis and specific treatment of catatonia in severely ill patients for whom the underlying diagnosis is not immediately available. These changes should improve the consistent recognition of catatonia across the range of psychiatric disorders and facilitate its specific treatment. Published by Elsevier B.V.

Diagnosis and management of primary autoimmune neutropenia in children: insights for clinicians

PubMed Central

Dufour, Carlo

2015-01-01

Autoimmune neutropenia of infancy (AIN), also called primary autoimmune neutropenia, is a disease in which antibodies recognize membrane antigens of neutrophils, mostly located on immunoglobulin G (IgG) Fc receptor type 3b (FcγIIIb receptor), causing their peripheral destruction. It is the most frequent type of neutropenia in children under 3–4 years of age and in most cases shows a benign, self-limited course. The diagnosis is based on evidence of indirect antineutrophil antibodies, whose detection frequently remains difficult. In this review we have analyzed the literature regarding AIN and present our personal experience in diagnosis and management. PMID:25642312

The role of patient activation in frequent attendance at primary care: a population-based study of people with chronic disease.

PubMed

Donald, Maria; Ware, Robert S; Ozolins, Ieva Z; Begum, Nelufa; Crowther, Ruth; Bain, Christopher

2011-05-01

This study explores a range of relevant socio-demographic, physical and psychological factors in a unique examination of the risk factors for frequent attendance at primary care. The impact of patient activation for self-management on health service utilisation is of particular interest. A population-based sample of people with chronic disease from Queensland, Australia, was interviewed using computer assisted telephone surveying. Data were collected from a random sample of 1470 people with either diabetes or a cardiovascular condition. As participants became more activated they were less likely to frequently attend their main health care provider for assistance with their chronic condition. For both conditions the association was graduated and for participants with a cardiovascular condition this association remained statistically significant even after controlling for other potentially influential factors such as disease severity, length of time since diagnosis, and psychological distress. Characteristics of the individual, including patient activation and psychological functioning, as well as disease factors contribute to primary care consulting patterns among people with chronic illness. Efforts to improve patient activation for self-management should remain a central element of chronic care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Injuries to primary school pupils and secondary school students during physical education classes and in their leisure time.

PubMed

Videmsek, Mateja; Karpljuk, Damir; Mlinar, Suzana; Mesko, Maja; Stihec, Joze

2010-09-01

The study aimed to establish the frequency of injuries in primary and secondary schools during leisure time and physical education classes in school as well as in group and individual sports. The sample included 2842 pupils from nine primary schools and 1235 students from five secondary schools in Slovenia. The data were processed with the SPSS statistical software package and the frequencies and Crosstabs were calculated. The results showed that substantially more pupils and students were injured in their leisure time than during physical education classes. Girls were more frequently injured in group and individual sports practiced during physical education classes and in individual sports practiced in their leisure time, whereas boys suffered more injuries in group sports practiced in their leisure time. As regards group sports, pupils and students were most frequently injured while playing football in their leisure time whereas, during physical education classes, they suffered most injuries in volleyball, followed closely by basketball and football; as regards individual sports, pupils and students were most frequently injured while cycling and rollerblading in their leisure time, whereas during physical education classes they suffered most injuries in athletics.

Liability of emergency physicians for studies ordered in the emergency department: court cases and legal defenses.

PubMed

Moore, Gregory P

2011-02-01

Laboratory tests are frequently ordered in the Emergency Department (ED), with results returning at a later time. Emergency physicians (EPs) are frequently held liable when the test results are not followed-up. Recent legal malpractice cases are presented to provide examples of the medical-legal risks encountered when poor patient outcomes occur because the results of laboratory tests and other studies done in the ED are not followed-up and communicated to the patient. Emergency physicians are obligated to follow-up with patients when the results of laboratory and radiographic studies ordered in the ED are returned at a later time, and EPs are liable for any poor outcome if there is no follow-up. Appropriate follow-up mechanisms must be in place to improve patient outcomes and reduce the risk for the physician. Knowledge of the legal concepts of contributory negligence and comparative fault allows EPs to place themselves in an optimal position for a legal defense if a challenge is raised. It is imperative that abnormal results of tests done for ED evaluation and orders must be properly noted and followed-up. Optimal communication and relay of information to both the patient and the primary physician will reduce physician liability and enhance patient outcomes. Published by Elsevier Inc.

Clinical and microbiological characteristics of patients with septic arthritis: A hospital-based study.

PubMed

Muñoz-Egea, María-Carmen; Blanco, Antonio; Fernández-Roblas, Ricardo; Gadea, Ignacio; García-Cañete, Joaquín; Sandoval, Enrique; Valdazo, María; Esteban, Jaime

2014-06-01

To determine the clinical and epidemiological characteristics, etiology, underlying conditions, and outcomes of patients with primary septic arthritis and no prosthetic joints at a university hospital. A retrospective study was performed between 2005 and 2012. Records from the Microbiology Department were reviewed, and patients with a positive culture of synovial fluid or biopsy were selected for the study. Clinical charts were reviewed using a designed protocol. 41 patients were diagnosed with septic arthritis with a positive culture. Most were diagnosed with monoarticular (85.37%) and monomicrobial (92.68%) arthritis. The most commonly involved joint was the knee (34.15%). The most frequent underlying conditions were hypertension and diabetes mellitus. Staphylococcus aureus was the most common pathogen (58.54%). Two cases of chronic arthritis, both caused by Mycobacterium tuberculosis were detected. The most frequently used antibiotic combinations were cloxacillin + ciprofloxacin and vancomycin + ciprofloxacin. Surgical treatment included needle aspiration, open joint debridement, or arthroscopic techniques. Twelve cases had a poor outcome (destructive articular disease), and 3 patients died from staphylococcal sepsis. In our hospital, septic arthritis is primarily acute, monoarticular, and monomicrobial; affects higher joints, is caused by S. aureus, and occurs in adult patients with underlying diseases. Outcome is good in most patients, although more than 25% of cases had articular sequels.

Acute lymphoblastic leukemia and lymphoma in the context of constitutional mismatch repair deficiency syndrome.

PubMed

Ripperger, Tim; Schlegelberger, Brigitte

2016-03-01

Constitutional mismatch repair deficiency (CMMRD) syndrome is one of the rare diseases associated with a high risk of cancer. Causative mutations are found in DNA mismatch repair genes PMS2, MSH6, MSH2 or MLH1 that are well known in the context of Lynch syndrome. CMMRD follows an autosomal recessive inheritance trait and is characterized by childhood brain tumors and hematological malignancies as well as gastrointestinal cancer in the second and third decades of life. There is a high risk of multiple cancers, occurring synchronously and metachronously. In general, the prognosis is poor. About one third of CMMRD patients develop hematological malignancies as primary (sometimes the only) malignancy or as secondary neoplasm. T-cell non-Hodgkin lymphomas, mainly of mediastinal origin, are the most frequent hematological malignancies. Besides malignant diseases, non-neoplastic features are frequently observed, e.g. café-au-lait spots sometimes resembling neurofibromatosis type I, hypopigmented skin lesions, numerous adenomatous polyps, multiple pilomatricomas, or impaired immunoglobulin class switch recombination. Within the present review, we summarize previously published CMMRD patients with at least one hematological malignancy, provide an overview of steps necessary to substantiate the diagnosis of CMMRD, and refer to the recent most relevant literature. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Permanent vascular access survival in children on long-term chronic hemodialysis.

PubMed

Briones, Liliana; Diaz Moreno, Alexia; Sierre, Sergio; Lopez, Laura; Lipsich, José; Adragna, Marta

2010-09-01

The aim of this study is to report a single-center experience regarding the management and outcome of permanent vascular accesses (VA) in children on chronic hemodialysis (HD). We analyzed the survival of permanent VA in 79 pediatric patients with end-stage renal disease patients on chronic HD between January 2000 and December 2008. One hundred and thirty-seven VA [89 native fistulas (AVFs) and 48 grafts (AVGs)] were created in 79 children. The creation of AVFs was significantly more frequent in children weighing >25 kg and AVGs in children weighing <25 kg (p = 0.003). The 1-year primary patency rate was 50% for AVF and 30% for AVG. The secondary patency rates at 1, 2, and 3 years for AVFs were 73, 50, and 20% and for AVGs were 64, 36, and 20%, respectively. The total number of surgical and endovascular interventions was significantly higher in AVGs (p

Heterogeneity of Powdery Mildew Resistance Revealed in Accessions of the ICARDA Wild Barley Collection

PubMed Central

Dreiseitl, Antonin

2017-01-01

The primary genepool of barley comprises two subspecies – wild barley (Hordeum vulgare subsp. spontaneum) and cultivated barley H. vulgare. subsp. vulgare. The former originated 5.5 million years ago in southwest Asia and is the immediate ancestor of cultivated barley, which arose around 10,000 years ago. In this study, the specific resistance of a set of 146 wild barley accessions, maintained by the International Center for Agriculture Research in the Dry Areas (ICARDA), to 32 isolates of barley powdery mildew caused by Blumeria graminis f. sp. hordei was evaluated. The set comprised 146 heterogeneous accessions of a previously tested collection. Seed was obtained by single seed descent and each accession was usually represented by five single plant progenies. In total, 687 plant progenies were tested. There were 211 phenotypes of resistance among the accessions, 87 of which were found in single plants, while 202 plants contained the eight most common phenotypes. The most frequent phenotype was found in 56 plants that were susceptible to all pathogen isolates, whereas the second most frequent phenotype, which occurred in 46 plants, was resistant to all isolates. The broad resistance diversity that was revealed is of practical importance and is an aid to determining the extent and role of resistance in natural ecosystems. PMID:28261253

Tumor Suppressor WWOX inhibits osteosarcoma metastasis by modulating RUNX2 function.

PubMed

Del Mare, Sara; Aqeilan, Rami I

2015-08-10

Osteosarcoma (OS) is among the most frequently occurring primary bone tumors, primarily affecting adolescents and young adults. This malignant osteoid forming tumor is characterized by its metastatic potential, mainly to lungs. We recently demonstrated that WW domain-containing oxidoreductase (WWOX) is frequently inactivated in human OS and that WWOX restoration in WWOX-negative OS cells suppresses tumorigenicity. Of note, WWOX levels are reduced in paired OS samples of post-treatment metastastectomies as compared to pre-treatment biopsies suggesting that decreased WWOX levels are associated with a more aggressive phenotype at the metastatic site. Nevertheless, little is known about WWOX function in OS metastasis. Here, we investigated the role of tumor suppressor WWOX in suppressing pulmonary OS metastasis both in vitro and in vivo. We demonstrated that ectopic expression of WWOX in OS cells, HOS and LM-7, inhibits OS invasion and cell migration in vitro. Furthermore, WWOX expression reduced tumor burden in vivo and inhibited metastases' seeding and colonization. Mechanistically, WWOX function is associated with reduced levels of RUNX2 metastatic target genes implicated in adhesion and motility. Our results suggest that WWOX plays a critical role in determining the aggressive phenotype of OS, and its expression could be an attractive therapeutic target to combat this devastating adolescent disease.

Tumor Suppressor WWOX inhibits osteosarcoma metastasis by modulating RUNX2 function

PubMed Central

Del Mare, Sara; Aqeilan, Rami I.

2015-01-01

Osteosarcoma (OS) is among the most frequently occurring primary bone tumors, primarily affecting adolescents and young adults. This malignant osteoid forming tumor is characterized by its metastatic potential, mainly to lungs. We recently demonstrated that WW domain-containing oxidoreductase (WWOX) is frequently inactivated in human OS and that WWOX restoration in WWOX-negative OS cells suppresses tumorigenicity. Of note, WWOX levels are reduced in paired OS samples of post-treatment metastastectomies as compared to pre-treatment biopsies suggesting that decreased WWOX levels are associated with a more aggressive phenotype at the metastatic site. Nevertheless, little is known about WWOX function in OS metastasis. Here, we investigated the role of tumor suppressor WWOX in suppressing pulmonary OS metastasis both in vitro and in vivo. We demonstrated that ectopic expression of WWOX in OS cells, HOS and LM-7, inhibits OS invasion and cell migration in vitro. Furthermore, WWOX expression reduced tumor burden in vivo and inhibited metastases’ seeding and colonization. Mechanistically, WWOX function is associated with reduced levels of RUNX2 metastatic target genes implicated in adhesion and motility. Our results suggest that WWOX plays a critical role in determining the aggressive phenotype of OS, and its expression could be an attractive therapeutic target to combat this devastating adolescent disease. PMID:26256646

Major ocular trauma in Taiwan: 2002-2004 versus 2012-2014.

PubMed

Chang, Yi-Sheng; Teng, Yu-Ti; Huang, Yi-Hsun; Liu, Mei-Ling; Hung, Jia-Horung; Hsu, Sheng-Min; Huang, Fu-Chin; Shih, Min-Hsiu; Chen, Wan-Ju; Lai, Chun-Chieh; Hsiao, Shu-Fang; Wang, Shih-Hao; Tseng, Sung-Huei

2018-05-04

We investigated the temporal changes in major eye injuries in Taiwan by reviewing the medical records of all patients with ocular trauma hospitalized at the National Cheng Kung University Hospital during 2002-2004 and 2012-2014. A total of 169 eyes (161 patients) during 2002-2004 and 121 eyes (120 patients) during 2012-2014 were enrolled (mean ± SD age: 41.9 ± 20.8 years in 2002-2004, and 51.8 ± 19.3 years in 2012-2014). Males accounted for ~75% of patients. The most frequent injury-causing object was metallic material (~24%), and blunt traumas were most frequently attributable to traffic accidents and falls. The most common locations of injuries for males and females were the workplace and home, respectively. Open-globe injuries occurred in ~70% of eyes, requiring primary repair, cataract extraction, and/or intraocular lens implantation. The frequencies of fall injury, lacrimal system laceration, lens injury, corneal/scleral foreign bodies, and use of intracameral antibiotics increased from 2002-2004 to 2012-2014, while those of closed-globe injury, vitreous haemorrhage, optic nerve injury, and medical treatment decreased. The final visual acuity remained poor (≤20/200) in >1/3 of injured eyes. Despite therapeutic advancements, major eye injuries still pose a high risk for poor visual outcome.

Information needs and information seeking in primary care: a study of nurse practitioners.

PubMed

Cogdill, Keith W

2003-04-01

The objective was to understand the information-related behavior of nurse practitioners (NPs), a population of clinicians responsible for an increasing proportion of primary care. Two phases of data collection addressed seven research questions. The initial phase of data collection was a questionnaire sent to 300 NPs, who were asked to report their experiences of needing information as a result of patient encounters as well as their experiences of seeking information. The second phase of data collection entailed a series of interviews with twenty NPs following their encounters with patients to collect data on instances of information needs and information seeking. NPs most frequently needed information related to drug therapy and diagnosis. NPs with a master's degree were found to perceive information needs more frequently than their colleagues who had not received a master's degree. The information resources NPs used most frequently were consultations with colleagues, drug reference manuals, and textbooks and protocol manuals. NPs were more likely to pursue needs related to drug therapy with a print resource and needs related to diagnosis with a colleague. The generalizability of a need emerged as a negative predictor of information seeking. This study has addressed a number of questions about the information-related behavior of NPs in primary care practices and led to the development of a temporal model of information seeking in these settings. Results of this research underscore the importance of access to information resources in primary care practices. This study's findings also support the development of educational and outreach programs to promote evidence-based decision making among primary care clinicians.

Primary care patients reporting concerns about their gambling frequently have other co-occurring lifestyle and mental health issues

PubMed Central

Goodyear-Smith, Felicity; Arroll, Bruce; Kerse, Ngaire; Sullivan, Sean; Coupe, Nicole; Tse, Samson; Shepherd, Robin; Rossen, Fiona; Perese, Lana

2006-01-01

Background Problem gambling often goes undetected by family physicians but may be associated with stress-related medical problems as well as mental disorders and substance abuse. Family physicians are often first in line to identify these problems and to provide a proper referral. The aim of this study was to compare a group of primary care patients who identified concerns with their gambling behavior with the total population of screened patients in relation to co-morbidity of other lifestyle risk factors or mental health issues. Methods This is a cross sectional study comparing patients identified as worrying about their gambling behavior with the total screened patient population for co morbidity. The setting was 51 urban and rural New Zealand practices. Participants were consecutive adult patients per practice (N = 2,536) who completed a brief multi-item tool screening primary care patients for lifestyle risk factors and mental health problems (smoking, alcohol and drug misuse, problem gambling, depression, anxiety, abuse, anger). Data analysis used descriptive statistics and non-parametric binomial tests with adjusting for clustering by practitioner using STATA survey analysis. Results Approximately 3/100 (3%) answered yes to the gambling question. Those worried about gambling more likely to be male OR 1.85 (95% CI 1.1 to 3.1). Increasing age reduced likelihood of gambling concerns – logistic regression for complex survey data OR = 0.99 (CI 95% 0.97 to 0.99) p = 0.04 for each year older. Patients concerned about gambling were significantly more likely (all p < 0.0001) to have concerns about their smoking, use of recreational drugs, and alcohol. Similarly there were more likely to indicate problems with depression, anxiety and anger control. No significant relationship with gambling worries was found for abuse, physical inactivity or weight concerns. Patients expressing concerns about gambling were significantly more likely to want help with smoking, other drug use, depression and anxiety. Conclusion Our questionnaire identifies patients who express a need for help with gambling and other lifestyle and mental health issues. Screening for gambling in primary care has the potential to identify individuals with multiple co-occurring disorders. PMID:16606465

A Morning in Clinic

ERIC Educational Resources Information Center

Dunn, Dena M.; Talmi, Ayelet

2012-01-01

Families with young children attend well-child visits in pediatric primary care settings frequently during the first 3 years of life and receive information and answers to questions about their young child's health and development. Integrating an infant-early childhood mental health and child development specialist into a pediatric primary care…

Characterization of Young Adult Emergency Department Users: Evidence to Guide Policy.

PubMed

Burns, Carson; Wang, N Ewen; Goldstein, Benjamin A; Hernandez-Boussard, Tina

2016-12-01

The purpose of this study was to characterize young adult patients aged 19-25 years who are emergency department (ED) frequent users and study factors associated with frequent ED use. ED visits among 19- to 25-year olds were identified from administrative records in California, Florida, Iowa, Massachusetts, and New York, 2010. Patients were analyzed for 12 months to study the frequency of their ED utilization. ED visits were categorized according to primary diagnosis. Patients were stratified by frequency of ED use: one visit (single users), two to four visits (infrequent users), and five or more visits (frequent users) in a 1-year period. We identified 1,711,774 young adult patients who made 3,650,966 ED visits. Sixty-six percent of patients were single users, 29% were infrequent users, and 4.6% were frequent users. Frequent users accounted for a disproportionate 28.8% of visits within the population studied. Frequent users had the largest proportion of visits for complications of pregnancy (13.6%) compared to single users (6.1%) and Medicaid (42.6%) compared to private insurance (17.3%). There was an increased risk of frequent ED use associated with females (odds ratio [OR]: 1.77), Medicaid (OR: 3.21), and Medicare insurance (OR: 4.22) compared to private insurance, and diseases of the blood (OR: 3.36) and mental illness (OR: 1.99) compared to injury and poisoning. Frequent users comprise a significant portion of the young adult ED population and present with a large proportion of visits for complications of pregnancy. Policies targeting this population might focus on improved access to primary and urgent care, acute obstetric care, and better coordination of care. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Comparative cytogenetic characterization of primary canine melanocytic lesions using array CGH and fluorescence in situ hybridization

PubMed Central

Poorman, Kelsey; Borst, Luke; Moroff, Scott; Roy, Siddharth; Labelle, Philippe; Motsinger-Reif, Alison

2017-01-01

Melanocytic lesions originating from the oral mucosa or cutaneous epithelium are common in the general dog population, with up to 100,000 diagnoses each year in the USA. Oral melanoma is the most frequent canine neoplasm of the oral cavity, exhibiting a highly aggressive course. Cutaneous melanocytomas occur frequently, but rarely develop into a malignant form. Despite the differential prognosis, it has been assumed that subtypes of melanocytic lesions represent the same disease. To address the relative paucity of information about their genomic status, molecular cytogenetic analysis was performed on the three recognized subtypes of canine melanocytic lesions. Using array comparative genomic hybridization (aCGH) analysis, highly aberrant distinct copy number status across the tumor genome for both of the malignant melanoma subtypes was revealed. The most frequent aberrations included gain of dog chromosome (CFA) 13 and 17 and loss of CFA 22. Melanocytomas possessed fewer genome wide aberrations, yet showed a recurrent gain of CFA 20q15.3–17. A distinctive copy number profile, evident only in oral melanomas, displayed a sigmoidal pattern of copy number loss followed immediately by a gain, around CFA 30q14. Moreover, when assessed by fluorescence in situ hybridization (FISH), copy number aberrations of targeted genes, such as gain of c-MYC (80 % of cases) and loss of CDKN2A (68 % of cases), were observed. This study suggests that in concordance with what is known for human melanomas, canine melanomas of the oral mucosa and cutaneous epithelium are discrete and initiated by different molecular pathways. PMID:25511566

Epidemiology of foreign bodies injuries in Ecuador: a first look based on a single centre experience.

PubMed

Chacon, Fernando Silva; Ballali, Simonetta; Passali, Desiderio; Cuestas, Giselle; Burbano, Gustavo; Perez, Rodolfo; Quintero, Mario; Passali, Giulio Cesare; Passali, Francesco Maria; Foltran, Francesca; Bellussi, Luisa; Rodriguez, Hugo; Gregori, Dario

2011-06-01

The analysis of foreign bodies (FB) injuries in the upper aero-digestive tract is not available for Ecuador and in this context, the present article represent the is the first presenting to the international community the basic epidemiological data on the Ecuador's experience on foreign bodies juries. Data on 258 cases were gleaned using Susy Safe database, choosing the cases coming from Ecuador's institutions, namely Francisco De Icaza Bustamante Children Hospital, in Guayaquil (Ecuador) which collects data on children injuries due to foreign bodies with the aid of a standardized case report forms. Patients showed a female:male ratio of 1:1.2. Fifty-three percent of the children were younger than 2 years of age, with a mean age of 3.22 years. The most frequent location of retrieval was the oesophagus (37.98%) followed by the ears (34.88%). Coins were the most frequent cause of accident (37.21%). Seeds and grain were the most frequent food FBs and they were seen in 13.95% of cases. Adult presence was recorded in 113 cases. There was indeed a significant correlation between the presence of an adult and the activity that the children were doing when the incident occurred. This first breach into the analysis of injuries in Ecuador gives the confirmation that the results coming from country's data agreed with the general Susy Safe ones. Similar preventive strategies are therefore highly recommended, stressing that primary prevention has the main role in children's protection. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

A multicenter randomized trial indicates initial prednisolone treatment for childhood nephrotic syndrome for two months is not inferior to six-month treatment.

PubMed

Yoshikawa, Norishige; Nakanishi, Koichi; Sako, Mayumi; Oba, Mari S; Mori, Rintaro; Ota, Erika; Ishikura, Kenji; Hataya, Hiroshi; Honda, Masataka; Ito, Shuichi; Shima, Yuko; Kaito, Hiroshi; Nozu, Kandai; Nakamura, Hidefumi; Igarashi, Takashi; Ohashi, Yasuo; Iijima, Kazumoto

2015-01-01

In this multicenter, open-label, randomized controlled trial, we determined whether 2-month prednisolone therapy for steroid-sensitive nephrotic syndrome was inferior or not to 6-month therapy despite significantly less steroid exposure. The primary end point was time from start of initial treatment to start of frequently relapsing nephrotic syndrome. The pre-specified non-inferiority margin was a hazard ratio of 1.3 with one-sided significance of 5%. We randomly assigned 255 children with an initial episode of steroid-sensitive nephrotic syndrome to either 2 - or 6-month treatment of which 246 were eligible for final analysis. The total prednisolone exposure counted both initial and relapse prednisolone treatment administered over 24 months. Median follow-up in months was 36.7 in the 2-month and 38.2 in the 6-month treatment group. Time to frequent relaps was similar in both groups; however, the median was reached only in the 6-month group (799 days). The hazard ratio was 0.86 (90% confidence interval, 0.64-1.16) and met the non-inferior margin. Time to first relapse was also similar in both groups: median day 242 (2-month) and 243 (6-month). Frequency and severity of adverse events were similar in both groups. Most adverse events were transient and occurred during initial or relapse therapy. Thus, 2 months of initial prednisolone therapy for steroid-sensitive nephrotic syndrome, despite less prednisolone exposure, is not inferior to 6 months of initial therapy in terms of time to onset of frequently relapsing nephrotic syndrome.

[A prompt diagnosis of Steinert's dystrophy in emergency unit].

PubMed

Suppa, M; Migliozzi, E; Magnanelli, E; Negri, S; Cavicchi, F; Colzi, M; Coppola, A

2012-11-01

Atrial fibrillation is frequently observed in Fist Aid. A rare cause is myotonic dystrophy There are two forms: Steinert's dystrophy caused by a defect of a gene myotoninaprotein kinase and Promm secondary to a defect of a Zinc Finger Protein Gene Clinical manifestations are localized in skeletal and face muscles, vitreous body, sexual glands, endocrine system, smooth muscle, central nervous system and myocardium. Sometimes, in mild and unrecognized forms of this rare disease there are arrhythmias as atrial fibrillation. We report the clinical case of a 52 year-old man, with a suspect diagnosis of Steinert's dystrophy, admitted to the emergency room for a persistent atrial fibrillation. The patient begins oral anticoagulation therapy. The patient perform a transesophageal echocardiogram before the electrical cardioversion with reset to sinus rhythm. In conclusion, with improving the screening methods of patients with primary and secondary myopathies, it has been seen an increase of cases in which a cardiac involvement occurred before or after the onset of the neuromuscular disorders. One of the most frequent alterations is represented by atrial fibrillation, responsible for an increased risk of cerebral embolism, with absolute indication for oral anticoagulation therapy. The myopathy more frequently associated with atrial fibrillation, is myotonic dystrophy, although the risk of cerebral embolism in these patients does not appear to be higher than the general population. The present case report is a spur to perform the diagnosis of Steinert disease in cases admitted to an Emergency Room because of arrhytmias, because of the possibility to perform fast and reliable specific genetic tests. A similar praxis confers to these Units an even more diagnostic clinical role.

Annular erythema in primary Sjogren's syndrome: description of 43 non-Asian cases.

PubMed

Brito-Zerón, P; Retamozo, S; Akasbi, M; Gandía, M; Perez-De-Lis, M; Soto-Cardenas, M-J; Diaz-Lagares, C; Kostov, B; Bove, A; Bosch, X; Perez-Alvarez, R; Siso, A; Ramos-Casals, M

2014-02-01

The objective of this paper is to evaluate the prevalence and characterize the main epidemiological, clinical and immunological features of annular erythema (AE) in non-Asian patients with primary Sjögren's syndrome (SS). We carried out a retrospective study searching for AE in 377 Spanish patients with primary SS fulfilling the 2002 American-European criteria. In addition, we searched PubMed (1994-2012) using the MeSH terms "annular erythema" and "primary Sjögren's syndrome" for additional cases. All cases with AE reported in patients with SS associated with systemic lupus erythematosus were excluded. In our Spanish cohort, we found 35 (9%) patients diagnosed with AE. All were white females, with a mean age of 47 years at diagnosis of AE. AE preceded diagnosis of SS in 27 (77%) patients. Cutaneous AE lesions involved principally the face and upper extremities. All patients reported photosensitivity, with cutaneous flares being reported during the warmest months in 93% of patients. Immunological markers consisted of anti-Ro/La antibodies in 31 (89%) patients. In the literature search, we identified eight additional non-Asian patients with primary SS diagnosed with AE. In comparison with 52 Asian patients, the 43 non-Asian patients with AE related to primary SS were more frequently women (100% vs 78%, p=0.008), and cutaneous lesions were less frequently reported in the face (55% vs 81%, p=0.045) and more frequently in the neck (40% vs 14%, p=0.041). Immunologically, non-Asian patients had a lower frequency of anti-Ro antibodies and a higher frequency of negative Ro/La antibodies, although the differences were not statistically significant. AE is not an exclusive cutaneous feature of Asian patients with primary SS. In addition to the characteristic cutaneous expression, AE has a very specific clinical and immunological profile: often presenting before the fulfillment of SS criteria, overwhelmingly associated with anti-Ro antibodies but weakly associated with other immunological markers and the main systemic SS-related features.

Bilateral vocal cord paralysis secondary to head and neck surgery.

PubMed

Tekin, Muhammet; Acar, Gul Ozbilen; Kaytaz, Asim; Savrun, Feray Karaali; Çelik, Melek; Cam, Osman Halit

2012-01-01

Even endotracheal intubation could be considered safe in operations under general anesthesia; rarely, it could cause recurrent laryngeal nerve paralysis as a complication. As mentioned in the literature, as a possible reason for this, anterior branches of the recurrent laryngeal nerve in the larynx could suffer from compression between the posteromedial part of the thyroid cartilage and the cuff of the tube. In the literature, unilateral vocal cord paralysis due to endotracheal intubation occurs more frequently in comparison to bilateral vocal cord paralysis. These types of palsies usually totally improve in approximately 6 months. A patient who experienced bilateral vocal cord paralysis in the early postoperative period after undergoing an endotracheal intubation process for general anesthesia and primary partial lip resection and supraomohyoid neck dissection due to lower lip carcinoma is presented in our article. Although vocal cord paralysis occurring after head and neck surgery is first thought as a complication of the surgery, endotracheal intubation should be considered as a possible cause of this paralysis. In relation with this patient, causes, clinical symptoms, and treatment procedures of vocal cord paralysis due to endotracheal intubation are discussed under guidance of the literature.

Oxidative Phosphorylation System in Gastric Carcinomas and Gastritis.

PubMed

Feichtinger, René G; Neureiter, Daniel; Skaria, Tom; Wessler, Silja; Cover, Timothy L; Mayr, Johannes A; Zimmermann, Franz A; Posselt, Gernot; Sperl, Wolfgang; Kofler, Barbara

2017-01-01

Switching of cellular energy production from oxidative phosphorylation (OXPHOS) by mitochondria to aerobic glycolysis occurs in many types of tumors. However, the significance of this switching for the development of gastric carcinoma and what connection it may have to Helicobacter pylori infection of the gut, a primary cause of gastric cancer, are poorly understood. Therefore, we investigated the expression of OXPHOS complexes in two types of human gastric carcinomas ("intestinal" and "diffuse"), bacterial gastritis with and without metaplasia, and chemically induced gastritis by using immunohistochemistry. Furthermore, we analyzed the effect of HP infection on several key mitochondrial proteins. Complex I expression was significantly reduced in intestinal type (but not diffuse) gastric carcinomas compared to adjacent control tissue, and the reduction was independent of HP infection. Significantly, higher complex I and complex II expression was present in large tumors. Furthermore, higher complex II and complex III protein levels were also obvious in grade 3 versus grade 2. No differences of OXPHOS complexes and markers of mitochondrial biogenesis were found between bacterially caused and chemically induced gastritis. Thus, intestinal gastric carcinomas, but not precancerous stages, are frequently characterized by loss of complex I, and this pathophysiology occurs independently of HP infection.

Bipolar femoral head arthroplasty in osteoarthritis. A prospective study with a minimum 5-year follow-up period.

PubMed

Pandit, R

1996-08-01

Primary bipolar femoral head arthroplasties performed on 100 osteoarthritic hips were studied to a minimum of 5 years after surgery. All arthroplasties were performed on physically active patients. At a mean follow-up period of 5.5 years, The Hospital for Special Surgery hip scores were good to excellent in 96 hips. Transient startup soreness constituted the most frequent complaint, occurring in 34 hips. Three hips had more persistent pain localized to the acetabulum, necessitating revision to fixed sockets, which alleviated the symptoms. Four additional hips, in heavy, active men, developed polyethylene fatigue fracture and component disassembly. Acetabular migration of more than 5 mm developed in one hip. Motion, as determined radiologically, occurred primarily at the inner bearing. There were no dislocations or infections in the series. The Bateman bipolar prosthesis provides generally good results in osteoarthritic hips. The shorter operating time and the case of revision are special advantages of bipolar devices. Start-up soreness and stiffness is a shortcoming in approximately one third of cases. Component disassembly in heavy, active men is a problem and the bipolar arthroplasty should be avoided in these patients. Start-up soreness was a significant problem in particular.

Oxidative Phosphorylation System in Gastric Carcinomas and Gastritis

PubMed Central

Skaria, Tom; Wessler, Silja; Cover, Timothy L.; Posselt, Gernot; Sperl, Wolfgang; Kofler, Barbara

2017-01-01

Switching of cellular energy production from oxidative phosphorylation (OXPHOS) by mitochondria to aerobic glycolysis occurs in many types of tumors. However, the significance of this switching for the development of gastric carcinoma and what connection it may have to Helicobacter pylori infection of the gut, a primary cause of gastric cancer, are poorly understood. Therefore, we investigated the expression of OXPHOS complexes in two types of human gastric carcinomas (“intestinal” and “diffuse”), bacterial gastritis with and without metaplasia, and chemically induced gastritis by using immunohistochemistry. Furthermore, we analyzed the effect of HP infection on several key mitochondrial proteins. Complex I expression was significantly reduced in intestinal type (but not diffuse) gastric carcinomas compared to adjacent control tissue, and the reduction was independent of HP infection. Significantly, higher complex I and complex II expression was present in large tumors. Furthermore, higher complex II and complex III protein levels were also obvious in grade 3 versus grade 2. No differences of OXPHOS complexes and markers of mitochondrial biogenesis were found between bacterially caused and chemically induced gastritis. Thus, intestinal gastric carcinomas, but not precancerous stages, are frequently characterized by loss of complex I, and this pathophysiology occurs independently of HP infection. PMID:28744336

Duane retraction syndrome: causes, effects and management strategies

PubMed Central

Kekunnaya, Ramesh; Negalur, Mithila

2017-01-01

Duane retraction syndrome (DRS) is a congenital eye movement anomaly characterized by variable horizontal duction deficits, with narrowing of the palpebral fissure and globe retraction on attempted adduction, occasionally accompanied by upshoot or down-shoot. The etiopathogenesis of this condition can be explained by a spectrum of mechanical, innervational, neurologic and genetic abnormalities occurring independently or which influence each other giving rise to patterns of clinical presentations along with a complex set of ocular and systemic anomalies. Huber type I DRS is the most common form of DRS with an earlier presentation, while Huber type II is the least common presentation. Usually, patients with unilateral type I Duane syndrome have esotropia more frequently than exotropia, those with type II have exotropia and those with type III have esotropia and exotropia occurring equally common. Cases of bilateral DRS may have variable presentation depending upon the type of presentation in each eye. As regards its management, DRS classification based on primary position deviation as esotropic, exotropic or orthotropic is more relevant than Huber’s classification before planning surgery. Surgical approach to these patients is challenging and must be individualized based on the amount of ocular deviation, abnormal head position, associated globe retraction and overshoots. PMID:29133973

Targeting the Epigenome with Bioactive Food Components for Cancer Prevention

PubMed Central

Ong, Thomas Prates; Moreno, Fernando Salvador; Ross, Sharon Ann

2012-01-01

Epigenetic processes participate in cancer development and likely influence cancer prevention. Global DNA hypomethylation, gene promoter hypermethylation and aberrant histone post-translational modifications are hallmarks of neoplastic cells which have been associated with genomic instability and altered gene expression. Because epigenetic deregulation occurs early in carcinogenesis and is potentially reversible, intervention strategies targeting the epigenome have been proposed for cancer prevention. Bioactive food components (BFCs) with anticancer potential, including folate, polyphenols, selenium, retinoids, fatty acids, isothiocyanates and allyl compounds, influence DNA methylation and histone modification processes. Such activities have been shown to affect the expression of genes involved in cell proliferation, death and differentiation that are frequently altered in cancer. Although the epigenome represents a promising target for cancer prevention with BFCs, few studies have addressed the influence of dietary components on these mechanisms in vivo, particularly on the phenotype of humans, and thus the exact mechanisms whereby diet mediates an effect on cancer prevention remains unclear. Primary factors that should be elucidated include the effective doses and dose timing of BFCs to attain epigenetic effects. Because diet-epigenome interactions are likely to occur in utero, the impact of early-life nutrition on cancer risk programming should be further investigated. PMID:22353664

Influence of surface vacancy defects on the carburisation of Fe 110 surface by carbon monoxide

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

Chakrabarty, Aurab, E-mail: aurab.chakrabarty@qatar.tamu.edu; Bouhali, Othmane; Mousseau, Normand

Adsorption and dissociation of gaseous carbon monoxide (CO) on metal surfaces is one of the most frequently occurring processes of carburisation, known as primary initiator of metal dusting corrosion. Among the various factors that can significantly influence the carburisation process are the intrinsic surface defects such as single surface vacancies occurring at high concentrations due to their low formation energy. Intuitively, adsorption and dissociation barriers of CO are expected to be lowered in the vicinity of a surface vacancy, due to the strong attractive interaction between the vacancy and the C atom. Here the adsorption energies and dissociation pathways ofmore » CO on clean and defective Fe 110 surface are explored by means of density functional theory. Interestingly, we find that the O adatom, resulting from the CO dissociation, is unstable in the electron-deficit neighbourhood of the vacancy due to its large electron affinity, and raises the barrier of the carburisation pathway. Still, a full comparative study between the clean surface and the vacancy-defected surface reveals that the complete process of carburisation, starting from adsorption to subsurface diffusion of C, is more favourable in the vicinity of a vacancy defect.« less

Spontaneous Osteoblastic Osteosarcoma in a Mongolian Gerbil (Meriones unguiculatus)

PubMed Central

Salyards, Gregory W; Blas-Machado, Uriel; Mishra, Sasmita; Harvey, Stephen B; Butler, Abigail M

2013-01-01

Spontaneous neoplasms in Mongolian gerbils have an incidence of 20% to 26.8%, but osteosarcomas occur at a much lower rate. Here we report a 1-y-old Mongolian gerbil with a spontaneous osteosarcoma at the level of the proximal tibia, with metastases to the pectoral muscles and lungs. Grossly, the tibial mass obliterated the tibia and adjacent muscles, and an axillary mass with a bloody, cavitary center expanded the pectoral muscles. Microscopically, the tibial mass was an infiltrative, osteoblastic mesenchymal neoplasm, and the axillary mass was an anaplastic mesenchymal neoplasm with hemorrhage. The lung contained multiple metastatic foci. Immunohistochemistry for osteonectin was strongly positive in the tibial, axillary, and pulmonary metastases. Although osteosarcoma is the most common primary malignant bone neoplasm that occurs spontaneously in all laboratory and domestic animal species and humans, it arises less frequently than does other neoplasms. The current case of spontaneous osteoblastic osteosarcoma of the proximal tibia and metastases to the pectoral muscles and lung in a Mongolian gerbil is similar in presentation, histology, and predilection site of both osteoblastic and telangiectatic osteosarcomas in humans. In addition, this case is an unusual manifestation of osteosarcoma in the appendicular skeleton of a Mongolian gerbil. PMID:23561939

A Description of Suicides in the Army National Guard During 2007-2014 and Associated Risk Factors.

PubMed

Griffith, James

2017-06-01

Suicide, due to its increased occurrence in recent years, has been a chief concern of the U.S. military. While there have been many published studies on the topic, conspicuously absent are studies that have included reserve military personnel. To fill this gap, this study reports descriptive statistics of personnel information and events surrounding 706 Army National Guard suicides that had occurred from 2007 through 2014. Comparative personnel information for random samples of nonsuicides for similar years (8 years, 1,000 cases per year) allowed examining factors associated most with suicide. Findings were very similar to those observed in the active duty Army and civilian populations. Primary risk factors for suicide were as follows: age (young), gender (male), and race/ethnicity (White). Most suicides occurred in nonmilitary status (86%) involving personal firearms (72%). Most frequent events surrounding the suicide were as follows: poor military performance (36% of all suicides), parent-family relationship problems (28%), substance abuse (27%), past behavioral health problem (20%), current behavioral health problems (10%), income problems (22%), and full-time employment problems (18%). Implications of findings for suicide prevention are discussed. © 2016 The American Association of Suicidology.

Single inhalation exposure to 90SrCl2 in the beagle dog: late biological effects.

PubMed

Gillett, N A; Muggenburg, B A; Boecker, B B; Griffith, W C; Hahn, F F; McClellan, R O

1987-08-01

Late-occurring biologic effects were studied in beagle dogs that were given graded levels of 90SrCl2 via single brief inhalation exposures and were subsequently observed for their life-span. Due to the soluble chemical form of the aerosol, 90Sr was rapidly translocated from lung and deposited in bone where it was subsequently retained for a long period of time. Radiation-induced lesions were confined to the bone, bone marrow, and adjacent soft tissue. Forty-five primary bone tumors occurred in 31 of 66 exposed dogs. Metastasis occurred from 21 tumors, with the lung being the most frequent site of metastasis (76%). Twenty-seven tumors were classified as different subtypes of osteosarcoma, 14 as hemangiosarcomas, 3 as fibrosarcomas, and 1 as a myxosarcoma. Four carcinomas arising from soft tissues adjacent to bone were also considered to be 90Sr induced. In contrast to bone tumors arising in beagles chronically exposed to 90Sr through ingestion, histologic lesions of radiation osteodystrophy were minimal in this study, indicating that these lesions are not a necessary precursor of osteosarcoma development. The incidences of hemangiosarcomas (31%) and telangiectatic osteosarcomas (11%) in addition to osteosarcomas suggest that the cell of origin for all of these neoplasms is a multipotent mesenchymal cell with the potential for various morphologic expressions dependent on local environmental factors.

Clustering of Caucasian Leber hereditary optic neuropathy patients containing the 11778 or 14484 mutations on an mtDNA lineage

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

Brown, M.D.; Sun, F.; Wallace, D.C.

1997-02-01

Leber hereditary optic neuropathy (LHON) is a type of blindness caused by mtDNA mutations. Three LHON mtDNA mutations at nucleotide positions 3460, 11778, and 14484 are specific for LHON and account for 90% of worldwide cases and are thus designated as {open_quotes}primary{close_quotes} LHON mutations. Fifteen other {open_quotes}secondary{close_quotes} LHON mtDNA mutations have been identified, but their pathogenicity is unclear. mtDNA haplotype and phylogenetic analysis of the primary LHON mutations in North American Caucasian patients and controls has shown that, unlike the 3460 and 11778 mutations, which are distributed throughout the European-derived (Caucasian) mtDNA phylogeny, patients containing the 14484 mutation tended tomore » be associated with European mtDNA haplotype J. To investigate this apparent clustering, we performed {chi}{sup 2}-based statistical analyses to compare the distribution of LHON patients on the Caucasian phylogenetic tree. Our results indicate that, unlike the 3460 and 11778 mutations, the 14484 mutation was not distributed on the phylogeny in proportion to the frequencies of the major Caucasian mtDNA haplogroups found in North America. The 14484 mutation was next shown to occur on the haplogroup J background more frequently that expected, consistent with the observation that {approximately}75% of worldwide 14484-positive LHON patients occur in association with haplogroup J. The 11778 mutation also exhibited a moderate clustering on haplogroup J. These observations were supported by statistical analysis using all available mutation frequencies reported in the literature. This paper thus illustrates the potential importance of genetic background in certain mtDNA-based diseases, speculates on a pathogenic role for a subset of LHON secondary mutations and their interaction with primary mutations, and provides support for a polygenic model for LHON expression in some cases. 18 refs., 3 tabs.« less

Consequences of Co-Occurring Attention-Deficit/Hyperactivity Disorder on Children's Language Impairments

ERIC Educational Resources Information Center

Redmond, Sean M.; Ash, Andrea C.; Hogan, Tiffany P.

2015-01-01

Purpose: Co-occurring attention-deficit/hyperactivity disorder (ADHD) and communication disorders represent a frequently encountered challenge for school-based practitioners. The purpose of the present study was to examine in more detail the clinical phenomenology of co-occurring ADHD and language impairments (LIs). Method: Measures of nonword…

Mucinous cystadenocarcinoma of the breast: a case report and review of the literature.

PubMed

Honma, Naoko; Sakamoto, Goi; Ikenaga, Motoko; Kuroiwa, Kojiro; Younes, Mamoun; Takubo, Kaiyo

2003-08-01

We report a case of mucinous cystadenocarcinoma (MCA) of the breast in a 96-year-old woman. This is an extremely rare variant of primary breast carcinoma that bears a striking resemblance to MCAs of the ovary and pancreas. The macroscopic appearance and secretion pattern (cytologic findings) resembled cystic hypersecretory carcinoma. However, microscopically, the epithelial cells were quite different from those of cystic hypersecretory carcinoma. In the present study as well as in the literature, MCAs tend to occur more frequently in elderly women. Immunohistochemical findings suggest that they may develop independently of estrogenic stimulation. Although MCAs show high proliferative activity, the prognosis was favorable in the present case as well as in the reported cases. Because MCAs appear to have a distinct pathogenesis and biologic behavior, they should be distinguished from ordinary mucinous carcinomas, cystic hypersecretory carcinomas, and carcinomas of other histologic subtypes.

Genetic effects of methyl benzimidazole-2-yl-carbamate on Saccharomyces cerevisiae.

PubMed Central

Wood, J S

1982-01-01

The genetic effects of the mitotic inhibitor methyl benzimidazole-2-yl-carbamate (MBC) have been studied in Saccharomyces cerevisiae. MBC had little or no effect on the frequency of mutation. In some experiments MBC caused an increase in the frequency of mitotic recombination; however, this effect was small and not reproducible. The primary genetic effect of MBC was to induce mitotic chromosome loss at a high frequency. Chromosome loss occurred at equal frequencies for all chromosomes tested (13 of 16). Cells which had lost multiple chromosomes were found more frequently than predicted if individual chromosome loss events were independent. The probability of loss for a particular chromosome increased with length of time cells were incubated with MBC. MBC treatment also increased the frequency at which polyploid cells were found. These results suggested that MBC acted to disrupt the structure or function of the mitotic spindle and cause chromosome nondisjunction. PMID:6757720

The incidence of Clostridioides difficile and Clostridium perfringens netF-positive strains in diarrheic dogs.

PubMed

Diniz, Amanda Nadia; Coura, Fernanda Morcatti; Rupnik, Maja; Adams, Vicki; Stent, Thomas L; Rood, Julian I; de Oliveira, Carlos Augusto; Lobato, Francisco Carlos Faria; Silva, Rodrigo Otávio Silveira

2018-02-01

The aim of this study was to examine the incidence of Clostridioides (previously Clostridium) difficile and Clostridium perfringens in the feces of diarrheic and non-diarrheic dogs. Also, the presence of other common canine enteropathogens was examined. Toxigenic C. difficile and C. perfringens positive for the NetF-encoding gene (netF) were detected in 11 (11.9%) and seven (7.6%) diarrheic dogs, respectively. Three dogs were diagnosed simultaneously with toxigenic C. difficile and netF-positive C. perfringens. Among other enteropathogens, Giardia sp. was the most common agent detected in dogs positive for toxigenic C. difficile or netF-positive C. perfringens. The results suggest that C. difficile and C. perfringens occur more frequently as a primary cause of diarrhea. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Management of Rhinosinusitis in Primary Care].

PubMed

Gabaldón, N Gómez; Arnaiz, C Manzanares; Cánovas, L Noguero; Armas, J Juan

2018-02-13

Acute rhinosinusitis is an important health problem. Even though its frequency is not well documented in our country?, the economic burden it bears is not insignificant as it notably alters the quality of life of affected patients. Its diagnosis is generally clinical in nature, with further studies reserved only for the differential diagnoses of complications or tumour-like processes. The most frequent causes are viral infections, although Streptococcus pneumoniae and Haemophilus influenzae are the most commonly isolated bacterial agents. Although complications are uncommon nowadays, they can be serious when they occur, and commonly include orbital infections, closely followed in frequency by intracranial and bone infections. Treatment should consist of symptomatic measures, like saline rinses and antibiotics in cases of bacterial origin. Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Tuberculous pleuritis secondary to Mycobacterium bovis in a veterinarian.

PubMed

Corcoran, John P; Hallifax, Robert J; Bettinson, Henry V; Psallidas, Ioannis; Rahman, Najib M

2016-07-01

Mycobacterium bovis is a rare cause of tuberculosis in humans, but should be considered in individuals at risk secondary to medical comorbidities (notably immunocompromise) or occupational exposure. Most cases are secondary to reactivation of latent infection in elderly individuals although cases of primary infection still occur, usually involving animal-to-human transmission. Pleural fluid culture in the context of suspected tuberculous pleuritis is frequently negative and pleural biopsy significantly increases the likelihood of confirming the diagnosis histologically and microbiologically. Although thoracoscopic biopsies are the reference standard, closed pleural biopsies are an appropriate and more accessible alternative in the majority of cases - these should be done under direct ultrasound guidance to maximise diagnostic yield. Treatment for M. bovis infection is with prolonged combination anti-tuberculous therapy, using an alternative to pyrazinamide as the organism is inherently resistant to this drug. © 2014 John Wiley & Sons Ltd.

Bloodstream infections in patients with solid tumors

PubMed Central

Gudiol, Carlota; Aguado, José María; Carratalà, Jordi

2016-01-01

ABSTRACT Little information is currently available regarding bloodstream infection (BSI) in patients with solid tumors who, for a variety of reasons, are particularly predisposed to develop this condition. In this review we focus on the incidence, epidemiology, clinical features, etiology, antimicrobial resistance, and outcomes of BSI of adult cancer patients with solid tumors. Most episodes of BSI occur in non-neutropenic patients, in whom the site of primary or metastatic tumor often serves as the portal of entry. The urinary tract and the abdomen are the most frequent sources of infection, and cholangitis is the most common recurrent source of BSI. Gram-negative bacilli are becoming the leading cause of BSI in patients with solid tumors, and the rate of multidrug resistance is increasingly being recognized. The case-fatality rate in patients with solid tumors and BSI is high, especially among those with comorbidities, advanced neoplasms, corticosteroid therapy, and shock at presentation. PMID:26787095

Thromboembolic complications following aminocaproic acid use in patients with hematologic malignancies.

PubMed

Juhl, Rebecca C; Roddy, Julianna V F; Wang, Tzu-Fei; Li, Junan; Elefritz, Jessica L

2018-02-09

Aminocaproic acid is frequently used in patients with hematologic malignancy that present with thrombocytopenia with or without hemorrhage. We conducted a retrospective study to evaluate the safety of aminocaproic acid in 109 patients with hematologic malignancies. Patients were included if aminocaproic acid had been administered for at least 24 hours for the prevention or treatment of thrombocytopenic hemorrhage. Our primary outcome was thromboembolic complications defined as arterial or venous thrombotic events objectively confirmed by imaging studies. Thromboembolic complications occurred in five patients (4.6%) and all were venous thromboses. Other than the underlying malignancy, these patients also had many concurrent risk factors including indwelling central venous catheters, which could have contributed to thromboses. In conclusion, in our population of patients with a variety of hematological malignancies, aminocaproic acid does not appear to be associated with a high incidence of thromboembolic complications.

Conjunction Assessment Late-Notice High-Interest Event Investigation: Space Weather Aspects

NASA Technical Reports Server (NTRS)

Pachura, D.; Hejduk, M. D.

2016-01-01

Late-notice events usually driven by large changes in primary (protected) object or secondary object state. Main parameter to represent size of state change is component position difference divided by associated standard deviation (epsilon divided by sigma) from covariance. Investigation determined actual frequency of large state changes, in both individual and combined states. Compared them to theoretically expected frequencies. Found that large changes ( (epsilon divided by sigma) is greater than 3) in individual object states occur much more frequently than theory dictates. Effect is less pronounced in radial components and in events with probability of collision (Pc) greater than 1 (sup -5) (1e-5). Found combined state matched much closer to theoretical expectation, especially for radial and cross-track. In-track is expected to be the most vulnerable to modeling errors, so not surprising that non-compliance largest in this component.

Breast cancer metastatic to the pituitary gland: a case report.

PubMed

Spinelli, Gian Paolo; Lo Russo, Giuseppe; Miele, Evelina; Prinzi, Natalie; Tomao, Federica; Antonelli, Manila; Giangaspero, Felice; Stati, Valeria; Strudel, Martina; Tomao, Silverio

2012-07-09

Metastases to the pituitary gland are rare events, and usually indicate widespread malignant disease. The lung and the breast are the most common sites of primary tumors that metastasize to the pituitary gland.Metastases are more frequent in older patients and the most common symptoms at presentation are diabetes insipidus and visual alterations. 72-year-old white woman was treated for a breast carcinoma with right superoexternal quadrantectomy, radiotherapy, and hormone therapy. Twelve years later, the patient presented with bone pain, bilateral progressive visual decline, and onset of hypopituitarism. A diagnosis of secondary bone involvement and pituitary metastasis was made. This was an unusual disease course, and stresses the importance of intensive follow-up in patients with breast cancer even many years after the initial diagnosis This case emphasizes that diagnosis can be difficult and controversial when relapse occurs at uncommon sites.

Leukemic Oral Manifestations and their Management.

PubMed

Francisconi, Carolina Favaro; Caldas, Rogerio Jardim; Oliveira Martins, Lazara Joyce; Fischer Rubira, Cassia Maria; da Silva Santos, Paulo Sergio

2016-01-01

Leukemia is the most common neoplastic disease of the white blood cells which is important as a pediatric malignancy. Oral manifestations occur frequently in leukemic patients and may present as initial evidence of the disease or its relapse. The symptoms include gingival enlargement and bleeding, oral ulceration, petechia, mucosal pallor, noma, trismus and oral infections. Oral lesions arise in both acute and chronic forms of all types of leukemia. These oral manifestations either may be the result of direct infiltration of leukemic cells (primary) or secondary to underlying thrombocytopenia, neutropenia, or impaired granulocyte function. Despite the fact that leukemia has long been known to be associated with oral lesions, the available literature on this topic consists mostly of case reports, without data summarizing the main oral changes for each type of leukemia. Therefore, the present review aimed at describing oral manifestations of all leukemia types and their dental management. This might be useful in early diagnosis, improving patient outcomes.

A mathematical model describes the malignant transformation of low grade gliomas: Prognostic implications.

PubMed

Bogdańska, Magdalena U; Bodnar, Marek; Piotrowska, Monika J; Murek, Michael; Schucht, Philippe; Beck, Jürgen; Martínez-González, Alicia; Pérez-García, Víctor M

2017-01-01

Gliomas are the most frequent type of primary brain tumours. Low grade gliomas (LGGs, WHO grade II gliomas) may grow very slowly for the long periods of time, however they inevitably cause death due to the phenomenon known as the malignant transformation. This refers to the transition of LGGs to more aggressive forms of high grade gliomas (HGGs, WHO grade III and IV gliomas). In this paper we propose a mathematical model describing the spatio-temporal transition of LGGs into HGGs. Our modelling approach is based on two cellular populations with transitions between them being driven by the tumour microenvironment transformation occurring when the tumour cell density grows beyond a critical level. We show that the proposed model describes real patient data well. We discuss the relationship between patient prognosis and model parameters. We approximate tumour radius and velocity before malignant transformation as well as estimate the onset of this process.

Association of the DAT1 genotype with inattentive behavior is mediated by reading ability in a general population sample.

PubMed

Cornish, Kim M; Savage, Robert; Hocking, Darren R; Hollis, Chris P

2011-12-01

Attention deficit hyperactivity disorder (ADHD) and reading disability (RD) frequently co-occur in the child population and therefore raise the possibility of shared genetic etiology. We used a quantitative trait loci (QTL) approach to assess the involvement of the dopamine transporter (DAT1) gene polymorphism in mediating reading disability and poor attention in a general population sample of primary school children aged 6-11 years in the UK. The potential confounding effects of IQ and chronological age were also investigated. We found an independent association between the homozygous DAT1 10/10 repeat genotype and RD that was not accounted for by the level of ADHD symptoms. This finding suggests that the DAT1 gene polymorphism may influence a common neural mechanism underlying both reading acquisition and ADHD symptoms. Copyright © 2011. Published by Elsevier Inc.

The Species Problem in Myxomycetes Revisited.

PubMed

Walker, Laura M; Stephenson, Steven L

2016-08-01

Species identification in the myxomycetes (plasmodial slime molds or myxogastrids) poses particular challenges to researchers as a result of their morphological plasticity and frequent alteration between sexual and asexual life strategies. Traditionally, myxomycete morphology has been used as the primary method of species delimitation. However, with the increasing availability of genetic information, traditional myxomycete taxonomy is being increasingly challenged, and new hypotheses continue to emerge. Due to conflicts that sometimes occur between traditional and more modern species concepts that are based largely on molecular data, there is a pressing need to revisit the discussion surrounding the species concept used for myxomycetes. Biological diversity is being increasingly studied with molecular methods and data accumulates at ever-faster rates, making resolution of this matter urgent. In this review, currently used and potentially useful species concepts (biological, morphological, phylogenetic and ecological) are reviewed, and an integrated approach to resolve the myxomycete species problem is discussed. Copyright © 2016 Elsevier GmbH. All rights reserved.

Adults with genetic syndromes and cardiovascular abnormalities: Clinical history and management

PubMed Central

Lin, Angela E.; Basson, Craig T.; Goldmuntz, Elizabeth; Magoulas, Pilar L.; McDermott, Deborah A.; McDonald-McGinn, Donna M.; McPherson, Elspeth; Morris, Colleen A.; Noonan, Jacqueline; Nowak, Catherine; Pierpont, Mary Ella; Pyeritz, Reed E.; Rope, Alan F.; Zackai, Elaine; Pober, Barbara R.

2009-01-01

Cardiovascular abnormalities, especially structural congenital heart defects (CHDs), commonly occur in malformation syndromes and genetic disorders. Individuals with syndromes comprise a significant proportion of those affected with selected CHDs such as complete atrioventricular canal, interrupted arch type B, supravalvar aortic stenosis and pulmonary stenosis. As these individuals age, they contribute to the growing population of adults with special health care needs. Although most will require longterm cardiology followup, primary care providers, geneticists and other specialists should be aware of (1) the type and frequency of cardiovascular abnormalities, (2) the range of clinical outcomes, and (3) guidelines for prospective management and treatment of potential complications. This article reviews fundamental genetic, cardiac, medical and reproductive issues associated with common genetic syndromes which are frequently associated with a cardiovascular abnormality. New data are also provided about the cardiac status of adults with a 22q11.2 deletion and with Down syndrome. PMID:18580689

Simulating the arrangement of subsystem to reduce inundation in the drainage system of Pepelegi housing area Sidoarjo

NASA Astrophysics Data System (ADS)

Brouwer, Steven; Wardoyo, Wasis; Lasminto, Umboro

2017-06-01

Pepelegi Indah Resident is a place which is frequently inundated by floodwater. This condition happened since the drainage system was designed with inappropriate waterflow method. The concern of this research was to figure out alternatives by managing the floodwater from the disposal drainage system. The existing information showed the area would be inundated if rainfall occurred for 2-3 hours. Half of Pepelegi Indah Resident would be inundated and subsidence time of flood on vulnerable time was 5-24 hours. To reduce the floodwater, some scenarios or simulations were carried out among others the management of tertiary drainage, the pool accommodation, and the provision of pumps at the enable point. From the simulation, the researcher should choose the best scenario which worked and optimally reduce the flooding. Based on the simulation results, the best scenario is the pool accommodation with new pumps at the primary channel.

A Cretaceous-Tertiary mass extinction? Were most of Earth's species killed off?

NASA Technical Reports Server (NTRS)

Briggs, J. C.

1991-01-01

For the past decade, the scientific and popular press have carried frequent articles about a catastrophic mass extinction that supposedly destroyed the majority of the earth's species, including the dinosaurs, approximately 65 million years ago. Since 1980, more than 2000 papers and books have dealt with some aspect of a mass extinction at the Cretaceous-Tertiary (K/T) boundary. One authoritative estimate of the severity of the extinctions is that 60-80% of all the living species became extinct at this boundary (Raup 1988). There appears to be a general acceptance of the fact that such a great catastrophe did occur. Most of the argument among scientists now is devoted to the determination of the cause. In this article, I argue that the species changes at the K/T boundary were neither sudden nor catastrophic. They were most likely caused by a regression of sea level that led to a decrease in primary production.

The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota.

PubMed Central

Bartley, G B

1994-01-01

Among incident cases of GO in Olmsted County, Minnesota: GO affected females six times more frequently than males (86% versus 14% of cases, respectively). The age-adjusted incidence rate was 16 cases per 100,000 population per year for females and 2.9 cases per 100,000 population for males. The peak incidence rates were bimodal, occurring in the age groups 40 to 44 years and 60 to 64 years in females and 45 to 49 years and 65 to 69 years in males. Among patients with GO, approximately 90% had Graves' hyperthyroidism, 1% had primary hypothyroidism, 3% had Hashimoto's thyroiditis, and 5% were euthyroid. Eyelid retraction was the most common ophthalmic feature of autoimmune thyroid disease, being present either unilaterally or bilaterally in more than 90% of patients at some point in their clinical course. Exophthalmos of one or both eyes affected approximately 60% of patients, restrictive extraocular myopathy was apparent in about 40% of patients, and optic nerve dysfunction occurred in either one or both eyes in 6% of patients with autoimmune thyroid disease. Only 5% of patients had the complete constellation of classic findings: eyelid retraction, exophthalmos, optic nerve dysfunction, extraocular muscle involvement, and hyperthyroidism. Upper eyelid retraction, either unilateral or bilateral, was documented in approximately 75% of patients at the time of diagnosis of GO. Lid lag also was a frequent early sign, being present either unilaterally or bilaterally in 50% of patients at the initial examination. At the time of diagnosis of GO, the most frequent ocular symptom was pain or discomfort, which affected 30% of patients. Some degree of diplopia was noted by approximately 17% of patients, lacrimation or photophobia was present in about 15% to 20% of patients, and 7.5% of patients complained of blurred vision. Decreased vision attributable to optic neuropathy was present in less than 2% of eyes at the time of diagnosis of GO. Thyroid dermopathy and acropachy accompanied GO in approximately 4% and 1% of patients, respectively. Myasthenia gravis occurred in less than 1% of patients. Superior limbic keratoconjunctivitis was documented in less than 4% of patients. The median age at the time of diagnosis of GO was 43 years (range, 8 to 88). Among patients with hyperthyroidism, 61% developed ophthalmopathy within 1 year of the onset of thyrotoxicosis. Symptoms and signs for which statistically significant changes occurred between the initial and final examinations included lacrimation, pain or ocular discomfort, photophobia, eyelid retraction, lid lag, eyelid fullness, conjunctival injection, chemosis, and exophthalmos.(ABSTRACT TRUNCATED AT 400 WORDS) Images FIGURE 1 FIGURE 2 FIGURE 3 PMID:7886878

Clinical characteristics and outcomes in pregnant women with Ebstein anomaly at the time of delivery in the USA: 2003-2012.

PubMed

Lima, Fabio V; Koutrolou-Sotiropoulou, Paraskevi; Yen, Tzyy Yun M; Stergiopoulos, Kathleen

2016-01-01

Ebstein anomaly is an uncommon congenital cardiac lesion that may be associated with cyanosis, arrhythmias and right heart dysfunction. Investigation into patient characteristics and outcomes in pregnant women with Ebstein anomaly has been limited. To characterize patient characteristics and clinical events for pregnant women with Ebstein anomaly during hospitalization for delivery in the USA; also, to determine the effect of Ebstein anomaly on maternal clinical outcomes and individual predictors of poor outcome at time of delivery. We screened the Healthcare Cost and Utilization Project's National Inpatient Sample for hospital admissions of pregnant women for delivery (vaginal or caesarean section) in the USA from 2003-2012, and identified a cohort of 7,850,381. Clinical characteristics and maternal outcomes were identified in those with and without Ebstein anomaly. The primary outcome of interest was major adverse cardiac events (MACE), a composite of in-hospital death, acute myocardial infarction, cerebrovascular events, embolic events, cardiac complications of labour and delivery heart failure or arrhythmia. Our study population consisted of 82 hospitalizations of pregnant women with Ebstein anomaly and 7,850,299 without. The Ebstein cohort more frequently had ostium secundum-type atrial septal defect and/or patent foramen ovale and anomalous atrioventricular excitation (P<0.001 for both). The MACE rate was significantly higher among Ebstein patients (P<0.001). Preterm delivery, postpartum haemorrhage and caesarean delivery occurred more frequently among the Ebstein cohort (19.5% vs 7.2%, 8.5% vs 2.8% and 47.6% vs 31.1%, respectively; P≤0.001). In a multivariable analysis, anomalous atrioventricular excitation (odds ratio [OR] 21.75, 95% confidence interval [CI] 1.03-457.91) and preterm delivery (OR 11.71, 95% CI 1.39-98.89) were associated with MACE among those with Ebstein anomaly. Pregnant women with Ebstein anomaly are at higher risk of MACE during pregnancy and delivery. Preterm delivery occurred more frequently in women with Ebstein anomaly. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The role of diseases, risk factors and symptoms in the definition of multimorbidity – a systematic review

PubMed Central

Willadsen, Tora Grauers; Bebe, Anna; Køster-Rasmussen, Rasmus; Jarbøl, Dorte Ejg; Guassora, Ann Dorrit; Waldorff, Frans Boch; Reventlow, Susanne; Olivarius, Niels de Fine

2016-01-01

Objective is to explore how multimorbidity is defined in the scientific literature, with a focus on the roles of diseases, risk factors, and symptoms in the definitions. Design: Systematic review. Methods: MEDLINE (PubMed), Embase, and The Cochrane Library were searched for relevant publications up until October 2013. One author extracted the information. Ambiguities were resolved, and consensus reached with one co-author. Outcome measures were: cut-off point for the number of conditions included in the definitions of multimorbidity; setting; data sources; number, kind, duration, and severity of diagnoses, risk factors, and symptoms. We reviewed 163 articles. In 61 articles (37%), the cut-off point for multimorbidity was two or more conditions (diseases, risk factors, or symptoms). The most frequently used setting was the general population (68 articles, 42%), and primary care (41 articles, 25%). Sources of data were primarily self-reports (56 articles, 42%). Out of the 163 articles selected, 115 had individually constructed multimorbidity definitions, and in these articles diseases occurred in all definitions, with diabetes as the most frequent. Risk factors occurred in 98 (85%) and symptoms in 71 (62%) of the definitions. The severity of conditions was used in 26 (23%) of the definitions, but in different ways. The definition of multimorbidity is heterogeneous and risk factors are more often included than symptoms. The severity of conditions is seldom included. Since the number of people living with multimorbidity is increasing there is a need to develop a concept of multimorbidity that is more useful in daily clinical work. Key pointsThe increasing number of multimorbidity patients challenges the healthcare system. The concept of multimorbidity needs further discussion in order to be implemented in daily clinical practice.Many definitions of multimorbidity exist and most often a cut-off point of two or more is applied to a range of 4–147 different conditions.Diseases are included in all definitions of multimorbidity.Risk factors are often included in existing definitions, whereas symptoms and the severity of the conditions are less frequently included. PMID:26954365

[Congenital talipes equinovarus--family occurrence].

PubMed

Kołecka, Ewa; Niedzielski, Kryspin Ryszard; Cukras, Zbigniew; Piotrowicz, Małgorzata

2011-01-01

Although congenital talipes equinovarus (CTEV) is one of the most frequently occurring congenital defects of locomotor organs, its ethiopathogenesis is still not fully known. Amongst the others, the inheritance patterns of that defect are not fully known, and that restricts genetic therapeutics and development of new treatment technologies. The aim of this study was analysis of family lineages of 205 children with CTEV (298 feet) treated at our centre in the years 1998-2008. The family occurrence of CTEV was found in 16 cases (8% of analysed group). 6 lineages, in which CTEV occurred in successive generations, were analysed in detail. Particularly interesting is the lineage of the family 1, in which the defect occurred in three successive generations. In case of that family, an autosomal dominant inheritance pattern is possible. Previously that pattern of CTEV inheritance was described only for isolated populations of Polynesians. In own material the family occurrence of CTEV was found to be less frequent than in bibliographic references. The defect occurred twice as often in boys, while the severe form was more frequently observed in girls, and that is consisted with data in the available bibliography. The analysis of presented lineages of families with CTEV did not allow unambiguous defining of the inheritance pattern for that defect. To confirm the autosomal dominant pattern of CTEV inheritance in the family in which the defect occurred in three successive generations, genetic tests would be necessary.

Words Spoken by Teachers to Primary-Level Classes of Deaf Children.

ERIC Educational Resources Information Center

Stuckless, E. Ross; Miller, Linda D.

1987-01-01

The study generated a list of the 1000 most frequently used words by teachers of hearing impaired children in six primary grade classes. Results have implications for real time captioning systems of communication. An alphabetical list and a list ordered by frequency of use are appended. (DB)

Elementary School Teachers' Use of Technology during Mathematics Teaching

ERIC Educational Resources Information Center

Polly, Drew

2014-01-01

Various educational technologies have been advanced as potential vehicles to transform teaching and learning. Still, research studies have documented that primary school teachers struggle to integrate technology in meaningful ways. This article presents the findings of a year-long study in which the author frequently observed three primary school…

Congenital hypothyroidism

PubMed Central

2010-01-01

Congenital hypothyroidism (CH) occurs in approximately 1:2,000 to 1:4,000 newborns. The clinical manifestations are often subtle or not present at birth. This likely is due to trans-placental passage of some maternal thyroid hormone, while many infants have some thyroid production of their own. Common symptoms include decreased activity and increased sleep, feeding difficulty, constipation, and prolonged jaundice. On examination, common signs include myxedematous facies, large fontanels, macroglossia, a distended abdomen with umbilical hernia, and hypotonia. CH is classified into permanent and transient forms, which in turn can be divided into primary, secondary, or peripheral etiologies. Thyroid dysgenesis accounts for 85% of permanent, primary CH, while inborn errors of thyroid hormone biosynthesis (dyshormonogeneses) account for 10-15% of cases. Secondary or central CH may occur with isolated TSH deficiency, but more commonly it is associated with congenital hypopitiutarism. Transient CH most commonly occurs in preterm infants born in areas of endemic iodine deficiency. In countries with newborn screening programs in place, infants with CH are diagnosed after detection by screening tests. The diagnosis should be confirmed by finding an elevated serum TSH and low T4 or free T4 level. Other diagnostic tests, such as thyroid radionuclide uptake and scan, thyroid sonography, or serum thyroglobulin determination may help pinpoint the underlying etiology, although treatment may be started without these tests. Levothyroxine is the treatment of choice; the recommended starting dose is 10 to 15 mcg/kg/day. The immediate goals of treatment are to rapidly raise the serum T4 above 130 nmol/L (10 ug/dL) and normalize serum TSH levels. Frequent laboratory monitoring in infancy is essential to ensure optimal neurocognitive outcome. Serum TSH and free T4 should be measured every 1-2 months in the first 6 months of life and every 3-4 months thereafter. In general, the prognosis of infants detected by screening and started on treatment early is excellent, with IQs similar to sibling or classmate controls. Studies show that a lower neurocognitive outcome may occur in those infants started at a later age (> 30 days of age), on lower l-thyroxine doses than currently recommended, and in those infants with more severe hypothyroidism. PMID:20537182

[CLINICAL BACKGROUND ANALYSIS ABOUT TRANSURETHRAL ELECTROCOAGULATION].

PubMed

Katsui, Masahiro; Kikuchi, Eiji; Yazawa, Satoshi; Hagiwara, Masayuki; Morita, Shinya; Shinoda, Kazunobu; Kosaka, Takeo; Mizuno, Ryuichi; Shinojima, Toshiaki; Asanuma, Hiroshi; Miyajima, Akira; Oya, Mototsugu

2015-10-01

Transurethral electrocoagulation (TUC) is a rare event but occurs in a constant manner with various causes or disorders and reduces patient quality of life. So far there have been no reports focusing on the details of TUC. We focused on the clinical background and related causes in cases of TUC in our institution. We identified 76 cases (65 patients) who underwent TUC at Keio University Hospital between April 2001 and March 2011. We focused on patient background, especially with respect to the primary disease, treatment modality, use of antiplatelet or anticoagulant agent, timing of TUC, type of electrosurgical device, and the incidence of transfusion. The primary disease for TUC included bladder tumor (BT) in 31 cases, benign prostate hyperplasia (BPH) in 13, prostate cancer (PCa) in 13, idiopathic bladder bleeding in 4, periarteritis nodosa in 3, uterine cervical cancer in 3, and others in 9. TUC after transurethral resection (TUR) was found in 38 cases, including transurethral resection of bladder tumor (TURBT) in 26 of 31 BT cases and transurethral resection of prostate (TURP) in 12 of 13 BPH cases. After TURBT, TUC was performed before removal of a urethral catheter in 7 cases, and after removal of a urethral catheter in 19 cases. With regard to TUC associated with TURP, the average estimated prostate volume in TUC cases before removal of the urethral catheter was 66.2 ml, which was significantly larger than that in TUC cases after removal of the urethral catheter (46.1 ml, p = 0.045). TUC after the radiation therapy was observed in 21 cases, and the average time from the radiation therapy to TUC was 3.4 years (7 months-10 years). TUC was caused by multiple causes or disorders, and 75% of our TUC was associated with BT, BPH or PCa. TUC associated with TURBT frequently occurred within 1 week after TURBT but was still observed after 1 month following the operation. All TUC associated with TURP occurred within 3 weeks after operation. The average period from radiation therapy to TUC was 3.4 years (7 months-10 years) and TUC associated with radiation cystitis could occur beyond 5 years after radiation.

Emerging Tuberculosis Pathogen Hijacks Social Communication Behavior in the Group-Living Banded Mongoose (Mungos mungo)

PubMed Central

Sanderson, Claire E.; Larsen, Michelle H.; Robbe-Austerman, Suelee; Williams, Mark C.; Palmer, Mitchell V.

2016-01-01

ABSTRACT An emerging Mycobacterium tuberculosis complex (MTC) pathogen, M. mungi, infects wild banded mongooses (Mungos mungo) in Northern Botswana, causing significant mortality. This MTC pathogen did not appear to be transmitted through a primary aerosol or oral route. We utilized histopathology, spoligotyping, mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR), quantitative PCR (qPCR), and molecular markers (regions of difference [RDs] from various MTC members, including region of difference 1 [RD1] from M. bovis BCG [RD1BCG], M. microti [RD1mic], and M. pinnipedii [RD1seal], genes Rv1510 [RD4], Rv1970 [RD7], Rv3877/8 [RD1], and Rv3120 [RD12], insertion element IS1561, the 16S RNA gene, and gene Rv0577 [cfp32]), including the newly characterized mongoose-specific deletion in RD1 (RD1mon), in order to demonstrate the presence of M. mungi DNA in infected mongooses and investigate pathogen invasion and exposure mechanisms. M. mungi DNA was identified in 29% of nasal planum samples (n = 52), 56% of nasal rinses and swabs (n = 9), 53% of oral swabs (n = 19), 22% of urine samples (n = 23), 33% of anal gland tissue (n = 18), and 39% of anal gland secretions (n = 44). The occurrence of extremely low cycle threshold values obtained with qPCR in anal gland and nasal planum samples indicates that high levels of M. mungi can be found in these tissue types. Histological data were consistent with these results, suggesting that pathogen invasion occurs through breaks in the nasal planum and/or skin of the mongoose host, which are in frequent contact with anal gland secretions and urine during olfactory communication behavior. Lesions in the lung, when present, occurred only with disseminated disease. No environmental sources of M. mungi DNA could be found. We report primary environmental transmission of an MTC pathogen that occurs in association with social communication behavior. PMID:27165798

Anti-Rh(c), "little c," isoimmunization: the role of rHuEpo in preventing late anemia.

PubMed

Zuppa, Antonio A; Cardiello, Valentina; Alighieri, Giovanni; Cota, Francesco; D'Antuono, Annamaria; Riccardi, Riccardo; Catenazzi, Piero; Romagnoli, Costantino

2013-08-01

The overall prevalence of non-Rh-D isoimmunization seems to lie between 0.15% and 1.1%. Anti-Rh(c) alloimmunization, "little c," occurs in 0.07% of pregnancies and shows a quite broad clinical presentation. Late anemia is a frequent problem occurring in the setting of isoimmunization. It occurs more frequently after intrauterine blood transfusions or exsanguinotransfusion, and it can be thought as a hyporegenerative anemia. The authors describe the use of human recombinant erythropoietin in preventing late anemia in a case of anti-Rh(c) isoimmunization. The use of human recombinant erythropoietin is a valid tool for preventing late-onset anemia due to either anti-Rh-D or non-anti-Rh-D isoimmunization.

Updates on attention-deficit/hyperactivity disorder and learning disorders.

PubMed

Semrud-Clikeman, Margaret; Bledsoe, Jesse

2011-10-01

The relationship of attention-deficit/hyperactivity disorder (ADHD) to learning disorders was reviewed and included reading disability, mathematics learning disability, and nonverbal learning disability. Genetic, neuroimaging, and neuropsychological functioning were examined for each disorder, along with a discussion of any existing literature when ADHD co-occurred with the disorder. All the disorders were found to frequently co-occur with ADHD. A review of the underlying neuroanatomic and neurofunctional data found specific structures that frequently co-occur in these disorders with others that are specific to the individual diagnosis. Aberrations in structure and/or function were found for the caudate, corpus callosum, and cerebellum, making these structures sensitive for the disorder but not specific. Suggestions for future research, particularly in relation to intervention, are provided.

A Physiologically-Based Pharmacokinetic (PBPK) Model With Metabolic Interactions of Chloroform (CHCL3) and Trichloroethylene

EPA Science Inventory

Exposure to mixtures is frequent, but biologic pathways such as metabolic inhibition, are poorly understood. CHCl3 and TCE are model volatiles frequently co-occurring; combined exposure results in less than additive hepatotoxicity. Here, we explore the underlying metabolic inte...

Outbreaks associated with recreational water in the United States, 1995-2004

EPA Science Inventory

In this article, we review the causes of 212 recreational waterborne outbreaks and 17975 cases of illness reported during 1995-2004. Gastroenteritis was the most frequently (91%) reported illness. Conditions or symptoms related to the skin, ear, or eye occurred less frequently (6...

Quality of life in Chinese patients with schizophrenia treated in primary care.

PubMed

Li, Yan; Hou, Cai-Lan; Ma, Xin-Rong; Zhong, Bao-Liang; Zang, Yu; Jia, Fu-Jun; Lin, Yong-Qiang; Lai, Kelly Y C; Chiu, Helen F K; Ungvari, Gabor S; Hall, Brian J; Cai, Mei-Ying; Ng, Chee H; Xiang, Yu-Tao

2017-08-01

In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians. This study examined the quality of life (QOL) in patients with schizophrenia treated in primary care and explored the demographic and clinical characteristics associated with QOL. Altogether, 612 patients with schizophrenia treated in 22 randomly selected primary care services in China formed the study sample. QOL, psychotic and depressive symptoms, extra-pyramidal symptoms and insight were assessed using standardized instruments. Data analyses were conducted with the one sample t-test and multiple linear regression analyses. Compared with the normative data for the Chinese general population, significantly lower scores in physical and mental QOL domains were found in the patient group. Older age, being unemployed, major medical conditions, no smoking, more severe depressive and negative symptoms, more frequent insomnia, and suicidality were independently associated with poor physical QOL. Male gender, more severe depressive and anxiety symptoms, more frequent insomnia, and suicidality were independently associated with poor mental QOL. Patients with schizophrenia treated in primary care had lower level of QOL in comparison with general population. Effective measures need to be implemented to improve their QOL. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

[Specificities of the logopenic variant of primary progressive aphasia].

PubMed

Magnin, E; Teichmann, M; Martinaud, O; Moreaud, O; Ryff, I; Belliard, S; Pariente, J; Moulin, T; Vandel, P; Démonet, J-F

2015-01-01

The logopenic variant of primary progressive aphasia is a syndrome with neuropsychological and linguistic specificities, including phonological loop impairment for which diagnosis is currently mainly based on the exclusion of the two other variants, semantic and nonfluent/agrammatic primary progressive aphasia. The syndrome may be underdiagnosed due (1) to mild language difficulties during the early stages of the disease or (2) to being mistaken for mild cognitive impairment or Alzheimer's disease when the evaluation of episodic memory is based on verbal material and (3) finally, it is not uncommon that the disorders are attributed to psychiatric co-morbidities such as, for example, anxiety. Moreover, compared to other variants of primary progressive aphasia, brain abnormalities are different. The left temporoparietal junction is initially affected. Neuropathology and biomarkers (cerebrospinal fluid, molecular amyloid nuclear imaging) frequently reveal Alzheimer's disease. Consequently this variant of primary progressive aphasia does not fall under the traditional concept of frontotemporal lobar degeneration. These distinctive features highlight the utility of correct diagnosis, classification, and use of biomarkers to show the neuropathological processes underlying logopenic primary progressive aphasia. The logopenic variant of primary progressive aphasia is a specific form of Alzheimer's disease frequently presenting a rapid decline; specific linguistic therapies are needed. Further investigation of this syndrome is needed to refine screening, improve diagnostic criteria and better understand the epidemiology and the biological mechanisms involved. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Perioperative surgical complications and learning curve associated with minimally invasive transforaminal lumbar interbody fusion: a single-institute experience.

PubMed

Park, Yung; Lee, Soo Bin; Seok, Sang Ok; Jo, Byung Woo; Ha, Joong Won

2015-03-01

As surgical complications tend to occur more frequently in the beginning stages of a surgeon's career, knowledge of perioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identify and describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbody fusion (TLIF). We performed a retrospective chart review of our first 124 patients who underwent minimally invasive TLIF. The primary outcome measure was adverse events during the perioperative period, including neurovascular injury, implant-related complications, and wound infection. Pseudarthroses and adjacent segment pathologies were not included in this review. Adverse events that were not specifically related to spinal surgery and did not affect recovery were also excluded. Perioperative complications occurred in 9% of patients (11/124); including three cases of temporary postoperative neuralgia, two deep wound infections, two pedicle screw misplacements, two cage migrations, one dural tear, and one grafted bone extrusion. No neurologic deficits were reported. Eight complications occurred in the first one-third of the series and only 3 complications occurred in the last two-thirds of the series. Additional surgeries were performed in 6% of patients (7/124); including four reoperations (two for cage migrations, one for a misplaced screw, and one for an extruded graft bone fragment) and three hardware removals (one for a misplaced screw and two for infected cages). We found perioperative complications occurred more often in the early period of a surgeon's experience with minimally invasive TLIF. Implant-related complications were common and successfully managed by additional surgeries in this series. We suggest greater caution should be exercised to avoid the potential complications, especially when surgeon is a novice to this procedure.

Onset of frequent dust storms in northern China at ~AD 1100.

PubMed

He, Yuxin; Zhao, Cheng; Song, Mu; Liu, Weiguo; Chen, Fahu; Zhang, Dian; Liu, Zhonghui

2015-11-26

Dust storms in northern China strongly affect the living and health of people there and the dusts could travel a full circle of the globe in a short time. Historically, more frequent dust storms occurred during cool periods, particularly the Little Ice Age (LIA), generally attributed to the strengthened Siberian High. However, limited by chronological uncertainties in proxy records, this mechanism may not fully reveal the causes of dust storm frequency changes. Here we present a late Holocene dust record from the Qaidam Basin, where hydrological changes were previously reconstructed, and examine dust records from northern China, including the ones from historical documents. The records, being broadly consistent, indicate the onset of frequent dust storms at ~AD 1100. Further, peaked dust storm events occurred at episodes of high total solar irradiance or warm-dry conditions in source regions, superimposed on the high background of frequent dust storms within the cool LIA period. We thus suggest that besides strong wind activities, the centennial-scale dust storm events over the last 1000 years appear to be linked to the increased availability of dust source. With the anticipated global warming and deteriorating vegetation coverage, frequent occurrence of dust storms in northern China would be expected to persist.

Designing services for frequent attenders to the emergency department: a characterisation of this population to inform service design.

PubMed

Jacob, Rebecca; Wong, Mai Luen; Hayhurst, Catherine; Watson, Peter; Morrison, Cecily

2016-08-01

Frequent attendance to the emergency department (ED) is a growing public health concern. Designing services for frequent attenders poses challenges, given the heterogeneous nature of this group. This was a two-part observational study identifying frequent attenders from ED records. The first stage studied trends and developed personas with emphasis on differentiating moderate frequent attenders (attending between 5 and 20 times per year) and extreme frequent attenders (attending more than 20 times). Stage 2 included a case note review of 100 consecutive frequent attenders. Results showed an increase in frequent attendance from 2.59% to 4.12% over 8 years. Moderate frequent attenders accounted for 97%. Of the 100 frequent attenders studied, 45% had medically unexplained symptoms (MUS), associated with younger age (p<0.001) but not with gender (p>0.05). In conclusion, the ED is a useful hub for identifying frequent attenders with MUS, particularly among moderate frequent attenders; service design for this group should consider a 'whole-systems approach' with integration between primary and secondary care, including specialist liaison psychiatry services where appropriate. © 2016 Royal College of Physicians.

Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care

PubMed Central

Thompson, Sandra C; Haynes, Emma; Woods, John A; Bessarab, Dawn C; Dimer, Lynette A; Wood, Marianne M; Sanfilippo, Frank M; Hamilton, Sandra J; Katzenellenbogen, Judith M

2016-01-01

Background: The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. Methods: The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Results: Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Conclusion: Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and inside the clinic for prevention and management of disease. A toolkit of proactive and holistic opportunities for interventions is proposed. PMID:27928502

Reduction in recurrent cardiovascular events with prasugrel compared with clopidogrel in patients with acute coronary syndromes from the TRITON-TIMI 38 trial

PubMed Central

Murphy, Sabina A.; Antman, Elliott M.; Wiviott, Stephen D.; Weerakkody, Govinda; Morocutti, Giorgio; Huber, Kurt; Lopez-Sendon, Jose; McCabe, Carolyn H.; Braunwald, Eugene

2008-01-01

Aims In the TRITON-TIMI 38 trial, greater platelet inhibition with prasugrel reduced the first occurrence of the primary endpoint (cardiovascular death, MI, or stroke) compared with clopidogrel in patients with an acute coronary syndrome (ACS) undergoing planned percutaneous coronary intervention. We hypothesized that prasugrel would reduce not only first events but also recurrent primary endpoint events and therefore total events compared with clopidogrel. Methods and results Poisson regression analysis was performed to compare the number of occurrences of the primary endpoint between prasugrel and clopidogrel in TRITON-TIMI 38. Landmark analytic methods were used to evaluate the risk of a recurrent primary endpoint event following an initial non-fatal endpoint event. Among patients with an initial non-fatal event, second events were significantly reduced with prasugrel compared to clopidogrel (10.8 vs. 15.4%, HR 0.65, 95% CI 0.46–0.92; P = 0.016), as was CV death following the non-fatal event (3.7 vs. 7.1%, HR 0.46, 95% CI 0.25–0.82; P = 0.008). Overall there was a reduction of 195 total primary efficacy events with prasugrel vs. clopidogrel (rate ratio 0.79, 95% CI 0.71–0.87; P < 0.001). Recurrent bleeding events occurred infrequently (TIMI major non-CABG bleeds: four with prasugrel and two with clopidogrel). Study drug discontinuation was frequent following the initial major bleeding event (42% of patients discontinued study drug). Conclusion While standard statistical analytic techniques for clinical trials censor patients who experience a component of the primary composite endpoint, total cardiovascular events remain important to both patients and clinicians. Prasugrel, a more potent anti-platelet agent, reduced both first and subsequent cardiovascular events compared with clopidogrel in patients with ACS. PMID:18682445

Update of sleep alterations in depression

PubMed Central

Medina, Andrés Barrera; Lechuga, DeboraYoaly Arana; Escandón, Oscar Sánchez; Moctezuma, Javier Velázquez

2014-01-01

Sleep disturbances in depression are up to 70%. Patients frequently have difficulty in falling asleep, frequent awakenings during the night and non-restorative sleep. Sleep abnormalities in depression are mainly characterized by increased rapid eye movement (REM) sleep and reduced slow wave sleep. Among the mechanisms of sleep disturbances in depression are hyperactivation of the hypothalamic-pituitary-adrenal axis, CLOCK gene polymorphism and primary sleep disorders. The habenula is a structure regulating the activities of monoaminergic neurons in the brain. The hyperactivation of the habenula has also been implicated, together with sleep disturbances, in depression. The presence of depression in primary sleep disorders is common. Sleep disturbances treatment include pharmacotherapy or Cognitive Behavioral Therapy. PMID:26483922

Wildfire impacts on the processes that generate debris flows in burned watersheds

USGS Publications Warehouse

Parise, M.; Cannon, S.H.

2012-01-01

Every year, and in many countries worldwide, wildfires cause significant damage and economic losses due to both the direct effects of the fires and the subsequent accelerated runoff, erosion, and debris flow. Wildfires can have profound effects on the hydrologic response of watersheds by changing the infiltration characteristics and erodibility of the soil, which leads to decreased rainfall infiltration, significantly increased overland flow and runoff in channels, and movement of soil. Debris-flow activity is among the most destructive consequences of these changes, often causing extensive damage to human infrastructure. Data from the Mediterranean area and Western United States of America help identify the primary processes that result in debris flows in recently burned areas. Two primary processes for the initiation of fire-related debris flows have been so far identified: (1) runoff-dominated erosion by surface overland flow; and (2) infiltration-triggered failure and mobilization of a discrete landslide mass. The first process is frequently documented immediately post-fire and leads to the generation of debris flows through progressive bulking of storm runoff with sediment eroded from the hillslopes and channels. As sediment is incorporated into water, runoff can convert to debris flow. The conversion to debris flow may be observed at a position within a drainage network that appears to be controlled by threshold values of upslope contributing area and its gradient. At these locations, sufficient eroded material has been incorporated, relative to the volume of contributing surface runoff, to generate debris flows. Debris flows have also been generated from burned basins in response to increased runoff by water cascading over a steep, bedrock cliff, and incorporating material from readily erodible colluvium or channel bed. Post-fire debris flows have also been generated by infiltration-triggered landslide failures which then mobilize into debris flows. However, only 12% of documented cases exhibited this process. When they do occur, the landslide failures range in thickness from a few tens of centimeters to more than 6 m, and generally involve the soil and colluvium-mantled hillslopes. Surficial landslide failures in burned areas most frequently occur in response to prolonged periods of storm rainfall, or prolonged rainfall in combination with rapid snowmelt or rain-on-snow events. ?? 2011 Springer Science+Business Media B.V.

Orbital metastases in Italy

PubMed Central

Magliozzi, Patrizio; Strianese, Diego; Bonavolontà, Paola; Ferrara, Mariantonia; Ruggiero, Pasquale; Carandente, Raffaella; Bonavolontà, Giulio; Tranfa, Fausto

2015-01-01

AIM To describe a series of Italian patients with orbital metastasis focusing on the outcomes in relation to the different primary site of malignancy. METHODS Retrospective chart review of 93 patients with orbital metastasis collected in a tertiary referral centre in a period of 38y and review of literature. RESULTS Out of 93 patients, 52 were females and 41 were males. Median age at diagnosis was 51y (range 1 to 88y). The patients have been divided into four groups on the basis of the year of diagnosis. The frequency of recorded cases had decreased significantly (P<0.05) during the last 9.5y. Primary tumor site was breast in 36 cases (39%), kidney in 10 (11%), lung in 8 (9%), skin in 6 (6%); other sites were less frequent. In 16 case (17%) the primary tumor remained unknown. The most frequent clinical findings were proptosis (73%), limited ocular motility (55%), blepharoptosis (46%) and blurred vision (43%). The diagnosis were established by history, ocular and systemic evaluation, orbital imaging studies and open biopsy or fine needle aspiration biopsy (FNAB). Treatment included surgical excision, irradiation, chemotherapy, hormone therapy, or observation. Ninety-one percent of patients died of metastasis with an overall mean survival time (OMST) after the orbital diagnosis of 13.5mo. CONCLUSION Breast, kidney and lung are the most frequent primary sites of cancer leading to an orbital metastasis. When the primary site is unknown, gastrointestinal tract should be carefully investigated. In the last decade a decrease in the frequency of orbital metastasis has been observed. Surgery provides a local palliation. Prognosis remains poor with a OMST of 13.5mo ranging from the 3mo in the lung cancer to 24mo in the kidney tumor. PMID:26558220

Does frequent residential mobility in early years affect the uptake and timeliness of routine immunisations? An anonymised cohort study

PubMed Central

Hutchings, Hayley A.; Evans, Annette; Barnes, Peter; Healy, Melanie A.; James-Ellison, Michelle; Lyons, Ronan A.; Maddocks, Alison; Paranjothy, Shantini; Rodgers, Sarah E.; Dunstan, Frank

2016-01-01

Background There are conflicting findings regarding the impact of residential mobility on immunisation status. Our aim was to determine whether there was any association between residential mobility and take up of immunisations and whether they were delayed in administration. Methods We carried out a cohort analysis of children born in Wales, UK. Uptake and time of immunisation were collected electronically. We defined frequent movers as those who had moved: 2 or more times in the period prior to the final scheduled on-time date (4 months) for 5 in 1 vaccinations; and 3 or more times in the period prior to the final scheduled on-time date (12 months) for MMR, pneumococcal and meningitis C vaccinations. We defined immunisations due at 2–4 months delayed if they had not been given by age 1; and those due at 12–13 months as delayed if they had not been given by age 2. Results Uptake rates of routine immunisations and whether they were given within the specified timeframe were high for both groups. There was no increased risk (odds ratios (95% confidence intervals) between frequent movers compared to non-movers for the uptake of: primary MMR 1.08 (0.88–1.32); booster Meningitis C 1.65 (0.93–2.92); booster pneumococcal 1.60 (0.59–4.31); primary 5 in 1 1.28 (0.92–1.78); and timeliness: primary MMR 0.92 (0.79–1.07); booster Meningitis C 1.26 (0.77–2.07); booster pneumococcal 1.69 (0.23–12.14); and primary 5 in 1 1.04 (0.88–1.23). Discussion Findings suggest that children who move home frequently are not adversely affected in terms of the uptake of immunisations and whether they were given within a specified timeframe. Both were high and may reflect proactive behaviour in the primary healthcare setting to meet Government coverage rates for immunisation. PMID:26923454

Critical Airway Team: A Retrospective Study of an Airway Response System in a Pediatric Hospital.

PubMed

Sterrett, Emily C; Myer, Charles M; Oehler, Jennifer; Das, Bobby; Kerrey, Benjamin T

2017-12-01

Objective Study the performance of a pediatric critical airway response team. Study Design Case series with chart review. Setting Freestanding academic children's hospital. Subjects and Methods A structured review of the electronic medical record was conducted for all activations of the critical airway team. Characteristics of the activations and patients are reported using descriptive statistics. Activation of the critical airway team occurred 196 times in 46 months (March 2012 to December 2015); complete data were available for 162 activations (83%). For 49 activations (30%), patients had diagnoses associated with difficult intubation; 45 (28%) had a history of difficult laryngoscopy. Results Activation occurred at least 4 times per month on average (vs 3 per month for hospital-wide codes). The most common reasons for team activation were anticipated difficult intubation (45%) or failed intubation attempt (20%). For 79% of activations, the team performed an airway procedure, most commonly direct laryngoscopy and tracheal intubation. Bronchoscopy was performed in 47% of activations. Surgical airway rescue was attempted 4 times. Cardiopulmonary resuscitation occurred in 41 activations (25%). Twenty-nine patients died during or following team activation (18%), including 10 deaths associated with the critical airway event. Conclusion Critical airway team activation occurred at least once per week on average. Direct laryngoscopy, tracheal intubation, and bronchoscopic procedures were performed frequently; surgical airway rescue was rare. Most patients had existing risk factors for difficult intubation. Given our rate of serious morbidity and mortality, primary prevention of critical airway events will be a focus of future efforts.

Psychometric Analysis of Young Children's Responses to the Slosson Intelligence Test-Primary (SIT-P)

ERIC Educational Resources Information Center

Erford, Bradley T.; Pauletta, Deborah

2005-01-01

When developing efficient treatment plans for a client or student, professional counselors frequently rely on information about intellectual ability. The Slosson Intelligence Test-Primary (SIT-P; Erford, Vitali, & Slosson, 1999) is an expansion of the Slosson Intelligence Test-Revised (SIT-R; Nicholson & Hibpshman, 1991) and includes a…

Obstetric Patients Who Select and Those Who Refuse Medical Students' Participation in Their Care.

ERIC Educational Resources Information Center

Magrane, Diane; And Others

1994-01-01

A survey of 222 obstetrics patients assisted by medical clerkship students from the University of Vermont and 78 who refused student participation found privacy the primary motivation for refusal and a desire to contribute to students' education a primary reason for accepting student participation. Patients frequently erroneously anticipated the…

The Governmentality of Childhood Obesity: Coca-Cola, Public Health and Primary Schools

ERIC Educational Resources Information Center

Powell, Darren; Gard, Michael

2015-01-01

In this paper, we examine the emergence of what might seem an unexpected policy outcome--a large multinational corporation, frequently blamed for exacerbating childhood obesity, operating as an officially sanctioned driver of anti-obesity initiatives in primary schools across the globe. We draw on Foucault's notion of governmentality to examine…

Patriotic Songs in Primary School Textbooks in Taiwan from 1949-1987

ERIC Educational Resources Information Center

Lee, Angela

2014-01-01

This study focused on the inclusion of patriotic songs in schooling that were popular in Taiwan between 1949 and 1987. Many patriotic songs were composed after 1949, and these frequently found their way into primary textbooks. School curriculum policies such as "education for patriotism" cultivate Chinese consciousness among Taiwanese…

School Social Work with Students with Mental Health Problems: Examining Different Practice Approaches

ERIC Educational Resources Information Center

McManama O'Brien, Kimberly H.; Berzin, Stephanie C.; Kelly, Michael S.; Frey, Andy J.; Alvarez, Michelle E.; Shaffer, Gary L.

2011-01-01

School social workers frequently serve as the primary mental health providers to youths with mental health problems. Although school social workers play a primary role in care, many students also receive outside counseling services. Previous research has not examined whether practice approaches differ when considering mental health practice with…

Duloxetine, Pregabalin, and Duloxetine Plus Gabapentin for Diabetic Peripheral Neuropathic Pain Management in Patients With Inadequate Pain Response to Gabapentin: An Open-Label, Randomized, Noninferiority Comparison

PubMed Central

Tanenberg, Robert J.; Irving, Gordon A.; Risser, Richard C.; Ahl, Jonna; Robinson, Michael J.; Skljarevski, Vladimir; Malcolm, Sandra K.

2011-01-01

OBJECTIVE: To determine whether duloxetine is noninferior to (as good as) pregabalin in the treatment of pain associated with diabetic peripheral neuropathy. PATIENTS AND METHODS: We performed a 12-week, open-label study of patients with diabetic peripheral neuropathic pain who had been treated with gabapentin (≥900 mg/d) and had an inadequate response (defined as a daily pain score of ≥4 on a numerical rating scale [0-10 points]). The first patient was enrolled on September 28, 2006, and the last patient visit occurred on August 26, 2009. Patients were randomized to duloxetine monotherapy (n=138), pregabalin monotherapy (n=134), or a combination of duloxetine and gabapentin (n=135). The primary objective was a noninferiority comparison between duloxetine and pregabalin on improvement in the weekly mean of the diary-based daily pain score (0- to 10-point scale) at end point. Noninferiority would be declared if the mean improvement for duloxetine was no worse than the mean improvement for pregabalin, within statistical variability, by a margin of –0.8 unit. RESULTS: The mean change in the pain rating at end point was –2.6 for duloxetine and –2.1 for pregabalin. The 97.5% lower confidence limit was a –0.05 difference in means, establishing noninferiority. As to adverse effects, nausea, insomnia, hyperhidrosis, and decreased appetite were more frequent with duloxetine than pregabalin; insomnia, more frequent with duloxetine than duloxetine plus gabapentin; peripheral edema, more frequent with pregabalin than with duloxetine; and nausea, hyperhidrosis, decreased appetite, and vomiting, more frequent with duloxetine plus gabapentin than with pregabalin. CONCLUSION: Duloxetine was noninferior to pregabalin for the treatment of pain in patients with diabetic peripheral neuropathy who had an inadequate pain response to gabapentin. Trial Registration: clinicaltrials.gov Identifier: NCT00385671 PMID:21719618

Doctor-patient communication without family is most frequently practiced in patients with malignant tumors in home medical care settings.

PubMed

Kimura, Takuma; Imanaga, Teruhiko; Matsuzaki, Makoto

2014-01-01

Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.

Irritable bowel syndrome in general practice: an overview.

PubMed

Oberndorff-Klein Woolthuis, A H; Brummer, R J M; de Wit, N J; Muris, J W M; Stockbrügger, R W

2004-01-01

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is frequently seen in gastroenterological practice. Population-based studies have shown that at any point in time IBS symptoms are present in about 3%-22% of the general Western population. In general practice, half of all new patients have functional disorders and IBS is responsible for about five consultations per week. General practitioners (GPs) manage the majority of IBS patients, but most knowledge (and research) is based on the smaller percentage of patients managed in secondary care. There is a paucity of literature on differences or similarities between these two groups with regard to clinical characteristics or diagnostic approach. The literature published in English about IBS in general practice was reviewed. Irritable bowel syndrome is frequently encountered in primary care. Primary care IBS patients, compared to secondary care patients, are likely to be young, female and to have less severe symptoms. But this is only true for some symptoms; for example, non-abdominal complaints are equally reported in both groups. The disorder can be diagnosed safely using internationally agreed symptom-based criteria, such as the Rome II criteria. Additional diagnostic measures will be necessary to support the diagnosis in only a minority of situations. Many primary care IBS patients can be managed given adequate reassurance and education, frequently without additional pharmacological treatment.

Three forms of somatization presenting in primary care settings in Spain.

PubMed

García-Campayo, J; Lobo, A; Pérez-Echeverría, M J; Campos, R

1998-09-01

The objective of this paper is to study the prevalence and clinical characteristics of functional, hypochondriacal, and presenting somatization (FSTS, HSTS, and PSTS, respectively) defined by standardized criteria, as well as the validity of their distinction in primary care in Spain. A two-stage epidemiological study of a representative sample (N = 1559) of primary care patients was carried out. In the first phase, the validated Spanish versions of General Health Questionnaire, Mini-Mental State Examination, and CAGE were used. In the second phase, the Standardized Polyvalent Psychiatric Interview, an interview for the multiaxial assessment of medical patients, was employed. The prevalence of any form of somatization in Spain was 21.3% (FSTS: 16.2%, PSTS: 9.4%, HSTS: 6.7%). Overlap of any of the three clinical forms was very frequent (42.7%). FSTS patients tended to be more chronic and showed higher scores in fatigue but lower scores in both depression and anxiety. Chronicity was frequent among somatizers, particularly in those who fulfilled more than one kind of somatization. Differences in diagnostic distribution among the three groups were also observed. In conclusion, this is the first study giving support to the validity of the distinction among three types of somatization in Spain, but overlap was more frequent than reported in North American studies.

Clinical and electroencephalographic features of carotid sinus syncope induced by internal carotid artery angioplasty.

PubMed

Martinez-Fernandez, E; García, F Boza; Gonzalez-Marcos, J R; Peralta, A Gil; Garcia, A Gonzalez; Deya, A Mayol

2008-02-01

Carotid sinus syncope may occur acutely during internal carotid artery angioplasty (CA). We performed this study to investigate the clinical, electroencephalographic (EEG), and hemodynamic features of carotid sinus syncope induced by CA. Between 1992 and 2003, clinical, EEG, and cardiovascular monitoring was performed in 359 consecutive patients undergoing CA. Carotid sinus reaction (CSR) and syncope occurred in 62.7% and 18.6% of the procedures, respectively. CSR and syncopal spells were classified into cardioinhibitory, vasodepressor, and mixed type. Syncope occurred more frequently in patients with cardioinhibitory CSR (P < .001). The odds ratios for the risk of syncope in patients with cardioinhibitory CSR and vasodepressor/mixed CSR were 6.9 and 1.4, respectively. Sixty-one patients had cardioinhibitory syncope; 7 had the vasodepressor/mixed type. Thirteen spells were not related to cardiovascular disturbances. This last syncope subtype was significantly associated with brain hemodynamic disturbances, including a decrease in cerebral vasoreactivity (P = .04) and the absence of function of both communicating arteries (P = .03). Convulsive movements resembling supplementary sensorimotor seizures occurred in 79% of patients who experienced syncopal spells. EEG changes were more prominent in patients with cardioinhibitory syncope. Syncope occurs frequently in patients undergoing CA and can be misdiagnosed as seizures. The most frequent mechanism was a cardioinhibitory response. Cerebral hemodynamic disturbances may play a crucial role in the pathophysiology of syncope with normal sinus rhythm and normotension. Moreover, direct depression of the CNS following carotid sinus distension is likely to be involved.

Peripheral osteoma, compound odontoma, focal cemento-osseous dysplasia, and cemento-ossifying fibroma in the same hemimandible: CBCT findings of an unusual case.

PubMed

Borghesi, Andrea; Tonni, Ingrid; Pezzotti, Stefania; Maroldi, Roberto

2017-12-01

Peripheral osteoma is the most common subtype of osteoma that arises most frequently in the craniofacial bones. It may occur at any age with a male-to-female ratio of 2:1. Peripheral osteoma may affect the mandible, particularly the ramus and the condyle. Compound odontoma is a subtype of odontoma that occurs in young subjects without gender predilection. It affects the maxilla more frequently than the mandible. Focal cemento-osseous dysplasia and cemento-ossifying fibroma are 2 benign fibro-osseous lesions with a female predominance that occur most commonly in the posterior region of the mandible. We report the first case involving the simultaneous occurrence of these 4 benign lesions in the same hemimandible diagnosed by CBCT.

Metachronous Multiple Primary Malignant Neoplasms of the Stomach and the Breast: Report of Two Cases With Review of Literature

PubMed Central

Karthikeyan, Vilvapathy Senguttuvan; Sistla, Sarath Chandra; Srinivasan, Ramachandran; Basu, Debdatta; Panicker, Lakshmi C.; Ali, Sheik Manwar; Rajkumar, Nagarajan

2014-01-01

Multiple primary malignant neoplasm is the occurrence of a second primary malignancy in the same patient within 6 months of the detection of first primary (synchronous), or 6 months or more after primary detection (metachronous). Multiple primary malignant neoplasms are not very frequently encountered in clinical practice. The relative risk for a second primary malignancy increases by 1.111-fold every month from the detection of the first primary malignancy in any individual. We present 2 patients treated for carcinoma of the breast who developed a metachronous primary malignancy in the stomach to highlight the rare occurrence of multiple primary malignant neoplasms. These tumors were histologically dissimilar, with distinct immunohistochemical parameters. The importance lies in carefully identifying the second primary malignancies, not dismissing them as metastases, and treating them accordingly. PMID:24444270

NUTM1 Gene Fusions Characterize a Subset of Undifferentiated Soft Tissue and Visceral Tumors.

PubMed

Dickson, Brendan C; Sung, Yun-Shao; Rosenblum, Marc K; Reuter, Victor E; Harb, Mohammed; Wunder, Jay S; Swanson, David; Antonescu, Cristina R

2018-05-01

NUT midline carcinoma is an aggressive tumor that occurs mainly in the head and neck and, less frequently, the mediastinum and lung. Following identification of an index case of a NUTM1 fusion positive undifferentiated soft tissue tumor, we interrogated additional cases of primary undifferentiated soft tissue and visceral tumors for NUTM1 abnormalities. Targeted next-generation sequencing was performed on RNA extracted from formalin-fixed paraffin-embedded tissue, and results validated by fluorescence in situ hybridization using custom bacterial artificial chromosome probes. Six patients were identified: mean age of 42 years (range, 3 to 71 y); equal sex distribution; and, tumors involved the extremity soft tissues (N=2), kidney (N=2), stomach, and brain. On systemic work-up at presentation all patients lacked a distant primary tumor. Morphologically, the tumors were heterogenous, with undifferentiated round-epithelioid-rhabdoid cells arranged in solid sheets, nests, and cords. Mitotic activity was generally brisk. Four cases expressed pancytokeratin, but in only 2 cases was this diffuse. Next-generation sequencing demonstrated the following fusions: BRD4-NUTM1 (3 cases), BRD3-NUTM1, MXD1-NUTM1, and BCORL1-NUTM1. Independent testing by fluorescence in situ hybridization confirmed the presence of NUTM1 and partner gene rearrangement. This study establishes that NUT-associated tumors transgress the midline and account for a subset of primitive neoplasms occurring in soft tissue and viscera. Tumors harboring NUTM1 gene fusions are presumably underrecognized, and the extent to which they account for undifferentiated mesenchymal, neuroendocrine, and/or epithelial neoplasms is unclear. Moreover, the relationship, if any, between NUT-associated tumors in soft tissue and/or viscera, and conventional NUT carcinoma, remains to be elucidated.

WaveOne Rotary Instruments after Clinical Use.

PubMed

Shen, Ya; Coil, Jeffrey M; Mo, Anthony John; Wang, Zhejun; Hieawy, Ahmed; Yang, Yan; Haapasalo, Markus

2016-02-01

The purpose of this study was to evaluate the incidence and mode of WaveOne (Dentsply Tulsa Dental Specialties, Tulsa, OK) instrument defects after single use at different endodontic clinics. A total of 438 WaveOne instruments were collected after clinical use from the 4 specialist clinics over a 12-month period and from 1 graduate program over a 20-month period. The incidence and type of instrument defects were analyzed. The lateral surfaces of part of the defective instruments and fracture surfaces of fractured files were examined using scanning electron microscopy. Unused and clinically used files were examined by a nanoindentation test. Of the 438 WaveOne instruments collected, 42 (9.6%) had defects: 40 (9.1%) were distorted and 2 (0.5%) files had fractured, 1 Small and 1 Primary file. Clear differences in the frequency of defects were found among the 3 file sizes; the occurrence of distortion and fracture were highest with the Small file (21.2% and 0.7%, respectively) followed by the Primary file (4.4% and 0.4%, respectively) (P < .05). No defects were detected on the Large file. The cause of the 2 fractures was shear stress. Instruments from various clinics showed no significantly different occurrence of instrument deformation. Unwinding occurred at 1.2-3.1 mm from the tip. No significant difference in nanohardness was detected among unused and used instruments. The risk of WaveOne fracture is very low when files are singly used by endodontists and residents. Unwinding of the files occurred most frequently in the Small file. The frequency of defects of WaveOne instruments were not influenced by the operator. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Redo buccal mucosa graft urethroplasty: success rate, oral morbidity and functional outcomes.

PubMed

Rosenbaum, Clemens M; Schmid, Marianne; Ludwig, Tim A; Kluth, Luis A; Dahlem, Roland; Fisch, Margit; Ahyai, Sascha

2016-11-01

To determine the success rate, oral morbidity and functional outcomes of redo buccal mucosa graft urethroplasty (BMGU) for treatment of stricture recurrence after previous BMGU. We included 50 patients who underwent redo BMGU between February 2009 and September 2014. Patients' charts and non-validated questionnaires were reviewed. The primary endpoint was success rate, defined as stricture-free survival. Stricture recurrence was defined as any postoperative claims of catheterization, dilatation, urethrotomy or repeat urethroplasty, or a maximum urinary flow rate <15 mL/s, and a stricture was consecutively verified in a combined cysto-urethrogram or cystoscopy at annual follow-up visit. The secondary endpoint was oral morbidity. Additional endpoints were erectile function, urinary continence and patients' satisfaction. Redo BMGU was performed for bulbar (71.4%) or penile (28.6%) recurrent strictures. The mean (median; range) follow-up was 25.6 (15.5; 3-70) months. Stricture recurrence occurred in 18.0% of patients within a mean (median; range) of 13.8 (9.0; 3-36) months. Stricture-free survival at 12, 24 and 36 months was 91.2, 86.2 and 80.8%, respectively. The majority of the patients (97.0%) reported no or only mildly changed salivation or problems in opening of the mouth. Severe or very severe oral numbness occurred in 13.5% of patients. Oral problems in daily life were a moderate or severe burden to 13.6 and 2.7% of the patients, respectively, while 75.0% of the patients reported improved quality of life compared with preoperative status. The success rate and oral morbidity of redo BMGU are almost the same as outcomes of primary BMGU. Oral numbness was the most frequently reported oral disorder. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Factors associated with therapeutic inertia in hypertension: validation of a predictive model.

PubMed

Redón, Josep; Coca, Antonio; Lázaro, Pablo; Aguilar, Ma Dolores; Cabañas, Mercedes; Gil, Natividad; Sánchez-Zamorano, Miguel Angel; Aranda, Pedro

2010-08-01

To study factors associated with therapeutic inertia in treating hypertension and to develop a predictive model to estimate the probability of therapeutic inertia in a given medical consultation, based on variables related to the consultation, patient, physician, clinical characteristics, and level of care. National, multicentre, observational, cross-sectional study in primary care and specialist (hospital) physicians who each completed a questionnaire on therapeutic inertia, provided professional data and collected clinical data on four patients. Therapeutic inertia was defined as a consultation in which treatment change was indicated (i.e., SBP >or= 140 or DBP >or= 90 mmHg in all patients; SBP >or= 130 or DBP >or= 80 in patients with diabetes or stroke), but did not occur. A predictive model was constructed and validated according to the factors associated with therapeutic inertia. Data were collected on 2595 patients and 13,792 visits. Therapeutic inertia occurred in 7546 (75%) of the 10,041 consultations in which treatment change was indicated. Factors associated with therapeutic inertia were primary care setting, male sex, older age, SPB and/or DBP values close to normal, treatment with more than one antihypertensive drug, treatment with an ARB II, and more than six visits/year. Physician characteristics did not weigh heavily in the association. The predictive model was valid internally and externally, with acceptable calibration, discrimination and reproducibility, and explained one-third of the variability in therapeutic inertia. Although therapeutic inertia is frequent in the management of hypertension, the factors explaining it are not completely clear. Whereas some aspects of the consultations were associated with therapeutic inertia, physician characteristics were not a decisive factor.

Clinical outcomes of atherectomy prior to percutaneous coronary intervention: A comparison of outcomes following rotational versus orbital atherectomy (COAP-PCI study).

PubMed

Meraj, Perwaiz M; Shlofmitz, Evan; Kaplan, Barry; Jauhar, Rajiv; Doshi, Rajkumar

2018-04-29

Because of the challenges in treating calcified coronary artery disease (CAD), lesion preparation has become increasingly important prior to percutaneous coronary intervention (PCI). Despite growing data for both rotational atherectomy (RA) and orbital atherectomy (OA), there have been no multicenter studies comparing the safety and efficacy of both. We sought to examine the clinical outcomes of patients with calcified CAD who underwent atherectomy. A total of 39 870 patients from five tertiary care hospitals who had PCI from January 2011 to January 2017 were identified. 907 patients who had RA or OA were included. This multicenter, prospectively collected observational analysis compared OA and RA. The primary end-point was myocardial infarction and safety outcomes including significant dissection, perforation, cardiac tamponade, and vascular complications. Propensity score matching (1:1) was performed to reduce selection bias. After matching, 546 patients were included in the final analysis. The primary endpoint, myocardial infarction occurred less frequently with OA compared to RA (6.7% vs 13.8%, P ≤ 0.01) in propensity score matched cohorts. Procedural safety outcomes were comparable between the groups. The secondary outcome of death on discharge occurred less in the OA group as compared with RA (0% vs 2.2%, P = 0.01). Fluoroscopy time was less in patients who were treated with OA (21.9 vs 25.6 min, P ≤ 0.01). Additional secondary outcomes were comparable between groups. In this non-randomized, multicenter comparison of contemporary atherectomy devices, OA was associated with significantly decreased in-hospital myocardial infarction and mortality after propensity score matching with decreased fluoroscopy time. © 2018, Wiley Periodicals, Inc.

[Signs and symptoms, etiologies and clinical course of parosmia + in a series of 84 patients].

PubMed

Portier, F; Faulcon, P; Lamblin, B; Bonfils, P

2000-02-01

Eighty-four patients (72% females and 28% males) consulted between January 1995 and January 1998 for olfactory disorders with parosmia (erroneous olfactory response to stimuli). Parosmia occurred immediately after or during the course of acute rhinitis (n=70, 83%), head trauma (n=7, 9%), naso-sinus polyposis (n=5, 6%), chronic rhinitis (n=1) or frontal tumor (n=1). Quantitative and qualitative olfactory disorders were analyzed and products producing the parosmia were identified. The only cases where parosmia regressed concerned patients who developed parosmia after acute rhinitis (n=28 cases, 33%). The prognosis of parosmia appeared to be better when it was a secondary phenomenon: i) the percentage of improvements was higher though not significant (41% versus 26.7% compared with primary parosmia), ii) delay to improvement was shorter (8.4 +/- 2.1 months versus 14.5 +/- 4.4 months for primary parosmia, p<10(-4) ), iii) there were no cases of persistent parosmia where quantitative disorders improved (compared with 7 cases of persistent primary parosmia, p<0.05). In addition, the prognosis of associated quantitative disorders was the same for both primary and secondary parosmia. Only the delay to improvement appeared to be shorter in case of secondary parosomia (though the difference was not significant). Products which produced the parosmic perception were identified by nearly all the patients (85%). The most frequently cited products were coffee, perfume, certain fruits (melon, banana, citric fruits), tobacco or chocolate. All these products contain tannic acid, a water-soluble polyphenol with many biological properties (influence feeding habits and metabolism in the rate, antioxidant and antimutagenic properties). Thus acid tannic could induce parosmic perception due to its antioxidant properties susceptible of integrating the P-450 cytochromes of the mucosal cells or olfactory neuroepithelium supporting cells.

Genetic heterogeneity after first-line chemotherapy in high-grade serous ovarian cancer.

PubMed

Lambrechts, Sandrina; Smeets, Dominiek; Moisse, Matthieu; Braicu, Elena Ioana; Vanderstichele, Adriaan; Zhao, Hui; Van Nieuwenhuysen, Els; Berns, Els; Sehouli, Jalid; Zeillinger, Robert; Darb-Esfahani, Silvia; Cacsire Castillo-Tong, Dan; Lambrechts, Diether; Vergote, Ignace

2016-01-01

Most high-grade serous ovarian carcinoma (HGSOC) patients benefit from first-line platinum-based chemotherapy, but progressively develop resistance during subsequent lines. Re-activating BRCA1 or MDR1 mutations can underlie platinum resistance in end-stage patients. However, little is known about resistance mechanisms occurring after a single line of platinum, when patients still qualify for other treatments. In 31 patients with primary platinum-sensitive HGSOC, we profiled tumours collected during debulking surgery before and after first-line chemotherapy using whole-exome sequencing and single nucleotide polymorphism profiling. Besides germline BRCA1/2 mutations, we observed frequent loss-of-heterozygosity in homologous recombination (HR) genes and mutation spectra characteristic of HR-deficiency in all tumours. At relapse, tumours differed considerably from their primary counterparts. There was, however, no evidence of events reactivating the HR pathway, also not in tumours resistant to second-line platinum. Instead, a platinum score of 13 copy number regions, among other genes including MECOM, CCNE1 and ERBB2, correlated with platinum-free interval (PFI) after first-line therapy, whereas an increase of this score in recurrent tumours predicted the change in PFI during subsequent therapy. Already after a single line of platinum, there is huge variability between primary and recurrent tumours, advocating that in HGSOC biopsies need to be collected at relapse to tailor treatment options to the underlying genetic profile. Nevertheless, all primary platinum-sensitive HGSOCs remained HR-deficient, irrespective of whether they became resistant to second-line platinum, further suggesting these tumours qualify for second-line Poly APD ribose polymerase (PARP) inhibitor treatment. Finally, chromosomal instability contributes to acquired resistance after a single line of platinum therapy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Fallopian tube cancer. The Roswell Park experience.

PubMed

Rose, P G; Piver, M S; Tsukada, Y

1990-12-15

Sixty-four patients with primary fallopian tube cancer treated at Roswell Park Memorial Institute from 1964 to 1987 underwent retrospective clinicopathologic review. In 40 patients fallopian tube cancer was the only primary, but in 24 patients primary fallopian tube cancer was part of a multifocal upper genital tract malignancy. Of the 40 patients with unifocal fallopian disease, the median survival was 28 months. Only 15% of patients were alive and disease free with follow-up ranging from 22 to 141 months (median, 90.5 months). Survival was not associated with stage of disease, tumor histology, grade, or depth of invasion in this series. Fourteen patients who received cisplatin-based chemotherapy were evaluable for response. Three patients (21%) responded; two complete and one partial. Twelve patients without clinical evidence of disease underwent second-look procedures, ten laparotomy and two laparoscopy. Four of ten second-look laparotomies were negative. Secondary debulking was done in three of four patients with gross disease, one of which had a negative third-look laparotomy. Negative laparotomy, second-look or third-look, was associated with improved survival (P = 0.016). One of the two laparoscopies was negative, but the patient recurred. In the remaining 24 patients cancer of the fallopian tube was part of a multifocal upper genital tract malignancy. In 12 patients tubal disease was invasive, and in 12, it was in situ. Separate primaries occurred in the ovaries (n = 20); uterus (n = 7); and cervix (n = 2). This represents 1.3% of ovarian malignancies treated at Roswell Park Memorial Institute during the study period. Fallopian tube cancer seems as virulent as ovarian cancer with few long-term survivors. It is frequently associated with other sites of upper genital tract malignancy. Second-look laparotomy is an important predictor of survival. Second-look laparoscopy may be useful if positive.

Systemic therapy of aggressive fibromatosis in children and adolescents: Report of the Cooperative Weichteilsarkom Studiengruppe (CWS).

PubMed

Sparber-Sauer, Monika; Seitz, Guido; von Kalle, Thekla; Vokuhl, Christian; Leuschner, Ivo; Scheer, Monika; Münter, Marc; Ljungman, Gustaf; Bielack, Stefan S; Niggli, Felix; Ladenstein, Ruth; Klingebiel, Thomas; Fuchs, Joerg; Koscielniak, Ewa

2018-05-01

Treatment algorithms for patients with aggressive fibromatosis (AF) are challenging. There are limited data available about the use of systemic therapy (ST) in pediatric patients with AF. Patient-, tumor-, and treatment-related factors of 90 children and adolescents with AF treated on multiple prospective trials of the Cooperative Weichteilsarkom Studiengruppe (1981-2015) were analyzed with focus on response and outcome of ST. Median age was 9.48 years (0.02-18.05). Primary resection was performed in 54 patients and ST was administered in 29 of 54 patients because of disease progression or relapse. In 35 patients, ST was the initial treatment modality. A secondary resection was performed in 21 of 35 patients after ST. A total of 64 patients received ST, mainly methotrexate and vinblastine (40%) with a median duration of 380 days. The most frequent radiological response to ST was stable disease at 3 months (39%) and partial response at 6 months (53%). Radiotherapy was administered to 15 of 90 patients. One patient remained on observation only. The 5-year overall survival was 100% and the 5-year event-free survival (EFS) was 44%. Patients who had a primary resection showed a 5-year EFS of 35% versus 59% in patients who had received primary ST (P = 0.08). Functional deficiencies as long-term sequelae following resection occurred in 11 patients. At a median follow-up of 5.05 years (0.25-14.88), complete remission was achieved in 51 patients and partial remission in 28 patients. ST seems appropriate if a primary complete resection is not feasible and at relapse/progression after resection. © 2018 Wiley Periodicals, Inc.

Comparison between minimally invasive and open surgical treatment in necrotizing pancreatitis.

PubMed

Wroński, Marek; Cebulski, Włodzimierz; Witkowski, Bartosz; Jankowski, Mieczysław; Kluciński, Andrzej; Krasnodębski, Ireneusz W; Słodkowski, Maciej

2017-04-01

Minimal access techniques have gained popularity for the management of necrotizing pancreatitis, but only a few studies compared open necrosectomy with a less invasive treatment. The aim of this study was to evaluate the outcomes of minimally invasive treatment for necrotizing pancreatitis in comparison with open necrosectomy. This retrospective study included 70 patients who underwent minimally invasive intervention or open surgical debridement for necrotizing pancreatitis between January 2007 and December 2014. Data were analyzed for postoperative morbidity and outcome. Of 70 patients, 22 patients underwent primary open necrosectomy and 48 patients were treated with minimally invasive techniques. Percutaneous and endoscopic drainage were successful in 34.9% and 75.0% of patients, respectively. The rates of postoperative new-onset organ failure and intensive care unit stay were significantly lower in the minimally invasive group (25.0% versus 54.5%; P = 0.016, and 29.2% versus 54.5%; P = 0.041, respectively). Gastrointestinal fistulas occurred more frequently after primary open necrosectomy (36.4% versus 10.4%; P = 0.009). Mortality was comparable in both groups (18.6% versus 27.3%; P = 0.420). Mortality for salvage open necrosectomy was similar to that for primary open debridement (28.6% versus 27.3%; P = 0.924). The independent risk factors for major postoperative complications were primary open necrosectomy (P = 0.028) and shorter interval to first intervention (P = 0.020). Mortality was independently associated only with older age (P = 0.009). Minimally invasive treatment should be preferred over open necrosectomy for initial management of necrotizing pancreatitis. Copyright © 2016 Elsevier Inc. All rights reserved.

High nymphal host density and mortality negatively impact parasitoid complex during an insect herbivore outbreak.

PubMed

Hall, Aidan A G; Johnson, Scott N; Cook, James M; Riegler, Markus

2017-08-26

Insect herbivore outbreaks frequently occur and this may be due to factors that restrict top-down control by parasitoids, for example, host-parasitoid asynchrony, hyperparasitization, resource limitation and climate. Few studies have examined host-parasitoid density relationships during an insect herbivore outbreak in a natural ecosystem with diverse parasitoids. We studied parasitization patterns of Cardiaspina psyllids during an outbreak in a Eucalyptus woodland. First, we established the trophic roles of the parasitoids through a species-specific multiplex PCR approach on mummies from which parasitoids emerged. Then, we assessed host-parasitoid density relationships across three spatial scales (leaf, tree and site) over one year. We detected four endoparasitoid species of the family Encyrtidae (Hymenoptera); two primary parasitoid and one heteronomous hyperparasitoid Psyllaephagus species (the latter with female development as a primary parasitoid and male development as a hyperparasitoid), and the hyperparasitoid Coccidoctonus psyllae. Parasitoid development was host-synchronized, although synchrony between sites appeared constrained during winter (due to temperature differences). Parasitization was predominantly driven by one primary parasitoid species and was mostly inversely host-density dependent across the spatial scales. Hyperparasitization by C. psyllae was psyllid-density dependent at the site scale, however, this only impacted the rarer primary parasitoid. High larval parasitoid mortality due to density-dependent nymphal psyllid mortality (a consequence of resource limitation) compounded by a summer heat wave was incorporated in the assessment and resulted in density independence of host-parasitoid relationships. As such, high larval parasitoid mortality during insect herbivore outbreaks may contribute to the absence of host density-dependent parasitization during outbreak events. © 2017 Institute of Zoology, Chinese Academy of Sciences.

Effects of sex on the incidence and prognosis of spinal meningiomas: a Surveillance, Epidemiology, and End Results study.

PubMed

Westwick, Harrison J; Shamji, Mohammed F

2015-09-01

Most spinal meningiomas are intradural lesions in the thoracic spine that present with both local pain and myelopathy. By using the large prospective Surveillance, Epidemiology, and End Results (SEER) database, the authors studied the incidence of spinal meningiomas and examined demographic and treatment factors predictive of death. Using SEER*Stat software, the authors queried the SEER database for cases of spinal meningioma between 2000 and 2010. From the results, tumor incidence and demographic statistics were computed; incidence was analyzed as a function of tumor location, pathology, age, sex, and malignancy code. Survival was analyzed by using a Cox proportional hazards ratio in SPSS for age, sex, marital status, primary site, size quartile, treatment modality, and malignancy code. In this analysis, significance was set at a p value of 0.05. The 1709 spinal meningiomas reported in the SEER database represented 30.7% of all primary intradural spinal tumors and 7.9% of all meningiomas. These meningiomas occurred at an age-adjusted incidence of 0.193 (95% CI 0.183-0.202) per 100,000 population and were closely related to sex (337 [19.7%] male patients and 1372 [80.3%] female patients). The Cox hazard function for mortality in males was higher (2.4 [95% CI1.7-3.5]) and statistically significant, despite the lower lesion incidence in males. All-cause survival was lowest in patients older than 80 years. Primary site and treatment modality were not significant predictors of mortality. Spinal meningiomas represent a significant fraction of all primary intradural spinal tumors and of all meningiomas. The results of this study establish the association of lesion incidence and survival with sex, with a less frequent incidence in but greater mortality among males.

Interactive effects of frequent burning and timber harvesting on above ground carbon biomass in temperate eucalypt forests

NASA Astrophysics Data System (ADS)

Collins, Luke; Penman, Trent; Ximenes, Fabiano; Bradstock, Ross

2015-04-01

The sequestration of carbon has been identified as an important strategy to mitigate the effects of climate change. Fuel reduction burning and timber harvesting are two common co-occurring management practices within forests. Frequent burning and timber harvesting may alter forest carbon pools through the removal and redistribution of biomass and demographic and structural changes to tree communities. Synergistic and antagonistic interactions between frequent burning and harvesting are likely to occur, adding further complexity to the management of forest carbon stocks. Research aimed at understanding the interactive effects of frequent fire and timber harvesting on carbon biomass is lacking. This study utilised data from two long term (25 - 30 years) manipulative burning experiments conducted in southern Australia in temperate eucalypt forests dominated by resprouting canopy species. Specifically we examined the effect of fire frequency and harvesting on (i) total biomass of above ground carbon pools and (ii) demographic and structural characteristics of live trees. We also investigated some of the mechanisms driving these changes. Frequent burning reduced carbon biomass by up to 20% in the live tree carbon pool. Significant interactions occurred between fire and harvesting, whereby the reduction in biomass of trees >20 cm diameter breast height (DBH) was amplified by increased fire frequency. The biomass of trees <20 cm DBH increased with harvesting intensity in frequently burnt areas, but was unaffected by harvesting intensity in areas experiencing low fire frequency. Biomass of standing and fallen coarse woody debris was relatively unaffected by logging and fire frequency. Fire and harvesting significantly altered stand structure over the study period. Comparison of pre-treatment conditions to current conditions revealed that logged sites had a significantly greater increase in the number of small trees (<40 cm DBH) than unlogged sites. Logged sites showed a significant decrease in the number of large trees (>60 cm DBH) over the study period, while unlogged sites showed an increase. Frequently burnt logged sites showed the greatest reduction in large trees, presumably due to increased fire related mortality and collapse. Analysis of tree survival and growth data suggest that mortality rate is increased and growth rate reduced in frequently burnt areas compared to unburnt areas. Our findings suggest that future shifts towards more frequent fire (both prescribed fire and wildfire) could potentially lead to broad scale reductions in carbon sequestration in temperate forests and woodlands dominated by resprouting canopy species. Reductions in carbon sequestration associated with frequent burning will potentially be amplified in intensively harvested landscapes.

Frequent Frames as a Cue for Grammatical Categories in Child Directed Speech

ERIC Educational Resources Information Center

Mintz, Toben H.

2003-01-01

This paper introduces the notion of frequent frames, distributional patterns based on co-occurrence patterns of words in sentences, then investigates the usefulness of this information in grammatical categorization. A frame is defined as two jointly occurring words with one word intervening. Qualitative and quantitative results from distributional…

Changes in Cognition and Decision Making Capacity Following Brain Tumour Resection: Illustrated with Two Cases.

PubMed

Veretennikoff, Katie; Walker, David; Biggs, Vivien; Robinson, Gail

2017-09-24

Changes in cognition, behaviour and emotion frequently occur in patients with primary and secondary brain tumours. This impacts the ability to make considered decisions, especially following surgical resection, which is often overlooked in the management of patients. Moreover, the impact of cognitive deficits on decision making ability affects activities of daily living and functional independence. The assessment process to ascertain decision making capacity remains a matter of debate. One avenue for evaluating a patient's ability to make informed decisions in the context of brain tumour resection is neuropsychological assessment. This involves the assessment of a wide range of cognitive abilities on standard measurement tools, providing a robust approach to ascertaining capacity. Evidence has shown that a comprehensive and tailored neuropsychological assessment has greater sensitivity than brief cognitive screening tools to detect subtle and/or specific cognitive deficits in brain tumours. It is the precise nature and severity of any cognitive deficits that determines any implications for decision making capacity. This paper focuses on cognitive deficits and decision making capacity following surgical resection of both benign and malignant, and primary and secondary brain tumours in adult patients, and the implications for patients' ability to consent to future medical treatment and make decisions related to everyday activities.

Prevalence of HHV-6 in cerebrospinal fluid of children younger than 2 years of age with febrile convulsion.

PubMed

Mamishi, Setareh; Kamrani, Laura; Mohammadpour, Masoud; Yavarian, Jila

2014-04-01

Febrile convulsion is a common disorder in children. Viral infections such as human herpes virus 6 (HHV-6) which results in roseola infantum may contribute to developing seizure. The objective of this study was to determine the prevalence of HHV-6 by detecting DNA in cerebrospinal fluid (CSF) of children with febrile convulsion and without any rash of roseola infantum. In this descriptive cross-sectional study, CSF of 100 children younger than 2 years of age with febrile convulsion was evaluated for detecting HHV-6 DNA by PCR. All of them were referred to emergency ward in Pediatric Medical Center from March 2010 to March 2011. General information, clinical manifestations, laboratory tests and outcomes were collected in the questionnaires. One hundred children including 59 males and 41 females were evaluated. HHV-6 was detected from CSF in six patients (6%) by PCR. Mean age was 8 months old. All children were younger than 12 months old. The most common primary manifestation was fever alone. None of them had rash. Majority of cases occurred in winter. All patients recovered without any encephalitis. These findings showed that primary infection with HHV-6 is frequently associated with febrile convulsion in infants which may be at risk for subsequent development of epilepsy.

Changes in Cognition and Decision Making Capacity Following Brain Tumour Resection: Illustrated with Two Cases

PubMed Central

Veretennikoff, Katie; Walker, David; Biggs, Vivien; Robinson, Gail

2017-01-01

Changes in cognition, behaviour and emotion frequently occur in patients with primary and secondary brain tumours. This impacts the ability to make considered decisions, especially following surgical resection, which is often overlooked in the management of patients. Moreover, the impact of cognitive deficits on decision making ability affects activities of daily living and functional independence. The assessment process to ascertain decision making capacity remains a matter of debate. One avenue for evaluating a patient’s ability to make informed decisions in the context of brain tumour resection is neuropsychological assessment. This involves the assessment of a wide range of cognitive abilities on standard measurement tools, providing a robust approach to ascertaining capacity. Evidence has shown that a comprehensive and tailored neuropsychological assessment has greater sensitivity than brief cognitive screening tools to detect subtle and/or specific cognitive deficits in brain tumours. It is the precise nature and severity of any cognitive deficits that determines any implications for decision making capacity. This paper focuses on cognitive deficits and decision making capacity following surgical resection of both benign and malignant, and primary and secondary brain tumours in adult patients, and the implications for patients’ ability to consent to future medical treatment and make decisions related to everyday activities. PMID:28946652

Proteomic and Bioinformatic Profile of Primary Human Oral Epithelial Cells

PubMed Central

Ghosh, Santosh K.; Yohannes, Elizabeth; Bebek, Gurkan; Weinberg, Aaron; Jiang, Bin; Willard, Belinda; Chance, Mark R.; Kinter, Michael T.; McCormick, Thomas S.

2012-01-01

Wounding of the oral mucosa occurs frequently in a highly septic environment. Remarkably, these wounds heal quickly and the oral cavity, for the most part, remains healthy. Deciphering the normal human oral epithelial cell (NHOEC) proteome is critical for understanding the mechanism(s) of protection elicited when the mucosal barrier is intact, as well as when it is breached. Combining 2D gel electrophoresis with shotgun proteomics resulted in identification of 1662 NHOEC proteins. Proteome annotations were performed based on protein classes, molecular functions, disease association and membership in canonical and metabolic signaling pathways. Comparing the NHOEC proteome with a database of innate immunity-relevant interactions (InnateDB) identified 64 common proteins associated with innate immunity. Comparison with published salivary proteomes revealed that 738/1662 NHOEC proteins were common, suggesting that significant numbers of salivary proteins are of epithelial origin. Gene ontology analysis showed similarities in the distributions of NHOEC and saliva proteomes with regard to biological processes, and molecular functions. We also assessed the inter-individual variability of the NHOEC proteome and observed it to be comparable with other primary cells. The baseline proteome described in this study should serve as a resource for proteome studies of the oral mucosa, especially in relation to disease processes. PMID:23035736

Malrotation of the McGhan Style 510 prosthesis.

PubMed

Schots, Jeroen M P; Fechner, Maarten R; Hoogbergen, Maarten M; van Tits, Herm W H J

2010-07-01

Anatomically shaped cohesive silicone breast implants are frequently used in aesthetic and reconstructive surgery. After successful results with the Style 410 prosthesis, McGhan (Natrelle, Allergan) introduced the Style 510 prosthesis. After using this novel prosthesis, the authors encountered a high number of prosthesis malrotations on self-reported follow-up. Therefore, a retrospective medical record review was performed to determine the prevalence of malrotation of the Style 510 prosthesis. From January of 2005 to December of 2006, 73 (146 prostheses) aesthetic augmentation mammaplasty procedures were performed using Style 510 prostheses. All prostheses were placed subglandularly through an inframammary incision. The postsurgical protocol for the first 3 weeks involved wearing a nonwired compression bra, abstinence from sports activities, and abstinence from heavy labor. Standard follow-up was at 1 week, 3 months, and if necessary. On self-reported follow-up, 8.2 percent of all prostheses were rotated. These rotations all occurred unilaterally after a mean period of 10 months (range, 3 to 19 months). No relation to an inciting incident or prosthesis volume could be found. The number of rotations of the Style 510 prosthesis seen after primary aesthetic breast augmentation is high. An obvious cause of this major problem has not been found. This led the authors to discontinue using the Style 510 prosthesis for primary aesthetic mammary augmentations in their practice.

What happens to reading between first and third grade? Implications for students who use AAC.

PubMed

Sturm, Janet M; Spadorcia, Stephanie A; Cunningham, James W; Cali, Kathleen S; Staples, Amy; Erickson, Karen; Yoder, David E; Koppenhaver, David A

2006-03-01

School-age students who use AAC need access to communication, reading, and writing tools that can support them to actively engage in literacy learning. They also require access to core literacy learning opportunities across grade levels that foster development of conventional literacy skills. The importance of the acquisition of conventional literacy skills for students who use AAC cannot be overemphasized. And yet, one of the critical challenges in supporting the literacy learning of students who use AAC has been a lack of knowledge about literacy curricula and supports to literacy learning for these students. Most students who use AAC do not become conventionally literate and few of those who do achieve literacy skills beyond the second grade level. This article will provide an overview of the most frequent reading instructional activities in first and third grade classrooms. To better understand the foundational experiences important to literacy learning, the results of a survey project that examined the reading activities of general education students and teachers during primary grade instruction are presented, and critical shifts in instruction that occurred between first and third grade are highlighted. The primary instructional focus of core reading activities is also examined, along with adaptations for students who use AAC.

A case report of a patient with high β-hCG levels after operation because of primary broad ligament pregnancy.

PubMed

Zu, M; Zhao, G Q; Liu, Z Q; Zhang, H T; Chen, L; Zhao, D H

2017-01-01

A broad ligament pregnancy is an extremely rare condition and diagnosis is frequently missed and finally made during laparotomy. This is a case of a young patient with high serum beta-human chorionic gonadotropin (β-hCG) levels after operation because of broad ligament pregnancy. A 31-year-old multipara complained of intermittent lower abdominal pain with vaginal bleeding for four months. A color ultrasonography revealed a cystic mass in the left attachment area, indicating an interstitial tubal pregnancy. However, trophoblastic disease could not be excluded. She accepted conservative treatment with methotrexate (MTX) at first, but observation showed that conservative treatment was slow and accompanied with liver function damage. Therefore, exploratory laparotomy was performed. Intraoperative situations and postoperative pathology confirmed broad ligament pregnancy. Her serum p- hCG was sustained at a high level for three months after operation. Her examinations of serum, CT, and ultrasonography could explain this situation. Primary broad ligament pregnancy refers to pregnancy where implantation of the fertilized ovum occurs directly between the two leaves of the broad ligament. The gravid substance was removed, however serum β-hCG could not gradually re- turn to normal levels. This case should be followed-up closely to prevent adverse outcomes.

Physician-patient communication about dietary supplements.

PubMed

Tarn, Derjung M; Paterniti, Debora A; Good, Jeffrey S; Coulter, Ian D; Galliher, James M; Kravitz, Richard L; Karlamangla, Arun S; Wenger, Neil S

2013-06-01

Describe the content and frequency of provider-patient dietary supplement discussions during primary care office visits. Inductive content analysis of 1477 transcribed audio-recorded office visits to 102 primary care providers was combined with patient and provider surveys. Encounters were collected in Los Angeles, CA (2009-2010), geographically diverse practice settings across the United States (2004-2005), and Sacramento, CA (1998-1999). Providers discussed 738 dietary supplements during encounters with 357 patients (24.2% of all encounters in the data). They mentioned: (1) reason for taking the supplement for 46.5% of dietary supplements; (2) how to take the supplement for 28.2%; (3) potential risks for 17.3%; (4) supplement effectiveness for 16.7%; and (5) supplement cost or affordability for 4.2%. Of these five topics, a mean of 1.13 (SD=1.2) topics were discussed for each supplement. More topics were reviewed for non-vitamin non-mineral supplements (mean 1.47 (SD=1.2)) than for vitamin/mineral supplements (mean 0.99 (SD=1.1); p<0.001). While discussions about supplements are occurring, it is clear that more discussion might be needed to inform patient decisions about supplement use. Physicians could more frequently address topics that may influence patient dietary supplement use, such as the risks, effectiveness, and costs of supplements. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Warts and All: HPV in Primary Immunodeficiencies

PubMed Central

Leiding, Jennifer W.; Holland, Steven M.

2012-01-01

Infection with human papilloma virus (HPV) is almost universal and eventually asymptomatic, but pathologic infection with HPV is severe, recurrent, and recalcitrant to therapy. It is also an underappreciated manifestation of primary immunodeficiency. Mutations in EVER1, EVER2, GATA2, CXCR4, and DOCK8 are typically associated with extensive HPV infections, whereas several other primary immune defects have severe HPV much less frequently. We review immunodeficiencies with severe HPV infections and the mechanisms underlying them. PMID:23036745

An audit of sports injuries in children attending an Accident & Emergency department.

PubMed

Boyce, S H; Quigley, M A

2003-08-01

To assess the incidence of attendance, type of injury, sport involved and management of sports injuries in children attending an Accident & Emergency (A&E) department. Children, aged between 5-16 years, presenting with an injury related to sport, were studied over a period of three months. 1858 children attended the A&E department during the three month period. 238 (12.8%) were classified as sports injuries. Boys (71%) were injured more frequently than girls (29%). Injury rates in boys peaked at 14 years whereas in girls a peak occurred earlier at 12 years. Football was the most common sport implicated in injuries (39%). Rollerblading (14%), Rugby (8%), Basketball (7%) and Physical Education at school (7%) were the next most frequently involved sports. Soft tissue injuries dominated (61%). The upper limb was the most common anatomical area injured (46%). Other injuries involved the lower limb (36%), head and neck (15%) and the trunk (3%). Injuries to the wrist were the most frequent presentation accounting for 30 fractures and 30 soft tissue injuries (25%). The majority of children were discharged from the A&E department after treatment (71%). 26% were reviewed at out-patient clinics and 3% required hospital admission. No children were referred for physiotherapy. Children participate in sport and can be injured. The majority of sports injuries presenting to an A&E department appear to be of a minor nature and could be managed with simple first aid techniques by parents, teachers and coaches at the scene or by attending primary care in the first instance. Supervision of children, participation in organised sport and the use of protection devices may help to prevent serious injury.

[A day in Spanish microbiology. Descriptive study of the activity of the clinical microbiology departments].

PubMed

Prieto, J; García-Rodríguez, Ja; Barberán, J; Granizo, Jj; Rodicio, Mp; González, J

2008-12-01

The laboratory is an essential part of the work in the Clinical Microbiology Department. This study has aimed to measure the activity of these laboratories. A survey was self-administered on the activity occurring during one work day by each hospital in October 2007. Thirty six hospitals reported 14,076 tests. Serology was the most frequently reported test (30.3%) followed by urine culture (27.8 %), blood tests (13.2 %), respiratory tract samples (8%), feces (7.1%), urethral (5.8%), skin (5.3%) and cerebrospinal fluid (2.6%). According to species, 73.2% of the isolates were bacteria (22.9 % were positive), 8.9% were virus (17% positive), fungi 8.1% (25.2% positive), and 5.5% mycobacterias (5.9% were positive) and parasite 4.5% (12.5% positive). Susceptibility test were performed by automatic methods (62.3%) followed by diffusion test (27.1%) and E-test (9.1%). A total of 5.6% of the susceptibility tests showed in vitro resistance to antibiotics. Fungi were identified in 108 isolates. Candida and Aspergillus were the most frequent genus (85.1% and 8.3%, respectively). Origins of the samples were: lower respiratory tract (32.4 %), genital tract (24.1 %), urine (10.2 %), blood (10.2 %) and skin (10.2 %). Twelve identification techniques were used, the most frequent being the morphological test (54.8%) and biochemical test (39.7%). Broken down by departments, 20.4% were sent from the ICU, 16.7% from surgery, 29.6% from medicine and 18.5% from primary care. Although the workload of the laboratories has been measured in this work, aspects such as specimen manipulation, clinical advice and research were not considered.

What is the meaning and nature of active play for today's children in the UK?

PubMed Central

2011-01-01

Background Preventing the decline in physical activity which occurs around 10-11 years of age is a public health priority. Physically active play can make unique contributions to children's development which cannot be obtained from more structured forms of physical activity. Encouraging active play in children's leisure time has potential to increase physical activity levels while promoting optimal child development. Aspired wisdom states that contemporary British children no longer play outdoors, but systematic evidence for this is lacking. We need to build a more informed picture of contemporary children's play before we consider interventions to increase it. Methods Eleven focus groups were conducted with 77, 10-11 year old children from four primary schools in Bristol, UK. Focus groups examined: 1) children's perceptions of 'play'; 2) how much of their play is active play; and 3) contexts of children's active play. All focus groups were audio-taped and transcribed verbatim. Data were analysed using a thematic approach. Results Children's perceptions of play were broad and included both physically active and sedentary behaviours. Children reported that they frequently engaged in active play and valued both the physical and social benefits it provided. Whereas boys frequently reported having a 'kick about' or riding bikes as their preferred forms of active play, girls were less likely to report a specific activity. Additionally, boys reported greater independent mobility in their active play compared to girls. Finally, boys were more likely to report playing with neighbourhood friends but girls more frequently reported playing with family members. Conclusions Promoting active play in children's leisure time may increase the physical activity of children, but interventions may need to be tailored according to gender. PMID:21385336

What is the meaning and nature of active play for today's children in the UK?

PubMed

Brockman, Rowan; Fox, Kenneth R; Jago, Russell

2011-03-07

Preventing the decline in physical activity which occurs around 10-11 years of age is a public health priority. Physically active play can make unique contributions to children's development which cannot be obtained from more structured forms of physical activity. Encouraging active play in children's leisure time has potential to increase physical activity levels while promoting optimal child development. Aspired wisdom states that contemporary British children no longer play outdoors, but systematic evidence for this is lacking. We need to build a more informed picture of contemporary children's play before we consider interventions to increase it. Eleven focus groups were conducted with 77, 10-11 year old children from four primary schools in Bristol, UK. Focus groups examined: 1) children's perceptions of 'play'; 2) how much of their play is active play; and 3) contexts of children's active play. All focus groups were audio-taped and transcribed verbatim. Data were analysed using a thematic approach. Children's perceptions of play were broad and included both physically active and sedentary behaviours. Children reported that they frequently engaged in active play and valued both the physical and social benefits it provided. Whereas boys frequently reported having a 'kick about' or riding bikes as their preferred forms of active play, girls were less likely to report a specific activity. Additionally, boys reported greater independent mobility in their active play compared to girls. Finally, boys were more likely to report playing with neighbourhood friends but girls more frequently reported playing with family members. Promoting active play in children's leisure time may increase the physical activity of children, but interventions may need to be tailored according to gender.

Hemorrhoids.

PubMed

Hussain, J N

1999-03-01

Hemorrhoids are one of the most frequent anorectal disorders encountered in the primary care setting. They are the most common cause of hematochezia, and are responsible for considerable patient suffering and disability. With the techniques of diagnosis and office-based interventions described in this article, the primary care provider can effectively relieve most patients' symptoms and ensure that more significant bowel disease is not overlooked.

Integrating fuel treatment into ecosystem management: A proposed project planning process

Treesearch

Keith D. Stockmann; Kevin D. Hyde; J. Greg Jones; Dan R. Loeffler; Robin P. Silverstein

2010-01-01

Concern over increased wildland fire threats on public lands throughout the western United States makes fuel reduction activities the primary driver of many management projects. This single-issue focus recalls a management planning process practiced frequently in recent decades - a least-harm approach where the primary objective is first addressed and then plans are...

Acceptability of Adaptations for Struggling Writers: A National Survey with Primary-Grade Teachers

ERIC Educational Resources Information Center

Graham, Steve; Harris, Karen R.; Bartlett, Brendan J.; Popadopoulou, Eleni; Santoro, Julia

2016-01-01

One hundred twenty-five primary-grade teachers randomly selected from across the United States indicated how frequently they made 20 instructional adaptations for the struggling writers in their classroom. The measure of frequency ranged from never, several times a year, monthly, weekly, several times a week, and daily. Using a 6-point Likert-type…

The Loss and Recovery of Erotic Intimacy in Primary Relationships: Narrative Therapy and Relationship Enhancement Therapy.

ERIC Educational Resources Information Center

Snyder, Maryhelen

2000-01-01

Therapists working with intimate relationships are frequently confronted with issues regarding the loss of erotic intimacy, differences in levels of sexual desire, and the existence of intimate relationships outside the primary. Proposes that an approach derived from an integration of narrative therapy and relationship enhancement therapy can be…

Bipolar Disorder.

PubMed

Miller, Thomas H

2016-06-01

Bipolar disorder is a chronic mental health disorder that is frequently encountered in primary care. Many patients with depression may actually have bipolar disorder. The management of bipolar disorder requires proper diagnosis and awareness or referral for appropriate pharmacologic therapy. Patients with bipolar disorder require primary care management for comorbidities such as cardiovascular and metabolic disorders. Copyright © 2016 Elsevier Inc. All rights reserved.

Understanding the relationship between domestic abuse and suicide behavior in adults receiving primary care: does forgiveness matter?

PubMed

Chang, Edward C; Kahle, Emma R; Yu, Elizabeth A; Hirsch, Jameson K

2014-10-01

This study examined the interrelation of domestic abuse, forgiveness of self, forgiveness of others, and suicide behavior in a community sample of 101 patients receiving primary care from a clinic in the southeastern United States. As expected, it was found that more frequent experience of domestic abuse was associated with more frequent suicide behavior. Results from conducting mediation analyses and using bootstrapping techniques provided support for a model in which the relationship between domestic abuse and suicide behavior was accounted for by forgiveness of self, but not by forgiveness of others. The article concludes with a discussion of some of the implications of the present findings for practice and the study's limitations.

[Profile of patients with anophthalmic cavity: study at Faculdade de Medicina de Botucatu - UNESP].

PubMed

Narikawa, Silvia; Natsuaki, Kryscia Leiko; Fruet, Juliana; Padovani, Carlos Roberto; Schellini, Silvana Artioli

2011-01-01

To evaluate the profile of anophthalmic cavity carriers and patients' evolution with the employed treatments. Retrospective study carried out at Faculdade de Medicina de Botucatu, to evaluate the profile and the evolution of patients with anophthalmic cavity treated in our service. Data were evaluated according to the frequency of occurrence and analysis of association. Anophthalmic cavity was more frequently observed in young males, workers in activities carried on with their hands. Trauma and phthisis bulbi were the most frequent causes, with differences according to age and gender. The complications were high (57.1% of cases), the majority occurred belatedly. Trauma is still an important cause of loss of the eye. The complications during the follow-up of the patient are frequent, occurring in general, very late, which reinforces the need for periodic and prolonged monitoring of patients with anophthalmic cavity.

Intrapartum sonography for fetal head asynclitism and transverse position: sonographic signs and comparison of diagnostic performance between transvaginal and digital examination.

PubMed

Malvasi, Antonio; Stark, Michael; Ghi, Tullio; Farine, Dan; Guido, Marcello; Tinelli, Andrea

2012-05-01

The primary goal of this study was to determine the ultrasonographic signs of asynclitic and transverse head positioning. In addition, we compared the performance of intrapartum ultrasound to vaginal digital examination. 150 women were evaluated by 2D transabdominal and translabial ultrasound (US) to detect the asynclitic and deep transverse positions. Transvaginal sterile digital examinations were performed immediately after each intrapartum US assessments, the examinations were repeated at intervals of 45-90 minutes. Examiners were blinded to each other's findings (clinical or sonographic). Data were reviewed and analyzed by an independent reviewer. The efficacy of digital examination was significantly lower than US evaluation for the detection of either transverse position or asynclitism. The most frequent transverse position was the left one, while the most frequent asynclitism was the anterior one. Digital pelvic examination for detection of fetal head transverse position during labor is inferior to US, especially in the deep transverse positioning, where caput succedaneum occurs and reduces the diagnostic accuracy of vaginal digital examination. The US examination leads to early detection of persistent transverse position allowing for earlier timing and optimal technique for the operative vaginal delivery. We describe two signs for diagnosing asynclitism. The "squint sign" and the "sunset of thalamus and cerebellum signs" are two simple US signs allowing detection of anterior and posterior asynclitism.

Elevated expression of activated forms of Neu/ErbB-2 and ErbB-3 are involved in the induction of mammary tumors in transgenic mice: implications for human breast cancer.

PubMed Central

Siegel, P M; Ryan, E D; Cardiff, R D; Muller, W J

1999-01-01

To assess the importance of Neu activation during mammary tumorigenesis, altered receptors harboring in-frame deletions within the extracellular domain were expressed in transgenic mice. Females from several independent lines develop multiple mammary tumors that frequently metastasize to the lung. Tumor progression in these strains was associated with elevated levels of tyrosine-phosphorylated Neu and ErbB-3. Consistent with these observations, a survey of primary human breast tumors revealed frequent co-expression of both erbB-2 and erbB-3 transcripts. The ability of altered Neu receptors to induce mammary tumorigenesis in transgenic mice prompted us to examine whether similar mutations occurred in ErbB-2 during human breast cancer progression. Interestingly, an alternatively spliced form of erbB-2, closely resembling spontaneous activated forms of neu, was detected in human breast tumors. The ErbB-2 receptor encoded by this novel transcript harbors an in-frame deletion of 16 amino acids in the extracellular domain and can transform Rat-1 fibroblasts. Together, these observations argue that co-expression of ErbB-2 and ErbB-3 may play a critical role in the induction of human breast tumors, and raise the possibility that activating mutations in the ErbB-2 receptor may also contribute to this process. PMID:10205169

Sleep disordered breathing in cardiac surgery patients: The NU-SLEEP trial.

PubMed

Sezai, Akira; Akahoshi, Toshiki; Osaka, Shunji; Yaoita, Hiroko; Arimoto, Munehito; Hata, Hiroaki; Tanaka, Masashi; Sekino, Hisakuni; Akashiba, Tsuneto

2017-01-15

Sleep disordered breathing (SDB) is associated with lifestyle-related diseases and its treatment influence the prognosis of cardiac disease, but little investigation of SDB has been conducted in cardiac surgery patients. A prospective study was performed in 1005 patients undergoing cardiac surgery. The primary endpoint was the severity of SDB determined from the apnea/hypopnea index. The secondary endpoints were patient background factors, cardiovascular risk factors, ejection fraction, atrial and brain natriuretic peptides, oxidative stress and inflammatory markers, and postoperative atrial fibrillation. While 227 patients (22.6%) did not have SDB, there were 361 patients (35.9%) with mild SDB, 260 patients (25.9%) with moderate SDB, and 157 patients (15.6%) with severe SDB. Patients with severe SDB had a lower ejection fraction and higher levels of atrial and brain natriuretic peptides than the other groups. Postoperative atrial fibrillation occurred in 28 patients without SDB (13.6%), 43 patients with mild SDB (13.5%), 74 patients with moderate SDB (31.9%), and 73 patients with severe SDB (52.5%), being significantly more frequent in the severe group than the other groups. SDB was frequent in cardiac surgery patients. Activation of the renin-angiotensin-aldosterone system, postoperative atrial fibrillation atrial, and cardiac dysfunction were associated with severe SDB. Markers of inflammation and oxidative stress also increased as SDB became more severe. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Utilization of Hospital Emergency Departments for non-traumatic dental care in New Hampshire, 2001-2008.

PubMed

Anderson, Ludmila; Cherala, Sai; Traore, Elizabeth; Martin, Nancy R

2011-08-01

Hospital Emergency Departments (ED) provide a variety of medical care, some of which is for non-urgent, chronic conditions. We describe the statewide use of hospital ED for selected non-traumatic dental conditions that occurred during 2001-2008 in New Hampshire. Using the administrative hospital discharge dataset for 2001-2007, and provisional 2008 data, we identified all visits for selected dental conditions and calculated age-adjusted rates per 10,000 New Hampshire residents by several socio-demographic characteristics. The Spearman correlation coefficient was used to assess the statistical significance for trend over time. Emergency department visits for non-traumatic dental conditions increased significantly from 11,067 in 2001 to 16,238 visits in 2007 (P < 0.007). There were persistent differences in ED visits by age, county and primary payor, and varying difference by gender. Self-paying individuals and those 15-44 years old were the most frequent ED dental care users. The most frequent dental complains (46%) were diseases of the teeth and supporting structures, diagnostic code ICD-9-CM-525. Dental care associated ED visits have increased in New Hampshire. Individuals seeking dental treatment in ED are not receiving definitive treatment, and they misuse limited resources. Future studies need to determine the specific barriers to timely and effective dental care in dental offices. Ongoing consistent monitoring of ED use for non-traumatic dental conditions is essential.

[Mobbing and its effects on health. the experience of the "Clinica del Lavoro Luigi Devoto" in Milan].

PubMed

Punzi, Silvia; Cassitto, Maria Grazia; Castellini, Giovanna; Costa, G; Gilioli, R

2007-01-01

There is increasing interest in research, prevention and management of mobbing in the field of occupational psychosocial risks. To describe mobbing and its health effects by analysis of the cases examined from 1997 to 2003 at the Department of Occupational Health "Clinica del Lavoro Luigi Devoto" in Milan. A total of 226 clinical records of patients who reported a mobbing situation when undergoing medical examination were selected out of 2455 patients examined for stress-related disorders. The percentage of women was higher (53.1%) than in men (46.9%) with a prevalent age range of 35-54 years. There was a great variety of jobs, especially white-collars and workers in large service companies. In one third of the cases, mobbing occurred within 4 years from beginning of employment and mostly after company reorganization and management changes. The most frequent negative acts included social isolation and demotion. The most frequent symptoms were exhaustion, sleep, mood and sexual disorders. The number of symptoms was not related to the duration of mobbing but to the number and frequency of negative actions. 61.1% of the subjects took psychotropic drugs. Occupational health physicians play an essential role in primary prevention (information on occupational risks) and in early diagnosis and rehabilitation and could act as mediators between workers and enterprises.

Clinical and microbiological characteristics of patients with septic arthritis: A hospital-based study

PubMed Central

Muñoz-Egea, María-Carmen; Blanco, Antonio; Fernández-Roblas, Ricardo; Gadea, Ignacio; García-Cañete, Joaquín; Sandoval, Enrique; Valdazo, María; Esteban, Jaime

2014-01-01

Background To determine the clinical and epidemiological characteristics, etiology, underlying conditions, and outcomes of patients with primary septic arthritis and no prosthetic joints at a university hospital. Methods A retrospective study was performed between 2005 and 2012. Records from the Microbiology Department were reviewed, and patients with a positive culture of synovial fluid or biopsy were selected for the study. Clinical charts were reviewed using a designed protocol. Results 41 patients were diagnosed with septic arthritis with a positive culture. Most were diagnosed with monoarticular (85.37%) and monomicrobial (92.68%) arthritis. The most commonly involved joint was the knee (34.15%). The most frequent underlying conditions were hypertension and diabetes mellitus. Staphylococcus aureus was the most common pathogen (58.54%). Two cases of chronic arthritis, both caused by Mycobacterium tuberculosis were detected. The most frequently used antibiotic combinations were cloxacillin + ciprofloxacin and vancomycin + ciprofloxacin. Surgical treatment included needle aspiration, open joint debridement, or arthroscopic techniques. Twelve cases had a poor outcome (destructive articular disease), and 3 patients died from staphylococcal sepsis. Conclusions In our hospital, septic arthritis is primarily acute, monoarticular, and monomicrobial; affects higher joints, is caused by S. aureus, and occurs in adult patients with underlying diseases. Outcome is good in most patients, although more than 25% of cases had articular sequels. PMID:25104892

Intra- and Interindividual Variability in the Behavioral, Affective, and Perceptual Effects of Alcohol Consumption in a Social Context.

PubMed

Franzen, Minita; Sadikaj, Gentiana; Moskowitz, Debbie S; Ostafin, Brian D; Aan Het Rot, Marije

2018-05-01

We examined the influence of interindividual differences in alcohol use on the intraindividual associations of drinking occurrence with interpersonal behaviors, affect, and perceptions of others during naturally occurring social interactions. For 14 consecutive days, 219 psychology freshmen (55% female; M age  = 20.7 years, SD = 2.18) recorded their behaviors, affect, and perceptions in social interactions soon after an interpersonal event occurred. Interpersonal behaviors and perceptions were assessed in terms of dominance-submissiveness and agreeableness-quarrelsomeness. Participants also reported the number of alcoholic drinks consumed within 3 hours of each interaction. We considered the intraindividual associations of (i) having a drinking episode and (ii) the number of drinks during an episode with behaviors, affect, and perceptions and examined interindividual differences in drinking frequency and intensity during social interactions as potential moderators of these associations. Social drinking frequency and intensity moderated the associations between drinking episode and behaviors, affect, and perceptions in social interactions. During a drinking episode, more frequent social drinkers perceived others as more dominant than less frequent social drinkers. During a drinking episode in which more alcohol was consumed than usual, more frequent social drinkers also reported behaving more dominantly and experiencing less pleasant affect. As more frequent social drinkers had different interpersonal responses to drinking than less frequent social drinkers, including when they had consumed larger amounts of alcohol than usual, our results suggest a differential susceptibility to the effects of alcohol during naturally occurring social interactions among drinkers with varying drinking frequency. Copyright © 2018 The Authors. Alcoholism: Clinical & Experimental Research published by Wiley Periodicals, Inc. on behalf of Research Society on Alcoholism.

Discovering interesting molecular substructures for molecular classification.

PubMed

Lam, Winnie W M; Chan, Keith C C

2010-06-01

Given a set of molecular structure data preclassified into a number of classes, the molecular classification problem is concerned with the discovering of interesting structural patterns in the data so that "unseen" molecules not originally in the dataset can be accurately classified. To tackle the problem, interesting molecular substructures have to be discovered and this is done typically by first representing molecular structures in molecular graphs, and then, using graph-mining algorithms to discover frequently occurring subgraphs in them. These subgraphs are then used to characterize different classes for molecular classification. While such an approach can be very effective, it should be noted that a substructure that occurs frequently in one class may also does occur in another. The discovering of frequent subgraphs for molecular classification may, therefore, not always be the most effective. In this paper, we propose a novel technique called mining interesting substructures in molecular data for classification (MISMOC) that can discover interesting frequent subgraphs not just for the characterization of a molecular class but also for the distinguishing of it from the others. Using a test statistic, MISMOC screens each frequent subgraph to determine if they are interesting. For those that are interesting, their degrees of interestingness are determined using an information-theoretic measure. When classifying an unseen molecule, its structure is then matched against the interesting subgraphs in each class and a total interestingness measure for the unseen molecule to be classified into a particular class is determined, which is based on the interestingness of each matched subgraphs. The performance of MISMOC is evaluated using both artificial and real datasets, and the results show that it can be an effective approach for molecular classification.

Laryngeal complications after type 1 thyroplasty.

PubMed

Cotter, C S; Avidano, M A; Crary, M A; Cassisi, N J; Gorham, M M

1995-12-01

Type I thyroplasty has become a primary surgical choice for voice restoration in patients with glottal incompetence. This study examines factors associated with laryngeal complications after type I thyroplasty. Ten laryngoscopic variables were analyzed from preoperative, intraoperative, and postoperative videolaryngoscopies of 51 patients undergoing 58 medialization procedures. Ten patient and operative variables were examined by medical record review. Major complications were defined as wound hemorrhage, airway obstruction, or prosthesis extrusion. Minor complications were defined as vocal fold hematoma without airway obstruction or prosthesis movement. The major complication rate was 8.6%, and the minor complication rate was 29%. No delayed hemorrhage or airway obstruction occurred. Prosthesis extrusion occurred in five (8.6%) patients 1 week to 5 months after surgery. Extrusion was associated with suboptimal prosthesis placement in 80% of cases. Two patients retained excellent glottal closure despite extrusion. Vocal fold hematoma was identified in 14 (24%) cases and resolved within 1 week. Prosthesis movement occurred in three (5%) patients 1 week to 6 months after surgery and resulted in poor glottal closure. All patients with prosthesis extrusion or movement were female. Type I thyroplasty remains a safe outpatient procedure with few major complications. Prosthesis extrusion was associated with suboptimal prosthesis placement and may or may not result in poor glottal closure. Minor vocal fold hematomas were relatively frequent, resolved rapidly, and were not associated with airway obstruction. Female patients may be more prone to complications because of their small laryngeal size.

Single inhalation exposure to /sup 90/SrCl/sub 2/ in the beagle dog: late biological effects

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

Gillett, N.A.; Muggenburg, B.A.; Boecker, B.B.

1987-08-01

Late-occurring biologic effects were studied in beagle dogs that were given graded levels of /sup 90/SrCl/sub 2/ via single brief inhalation exposures and were subsequently observed for their life-span. Due to the soluble chemical form of the aerosol, /sup 90/Sr was rapidly translocated from lung and deposited in bone where it was subsequently retained for a long period of time. Radiation-induced lesions were confined to the bone, bone marrow, and adjacent soft tissue. Forty-five primary bone tumors occurred in 31 of 66 exposed dogs. Metastasis occurred from 21 tumors, with the lung being the most frequent site of metastasis (76%).more » Twenty-seven tumors were classified as different subtypes of osteosarcoma, 14 as hemangiosarcomas, 3 as fibrosarcomas, and 1 as a myxosarcoma. Four carcinomas arising from soft tissues adjacent to bone were also considered to be /sup 90/Sr induced. In contrast to bone tumors arising in beagles chronically exposed to 90Sr through ingestion, histologic lesions of radiation osteodystrophy were minimal in this study, indicating that these lesions are not a necessary precursor of osteosarcoma development. The incidences of hemangiosarcomas (31%) and telangiectatic osteosarcomas (11%) in addition to osteosarcomas suggest that the cell of origin for all of these neoplasms is a multipotent mesenchymal cell with the potential for various morphologic expressions dependent on local environmental factors.« less

Frequency of bullying at work, physiological response, and mental health.

PubMed

Hansen, Åse Marie; Hogh, Annie; Persson, Roger

2011-01-01

The present study aimed to elucidate the relationship between bullying at work and cortisol secretion. Of particular interest was to examine whether frequently and occasionally bullied persons differed from nonbullied persons. The study included 1944 employees (1413 women and 531 men) from 55 workplaces in Denmark (16 private and 39 public workplaces). During a work day three saliva samples were collected at awakening, +30 min later, and at 20:00 hours, and analyzed for cortisol concentrations. Mental health was assessed using items on somatic, cognitive, stress, and depressive mood. Of the 1944 employees, 1.1% was frequently bullied and 7.2% occasionally bullied. Frequently bullied persons reported poorer mental health and had a 24.8% lower salivary cortisol concentration compared with the nonbullied reference group. Occasionally bullied persons had a poorer self-reported mental health, but their cortisol concentrations did not deviate from the group of nonbullied persons. The associations remained significant even after controlling for age, gender, exact time of sampling, mental health, and duration of bullying. Bullying occurred at 78% of the workplaces (43 workplaces); frequent bullying occurred at 21% of the workplaces (40%). Frequent bullying was associated with lower salivary cortisol concentrations. No such association was observed for occasional bullying. Whether the generally lower secretion of cortisol among the frequently bullied persons indicate an altered physiological status remains to be evaluated in future studies. Yet, the physiological response seems to underscore the possibility that bullying indeed may have measurable physiological consequences. Hence, the physiological response supports the mental symptoms found among the frequently bullied. Copyright © 2011 Elsevier Inc. All rights reserved.

Co-Occurring Mental Health Problems and Peer Functioning among Youth with Attention-Deficit/Hyperactivity Disorder: A Review and Recommendations for Future Research

ERIC Educational Resources Information Center

Becker, Stephen P.; Luebbe, Aaron M.; Langberg, Joshua M.

2012-01-01

It is well established that children and adolescents with attention-deficit/hyperactivity disorder (ADHD) frequently experience co-occurring mental health problems in addition to difficulties in their peer relationships. Although substantial research has focused on the extent to which peer functioning contributes to subsequent co-occurring mental…

Sterilization: A Review and Update.

PubMed

Moss, Chailee; Isley, Michelle M

2015-12-01

Sterilization is a frequently used method of contraception. Female sterilization is performed 3 times more frequently than male sterilization, and it can be performed immediately postpartum or as an interval procedure. Methods include mechanical occlusion, coagulation, or tubal excision. Female sterilization can be performed using an abdominal approach, or via laparoscopy or hysteroscopy. When an abdominal approach or laparoscopy is used, sterilization occurs immediately. When hysteroscopy is used, tubal occlusion occurs over time, and additional testing is needed to confirm tubal occlusion. Comprehensive counseling about sterilization should include discussion about male sterilization (vasectomy) and long-acting reversible contraceptive methods. Copyright © 2015 Elsevier Inc. All rights reserved.

Rise of PD-L1 expression during metastasis of colorectal cancer: Implications for immunotherapy.

PubMed

Wang, Huan Bin; Yao, Han; Li, Chu Shu; Liang, Lun Xi; Zhang, Yao; Chen, Ying Xuan; Fang, Jing-Yuan; Xu, Jie

2017-10-01

Programmed death-ligand 1 (PD-L1) expression in colorectal cancer (CRC) was implicated in predicting anti-PD-1/PD-L1 therapy efficacy. However, therapeutic response has also been found in patients without PD-L1 expression in the primary tumor. In the present study, we aimed to clarify the prevalence of PD-L1 in primary and metastatic CRC. The expression of PD-L1 was determined by immunohistochemistry in matched primary and metastatic CRC. PD-L1 expression was significantly more prevalent in metastatic CRCs than in primary tumors, and the expression of PD-L1 in primary CRC may not represent the tumors that spread to distant organs. Positive expression of PD-L1 was found in 81.8% of metastatic CRC, being significantly more prevalent than in primary CRC (40.9%; P = 0.012, Fisher's exact test). While comparing the primary and metastatic lesions of the same patients, we found that PD-L1 expression frequently increased during the metastatic process. However, PD-L1 expression was rarely decreased in metastatic lesions. Intratumoral heterogeneity expression of PD-L1 was found in both metastatic CRC (22.2%) and primary CRCs (33.3%). PD-L1 was prevalently expressed in metastatic CRC, and increased PD-L1 expression was frequently found in metastatic CRC as compared to primary tumors. PD-L1 expression in metastatic CRC should be considered as an independent factor while evaluating the suitability of patients for immunotherapy. © 2017 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Review of medication errors that are new or likely to occur more frequently with electronic medication management systems.

PubMed

Van de Vreede, Melita; McGrath, Anne; de Clifford, Jan

2018-05-14

Objective. The aim of the present study was to identify and quantify medication errors reportedly related to electronic medication management systems (eMMS) and those considered likely to occur more frequently with eMMS. This included developing a new classification system relevant to eMMS errors. Methods. Eight Victorian hospitals with eMMS participated in a retrospective audit of reported medication incidents from their incident reporting databases between May and July 2014. Site-appointed project officers submitted deidentified incidents they deemed new or likely to occur more frequently due to eMMS, together with the Incident Severity Rating (ISR). The authors reviewed and classified incidents. Results. There were 5826 medication-related incidents reported. In total, 93 (47 prescribing errors, 46 administration errors) were identified as new or potentially related to eMMS. Only one ISR2 (moderate) and no ISR1 (severe or death) errors were reported, so harm to patients in this 3-month period was minimal. The most commonly reported error types were 'human factors' and 'unfamiliarity or training' (70%) and 'cross-encounter or hybrid system errors' (22%). Conclusions. Although the results suggest that the errors reported were of low severity, organisations must remain vigilant to the risk of new errors and avoid the assumption that eMMS is the panacea to all medication error issues. What is known about the topic? eMMS have been shown to reduce some types of medication errors, but it has been reported that some new medication errors have been identified and some are likely to occur more frequently with eMMS. There are few published Australian studies that have reported on medication error types that are likely to occur more frequently with eMMS in more than one organisation and that include administration and prescribing errors. What does this paper add? This paper includes a new simple classification system for eMMS that is useful and outlines the most commonly reported incident types and can inform organisations and vendors on possible eMMS improvements. The paper suggests a new classification system for eMMS medication errors. What are the implications for practitioners? The results of the present study will highlight to organisations the need for ongoing review of system design, refinement of workflow issues, staff education and training and reporting and monitoring of errors.

Bimatoprost 0.03% for the Treatment of Eyebrow Hypotrichosis

PubMed Central

Beer, Kenneth; Carruthers, Alastair; Coleman, William P.; Draelos, Zoe Diana; Jones, Derek; Goldman, Mitchel P.; Pucci, Michael L.; VanDenburgh, Amanda; Weng, Emily; Whitcup, Scott M.

2016-01-01

BACKGROUND Eyebrow loss may have substantial negative functional and social consequences. OBJECTIVE Evaluate the safety and efficacy of bimatoprost 0.03% in subjects with eyebrow hypotrichosis. METHODS This multicenter, double-masked study randomized adult females or males with eyebrow hypotrichosis to receive bimatoprost 0.03% twice (BID) or once daily (QD) or vehicle BID for 7 months. Primary endpoint was overall eyebrow fullness at Month 7. Secondary endpoints included eyebrow fullness (mm2), darkness (intensity units), and subject satisfaction with treatment. Safety was also assessed. RESULTS At Month 7, the proportion of subjects with improvement was significantly higher in bimatoprost groups versus vehicle (both, p < .001). Improvements occurred in both bimatoprost groups versus vehicle after Month 1 and continued through follow-up; eyebrow fullness and darkness improved as early as Months 2 and 1, respectively (both, p < .001). Greater satisfaction was reported with bimatoprost versus vehicle at Month 2 and all subsequent time points. Overall, 38.1%, 42.4%, and 35.5% of subjects in the bimatoprost BID, QD, and vehicle groups, respectively, experienced ≥1 treatment-emergent adverse event (TEAE). Most frequent TEAEs were similar across groups. No skin or iris hyperpigmentation or conjunctival hyperemia occurred. CONCLUSION Bimatoprost 0.03% BID and QD is safe, well tolerated, and effective for eyebrow hypotrichosis. PMID:27124878

Enhanced Expression of Interferon-γ-Induced Antigen-Processing Machinery Components in a Spontaneously Occurring Cancer1

PubMed Central

Cerruti, Fulvia; Martano, Marina; Petterino, Claudio; Bollo, Enrico; Morello, Emanuela; Bruno, Renato; Buracco, Paolo; Cascio, Paolo

2007-01-01

In human tumors, changes in the surface expression and/or function of major histocompatibility complex (MHC) class I antigens are frequently found and may provide malignant cells with a mechanism to escape control of the immune system. This altered human lymphocyte antigen (HLA) class I phenotype can be caused by either structural alterations or dysregulation of genes encoding subunits of HLA class I antigens and/or components of the MHC class I antigen-processing machinery (APM). Herein we analyze the expression of several proteins involved in the generation of MHC class I epitopes in feline injection site sarcoma, a spontaneously occurring tumor in cats that is an informativemodel for the study of tumor biology in other species, including humans. Eighteen surgically removed primary fibrosarcoma lesions were analyzed, and an enhanced expression of two catalytic subunits of immunoproteasomes, PA28 and leucine aminopeptidase, was found in tumors compared to matched normal tissues. As a functional counterpart of these changes in protein levels, proteasomal activities were increased in tissue extracts from fibrosarcomas. Taken together, these results suggest that alterations in the APM system may account for reduced processing of selected tumor antigens and may potentially provide neoplastic fibroblasts with a mechanism for escape from T-cell recognition and destruction. PMID:18030364

Enhanced expression of interferon-gamma-induced antigen-processing machinery components in a spontaneously occurring cancer.

PubMed

Cerruti, Fulvia; Martano, Marina; Petterino, Claudio; Bollo, Enrico; Morello, Emanuela; Bruno, Renato; Buracco, Paolo; Cascio, Paolo

2007-11-01

In human tumors, changes in the surface expression and/or function of major histocompatibility complex (MHC) class I antigens are frequently found and may provide malignant cells with a mechanism to escape control of the immune system. This altered human lymphocyte antigen (HLA) class I phenotype can be caused by either structural alterations or dysregulation of genes encoding subunits of HLA class I antigens and/or components of the MHC class I antigen-processing machinery (APM). Herein we analyze the expression of several proteins involved in the generation of MHC class I epitopes in feline injection site sarcoma, a spontaneously occurring tumor in cats that is an informative model for the study of tumor biology in other species, including humans. Eighteen surgically removed primary fibrosarcoma lesions were analyzed, and an enhanced expression of two catalytic subunits of immunoproteasomes, PA28 and leucine aminopeptidase, was found in tumors compared to matched normal tissues. As a functional counterpart of these changes in protein levels, proteasomal activities were increased in tissue extracts from fibrosarcomas. Taken together, these results suggest that alterations in the APM system may account for reduced processing of selected tumor antigens and may potentially provide neoplastic fibroblasts with a mechanism for escape from T-cell recognition and destruction.

Efficient Processing of the Immunodominant, HLA-A*0201-Restricted Human Immunodeficiency Virus Type 1 Cytotoxic T-Lymphocyte Epitope despite Multiple Variations in the Epitope Flanking Sequences

PubMed Central

Brander, Christian; Yang, Otto O.; Jones, Norman G.; Lee, Yun; Goulder, Philip; Johnson, R. Paul; Trocha, Alicja; Colbert, David; Hay, Christine; Buchbinder, Susan; Bergmann, Cornelia C.; Zweerink, Hans J.; Wolinsky, Steven; Blattner, William A.; Kalams, Spyros A.; Walker, Bruce D.

1999-01-01

Immune escape from cytotoxic T-lymphocyte (CTL) responses has been shown to occur not only by changes within the targeted epitope but also by changes in the flanking sequences which interfere with the processing of the immunogenic peptide. However, the frequency of such an escape mechanism has not been determined. To investigate whether naturally occurring variations in the flanking sequences of an immunodominant human immunodeficiency virus type 1 (HIV-1) Gag CTL epitope prevent antigen processing, cells infected with HIV-1 or vaccinia virus constructs encoding different patient-derived Gag sequences were tested for recognition by HLA-A*0201-restricted, p17-specific CTL. We found that the immunodominant p17 epitope (SL9) and its variants were efficiently processed from minigene expressing vectors and from six HIV-1 Gag variants expressed by recombinant vaccinia virus constructs. Furthermore, SL9-specific CTL clones derived from multiple donors efficiently inhibited virus replication when added to HLA-A*0201-bearing cells infected with primary or laboratory-adapted strains of virus, despite the variability in the SL9 flanking sequences. These data suggest that escape from this immunodominant CTL response is not frequently accomplished by changes in the epitope flanking sequences. PMID:10559335

Productivity depends more on the rate than the frequency of N addition in a temperate grassland.

PubMed

Zhang, Yunhai; Feng, Jinchao; Isbell, Forest; Lü, Xiaotao; Han, Xingguo

2015-07-28

Nitrogen (N) is a key limiting resource for aboveground net primary productivity (ANPP) in diverse terrestrial ecosystems. The relative roles of the rate and frequency (additions yr(-1)) of N application in stimulating ANPP at both the community- and species-levels are largely unknown. By independently manipulating the rate and frequency of N input, with nine rates (from 0 to 50 g N m(-2) year(-1)) crossed with two frequencies (twice year(-1) or monthly) in a temperate steppe of northern China across 2008-2013, we found that N addition increased community ANPP, and had positive, negative, or neutral effects for individual species. There were similar ANPP responses at the community- or species-level when a particular annual amount of N was added either twice year(-1) or monthly. The community ANPP was less sensitive to soil ammonium at lower frequency of N addition. ANPP responses to N addition were positively correlated with annual precipitation. Our results suggest that, over a five-year period, there will be similar ANPP responses to a given annual N input that occurs either frequently in small amounts, as from N deposition, or that occur infrequently in larger amounts, as from application of N fertilizers.

Time to explore preventive and novel therapies for bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation.

PubMed

Sengsayadeth, Salyka M; Srivastava, Shivani; Jagasia, Madan; Savani, Bipin N

2012-10-01

Although allogeneic hematopoietic stem cell transplant (allo-HSCT) is performed to treat otherwise incurable and fatal diseases, transplantation itself can lead to life-threatening complications due to organ damage. Pulmonary complications remain a significant barrier to the success of allo-HSCT. Lung injury, a frequent complication after allo-HSCT, and noninfectious pulmonary deaths account for a significant proportion of non-relapse mortality. Bronchiolitis obliterans syndrome (BOS) is a common and potentially devastating complication. BOS is now considered a diagnostic criterion of chronic graft-versus-host-disease (cGVHD), and National Institutes of Health (NIH) consensus has been published to establish guidelines for diagnosis and monitoring of BOS. It usually occurs within the first 2 years but may develop as late as 5 years after transplantation. Recent prevalence estimates suggest that BOS is likely underdiagnosed, and when severe BOS does occur, current treatments have been largely ineffective. Prevention and effective novel approaches remain the primary tools in the clinician's arsenal in managing BOS. This article provides an overview of the currently available and novel strategies for BOS, and we also discuss specific preventive interventions to reduce severe BOS after allo-HSCT. Therapeutic trials continue to be needed for this orphan disease. Published by Elsevier Inc.

Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Prevention

MedlinePlus

... early menopause. Symptoms of menopause include the following: Hot flashes . Night sweats. Trouble sleeping. Mood changes. Decreased sex drive . Heart disease. Vaginal dryness. Frequent urination. Osteoporosis ( ...

76 FR 6009 - Shareholder Approval of Executive Compensation and Golden Parachute Compensation

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-02

...)(1) requires that ``[n]ot less frequently than once every 3 years, a proxy or consent or... Exchange Act, requiring that, ``[n]ot less frequently than once every 6 years, a proxy or consent or... determine whether [the say- on-pay vote] will occur every 1, 2, or 3 years.'' \\20\\ As discussed below, this...

The Experience of Insight Follows Incubation in the Compound Remote Associates Task

ERIC Educational Resources Information Center

Morrison, Robert G.; McCarthy, Sean W.; Molony, John M.

2017-01-01

The phenomenon of insight is frequently characterized by the experience of a sudden and certain solution. Anecdotal accounts suggest that insight frequently occurs after the problem solver has taken some time away from the problem (i.e., incubation). However, the mechanism by which incubation may facilitate insight problem-solving remains unclear.…

Categorizing Words Using "Frequent Frames": What Cross-Linguistic Analyses Reveal about Distributional Acquisition Strategies

ERIC Educational Resources Information Center

Chemla, Emmanuel; Mintz, Toben H.; Bernal, Savita; Christophe, Anne

2009-01-01

Mintz (2003 ) described a distributional environment called a frame, defined as the co-occurrence of two context words with one intervening target word. Analyses of English child-directed speech showed that words that fell within any frequently occurring frame consistently belonged to the same grammatical category (e.g. noun, verb, adjective,…

A reassessment of the indicators of primary education quality in developing countries: Emerging evidence from Tanzania

NASA Astrophysics Data System (ADS)

Mosha, Herme Joseph

1988-03-01

This article seeks to identify factors affecting the quality of primary education in five regions of Tanzania by extensively reviewing relevant literature and empirical data. Some of the shortcomings emphasised by the author are: frequent staff turnover, declining financial support for primary education, ineffective curricula, shortage of teachers' guides and textbooks, and unfavourable working conditions for teachers in rural areas. Beyond this, the need for freely available material, efficient school management and regular inspections is stressed by the author.

Gender inequalities in COPD decision-making in primary care.

PubMed

Delgado, Ana; Saletti-Cuesta, Lorena; López-Fernández, Luis Andrés; Gil-Garrido, Natalia; Luna Del Castillo, Juan de Dios

2016-05-01

COPD is a frequent severe illness that increasingly affects females. Gender inequalities have been reported in COPD care. To analyze decision-making in primary care for men and women with identical COPD as a function of the gender of the family physician (FP). Cross-sectional, multicenter study in 457 Andalusian FPs, using a self-administered vignette-based questionnaire on COPD featuring a male or female patient, with four variables on clinical reasoning: "tobacco as most important risk factor (RF)", "ordering of spirometry", "COPD as most likely diagnosis", and "referral". Multilevel logistic regression analysis. Response rate was 67.4% (308/457). In analysis of the four FP gender-patient gender dyads, tobacco was more frequently considered as priority RF for the man than for the woman in the vignette by female (95.6%vs.67.1%) and male (79.8%vs.62.5%) FPs. COPD was more frequently the most likely diagnosis for the man versus woman by female (84.4%vs.49.9%) and male (78.5%vs.57.8%) FPs. Male FPs more frequently ordered spirometry for the man versus woman (68.1%vs.46.8%). There were no differences in referral between male and female patients. Male FPs were more likely than female FPs to consider tobacco as priority RF for the man (p = 002). Female FPs were more likely than male FPs to refer the man (22.5%vs.8%). There may be gender inequalities in primary care for COPD in our setting. Diagnostic and therapeutic efforts appear lower in female patients. Male and female FPs only differed in care of the male patient, indicating FP gender-patient gender interaction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Risk factors for acute exacerbations of COPD in a primary care population: a retrospective observational cohort study

PubMed Central

Müllerová, Hana; Shukla, Amit; Hawkins, Adam; Quint, Jennifer

2014-01-01

Objectives To evaluate risk factors associated with exacerbation frequency in primary care. Information on exacerbations of chronic obstructive pulmonary disease (COPD) has mainly been generated by secondary care-based clinical cohorts. Design Retrospective observational cohort study. Setting Electronic medical records database (England and Wales). Participants 58 589 patients with COPD aged ≥40 years with COPD diagnosis recorded between 1 April 2009 and 30 September 2012, and with at least 365 days of follow-up before and after the COPD diagnosis, were identified in the Clinical Practice Research Datalink. Mean age: 69 years; 47% female; mean forced expiratory volume in 1s 60% predicted. Outcome measures Data on moderate or severe exacerbation episodes defined by diagnosis and/or medication codes 12 months following cohort entry were retrieved, together with demographic and clinical characteristics. Associations between patient characteristics and odds of having none versus one, none versus frequent (≥2) and one versus frequent exacerbations over 12 months follow-up were evaluated using multivariate logistic regression models. Results During follow-up, 23% of patients had evidence of frequent moderate-to-severe COPD exacerbations (24% one; 53% none). Independent predictors of increased odds of having exacerbations during the follow-up, either frequent episodes or one episode, included prior exacerbations, increasing dyspnoea score, increasing grade of airflow limitation, females and prior or current history of several comorbidities (eg, asthma, depression, anxiety, heart failure and cancer). Conclusions Primary care-managed patients with COPD at the highest risk of exacerbations can be identified by exploring medical history for the presence of prior exacerbations, greater COPD disease severity and co-occurrence of other medical conditions. PMID:25524545

Urban-rural fog differences in Belgrade area, Serbia

NASA Astrophysics Data System (ADS)

Vujović, Dragana; Todorović, Nedeljko

2018-02-01

Urban/rural fog appearance during the last 27 years in the Belgrade region is analysed using hourly meteorological records from two meteorological stations: an urban station at Belgrade-Vračar (BV) and a rural station at Belgrade-Airport (BA). The effects of urban development on fog formation are discussed through analysis of fog frequency trends and comparison with a number of meteorological parameters. The mean annual and the mean annual minimum temperatures were greater at the urban BV station than at the rural BA station. The mean monthly relative humidity and the mean monthly water vapour pressure were greater at the rural than urban station. During the period of research (1988-2014), BA experiences 425 more days with fog than BV, which means that BV experiences fog for 62.68% of foggy days at BA. Trends in the number of days with fog were statistically non-significant. We analysed the fog occurrence during different types of weather. Fog in urban BV occurred more frequently during cyclonal circulation (in 52.75% of cases). In rural BA, the trend was the opposite and fog appeared more frequently during anticyclonic circulation (in 53.58% of cases). Fog at BV occurred most frequently in stable anticyclonic weather with light wind, when a temperature inversion existed (21.86% of cases). Most frequently, fog at BA occurred in the morning and only lasted a short time, followed by clearer skies during the anticyclonic warm and dry weather (22.55% of cases).

[Work-related accidents in minors in Lombardy].

PubMed

Pianosi, G; Zocchetti, C

1995-01-01

Work-related injuries in children and adolescents represent a negative indication of more general inequities of the society in which events occur. Their characteristics are not well described, particularly in Italy, and this paper is aimed at highlighting some fundamental aspects of these injuries. The case in point is represented by the injuries that received compensation and occurred in the Lombardy Region (Italy) between 1984 and 1989 and involved people under the age of eighteen. The injuries occurring in the same period and area in workers over eighteen were used for comparison. Work related injuries in minors were more frequent in crafts activities than in industry, but their gravity (in terms of deaths or permanent consequences) was lower than in the corresponding adult workers. Ninety percent of the events in young workers occurred in males, in each age category, and about 5% of the cases pertains to very young workers (less than 15 years). Cuts/lacerations are the most frequent type of lesion (49.9%) and the hands represent the site most frequently involved (55.5%). The great majority of the observed injuries pertains to a limited number of economic activity sectors: about 75% of the cases occurred in ten sectors. Metal manufacturing, construction and machine production scored first, with interesting correlations with the same sectors in adult workers. Ten specific occupations represent over fifty percent of the cases, with mechanics and bricklayers at the top. The description of the accident in terms of mode of occurrence and the agents involved was less informative and not specific.(ABSTRACT TRUNCATED AT 250 WORDS)

Surveyed opinion of American trauma surgeons in management of colon injuries.

PubMed

Eshraghi, N; Mullins, R J; Mayberry, J C; Brand, D M; Crass, R A; Trunkey, D D

1998-01-01

Primary repair or resection and anastomosis of colon wounds have been advocated in many recent studies, but the proportion of trauma surgeons accepting these recommendations is unknown. To determine the current preferences of American trauma surgeons for colon injury management. Four hundred forty-nine members of the American Association for the Surgery of Trauma were surveyed regarding their preferred management of eight types of colon wounds among three options: diverting colostomy (DC), primary repair (PR), or resection and anastomosis (RA). The influence of selected patient factors and surgeons' characteristics on the choice of management was also surveyed. Seventy-three percent of surgeons completed the survey. Ninety-eight percent chose PR for at least one type of injury. Thirty percent never selected DC. High-velocity gunshot wound was the only injury for which the majority (54%) would perform DC. More than 55% of the surgeons favored RA when the isolated colon injury was a contusion with possible devascularization, laceration greater than 50% of the diameter, or transection. Surgeons who managed five or fewer colon wounds per year chose DC more frequently (p < 0.001) and PR less frequently (p < 0.001) than surgeons who managed six or more colon wounds per year. The prevailing opinion of trauma surgeons favors primary repair or resection of colon injuries, including anastomosis of unprepared bowel. Surgeons who manage fewer colon wounds prefer colostomy more frequently.

Improved outcomes in the non-operative management of liver injuries

PubMed Central

Saltzherr, Teun Peter; van der Vlies, Cees H; van Lienden, Krijn P; Beenen, Ludo F M; Ponsen, Kees Jan; van Gulik, Thomas M; Goslings, J Carel

2011-01-01

Objectives Non-operative management has become the treatment of choice in the majority of liver injuries. The aim of this study was to assess the changes in primary treatment and outcomes in a single Dutch Level 1 trauma centre with wide experience in angio-embolisation (AE). Methods The prospective trauma registry was retrospectively analysed for 7-year periods before (Period 1) and after (Period 2) the introduction of AE. The primary outcome was the failure rate of primary treatment defined as liver injury-related death or re-bleeding requiring radiologic or operative (re)interventions. Secondary outcomes were liver injury-related intra-abdominal complications. Results Despite an increase in high-grade liver injuries, the incidence of primary non-operative management more than doubled over the two periods, from 33% (20 of 61 cases) in Period 1 to 72% (84 of 116 cases) in Period 2 (P < 0.001). The failure rate of primary treatment in Period 1 was 18% (11/61), compared with 11% (13/116) in Period 2 (P = 0.21). Complication rates were 23% (14/61) and 16% (18/116) in Periods 1 and 2, respectively (P = 0.22). Liver-related mortality rates were 10% (6/61) and 3% (4/116) in Periods 1 and 2, respectively (P = 0.095). The increase in the frequency of non-operative management was even higher in high-grade injuries, in which outcomes were improved. In high-grade injuries in Periods 1 and 2, failure rates decreased from 45% (9/20) to 20% (11/55) (P = 0.041), liver-related mortality decreased from 30% (6/20) to 7% (4/55) (P = 0.019) and complication rates fell from 60% (12/20) to 27% (15/55) (P = 0.014). Liver infarction or necrosis and abscess formation seemed to occur more frequently with AE. Conclusions Overall, liver-related mortality, treatment failure and complication rates remained constant despite an increase in non-operative management. However, in high-grade injuries outcomes improved after the introduction of AE. PMID:21492335

Effect of platelet inhibition with cangrelor during PCI on ischemic events.

PubMed

Bhatt, Deepak L; Stone, Gregg W; Mahaffey, Kenneth W; Gibson, C Michael; Steg, P Gabriel; Hamm, Christian W; Price, Matthew J; Leonardi, Sergio; Gallup, Dianne; Bramucci, Ezio; Radke, Peter W; Widimský, Petr; Tousek, Frantisek; Tauth, Jeffrey; Spriggs, Douglas; McLaurin, Brent T; Angiolillo, Dominick J; Généreux, Philippe; Liu, Tiepu; Prats, Jayne; Todd, Meredith; Skerjanec, Simona; White, Harvey D; Harrington, Robert A

2013-04-04

The intensity of antiplatelet therapy during percutaneous coronary intervention (PCI) is an important determinant of PCI-related ischemic complications. Cangrelor is a potent intravenous adenosine diphosphate (ADP)-receptor antagonist that acts rapidly and has quickly reversible effects. In a double-blind, placebo-controlled trial, we randomly assigned 11,145 patients who were undergoing either urgent or elective PCI and were receiving guideline-recommended therapy to receive a bolus and infusion of cangrelor or to receive a loading dose of 600 mg or 300 mg of clopidogrel. The primary efficacy end point was a composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours after randomization; the key secondary end point was stent thrombosis at 48 hours. The primary safety end point was severe bleeding at 48 hours. The rate of the primary efficacy end point was 4.7% in the cangrelor group and 5.9% in the clopidogrel group (adjusted odds ratio with cangrelor, 0.78; 95% confidence interval [CI], 0.66 to 0.93; P=0.005). The rate of the primary safety end point was 0.16% in the cangrelor group and 0.11% in the clopidogrel group (odds ratio, 1.50; 95% CI, 0.53 to 4.22; P=0.44). Stent thrombosis developed in 0.8% of the patients in the cangrelor group and in 1.4% in the clopidogrel group (odds ratio, 0.62; 95% CI, 0.43 to 0.90; P=0.01). The rates of adverse events related to the study treatment were low in both groups, though transient dyspnea occurred significantly more frequently with cangrelor than with clopidogrel (1.2% vs. 0.3%). The benefit from cangrelor with respect to the primary end point was consistent across multiple prespecified subgroups. Cangrelor significantly reduced the rate of ischemic events, including stent thrombosis, during PCI, with no significant increase in severe bleeding. (Funded by the Medicines Company; CHAMPION PHOENIX ClinicalTrials.gov number, NCT01156571.).

Use of Social Support during Communication about Sickle Cell Carrier Status

PubMed Central

Bradford, Lisa; Roedl, Sara J.; Christopher, Stephanie A.; Farrell, Michael H.

2012-01-01

Objective To examine the use of social support behaviors by primary care providers during delivery of positive newborn screening results for Sickle Cell Anemia carrier status. Methods Transcripts from 125 primary care providers who conveyed Sickle Cell Anemia carrier status to standardized parents were content analyzed using categories derived from Cutrona and Suhr’s social support taxonomy. Frequencies and cross-tabulation matrices were calculated to study providers’ social support utilization. Results Results showed most primary care providers (80%) incorporate social support behaviors into delivery of Sickle Cell Anemia carrier results and most frequently employed social network (61.6%) and informational support (38.4%) behaviors. Providers used tangible aid (8%), esteem (1.6%), and emotional support (9.6%) behaviors less frequently. Conclusion Cutrona and Suhr’s taxonomy may be a useful tool for assessing supportive communication during the delivery of Sickle Cell Anemia carrier status and could be incorporated into population scale assessments of communication quality assurance. Practice Implications Primary care providers may need training in how to adapt supportive behaviors to parents’ needs during communication of Sickle Cell Anemia carrier status. They also may benefit from specific training about how to use esteem and emotional support. PMID:22658247

Precipitation and primary health care visits for gastrointestinal illness in Gothenburg, Sweden.

PubMed

Tornevi, Andreas; Barregård, Lars; Forsberg, Bertil

2015-01-01

The river Göta Älv is a source of freshwater for the City of Gothenburg, Sweden, and we recently identified a clear influence of upstream precipitation on concentrations of indicator bacteria in the river water, as well as an association with the daily number of phone calls to the nurse advice line related to acute gastrointestinal illnesses (AGI calls). This study aimed to examine visits to primary health-care centers owing to similar symptoms (AGI visits) in the same area, to explore associations with precipitation, and to compare variability in AGI visits and AGI calls. We obtained data covering six years (2007-2012) of daily AGI visits and studied their association with prior precipitation (0-28 days) using a distributed lag nonlinear Poisson regression model, adjusting for seasonal patterns and covariates. In addition, we studied the effects of prolonged wet and dry weather on AGI visits. We analyzed lagged short-term relations between AGI visits and AGI calls, and we studied differences in their seasonal patterns using a binomial regression model. The study period saw a total of 17,030 AGI visits, and the number of daily visits decreased on days when precipitation occurred. However, prolonged wet weather was associated with an elevated number of AGI visits. Differences in seasonality patterns were observed between AGI visits and AGI calls, as visits were relatively less frequent during winter and relatively more frequent in August, and only weak short-term relations were found. AGI visits and AGI calls seems to partly reflect different types of AGI illnesses, and the patients' choice of medical contact (in-person visits versus phone calls) appears to depend on current weather conditions. An association between prolonged wet weather and increased AGI visits supports the hypothesis that the drinking water is related to an increased risk of AGI illnesses.