Experiences in feeding and gastrointestinal dysfunction in children with CHARGE syndrome

Feeding issues are very common in individuals with CHARGE syndrome and can lead to increased morbidity and mortality. The aim of this study was to expand upon the limited knowledge base of feeding and gastrointestinal issues in individuals with CHARGE syndrome. Parents of individuals (age range 1–18 years) with CHARGE syndrome, with or without feeding/gastrointestinal issues, were recruited through international CHARGE syndrome associations and CHARGE syndrome Facebook pages. Parents completed three questionnaires: CHARGE diagnostic characteristics; Pediatric Assessment Scale for Severe Feeding Problems © and PedsQL™ Gastrointestinal Symptoms Scale; and open-ended questions. Sixty-nine completed questionnaires were included in the study analysis (median age 7; 58% females). Individuals who were completely tube fed (n = 21) had significantly more feeding difficulties than individuals who were either partially (n = 26) or completely orally fed (n = 20; p < 0.001). Tube fed individuals also experienced more problematic gastrointestinal symptoms (p < 0.001). Constipation (n = 19, 30%), vomiting (n = 12, 19%), and choking (n = 11, 17%) were reported by parents as the greatest challenges. Problems exist throughout the entire gastrointestinal tract in many individuals with CHARGE syndrome. These issues are more common in individuals who receive nutrition completely through a feeding tube compared to individuals with at least partial oral feeding behaviors.

http://ift.tt/2xWEOVc

The Influence of Hyaluronic Acid and Glioblastoma Cell Coculture on the Formation of Endothelial Cell Networks in Gelatin Hydrogels

Glioblastoma (GBM) is the most common and deadly form of brain cancer. Interactions between GBM cells and vasculature in vivo contribute to poor clinical outcomes, with GBM-induced vessel co-option, regression, and subsequent angiogenesis strongly influencing GBM invasion. Here, elements of the GBM perivascular niche are incorporated into a methacrylamide-functionalized gelatin hydrogel as a means to examine GBM–vessel interactions. The complexity of 3D endothelial cell networks formed from human umbilical vein endothelial cells and normal human lung fibroblasts as a function of hydrogel properties and vascular endothelial growth factor (VEGF) presentation is presented. While overall length and branching of the endothelial cell networks decrease with increasing hydrogel stiffness and incorporation of brain-mimetic hyaluronic acid, it can be separately altered by changing the vascular cell seeding density. It is shown that covalent incorporation of VEGF supports network formation as robustly as continuously available soluble VEGF. The impact of U87-MG GBM cells on the endothelial cell networks is subsequently investigated. GBM cells localize in proximity to the endothelial cell networks and hasten network regression in vitro. Together, this in vitro platform recapitulates the close association between GBM cells and vessel structures as well as elements of vessel co-option and regression preceding angiogenesis in vivo.

The glioblastoma perivascular niche is incorporated into a gelatin hydrogel via coculture of endothelial, stromal, and glioblastoma cells. Endothelial network complexity can be manipulated through hydrogel stiffness and covalent immobilization of brain-mimetic hyaluronic acid and vascular endothelial growth factor into the hydrogel network. Glioblastoma cells associate closely with endothelial cell networks and promote processes similar to vessel co-option and regression seen in vivo.

http://ift.tt/2xW83Ho

Co-Delivery of Drugs and Genes Using Polymeric Nanoparticles for Synergistic Cancer Therapeutic Effects

Abstract

Drug and gene delivery systems based on nanoparticles, microparticles and hydrogels have been widely studied for cancer treatment in the past decade. To achieve an efficient and safe delivery, selection of drug and gene delivery carrier is critical. Biocompatible polymeric nanoparticles are considerably promising carrier candidates in delivery of drugs and genes because of their unique chemical and physical properties. However, delivery of a drug or gene sometimes cannot achieve a satisfactory treatment effect. Therefore, co-delivery of dual drugs or co-delivery of a drug and a gene in a polymeric nanoparticle has attracted attention. Such co-delivery systems can overcome multi-drug resistance of chemical drugs and achieve a synergistic therapeutic effect. In this progress report, we summarize recent progress in the preparation and application of polymeric drug and gene co-delivery nanosystems. The remaining challenges and future trends in this field are also included.

Polymeric nanoparticles-mediated combination therapy is an effective strategy in cancer treatment. Co-delivery of dual drugs or drug/gene can enhance anti-cancer efficacy due to a synergistic effect. Moreover, polymeric nanocarriers can improve biodistribution of the therapeutics as well as release them at target sites. In this Progress Report, recent progresses in preparation and application of polymeric drug and gene co-delivery nanosystems are summarized.

http://ift.tt/2jPNVAN

Developing a short form of the German Barriers Questionnaire-II: A validation study in four steps

Patient-related barriers to cancer pain management are most commonly assessed with the Barriers Questionnaire-II (BQII; 27 items). Objectives: The aim of this study was to develop a valid short form of the BQII-German (BQII-G) to increase usability in clinical routines and reduce patient burden.

http://ift.tt/2hnAMdt

Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety

Documenting patients' advance care planning wishes is essential to providing value-aligned care, as is having this documentation readily accessible. Little is known about advance care planning documentation practices in the electronic health record.

http://ift.tt/2hjI5qh

Help-seeking behaviours, opportunistic treatment and psychological implications of adolescent acne: cross-sectional studies in schools and hospital outpatient departments in the UK

Background

Acne vulgaris (acne) is a common adolescent skin condition. It is associated with negative psychological impacts and sufferers do not easily seek help, hence is undertreated.

Objectives

We investigated the self-reported prevalence, severity and psychological sequelae of acne, together with assessing help-seeking behaviour and its barriers, in separate school and hospital samples. We explored opportunistic treatment by paediatricians.

Methods

Self-reported survey with participants drawn from: (1) 120 adolescents aged 13–18 in a London tertiary paediatric outpatient department and (2) 482 adolescents from two London schools, aged 11–18. Adolescents confidentially and anonymously completed a questionnaire (paper or online) and those with acne completed the Cardiff Acne Disability Index (CADI) questionnaire.

Outcome measures

To explore if acne is being addressed opportunistically in outpatient appointments and the behaviours associated with seeking help and psychological implications of acne.

Results

Acne prevalence was reported as 58.3% in the clinic and 42.3% in schools, with 34.3% and 20.6% of participants having moderate acne (MA) or severe acne (SA), respectively. The correlation between acne severity and CADI was significant (regression coefficient=4.86, p<0.005 (MA) and 9.08, p<0.005 (SA) in the hospital; 1.92, p<0.001 (MA) and 7.41, p<0.005 (SA) in schools). Severity of acne was associated with increased likelihood of seeing a doctor in both samples (OR=8.95, 2.79–28.70 (MA) in the clinic and 1.31, 1.30–2.90 (MA) and 3.89, 0.66–22.98 (SA) in the community). Barriers to help seeking included embarrassment and believing doctors were unapproachable. Doctors addressed acne opportunistically in 2.9% of the sample, although 16.7% of those with MA and SA wished their doctor had raised it.

Conclusion

Acne is common and has negative psychological implications, correlating with severity. Young people often forego seeking help and hospital clinicians rarely address acne opportunistically. Further work is needed to investigate how to reduce barriers to help seeking for acne.

http://ift.tt/2fEzrzc

Urine cytology screening of French workers exposed to occupational urinary tract carcinogens: a prospective cohort study over a 20-year period

Objectives

To demonstrate that urine cytology screening can provide relevant epidemiological data for earlier detection of urothelial cancer caused by occupational exposure.

Design

Prospective cohort study.

Setting

Industries using urothelial carcinogens in France. Urine samples were collected on site, after a work week and were analysed at the University Hospital of Clermont-Ferrand, France.

Participants

Participants were workers exposed to urothelial carcinogens. Women and current smokers at time of study recruitment were exclusion criteria.

Outcomes

Urine cells atypia were ranged into three classes: negative/normal, atypical/suspicious/dysplasia or positive/malignant.

Results

We included 2020 workers over a period of 20 years from 1993 to 2013: 606 worked in rubber manufacturing, 692 from metal processing, 245 in chemical industry and 477 in roadwork and building industry. Workers had a mean exposure of 15.2±10.4 years before their first urine cytology screening. There was a mean of 3.4±4.3 urine cytology screenings per worker between 1993 and 2013. 6478 cytology were normal, 462 suspicious and 13 malignant. Suspicious and malignant cytology occurred in 4.8% of workers exposed for 1–10 years, 6.2% for 11–20 years of exposure, 7.6% for 21–30 years and 8.6% for >30 years (p<0.001). Using exposure for 1–10 years as reference, the adjusted OR of receiving a suspicious or malignant diagnosis increased with duration of exposure: OR=1.50 (95% CI 1.10 to 2.05, p=0.01) for 21–30 years and OR=1.78 (95% CI 1.23 to 2.56, p=0.002) for >30 years of exposure. Using metal processing as reference, the risk of pathological urine cytology results increased for rubber manufacturing (OR=1.32, 95% CI 1.05 to 1.65, p=0.02), with a trend for roadwork and building industry (OR=1.39, 95% CI 0.98 to 1.97, p=0.07) and for chemical industry (OR=1.34, 95% CI 0.94 to 1.93, p=0.11).

Conclusions

Urine cytology is a useful tool in occupational medicine. We promote new guidelines with an early screening of urothelial cancer by cytology, starting with beginning of exposure.

http://ift.tt/2fEzzPc

Association between gender and short-term outcome in patients with ST elevation myocardial infraction participating in the international, prospective, randomised Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) trial: a prespecified analysis

Objectives

To evaluate gender differences in outcomes in patents with ST-segment elevation myocardial infarction (STEMI) planned for primary percutaneous coronary intervention (PPCI).

Settings

A prespecified gender analysis of the multicentre, randomised, double-blind Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery.

Participants

Between September 2011 and October 2013, 1862 patients with STEMI and symptom duration <6 hours were included.

Interventions

Patients were assigned to prehospital versus in-hospital administration of 180 mg ticagrelor.

Outcomes

The main objective was to study the association between gender and primary and secondary outcomes of the main study with a focus on the clinical efficacy and safety outcomes. Primary outcome: the proportion of patients who did not have 70% resolution of ST-segment elevation and did not meet the criteria for Thrombolysis In Myocardial Infarction (TIMI) flow 3 at initial angiography. Secondary outcome: the composite of death, MI, stent thrombosis, stroke or urgent revascularisation and major or minor bleeding at 30 days.

Results

Women were older, had higher TIMI risk score, longer prehospital delays and better TIMI flow in the infarct-related artery. Women had a threefold higher risk for all-cause mortality compared with men (5.7% vs 1.9%, HR 3.13, 95% CI 1.78 to 5.51). After adjustment, the difference was attenuated but remained statistically significant (HR 2.08, 95% CI 1.03 to 4.20). The incidence of major bleeding events was twofold to threefold higher in women compared with men. In the multivariable model, female gender was not an independent predictor of bleeding (Platelet Inhibition and Patient Outcomes major HR 1.45, 95% CI 0.73 to 2.86, TIMI major HR 1.28, 95% CI 0.47 to 3.48, Bleeding Academic Research Consortium type 3–5 HR 1.45, 95% CI 0.72 to 2.91). There was no interaction between gender and efficacy or safety of randomised treatment.

Conclusion

In patients with STEMI planned for PPCI and treated with modern antiplatelet therapy, female gender was an independent predictor of short-term mortality. In contrast, the higher incidence of bleeding complications in women could mainly be explained by older age and clustering of comorbidities.

Clinical trial registration

NCT01347580;Post-results.

http://ift.tt/2fFkNI3

Usage of purchased self-tests for HIV and sexually transmitted infections in Amsterdam, the Netherlands: results of population-based and serial cross-sectional studies among the general population and sexual risk groups

Objectives

There are limited data on the usage of commercially bought self-tests for HIV and other sexually transmitted infections (STIs). Therefore, we studied HIV/STI self-test usage and its determinants among the general population and sexual risk groups between 2007 and 2015 in Amsterdam, the Netherlands.

Setting

Data were collected in four different studies among the general population (S1–2) and sexual risk groups (S3–4).

Participants

S1–Amsterdam residents participating in representative population-based surveys (2008 and 2012; n=6044) drawn from the municipality register; S2–Participants of a population-based study stratified by ethnicity drawn from the municipality register of Amsterdam (2011–2015; n=17 603); S3–Men having sex with men (MSM) participating in an HIV observational cohort study (2008 and 2013; n=597) and S4–STI clinic clients participating in a cross-sectional survey (2007–2012; n=5655).

Primary and secondary outcome measures

Prevalence of HIV/STI self-test usage and its determinants.

Results

The prevalence of HIV/STI self-test usage in the preceding 6–12 months varied between 1% and 2% across studies. Chlamydia self-tests were most commonly used, except among MSM in S3. Chlamydia and syphilis self-test usage increased over time among the representative sample of Amsterdam residents (S1) and chlamydia self-test usage increased over time among STI clinic clients (S4). Self-test usage was associated with African Surinamese or Ghanaian ethnic origin (S2), being woman or MSM (S1 and 4) and having had a higher number of sexual partners (S1–2). Among those in the general population who tested for HIV/STI in the preceding 12 months, 5–9% used a self-test.

Conclusions

Despite low HIV/STI self-test usage, we observed increases over time in chlamydia and syphilis self-test usage. Furthermore, self-test usage was higher among high-risk individuals in the general population. It is important to continue monitoring self-test usage and informing the public about the unknown quality of available self-tests in the Netherlands and about the pros and cons of self-testing.

http://ift.tt/2fE8Ou7

Protocol for a realist review of complex interventions to prevent adolescents from engaging in multiple risk behaviours

Objectives

Adolescent risk behaviours are a key health concern. The purpose of this research is to gaina deeper understanding of how, why, for whom, and inwhat circumstances complex adolescent risk behaviourprevention programmes are most successful.

Methods and analysis

To understand how adolescent risk behaviour prevention programmes work in a reallife context, a realist synthesis will be undertaken, operationalised in four phases.

Phase one Developing a framework to map the theoretical and conceptual landscape of adolescent risk behaviour prevention. Guided by stakeholder consultation.

Phase two Formulating initial programme theories through exploration of the literature, along with primary data from professional stakeholder interviews.

Phase three Refining programme theories through more purposeful, in depth screening of the literature, along with primary qualitative data, from young people and professionals. Data will be collected through semi structured focus groups, to explore specific elements of the emerging programme theories.

Phase four Testing programme theories through interviews with youth workers, following consultation with young people, using vignettes to explore the relationship between specific programme theories. This relatively novel method of primary and secondary data integration within a realist synthesis will provide deeper insight in to young peoples lived experience of risk behaviour prevention programmes, while maintaining transparency in the process of programme theory development.

Data analysis

A realist logic of analysis will be used to align data from each phase with context mechanism outcome configurations or specific elements thereof. Substantive theory will then be sought to understand and explain the findings.

Ethics and dissemination

This study has been approved by the Ethics committee at Northumbria University, UK. Findings will be disseminated through knowledge exchange with stakeholders, publications in peer-reviewed journals, conference presentations, and formal and informal reports.

http://ift.tt/2xjOFDK

Protocol of a randomised controlled trial characterising the immune responses induced by varicella-zoster virus (VZV) vaccination in healthy Kenyan women: setting the stage for a potential VZV-based HIV vaccine

Introduction

A protective HIV vaccine would be expected to induce durable effector immune responses at the mucosa, restricting HIV infection at its portal of entry. We hypothesise that use of varicella-zoster virus (VZV) as an HIV delivery vector could generate sustained and robust tissue-based immunity against HIV antigens to provide long-term protection against HIV. Given that HIV uniquely targets immune-activated T cells, the development of human vaccines against HIV must also involve a specific examination of the safety of the vector. Thus, we aim to evaluate the effects of VZV vaccination on the recipients' immune activation state, and on VZV-specific circulating humoral and cellular responses in addition to those at the cervical and rectal mucosa.

Methods and analysis

This open-label, randomised, longitudinal crossover study includes healthy Kenyan VZV-seropositive women at low risk for HIV infection. Participants receive a single dose of a commercial live-attenuated VZV_Oka vaccine at either week 0 (n=22) or at week 12 (n=22) of the study and are followed for 48 and 36 weeks postvaccination, respectively. The primary outcome is the change on cervical CD4⁺ T-cell immune activation measured by the coexpression of CD38 and HLA-DR 12 weeks postvaccination compared with the baseline (prevaccination). Secondary analyses include postvaccination changes in VZV-specific mucosal and systemic humoral and cellular immune responses, changes in cytokine and chemokine measures, study acceptability and feasibility of mucosal sampling and a longitudinal assessment of the bacterial community composition of the mucosa.

Ethics and dissemination

The study has ethical approval from Kenyatta National Hospital/University of Nairobi Ethics and Research Committee, the University of Toronto Research Ethics Board and by Kenyan Pharmacy and Poisons Board. Results will be presented at conferences, disseminated to participants and stakeholders as well as published in peer-reviewed journals.

Trial registration number

NCT02514018. Pre-results.

http://ift.tt/2fEzkng

Perceptions of parents and paediatricians on pain induced by bone marrow aspiration and lumbar puncture among children with acute leukaemia: a qualitative study in China

Objective

To obtain in-depth insight into the perceptions of parents and paediatricians in China regarding current procedural pain management on bone marrow aspirations and lumbar punctures in paediatric haemato-oncology department.

Design, setting and participants

This qualitative study was conducted in a 4500-bed university hospital in northwest China. To collect data, in-depth semistructured interviews were conducted with parents of children with acute leukaemia (n=12) and haemato-oncology paediatricians (n=11) using purposive sampling. Interviews were audiotaped and transcribed and subjected to thematic analysis.

Results

The suffering of procedural pain among paediatric patients was not adequately recognised and properly treated at the paediatric haemato-oncology department. The current paediatric procedural pain management is inadequate for paediatric patients. Crucial factors were identified including lack of awareness about the damage of uncontrolled pain in children, parents' low supportive ability, the limited capacity to provide general analgesia by anaesthetists, inadequate knowledge in the usage of analgesia and sedation and lack of efficient analgesic for children's procedural pain. The participants strongly expected optimal interventions to improve paediatric procedural pain management.

Conclusions

The result suggested a perceived and actual poor management of paediatric procedural pain in haemato-oncology department in northwest China. A relevant pain management education programme for paediatricians and parents as well as an effective pain medication are urgently needed in northwest China.

Trial registration

Chinese Clinical Trial Registry. Identifier: ChiCTR-INR-16007989.

http://ift.tt/2xk0t9b

Is increasing urbanicity associated with changes in breastfeeding duration in rural India? An analysis of cross-sectional household data from the Andhra Pradesh children and parents study

Objective

To investigate whether village-level urbanicity and lower level socioeconomic factors are associated with breastfeeding practices in transitioning rural communities in India.

Setting

29 villages in Ranga Reddy district, southern India between 2011 and 2014.

Participants

7848 children under 6 years identified via a cross-sectional household survey conducted as part of the Andhra Pradesh Children and Parents Study.

Outcome measures

Two key indicators of optimal breastfeeding: termination of exclusive breastfeeding before 6 months and discontinuation of breastfeeding by 24 months. Village urbanicity was classified as low, medium or high according to satellite assessed night-light intensity.

Results

Breastfeeding initiation was almost universal, and approximately two in three children were exclusively breastfed to 6 months and a similar proportion breastfed to 24 months. Using multilevel logistic regression, increasing urbanicity was associated with breastfeeding discontinuation before 24 months (medium urbanicity OR 1.45, 95% CI 0.71 to 2.96; high urbanicity OR 2.96, 95% CI 1.45 to 6.05) but not with early (<6 months) termination of exclusive breastfeeding. Increased maternal education was independently associated with both measures of suboptimal breastfeeding, and higher household socioeconomic position was associated with early termination of exclusive breastfeeding.

Conclusion

In this transitional Indian rural community, early stage urbanicity was associated with a shorter duration of breastfeeding. Closer surveillance of changes in breastfeeding practices alongside appropriate intervention strategies are recommended for emerging economies.

http://ift.tt/2xjOpVi

Determinants of community pharmacists quality of care: a population-based cohort study using pharmacy administrative claims data

Objective

To determine if a prototype pharmacists' services evaluation programme that uses linked community pharmacy claims and health administrative data to measure pharmacists' performance can be used to identify characteristics of pharmacies providing higher quality of care.

Design

Population-based cohort study using community pharmacy claims from 1 November 2009 to 30 June 2010.

Setting

All community pharmacies in Quebec, Canada.

Participants

1742 pharmacies dispensing 8 655 348 antihypertensive prescriptions to 760 700 patients.

Primary outcome measure

Patient adherence to antihypertensive medications.

Predictors

Pharmacy level: dispensing workload, volume of pharmacist-provided professional services (eg, refusals to dispense, pharmacotherapy recommendations), pharmacy location, banner/chain, pharmacist overlap and within-pharmacy continuity of care. Patient level: sex, age, income, patient prescription cost, new/chronic therapy, single/multiple antihypertensive medications, single/multiple prescribers and single/multiple dispensing pharmacies. Dispensing level: prescription duration, time of day dispensed and antihypertensive class. Multivariate alternating logistic regression estimated predictors of the primary outcome, accounting for patient and pharmacy clustering.

Results

9.2% of dispensings of antihypertensive medications were provided to non-adherent patients. Male sex, decreasing age, new treatment, multiple prescribers and multiple dispensing pharmacies were risk factors for increased non-adherence. Pharmacies that provided more professional services were less likely to dispense to non-adherent hypertensive patients (OR: 0.60; 95% CI: 0.57 to 0.62) as were those with better scores on the Within-Pharmacy Continuity of Care Index. Neither increased pharmacists' services for improving antihypertensive adherence per se nor increased pharmacist overlap impacted the odds of non-adherence. However, pharmacist overlap was strongly correlated with dispensing workload. There was significant unexplained variability among pharmacies belonging to different banners and chains.

Conclusions

Pharmacy administrative claims data can be used to calculate pharmacy-level characteristics associated with improved quality of care. This study supports the importance of pharmacist's professional services and continuity of pharmacist's care.

http://ift.tt/2fDW4U6

Is the Salut Programme an effective and cost-effective universal health promotion intervention for parents and their children? A register-based retrospective observational study

Objectives

This study investigates the effectiveness and cost-effectiveness of the Salut Programme, a universal health promotion intervention, compared with care-as-usual, over the periods of pregnancy, delivery and the child's first 2 years of life.

Method

We adopted a register-based retrospective observational design using existing data sources with respect to both exposures and outcomes. Health outcomes and costs were compared between geographical areas that received care-as-usual (non-Salut area) and areas where the programme was implemented (Salut area). We included mothers and their children from both the Salut and non-Salut areas if: (1) the child was born 2002–2004 (premeasure period) or (2) the child was born 2006–2008 (postmeasure period). The effectiveness study adopted two strategies: (1) a matched difference-in-difference analysis using data from all participants and (2) a longitudinal analysis restricted to mothers who had given birth twice, that is, both in the premeasure and postmeasure periods. The economic evaluation was performed from a healthcare and a limited societal perspective. Outcomes were clustered during pregnancy, delivery and birth and the child's first 2 years.

Results

Difference-in-difference analyses did not yield any significant effect on the outcomes. Longitudinal analyses resulted in significant positive improvement in Apgar scores, reflecting the newborn's physical condition, with more children having a normal Apgar score (1 min +3%, 5 min +1%). The cost of the programme was international dollar (INT$)308/child. From both costing perspectives, the programme yielded higher effects and lower costs than care-as-usual, being thus cost-saving (probability of around 50%).

Conclusions

Our findings suggest that the Salut Programme is an effective universal intervention to improve maternal and child health, and it may be good value for money; however, there is large uncertainty around the cost estimates.

http://ift.tt/2xj4fiU

Understanding barriers and outcomes of unspecified (non-directed altruistic) kidney donation from both professionals and patients perspectives: research protocol for a national multicentre mixed-methods prospective cohort study

Introduction

Living donation accounts for over one-third of all kidney transplants taking place in the UK.¹ The concept of anonymously donating a kidney to a stranger (non-directed altruistic or unspecified kidney donation (UKD)) remains uncomfortable for some clinicians, principally due to concerns about the motivations and long-term physical and psychological outcomes in this donor group.

Aims

The research programme aims to provide a comprehensive assessment of the unspecified donor programme in the UK. It aims to identify reasons for variations in practice across centres, explore outcomes for donors and ascertain barriers and facilitators to UKD, as well as assess the economic implications of unspecified donation.

Methods

The research programme will adopt a mixed-methods approach to assessing UKD nationally using focus groups, interviews and questionnaires. Two study populations will be investigated. The first will include transplant professionals involved in unspecified kidney donation. The second will include a 5-year prospective cohort of individuals who present to any of the 23 UK transplant centres as a potential unspecified living kidney donor. Physical and psychological outcomes will be followed up to 1 year following donation or withdrawal from the donation process. A matched sample of specified donors (those donating to someone they know) will be recruited as a control group. Further qualitative work consisting of interviews will be performed on a purposive sample of unspecified donors from both groups (those who do and do not donate).

Dissemination

The findings will be reported to NHS Blood and Transplant and the British Transplant Society with a view to developing national guidelines and a protocol for the management of those presenting for unspecified donation.

Trial registration number

ISRCTN23895878, Pre-results.

http://ift.tt/2xjOwQI

A randomised controlled trial of an intervention delivered by app instant messaging to increase the acceptability of effective contraception among young people in Tajikistan: study protocol

Introduction

Women in lower income countries experience unintended pregnancies at a higher rate compared with women in higher income countries. Unintended pregnancy is associated with numerous poorer health outcomes for both women and their children. In Tajikistan, an estimated 26% of married individuals aged 15–24 years have an unmet need for contraception. The strong cultural value placed on childbearing and oppositional attitudes towards contraception are major barriers to contraceptive uptake in the country.

Mobile phone ownership is widespread in Tajikistan. The option of receiving reproductive health support on your personal phone may be an appealing alternative to attending a clinic, particularly for young people. The London School of Hygiene & Tropical Medicine and the Tajik Family Planning Association have partnered to develop and evaluate a contraceptive behavioural intervention delivered by mobile phone. The intervention was developed in 2015–2016 guided by behavioural science. It consists of short instant messages sent through an app over 4 months, contains information about contraception and behaviour change methods.

Methods and analysis

This randomised controlled trial is designed to evaluate the effect of the intervention on self-reported acceptability of effective contraception at 4 months. 570 men and women aged 16–24 years will be allocated with a ratio of 1:1 to receive the intervention messages or the control messages about trial participation. The messages will be sent through the Tajik Family Planning Association's 'healthy lifestyles' app, which contains basic information about contraception.

Ethics and dissemination

The trial was granted ethical approval by the London School of Hygiene & Tropical Medicine Interventions Research Ethics Committee on 16 May 2016 and by the Tajik National Scientific and Research Centre on Paediatrics and Child Surgery on 15 April 2016. The results of the trial will be submitted for publication in peer-reviewed academic journals and disseminated to study stakeholders.

Trial registration number

Clinicaltrial.gov NCT02905513.

Date of registration

14 September 2016.

WHO trial registration dataset

http://ift.tt/2jOZQif

http://ift.tt/2xjIFut

Long-term risk of recurrence after discontinuing anticoagulants for a first unprovoked venous thromboembolism: protocol for a systematic review and meta-analysis

Introduction

For patients with a first unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is a crucial clinical dilemma which has yet to be resolved. The decision to stop anticoagulant therapy (AT) after the initial 3–6 months or to continue AT indefinitely, is primarily governed by the long-term risk of recurrence when treatment is discontinued. This risk however, is not well established, hindering decision making.

Methods and analysis

We will conduct a systematic review and a meta-analysis of studies involving patients diagnosed with a first, symptomatic unprovoked VTE or VTE provoked by minor transient risk factors, who have completed at least 3 months of initial AT; and who were followed-up for standardised time intervals of 1, 2, 5, 10 and 20 years (±3 months) after stopping AT. We will search (from inception to January 2017) MEDLINE, Embase and the Cochrane library for randomised controlled trials and prospective observational studies. Two reviewers will conduct all screening and data collection independently. The primary outcome of the rate of recurrent VTE at the standardised time intervals will be calculated for each study from the total number of recurrent events and the corresponding number of patient-years of follow-up. We will use a random-effects model to pool study results and report a weighted estimate of the absolute rate of recurrent VTE (events per 100 patient-years) over standardised time intervals of 1, 2, 5, 10 and 20 years after discontinuing anticoagulants.

Ethics and dissemination

Ethical approval is not applicable for this study. Findings from this study will be disseminated through peer-reviewed journal publication as well as relevant national and international conference presentations.

PROSPERO registration number

CRD42017056309.

http://ift.tt/2fDVHZI

Production, partial optimization and characterization of keratinase enzyme by Arthrobacter sp. NFH5 isolated from soil samples

The study was conducted to select the best promising keratinolytic bacterial strain. A good keratinase positive bacterium isolated from the soil samples of Hazaribagh tannery industrial zone, Dhaka was identif...

http://ift.tt/2yukGqc

Posteriorly dislocated capsular tension ring leading to rhegmatogenous retinal detachment

Description

A 54-year-old woman presented with sudden diminution of vision in her left eye 4 months before. Medical history revealed that she underwent a phacoemulsification 1 year before in the left eye and 4 years before in the right eye. Snellen visual acuity in the right eye was 20/20 while she was just able to count fingers at 1 m in the left eye. She had a divergent squint of 30 prism dioptres in the left eye. The right eye had a well-centred foldable posterior chamber intraocular lens (PCIOL) in the capsular bag, while the left eye had a rigid polymethyl methacrylate (PMMA) PCIOL in the sulcus with a large posterior capsular defect (figure 1A). On fundus examination of the left eye, we found a total rhegmatogenous retinal detachment with a large punched-out toxoplasma scar at the macula, three retinal horseshoe tears superonasally at the equator (figure 2B) and a...

http://ift.tt/2xVYSGX

Splenic calcification in systemic lupus erythematosus

Description

A 39-year-old woman with known systemic lupus erythematosus (SLE) nephropathy, antiphospholipid syndrome and chronic renal failure was evaluated for renal transplant. She was asymptomatic; nevertheless, the abdominal ultrasonogram showed splenic calcification (figure 1). The chest radiograph showed faint lesions suggestive of (L) hypochondrial calcification (figure 2). The tuberculin skin test result revealed induration of 3 mm. She had no history of treatment for tuberculosis or brucellosis. The angiotensin-converting enzyme was normal at 19 U/L (normal range 29–112 U/L). A CT scan of the abdomen and pelvis showed a bulky spleen that contained numerous small and differently sized smooth calcific foci probably related to granulomatous disease. No calcification was seen in the liver (figure 3A, B). There were no definite or suspicious pulmonary nodules seen on a whole body fluorodeoxyglucose positron-emission tomography (PET) scan. Similarly, numerous tiny splenic calcifications with no abnormal metabolic activity were detected...

http://ift.tt/2jQH61F

Diaphyseal tuberculosis - a rare manifestation

DESCRIPTION

A 2 year old child presented with low-grade fever, progressive pain and swelling of right leg for the past 3 months. There was no history of injury, chronic cough, respiratory symptoms, weight loss or arthritis. Child's father had been treated for pulmonary tuberculosis 1 year back. On examination, there was a firm, diffuse, tender swelling over the medial aspect of middle one-third of right tibia and matted inguinal lymphadenopathy. Rest of the systemic examination was not contributory. A clinical diagnosis of diaphyseal bone tumour or chronic infective osteomyelitis was considered.

Investigations showed erythrocyte sedimentation rate 46 mm in first hour, haemoglobin 96 g/L and 20 mm induration after Mantoux test and normal chest radiograph. Radiograph of the right tibia showed a lytic intramedullary bone lesion (Figure 1A–B). MRI confirmed an intramedullary lytic lesion with cortical breach and thickening (figure 1C). Histopathology showed caseous necrosis, granuloma formation, Langhans giant cells...

http://ift.tt/2xVhg2O

Cholesterol embolism: its always a good idea to look into the eye

Description

Atheroembolism is a rare but feared complication of arteriography, causing a myriad of signs and symptoms including livedo reticularis, abdominal pain, cyanosis of the toes and renal injury. The main cause is a rupture of atherosclerotic plaque in vessel walls and its embolisation to small diameter vessels affecting more frequently skin and kidneys.1 Here, we present a 69-year-old Hispanic male with medical history of hypertension, type 2 diabetes mellitus and unstable angina status post drug-eluting stent in the left anterior descending coronary artery placement 10 days prior to admission, who arrived to the emergency department with intense diffuse sharp abdominal pain, nausea, vomiting, oliguria and lower extremity pain. Physical examination disclosed livedo reticularis in lower extremities (figure 1), tender abdomen with decreased bowel sounds and funduscopy positive for a Hollenhorst crystal observed in right inferotemporal quadrant (figure 2) and increased creatinine and...

http://ift.tt/2jOfRVv

Infected enteric duplication cyst

Description

An 8-month-old female infant presented with a 2-day history of vomiting, diarrhoea and fever. Physical examination revealed a painful right abdomen. Laboratory tests showed a C-reactive protein of 140 mg/L (normal: <6 mg/L) and a white blood cell count of 12.8x10⁹/L (normal: 4–15x10⁹/L). Ultrasound of the abdomen revealed a paracolic cystic mass of 1.4x5 cm with septations from the lower part of the liver into the right fossa with no signs of volvulus or intussusception (figure 1). Abdominal CT confirmed the cystic mass and revealed signs of infection. MRI of the abdomen suggested an enteric duplication cyst as the most likely diagnosis (figure 2).

Figure 1

Ultrasound: encapsulated tubular mass with predominant hypoechoic heterogeneous echogenicity under the right lobe of the liver.

Figure 2

MRI coronal T1-weighted image with intravenous contrast: tubular cystic mass with thick wall ventral and lateral...

http://ift.tt/2xVh97o

An airway traffic jam: a plastic traffic cone masquerading as bronchial carcinoma

Tracheobronchial foreign body (TFB) aspiration is a common occurrence in children compared with adults. Long-standing cases of TFB aspiration during childhood presenting in an adult have rarely been reported. We report the unique case of an endobronchial Playmobil traffic cone that went undetected for 40 years and presented as a suspected bronchogenic carcinoma. This was subsequently removed successfully with flexible bronchoscopy. To our knowledge this is the first case of a TFB that was overlooked this length of time.

http://ift.tt/2jQGMzZ

Reply to ‘Comment on ‘Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study’’

Reply to 'Comment on 'Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study''

British Journal of Cancer advance online publication, September 21 2017. doi:10.1038/bjc.2017.328

Authors: Stephen Morrell, David Roder & Richard Taylor

http://ift.tt/2wDZJfm

Rare cancers: the greatest inequality in cancer research and oncology treatment

Rare cancers: the greatest inequality in cancer research and oncology treatment

British Journal of Cancer advance online publication, September 21 2017. doi:10.1038/bjc.2017.321

Authors: Muhammad A Alvi, Richard H Wilson & Manuel Salto-Tellez

http://ift.tt/2wDiY8O

Dose–response effects of aerobic exercise on body composition among colon cancer survivors: a randomised controlled trial

Dose–response effects of aerobic exercise on body composition among colon cancer survivors: a randomised controlled trial

British Journal of Cancer advance online publication, September 21 2017. doi:10.1038/bjc.2017.339

Authors: Justin C Brown, Babette S Zemel, Andrea B Troxel, Michael R Rickels, Nevena Damjanov, Bonnie Ky, Andrew D Rhim, Anil K Rustgi, Kerry S Courneya & Kathryn H Schmitz

http://ift.tt/2wDkMyD

Response to Morrell et al's reply

Response to Morrell et al's reply

British Journal of Cancer advance online publication, September 21 2017. doi:10.1038/bjc.2017.322

Author: Anthony B Miller

http://ift.tt/2wEmPT0

Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer

Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer

British Journal of Cancer advance online publication, September 21 2017. doi:10.1038/bjc.2017.320

Authors: Francesco Sclafani, Gina Brown, David Cunningham, Andrew Wotherspoon, Larissa Sena Teixeira Mendes, Svetlana Balyasnikova, Jessica Evans, Clare Peckitt, Ruwaida Begum, Diana Tait, Josep Tabernero, Bengt Glimelius, Susana Roselló, Janet Thomas, Jacqui Oates & Ian Chau

http://ift.tt/2wEj7ZC

Clinically significant mutations in HIV-infected patients with lung adenocarcinoma

Clinically significant mutations in HIV-infected patients with lung adenocarcinoma

British Journal of Cancer advance online publication, September 21 2017. doi:10.1038/bjc.2017.333

Authors: Jonathan Thaler, Carlie Sigel, Mary Beth Beasley, Juan Wisnivesky, Kristina Crothers, Joshua Bauml, Kristen Hysell, Brinda Emu, Laetitia Borsu & Keith Sigel

http://ift.tt/2wF9euY

Pervasive, Genome-Wide Transcription in the Organelle Genomes of Diverse Plastid-Bearing Protists

Organelle genomes are among the most sequenced kinds of chromosome. This is largely because they are small and widely used in molecular studies, but also because next-generation sequencing (NGS) technologies made sequencing easier, faster, and cheaper. However, studies of organelle RNA have not kept pace with those of DNA, despite huge amounts of freely available eukaryotic RNA-sequencing (RNA-seq) data. Little is known about organelle transcription in non-model species, and most of the available eukaryotic RNA-seq data have not been mined for organelle transcripts. Here, we use publicly available RNA-seq experiments to investigate organelle transcription in 30 diverse plastid-bearing protists with varying organelle genomic architectures. Mapping RNA-seq data to organelle genomes revealed pervasive, genome-wide transcription, regardless of the taxonomic grouping, gene organization, or non-coding content. For every species analyzed, transcripts covered at least 85% of the mitochondrial and/or plastid genomes (all of which were ≤ 105 kb), indicating that most of the organelle DNA-coding and non-coding-is transcriptionally active. These results follow earlier studies of model species showing that organellar transcription is coupled and ubiquitous across the genome, requiring significant downstream processing of polycistronic transcripts. Our findings suggest that non-coding organelle DNA can be transcriptionally active, raising questions about the underlying function of these transcripts and underscoring the utility of publicly available RNA-seq data for recovering complete genome sequences. If pervasive transcription is also found in bigger organelle genomes (>105 kb) across a broader range of eukaryotes, this could indicate that non-coding organelle RNAs are regulating fundamental processes within eukaryotic cells.

http://ift.tt/2fltvhI

Mechanisms of Transmission Ratio Distortion at Hybrid Sterility Loci Within and Between Mimulus Species

Hybrid incompatibilities are a common correlate of genomic divergence and a potentially important contributor to reproductive isolation. However, we do not yet have a detailed understanding of how hybrid incompatibility loci function and evolve within their native species, or why they are dysfunctional in hybrids. Here, we explore these issues for a well-studied, two-locus hybrid incompatibility between hybrid male sterility 1 (hms1) and hybrid male sterility 2 (hms2) in the closely related yellow monkeyflower species Mimulus guttatus and M. nasutus. By performing reciprocal backcrosses with introgression lines, we find evidence for gametic expression of the hms1-hms2 incompatibility. Surprisingly, however, hybrid transmission ratios at hms1 do not reflect this incompatibility, suggesting additional mechanisms counteract the effects of gametic sterility. Indeed, our backcross experiment shows hybrid transmission bias toward M. guttatus through both pollen and ovules, an effect that is particularly strong when hms2 is homozygous for M. nasutus alleles. In contrast, we find little evidence for hms1 transmission bias in crosses within M. guttatus, providing no indication of selfish evolution at this locus. Although we do not yet have sufficient genetic resolution to determine if hybrid sterility and transmission ratio distortion map to the same loci, our preliminary fine-mapping uncovers a genetically independent hybrid lethality system involving at least two loci linked to hms1. This fine-scale dissection of transmission ratio distortion at hms1 and hms2 provides insight into genomic differentiation between closely related Mimulus species and reveals multiple mechanisms of hybrid dysfunction.

http://ift.tt/2xyImvx

Effectiveness of acupuncture for breast cancer related lymphedema: protocol for a single-blind, sham-controlled, randomized, multicenter trial

Although various treatments for breast cancer related lymphedema exist, there is still a need for a more effective and convenient approach. Pilot studies and our clinical observations suggested that acupunctur...

http://ift.tt/2hn6GqO

Adverse Effects of a Single Dose of Gentamicin in Adults: A Systematic Review

Summary

Aim

Systematically review the frequency and type of adverse events associated with a single dose of intravenous or intramuscular gentamicin in adults, for any indication, in studies where a comparator was available.

Methods

A review protocol was developed and registered (PROSPERO: CRD42013003229). Studies were eligible for review if they; recruited participants ≥16 years old, used gentamicin intramuscularly or intravenously as a single one-off dose, compared gentamicin to another medication or placebo, and if adverse events were monitored. MEDLINE, EMBASE, Cochrane Library, trial registries, conference proceedings and other relevant databases were searched up to November 2016. Risk of bias was assessed on all included studies.

Results

15,522 records were identified. After removal of duplicates, screening of title/abstracts for relevance and independent selection of full texts by two reviewers, 36 studies were included. 24,107 received a single one-off dose of gentamicin (doses ranged from 1mg/kg - 480mg per dose). Acute kidney injury was described in 2520 participants receiving gentamicin. The large majority of cases were reversible. There were no cases of ototoxicity reported in patients receiving gentamicin. A meta-analysis was not performed due to study heterogeneity.

Conclusions

A significant number of patients saw a transient rise in creatinine after a single dose of gentamicin at doses up to 480mg. Persistent renal impairment and other adverse events were relatively rare.

http://ift.tt/2xrZzXk

Novel 9 amino acid in-frame deletion in the NTRK1 tyrosine kinase domain in a patient with congenital insensitivity to pain with anhydrosis

Schematic presentation of NTRK1 protein structure. Variants identified in this study are shown in red and previously reported variants associated with CIPA are shown in black (LRM, leucine rich motif; Ig, immunoglobulin-like domain; TM, transmembrane domain; TK, tyrosine kinase domain).

http://ift.tt/2xjdtMc

Issue Information - Editorial Board

http://ift.tt/2fDXRZu

Shifting trends in bacteriology and antimicrobial resistance among gastrointestinal fistula patients in China: an eight-year review in a tertiary-care hospital

The purpose of this study was to determine the shifting trends in bacteriology and antimicrobial resistance of infectious specimens isolated from gastrointestinal (GI) fistula patients over eight years in China.

http://ift.tt/2xkOIMV

Clostridium difficile infection in the Lao People’s Democratic Republic: first isolation and review of the literature

Current knowledge of the epidemiology of Clostridium difficile infection in Asia, and in particular the Greater Mekong Subregion, is very limited. Only a few studies from Thailand and Vietnam have been reported f...

http://ift.tt/2xiBJ0S

Effects of X-ray on the metacestodes of Echinococcus granulosus in vitro

Radiotherapy may represent an alternative treatment modality for cystic echinococcosis (CE), but there is no adequate evidence for it up to now. In this study, we aim to investigate the parasiticidal effects o...

http://ift.tt/2xkOyVP

ASXL3 is a Novel Pluripotency Factor in Human Respiratory Epithelial Cells and a Potential Therapeutic Target in Small Cell Lung Cancer

In this study, we generated induced pluripotent stem cells (iPSC) from normal human small airway epithelial cells (SAEC) to investigate epigenetic mechanisms of stemness and pluripotency in lung cancers. We documented key hallmarks of reprogramming in lung iPSC (Lu-iPSC) that coincided with modulation of more than 15,000 genes relative to parental SAEC. Of particular novelty, we identified the PRC2-associated protein, ASXL3 which was markedly upregulated in Lu-iPSC and small cell lung cancer (SCLC) lines and clinical specimens. ASXL3 overexpression correlated with increased genomic copy number in SCLC lines. ASXL3 silencing inhibited proliferation, clonogenicity and teratoma formation by Lu-iPSC, and diminished clonogenicity and malignant growth of SCLC cells in-vivo. Collectively, our studies validate the utility of the Lu-iPSC model for elucidating epigenetic mechanisms contributing to pulmonary carcinogenesis, and highlight ASXL3 as a novel candidate target for SCLC therapy.

http://ift.tt/2xrNZvb

miR-130a deregulates PTEN and stimulates tumor growth

H-RasV12 oncogene has been shown to promote autophagic cell death. Here we provide evidence of a contextual role for H-RasV12 in cell death that is varied by its effects on miR-130a. In E1A-immortalized murine embryo fibroblasts, acute expression of H-RasV12 promoted apoptosis but not autophagic cell death. miRNA screens in this system showed that miR-130a was strongly downregulated by H-RasV12 in this model system. Enforced expression of miR-130a increased cell proliferation in part via repression of PTEN. Consistent with this effect, miR-130a overexpression in human breast cancer cells promoted Akt phosphorylation, cell survival and tumor growth. In clinical specimens of multiple human cancers, expression of miR-130 family members correlated inversely with PTEN expression. Overall, our results defined miR-130a as an oncogenic microRNA that targets PTEN to drive malignant cell survival and tumor growth.

http://ift.tt/2wLlsxa

Diabetes treatments and risks of adverse breast cancer outcomes among early stage breast cancer patients: A SEER-Medicare analysis

The widely prescribed diabetes medicine metformin has been reported to lower the risk of incident breast cancer, but it is unclear if it affects malignant progression after diagnosis. In this study, we conducted a retrospective cohort study using the linked Surveillance, Epidemiology and End-Results (SEER)-Medicare database. Women were included in the study if they were aged 66-80 years, newly diagnosed with stage I or II breast cancer, and enrolled in Medicare Parts A, B, and D during 2007-2011. Information on dispensed diabetes-related medications was obtained from Medicare Part D claims data. Our primary outcomes were second breast cancer events (SBCE), breast cancer recurrence, and breast cancer death. Time-varying Cox proportional hazard models were used to estimate hazard ratios and their 95% confidence intervals (CI). Among 14,766 women included in the study, 791 experienced SBCE, 627 had a recurrence, and 237 died from breast cancer. Use of metformin (n=2,558) was associated with 28% (95% CI: 0.57-0.92), 31% (95% CI: 0.53-0.90), and 49% (95% CI: 0.33-0.78) lower risks of a SBCE, breast cancer recurrence, and breast cancer death. Use of sulfonylureas or insulin was associated with 1.49 (95% CI: 1.00-2.23) and 2.58-fold (95%CI: 1.72-3.90) higher risks of breast cancer death. Further research may be warranted to determine if metformin is a preferred treatment for diabetes among breast cancer survivors and whether it benefits breast cancer patients without diabetes.

http://ift.tt/2xs3wLI

Immunomodulation in multiple sclerosis: promises and pitfalls

Calliope A Dendrou | Lars Fugger

http://ift.tt/2jPi9DW

Cost minimization analysis of a long-term randomized clinical trial of patients treated with immediately loaded implant-supported fixed prosthesis

Abstract

Purpose

To document the long-term costs from a randomized controlled clinical trial (RCT) on edentulous patients treated with mandibular 4-implant-supported fixed prosthesis and two loading protocols.

Methods

Taking the perspective of the individual patient, costs associated with treatment, complications, and patients' time from 18 patients who received an immediate-loading protocol and 21 patients treated with a conventional loading protocol were compared over 10 years of observation. All costs are in Canadian dollars and discounted to the RCT base year of 2006 at a rate of 1.5%.

Results

The complication rate in both arms was similar and relatively low. No statistically significant difference was observed in the total cost and discounted total cost, along with its five comprising parameters between the two arms.

Conclusions

Over the 10-year time frame, the immediate loading of dental implants with mandibular fixed prosthesis proved to cost similar to the conventional loading protocol, underscoring the feasibility and reliability of this protocol from the patient's perspective. (REB protocol reference # 33395).

http://ift.tt/2xVUNCR

A comparative study of encode protocol versus conventional protocol for restoring single implants: One-year prospective randomized controlled clinical trial

Abstract

Background

The Encode protocol (Biomet 3i, Palm Beach Gardens, Fla) has been proposed as a simplified implant restoration protocol.

Purpose

To compare the 1-year clinical outcome of the Encode and conventional protocols for restoring single implants.

Materials and methods

Forty-seven implants were inserted in 44 patients. After randomizing the implants, 24 implants were allocated to the Encode protocol and 23 implants were allocated to the conventional protocol. After 1 year, changes in esthetics, patient satisfaction, proximal contacts quality, occlusal contacts quality, marginal bone level (MBL), and probing pocket depth (PPD) were evaluated. Further, the prosthesis cleansability, mucosal health, bleeding on probing (BoP), metallic discoloration, and all forms complications were recorded.

Results

Forty patients with 41 implants (22 Encode and 19 conventional) were recalled. One conventional crown failed due to excessive looseness. Esthetics, patient satisfaction, and prosthesis cleansability were favorable for the two protocols. One Encode crown (4.5%) and six conventional crowns (33.3%) had slight mucosal redness. BoP was present around 8 Encode crowns (36.4%) and eight conventional crowns (45.4%). Only two conventional crowns showed metallic discoloration of the mucosa. The two protocols had similar PPD alteration (Encode = 0.04 mm, conventional = 0.13 mm), and MBL loss (Encode = 0.71 mm, conventional = 0.78 mm). Similar proximal contacts and occlusal contacts were observed for the two protocols.

Conclusions

After 1 year, the Encode protocol for restoring single implants appears to be comparable to the conventional protocol from the biological, prosthetic, and esthetic perspectives.

http://ift.tt/2jODJIL

Long-term stable vertical bone regeneration after sinus floor elevation and simultaneous implant placement with and without grafting

Abstract

Background

Less invasive surgical approaches to regenerate bone intra-sinus and allow long-term functional implant stability are needed.

Purpose

To evaluate long-term vertical bone regeneration after sinus floor elevation and simultaneous implant placement with and without bone grafting.

Methods

Vertical bone gains (VBG) post-sinus elevation, with and without grafting, were evaluated in thirty individuals presenting an average residual bone height (RBH) of 4.2 mm using a standardized digital technique. Measurements were taken preoperatively, and at an average of 64.6 months follow-up. Clinically, peri-implant tissues were assessed for pocket formation and presence of inflammation to evaluate established success criteria.

Results

Overall, RBH averaged 4.2 ± 1.1 mm (range: 1.8-5.8) and VBG 7.7 ± 1.6 mm (range: 6.0-12.9). Mean difference of 7.6 mm between vertical bone heights (VBH) at augmented implants sites and initial RBH, 11.8 versus 4.2 mm, (P < .0001, CI95%: 6.9-8.2) was statistically significant. RBH averaged 4.5 ± 0.8 mm and 3.8 ± 1.2 (P = .07) and VBG 6.8 ± 0.5 and 8.5 ± 1.9 mm (P = .003, CI95%: 0.6-2.7), for nongrafted and grafted individuals, respectively. The grafting group received an average graft volume of 0.35 ± 0.1 cc (range: 0.25-0.5) per implant site. Long-term follow-ups average 64.6 months (range: 36-144) and all implants met the success criteria. VBG ≥ 7 mm were 7.3 times more likely to develop on grafted sites (OR = 7.3, P = 0.02, CI95%: 1.2-46.2).

Conclusion

None to negligible amounts of grafting material are required to regenerate substantial amounts of autogenous bone into atrophic sinus cavities after simultaneous implant placement. The regenerated VBH seems stable for functional implant stability long-term. Implant success rates were 100% at an average of 64.6 months.

http://ift.tt/2xVUGqV

Short-term Follow-up Mammography in Breast Conservation Therapy likely Leads to Unnecessary Downstream Workup: A Longitudinal Study

Early post-treatment in breast conservation therapy is common. Patients who underwent screening mammogram prior to 6 months after completion of radiation treatment were more likely to undergo downstream workup, including additional diagnostic imaging and biopsies compared to those with mammograms after 6 months. Radiation boost to the postoperative bed was associated with supplementary imaging, whereas accelerated partial breast irradiation and hypofractionated treatment did not demonstrate this association.

http://ift.tt/2yulj39

Using Indocyanine Green Extraction to Predict Liver Function After Stereotactic Body Radiotherapy for Hepatocellular Carcinoma

Indocyanine green (ICG) is a direct measure of hepatocyte function. Incorporation of ICG with standard clinical factors significantly improves the prediction of post SBRT liver function when toxicity is defined by an increase of Child Pugh (CP) > 2 or change in absolute albumin-bilirubin (ALBI) score > 0.5 or ALBI grade > 1. The use of ICG may facilitate the delivery of the maximum safe dose of radiation for patients with hepatocellular carcinoma and has the potential to improve uncomplicated tumor control and survival.

http://ift.tt/2wEiXkV

Arthroscopic, open and mini-open approach for rotator cuff repair: no difference in pain or function at 24 months

Background

The New Zealand Rotator Cuff Registry was established in 2009 to collect prospective functional, pain and outcome data on patients undergoing rotator cuff repair (RCR).

Methods

Information collected included an operation day technical questionnaire completed by the surgeon and Flex Shoulder Function (SF) functional and pain scores preoperatively, immediately post-operatively and at 6, 12 and 24 months. A multivariate analysis was performed analysing the three surgical approaches to determine if there was a difference in pain or functional outcome scores.

Results

A total of 2418 RCRs were included in this paper. There were 418 (17.3%) arthroscopic, 956 (39.5%) mini-open and 1044 (43.2%) open procedures. Twenty-four-month follow-up data were obtained for pain and Flex SF in 71% of patients. At 24 months, there was no difference in the average Flex SF score for the arthroscopic, mini-open and open groups. There was no difference in improvement in Flex SF score at 24 months. At 24 months, there was no difference in mean pain scores. There was no difference in improvement in pain score from preoperation to 24 months. Most patients returned to work within 3 months of surgery, with no difference between the three surgical approaches.

Conclusion

RCR has good to excellent outcomes in terms of improvement in pain and function at 2-year follow-up. We found no difference in pain or functional outcome at 24 months between arthroscopic, open and mini-open approaches for RCR.

http://ift.tt/2wDIdrF

Burden, etiology and predictors of visual impairment among children attending Mulago National Referral Hospital eye clinic, Uganda

Background: Childhood visual impairment (CVI) has not been given due attention. Knowledge of CVI is important in planning preventive measures. The aim of this study was determine the prevalence, etiology and the factors associated with childhood visual impairment among the children attending the eye clinic in Mulago National Referral Hospital.

Methods: This was a cross sectional hospital based study among 318 children attending the Mulago Hospital eye clinic between January 2015 to March 2015. Ocular and general history was taken and patient examination done. The data generated was entered by Epidata and analyzed by STATA 12.

Results: The prevalence of CVI was 42.14%, 134 patients with 49 patients (15.41%) having moderate visual impairment, 45 patients (14.15%) having severe visual impairment and 40 patients (12.58%) presenting with blindness. Significant predictors included; increasing age, delayed developmental milestones and having abnormal corneal, refractive and fundus findings.

Conclusion: There is a high burden of visual impairment among children in Uganda. It is vital to screen all the children presenting to hospital for visual impairment. Majority of the causes of the visual impairment are preventable.

Keywords: Visual impairment, Mulago National Referral Hospital, Eye clinic, Uganda

http://ift.tt/2jN5pxw

Multidrug and vancomycin resistance among clinical isolates of Staphylococcus aureus from different teaching hospitals in Nigeria

Backgrounds: Staphylococcus aureus has emerged as a major public health concern because of the occurrence of multi-drug resistant strains. This study aimed at investigating the multi-drug and vancomycin resistance profile of S. aureus from different infection sites in some teaching hospitals in Nigeria.

Methods: Swabs were collected from different infection sites from out-patients in three teaching hospitals from October 2015 to May, 2016. The antibiotic-susceptibility test was carried out with selected antibiotics usually administered anti-microbials in the treatment of infections in these hospitals. The prevalence of multi-drug and vancomycin resistance strains of S. aureus from clinical samples was determined using disk diffusion and agar dilution methods respectively.

Results: The result showed (165)82.5% of the isolates were resistant to ≥3 antibiotics tested. They were highly resistant to ceftazidime 180(90%), cloxacillin 171(85.6%) and augmentin 167(83.3%), but susceptible to ofloxacin 150(75%), gentamicin 142(71.7%), erythromycin 122(61.1%), ceftriaxone 111(55.6%) and cefuroxime 103(51.7%). All the isolates from the HVS were all multidrug resistant strains. While (56)90.16% were multidrug resistant (MDR) in urine samples, followed by (8)88.89% MDR strains in sputum, (37)88.81% MDR strains in semen, (49)71.64% MDR strains in wounds and (6)60% MDR strains in ear swabs samples. Although (147)73.5% of the isolates were vancomycin susceptible S. aureus (VSSA), (30)15% were vancomycin intermediate resistant S. aureus (VISA) and (89)44.5% of the isolates were considered vancomycin resistant S. aureus (VRSA).

Conclusions: The high percentage of the VRSA could have resulted from compromising treatment options and inadequate antimicrobial therapy. The implication, infections caused by VRSA would be difficult to treat with vancomycin and other effective antibiotics of clinical importance. Ensuring proper monitoring of drug administration will, therefore, enhance the legitimate role of vancomycin as an empiric choice for both prophylaxis against and treatment of staphylococcal infections.

Keywords: Bacterial resistance, vancomycin resistant S. aureus, susceptibility studies, agar dilution

http://ift.tt/2xrNAsD

Efficacy of combined traditional Chinese medicine spray with premature ejaculation desensitization therapy for the treatment of primary premature ejaculation

Objectives: We recommend a new kind of spray made from eight kinds of traditional Chinese medicine, we aimed to investigate the safety and clinical efficacy of combined traditional Chinese medicine spray (TCMS) with premature ejaculation desensitization therapy (PEDT) for the treatment of primary premature ejaculation (PPE).

Methods: A total of 90 patients with PPE were randomly assigned to receive TCMS, PEDT monotherapy or TCMS plus PEDT combination therapy for 6 weeks. Intravaginal ejaculation latency time (IELT) and Chinese index of sexual function for premature ejaculation (CIPE-5) were measured to evaluate the effect of each treatment.

Results: Eighty six (86) participants completed the study voluntarily. Both IELT and CIPE-5 in these three groups increased after treatment when compared with baseline levels (p< 0.01). IELT and CIPE-5 after treatment in TCMS plus PEDT group were significantly higher than those in the other two groups (both p <0.05). Additionally, clinical efficacy in TCMS plus PEDT group (89.7%) was significantly higher than in TCMS (65.5%) and PEDT group (67.9%) (p< 0.01).

Conclusion: The self-made TCMS was safe and effective for the treatment of PPE, a combination of TCMS and PEDT therapy was more effective than the TCMS or PEDT monotherapy.

Keywords: Primary premature ejaculation (PPE); traditional Chinese mdicine spray (TCMS); premature ejaculation desensitization training therapy (PEDT); Intravaginal ejaculation latency time (IELT); Chinese index of sexual function for premature ejaculation (CIPE-5)

http://ift.tt/2xrW6Il

Editorial: Sexuality, mother-child health and infectious diseases

No Abstract

http://ift.tt/2jRooHw

Early sexual debut: prevalence and risk factors among secondary school students in Ido-ekiti, Ekiti state, South-West Nigeria

Background: Early adolescent sexual activity remains a recurring problem with negative psychosocial and health outcomes. The age at sexual debut varies from place to place and among different individuals and is associated with varying factors. The aim was to determine the prevalence and risk factors of early sexual debut among secondary school students in Ido-Ekiti, South-West Nigeria.

Methodology: This was a cross-sectional study. The respondents were selected using multi-stage sampling technique. Pre-tested, semi-structured, self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 15.

Results: More than two-thirds, 40(67.8%), had early sexual debut. The prevalence of early sexual debut was about 11%. The mean age of sexual debut was 13.10±2.82; the mean age for early sexual debutants was 11.68±1.98. The mean number of sexual partners was 2.44±1.99. Male gender, having friends who engaged in sexual activities had association with early sexual exposure (p<0.05). Alcohol intake had the strongest strength of association for early sexual debut among the students.

Conclusion: The high prevalence of early sexual exposure among the students calls for urgent interventions to stem the trend. This will help to reduce the devastating negative psycho-social and health sequels.

Keywords: Sexual debut, prevalence, risk factors, Nigeria

http://ift.tt/2xruOSn

Common mental disorders among medical students in Jimma University, SouthWest Ethiopia

Background: Medical students are at risk of common mental disorders due to difficulties of adjustment to the medical school environment, exposure to death and human suffering. However there is limited data on this aspect. Therefore, the current study assessed the magnitude of common mental disorders and contributing factors among medical students.

Methods: An institutional based cross-sectional study was conducted from May 12–16, 2015 using stratified sampling technique. Three hundred and five medical students participated in the study. Common mental disorders were assessed using the self-reported questionnaire (SRQ-20). Logistic regression analysis was used to identify factors associated with common mental disorders among students. Adjusted odds ratios with 95% confidence interval were computed to determine the level of significance.

Result: Prevalence of common mental disorders among medical students was 35.2%. Being female, younger age, married, having less than 250 birr monthly pocket money, attending pre-clinical class, khat chewing, smoking cigarettes, alcohol drinking and ganja/shisha use were significantly associated with common mental disorders.

Conclusion: The overall prevalence of common mental disorders among medical students was high. Therefore, it is essential to institute effective intervention strategies giving emphasis to contributing factors to common mental disorders.

Keywords: Common mental disorders, medical students, prevalence, Ethiopia

http://ift.tt/2jRwcZR

Female sexual outcomes in primiparous women after vaginal delivery and cesarean section

Background: Sexual function is an essential component of life and yet very little is known about the relationships between the female sexuality and the mode of delivery.

Objective: To compare sexual outcomes after vaginal delivery and cesarean section.

Methods: A cross-sectional study was conducted on women in two stages; early pregnancy and 3 to 6 months after delivery in health centers. Female sexual outcomes evaluated were female Sexual Function Index scores and the time required to resume sexual activities after delivery.

Results: Sexual function did not differ significantly among two groups vaginal delivery n=90 and cesarean section n = 113 with regard to duration of marriage, educational level, contraception methods, and occupational status p = 0.8.The mean timing of the resumption of sexual activity was 8.9 ± 1.3, and there was no substantial conflict between the two groups. Mean frequency of intercourse in the post-partum period was 1.8±1.2 times per week with significant difference compared to pre pregnancy P<0.05. The individual domain scores after the delivery was significantly lower in comparison with pre-pregnancy p<0.004.

Conclusion: No differences in sexual outcomes between vaginal delivery and cesarean section. Consequently cesarean section cannot be recommended in the view of maintenance of normal sexuality after child birth.

Keywords: Women's health, cesarean section, post-partum, vaginal delivery, female sexual function

http://ift.tt/2xrSrtZ

Methodological challenges in a study on falls in an older population of Cape Town, South Africa

Background: Falls are a major cause of disability, morbidity and mortality in older persons, but have been under researched in developing countries. .

Objective: To describe challenges encountered in a community-based study on falls in a multi-ethnic population aged ≥65 years in a low-income setting.

Methods: The study was conducted in four stages: A pilot study (n=105) to establish a sample size for the survey. An equipment validation study (n=118) to use for fall risk determination. A cross-sectional baseline (n=837) and a 12-month follow-up survey (n=632) to establish prevalence and risk factors for falls.

Results: Prevalence rate of 26.4% (95% CI 23.5-29.5%) and risk factors for recurrent falls: previous falls, self-reported poor mobility and dizziness were established. Adaptations to the gold standard prospective fall research study design were employed: 1) to gain access to the study population in three selected suburbs, 2) to perform assessments in a non-standardised setting, 3) to address subjects' poverty and low literacy levels, and high attrition of subjects and field workers.

Conclusion: Studies on falls in the older population of low- to middle-income countries have methodological challenges. Adaptive strategies used in the Cape Town study and the research experience reported may be instructive for investigators planning similar studies in such settings.

Keywords: Falls, older people, community-based research, low and middle income countries, methodology, study design

http://ift.tt/2jPzRXJ

Diagnosis and treatment of unconsummated marriage in an Iranian couple

Background: Unconsummated marriage is a problem among couples who would not be able to perform natural sexual intercourse and vaginal penetration. This disorder is more common in developing countries and sometimes couples would come up with non-technical and non-scientific methods to overcome their problem. Multi-dimensional approach and narrative exposure therapy used in this case.

Methods: This study would report a case of unconsummated marriage between a couple after 6 years. The main problem of this couple was vaginismus and post-traumatic stress.

Results: Treatment with multi-dimensional approach for this couple included methods like narrative exposure therapy, educating the anatomy of female and male reproductive system, correcting misconceptions, educating foreplay, educating body exploring and non-sexual and sexual massage and penetrating the vagina first by women finger and then men's after relaxation. The entire stages of the treatment lasted for four sessions and at the one-month follow-up couple's satisfaction was desirable.

Conclusion: Unconsummated marriage is one of the main sexual problems; it is more common in developing countries than developed countries and cultural factors are effective on intensifying this disorder. The use of multi-dimensional approach in this study led to expedite diagnosis and treatment of vaginismus.

Keywords: Unconsummated marriage, couple's therapy, vaginismus, behavioral therapy

http://ift.tt/2xriBNi

Anti-mycobacterium tuberculosis activity of polyherbal medicines used for the treatment of tuberculosis in Eastern Cape, South Africa

Background: The emergence of drug-resistant strains of Mycobacterium tuberculosis has become a global public health problem. Polyherbal medicines offer great hope for developing alternative drugs for the treatment of tuberculosis.

Objective: To evaluate the anti-tubercular activity of polyherbal medicines used for the treatment of tuberculosis.

Methods: The remedies were screened against Mycobacterium tuberculosis H37Rv using Middlebrook 7H9 media and MGIT BACTEC 960 system. They were liquid preparations from King Williams Town site A (KWTa), King Williams Town site B (KWTb), King Williams Town site C (KWTc), Hogsback first site (HBfs), Hogsback second site (HBss), Hogsback third site (HBts), East London (EL), Alice (AL) and Fort Beaufort (FB).

Results: The susceptibility testing revealed that all the remedies contain anti-tubercular activity with KWTa, KWTb, KWTc, HBfs, HBts, AL and FB exhibiting more activity at a concentration below 25 μl/ml. Furthermore, MIC values exhibited inhibitory activity with the most active remedies from KWTa, HBfs and HBts at 1.562 μg/ml. However, isoniazid showed more inhibitory activity against M. tuberculosis at 0.05 μg/ml when compare to the polyherbal remedies.

Conclusion: This study has indicated that these remedies could be potential sources of new anti-mycobacterial agents against M. tuberculosis. However, the activity of these preparations and their active principles still require in vivo study in order to assess their future as new anti-tuberculosis agents.

Keywords: Mycobacterium tuberculosis; in vitro activity, polyherbal medicines, South Africa

http://ift.tt/2jOKFFI

A binary logistic regression model with complex sampling design of unmet need for family planning among all women aged (15-49) in Ethiopia

Background: Unintended pregnancy related to unmet need is a worldwide problem that affects societies. The main objective of this study was to identify the prevalence and determinants of unmet need for family planning among women aged (15-49) in Ethiopia.

Methods: The Performance Monitoring and Accountability2020/Ethiopia was conducted in April 2016 at round-4 from 7494 women with two-stage-stratified sampling. Bi-variable and multi-variable binary logistic regression model with complex sampling design was fitted.

Results: The prevalence of unmet-need for family planning was 16.2% in Ethiopia. Women between the age range of 15-24 years were 2.266 times more likely to have unmet need family planning compared to above 35 years. Women who were currently married were about 8 times more likely to have unmet need family planning compared to never married women. Women who had no under-five child were 0.125 times less likely to have unmet need family planning compared to those who had more than two-under-5.

Conclusion: The key determinants of unmet need family planning in Ethiopia were residence, age, marital-status, education, household members, birth-events and number of under-5 children. Thus the Government of Ethiopia would take immediate steps to address the causes of high unmet need for family planning among women.

Keywords: Complex sampling design, Ethiopia, family planning, Performance Monitoring and Accountability, unmet need

http://ift.tt/2xrDDLU

Effects of meteorological factors on the incidence of meningococcal meningitis

Background and Objectives: Substantial climate changes have led to the emergence and re-emergence of various infectious diseases worldwide, presenting an imperative need to explore the effects of meteorological factors on serious contagious disease incidences such as that of meningococcal meningitis (MCM).

Methods: The incidences of MCM and meteorology data between 1981 and 2010 were obtained from Chaoyang city. Structure Equation Modeling was used to analyze the relationships between meteorological factors and the incidence of MCM, using the LISREL software.

Results: The SEM results showed that Adjusted Goodness of Fit Index (AGFI) = 0.30, Goodness of Fit Index (GFI) = 0.63, and Root Mean Square Error of Approximation (RMSEA) = 0.31. Humidity and temperature both had negative correlations with MCM incidence, with factor loads of -0.32 and -0.43, while sunshine was positively correlated with a factor load of 0.42. For specific observable variables, average air pressure, average evaporation, average air temperature, and average ground temperature exerted stronger influence, with item loads between observable variables and MCM incidence being -0.42, 0.34, -0.32, and -0.32 respectively.

Conclusion: Public health institutions should pay more attention to the meteorological variables of humidity, sunshine, and temperature in prospective MCM control and prevention.

Keywords: Meningococcal meningitis, Neisseria meningitidis, epidemiology, humidity, temperature, sunshine, meteorological variables, structure equation model

http://ift.tt/2jOwuR5

Contribution of IgG avidity and PCR for the early diagnosis of toxoplasmosis in pregnant women from the North-Eastern region of Algeria

Background: Acute toxoplasmosis in pregnant women presents a high risk of Toxoplasma transmission to the fetus. Early diagnosis is difficult, especially when serological testing for IgG/IgM antibodies fail to differentiate between a recent and a past infection. In this case, we rely on IgG avidity or PCR assays.

Objectives: The aim of this study was to compare conventional ELISA and IgG avidity, with PCR using B1 and P30 primers for the early diagnosis of toxoplasmosis in pregnant women.

Methods: Sera were collected from 143 pregnant women and measured by ELISA for anti-Toxoplasma IgG, IgM, IgA and IgG avidity. DNA was extracted from 57 peripheral blood and 14 amniotic fluid samples for PCR amplification.

Results: A total of 57 out 143 women were seropositive: 30 (52.6%) were IgG+/IgM- and 27 (43.8%) were IgG+/IgM+; IgA antibodies were positive in 7 (12.2%) cases. IgG avidity was low in 9 women suggesting an acute infection; 3 women presented an intermediate avidity. PCR detected Toxoplasma DNA in 9 women presenting low avidity and was negative for the intermediate avidity cases.

Conclusion: PCR combined to avidity IgG performed better than ELISA IgG, IgM and/or IgA assays alone. PCR was useful in the case of intermediate avidity.

Keywords: Toxoplasmosis, pregnant women, serology, IgG avidity, PCR

http://ift.tt/2xrMld8

Burden and factors associated with post-stroke depression in East central Nigeria

Objective: To determine the burden and factors associated with post-stroke depression in East central Nigeria.

Method: We carried out this cross-sectional study of 50 stroke survivors (mean age=54.8 ± 8.8 years), at the physiotherapy Department of the University of Nigeria Teaching Hospital, Enugu. Data were collected using Becks Depression Inventory , it was analyzed using Z-scores, Chi-square test and univariate logistic regression.

Results: PSD was more common in females (45.45%); middle-age(60%) adults (27-36/47-56 years respectively); living with spouse (45%); left cerebral lesions (40.74%). Self-employed and unemployed (66.67%), respectively. Age was significantly associated with depression (p=0.03), and was related to the risk ofOR3.7 (95% CI 1.1-12.0 )

Conclusion: Age could be a risk factor for PSD, which was more prevalent in the elderly than young/middle-age adults, female gender, left cerebral lesion, complications, cold case; those living with a spouse, self-employed and unemployed.

Keywords: Symptoms of post-stroke depression, modifiable characteristics of the vulnerable patients, African socio-cultural context

http://ift.tt/2jOwvV9

Compliance with the consumption of iron and folate supplements by pregnant women in Mafikeng local municipality, North West province, South Africa

Background: Anaemia due to iron deficiency is recognized as one of the major nutritional deficiencies in women and children in developing countries. Daily iron supplementation for pregnant women is recommended in many countries. The aim of the study was to investigate the factors that contribute to compliance to the consumption of iron and folate supplements by pregnant woman in Mafikeng local municipality, North West Province, South Africa.

Research Methods: A mixed method of descriptive, exploratory and cross-sectional design was used. Ten clinics were used as a sample frame where 57 pregnant women and 10 health workers were purposefully and conveniently selected. Quantitative techniques were used to collect data on attendance, consumption and nutrition knowledge using the self-reported questionnaire by pregnant women, and structured interview for health workers. Qualitative design was used to conduct in - depth focus-group discussions to gather information on compliance to the consumption of supplements by pregnant women.

Findings: The findings of the study revealed good antenatal clinic attendance, availability of supplements and 93% compliance to the consumption of iron and folate supplements.

Recommendations: High compliance to the consumption of iron and folate supplements by pregnant women was reported, and this should be reinforced.

Keywords: Iron and folate supplements, Mafikeng local municipality, North West province, South Africa

http://ift.tt/2xr6ksb

Cigarette smoke condensate attenuates phorbol ester-mediated neutrophil extracellular trap formation

Background: Neutrophil extracellular traps (NETs) constitute a network of chromatin fibres containing histone and antimicrobial peptides that are released by activated neutrophils. NETs protect the host against infection by trapping and facilitating phagocytosis of potentially harmful pathogens.

Objectives: The aim of the current study was to investigate the effects of cigarette smoke condensate (CSC) on phorbol-ester (PMA)-mediated NETosis in vitro.

Methods: Isolated human blood neutrophils were exposed to PMA (6.25 ng/ml) in the presence or absence of CSC (40-80 μg/ ml) for 90 min at 37oC. NET formation was measured using a spectrofluorimetric procedure to detect extracellular DNA and fluorescence microscopy was used to visualize nets. Oxygen consumption by PMA-activated neutrophils was measured using an oxygen sensitive electrode.

Results: Activation of neutrophils with PMA was associated with induction of NETosis that was significantly attenuated in the presence of CSC (40 and 80 μg/ml), with mean fluorescence intensities of 65% and 66% of that observed with untreated cells, respectively, and confirmed by fluorescence microscopy. The rate and magnitude of oxygen consumption by activated neutrophils pre-treated with CSC (80 μg/ml) was significantly less than that observed with untreated cells (73% of the control system), indicative of decreased production of reactive oxidants in the presence of CSC.

Conclusion: The inhibition of NETosis observed in the presence of CSC correlated with attenuation of oxygen consumption by PMA-activated neutrophils suggesting a mechanistic relationship between these events. If operative in vivo, smoking-related attenuation of NETosis may impair host immune responses and increase the risk of respiratory infections.

Keywords: Neutrophils, reactive oxygen species, respiratory infection, smoking

http://ift.tt/2jOQmn1

Determinants of obstetric fistula in Ethiopia

Background: Obstetric fistula is a maternal morbidity creating devastating health problems for the women. Continuous and uncontrollable leaking of urine or faeces from vagina can lead to life changing stigmatization for women in third world countries. The underlying factors and consequences of this problem are not yet fully identified and adequately documented in Ethiopia.

Methods: This study is based on the Ethiopian Demographic and Health Survey data (EDHS, 2005). The survey collected information on a total of 14,070 women who were interviewed face to face on their background characteristics as well as reproductive health issues, out of which 3178 women had complete measurements and were considered in this study. Descriptive and binary logistic regressions techniques were used using demographic, socio-economic, health and environmental related variables as explanatory variables and status of obstetric fistula as a response variable.

Results: The results showed that geographical region, place of residence, educational status, age at first birth, age at first marriage, employment status, place of delivery and follow up of antenatal care during pregnancy were significant determinant factors of obstetric fistula in Ethiopia.

Conclusion: The study showed that demographic, socio-economic, environmental and health related variables have an important effect on determinants of obstetric fistula in Ethiopia.

Keywords: Obstetric fistula, logistic regression, determinant factors

http://ift.tt/2xr2xLw

Evaluation of iron transport from ferrous glycinate liposomes using Caco-2 cell model

Background: Iron fortification of foods is currently a strategy employed to fight iron deficiency in countries. Liposomes were assumed to be a potential carrier of iron supplements.

Objective: The objective of this study was to investigate the iron transport from ferrous glycinate liposomes, and to estimate the effects of liposomal carriers, phytic acid, zinc and particle size on iron transport using Caco-2 cell models.

Methods: Caco-2 cells were cultured and seeded in DMEM medium. Minimum essential medium was added to the basolateral side. Iron liposome suspensions were added to the apical side of the transwell.

Results: The iron transport from ferrous glycinate liposomes was significantly higher than that from ferrous glycinate. In the presence of phytic acid or zinc ion, iron transport from ferrous glycinate liposomes and ferrous glycinate was evidently inhibited, and iron transport decreased with increasing phytic acid concentration. Iron transport was decreased with increase of particle size increasing of ferrous glycinate liposome.

Conclusion: Liposomes could behave as more than a simple carrier, and iron transport from liposomes could be implemented via a mechanism different from the regulated non-heme iron pathway.

Keywords: Ferrous glycinate liposomes, iron transport, phytic acid, particle size

http://ift.tt/2jPw7G1

Effect of intimate partner violence on birth outcomes

Background: Violence by intimate partner during pregnancy has many adverse pregnancy outcomes. Thus, that's why we sought to determine association between intimate partner violence during pregnancy and adverse birth outcomes.

Methods: A facility based cross-sectional study was conducted among 183 recently delivered women from March 31- April 30, 2014 in public health facilities of Hossana Town. The data were collected through structured questionnaire and record review. Women who were not mentally and physically capable of being interviewed and those admitted for abortion were excluded. Ethical clearance was obtained from Jimma University. Logistic regression analysis was employed to determine the association between intimate partner violence and adverse birth outcomes.

Results: About 23 % of women experienced intimate partner violence during pregnancy. The result of this study indicated an association of intimate partner violence with low birth weight of the new born (AOR:14.3,95% CI: (5.03, 40.7). Intimate partner violence was not associated with still birth, pre-term birth and Apgar score less than 7 at 5 minutes.

Conclusion: The findings of this study showed that intimate partner violence during pregnancy was associated with a low birth weight of the new born. Health sectors should train health care providers on how to screen, counsel, treat and follow up abused women.

Keywords: Intimate partner violence, birth outcomes, Ethiopia

http://ift.tt/2xrDCrk

Prevalence of diabetes mellitus in newly diagnosed pulmonary tuberculosis in Beira, Mozambique

Introduction: Data regarding the association between diabetes mellitus (DM) and tuberculosis (TB) in Africa are scarce. DM screening among TB patients in Mozambique was carried out.

Methods: The study was implemented from January to August 2016 in three Urban Health Centers in Beira, Mozambique and recruited adult (>18 years) patients newly diagnosed with pulmonary TB.

Results: Three hundred and one patients were enrolled (67.4%, males mean age 31.7(SD 11 years). Diabetes was diagnosed in only 3 patients (1%) and impaired glucose tolerance (IGT) in an additional 6 subjects (2%).

Conclusion: A lower than expected prevalence of DM was observed, which could be explained by the lack of traditional risk factors for DM (overweight, age over 45 years, hypertension and smoking) in Mozambique.

Keywords: Diabetes mellitus, pulmonary tuberculosis, Beira, Mozambique

http://ift.tt/2jO2IMo

Can We Cure Bronchopulmonary Dysplasia?

Fifty years after Dr Northway's original description of bronchopulmonary dysplasia (BPD), the disease still lacks a cure. This can be interpreted as a failure of progress, or conversely, as a ransom of our success in improving the survival of ever more preterm infants. Consequently, preterm infants at risk for BPD today have more immature lungs than in the past, making the task of preventing or rescuing lung damage more daunting. Classic pharmacologic therapies and past technologic advances appear to have had only minor impact on disease progression.

http://ift.tt/2hkbYXD

The Need for Pediatric Drug Development

Therapeutic tragedies in pediatric patients contributed to formulation of the legal requirement that new medications had to be carefully studied before they could be approved for interstate sale.1 Despite this, the majority of pediatric patients who require treatment are prescribed medications that are either not approved for pediatric use or contain incomplete directions for pediatric use in the approved product label.2,3

http://ift.tt/2hmCSdI

Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee

Proton therapy was first suggested in the management of lymphoma in 1974 as a way to spare the bone marrow when treating total nodal fields (1). However, interest in its use in lymphoma has grown only recently with the global growth in proton therapy centers, as well as with improvements in treatment delivery techniques. Hodgkin lymphoma (HL) is a rare malignancy, with approximately 8500 new cases annually in the United States, of which approximately 50% may ultimately receive radiation therapy (RT).

http://ift.tt/2xj74An

Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer

http://ift.tt/2xyufGI

Clinically significant mutations in HIV-infected patients with lung adenocarcinoma

http://ift.tt/2flQKYX

Rare cancers: the greatest inequality in cancer research and oncology treatment

http://ift.tt/2xyQpJ0

Reply to ‘Comment on ‘Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study’’

http://ift.tt/2fkzsez

Response to Morrell et al's reply

http://ift.tt/2xyQhcu

Dose–response effects of aerobic exercise on body composition among colon cancer survivors: a randomised controlled trial

http://ift.tt/2flQKrV

Vegetable Vigra by Natures Supplement: Recall - Undeclared Drug Ingredient

Audience: Consumer [Posted 09/21/2017] ISSUE: Natures Supplement, Inc. is voluntarily recalling 260 bottles of Vegetable Vigra, 200 mg capsules to the consumer level. FDA analysis found this product to be tainted with Sidenafil. Sildenafil is an...

http://ift.tt/2wapGis

Vegetable Vigra by Natures Supplement: Recall - Undeclared Drug Ingredient

Audience: Consumer [Posted 09/21/2017] ISSUE: Natures Supplement, Inc. is voluntarily recalling 260 bottles of Vegetable Vigra, 200 mg capsules to the consumer level. FDA analysis found this product to be tainted with Sidenafil. Sildenafil is an...

http://ift.tt/2wapGis

Significance of glucocorticoid receptor expression in patients with non-small cell lung cancer treated with pemetrexed-based chemotherapy

Abstract

Background

Pemetrexed is the preferred chemotherapy agent in the management of non-squamous non-small cell lung cancer (non-sq-NSCLC), but lacks biomarkers predicting its efficacy. Dexamethasone, one of the premedications of pemetrexed, may downregulate p53 through the glucocorticoid receptor (GR). The purpose of our study was to explore the effect of GR in peripheral blood mononuclear cells (PBMC) and its role in predicting pemetrexed efficacy.

Methods

In all, 122 patients with stage IV non-sq-NSCLC who received first-line pemetrexed-containing chemotherapy were retrospectively reviewed. The expression of GR in PBMC was measured before treatment with pemetrexed using real-time PCR was used to detect the levels of GRα and GRβ.

Results

The response rate for all patients was 38.5%, with a median progression-free survival (PFS) of 5.9 months and overall survival (OS) of 14.3 months. In univariate analyses, patients with a low GRα/GRβ ratio in PBMC had higher RR, better PFS, and better OS than those with a high GRα/GRβ ratio (RR: 48.2 vs. 30.3%, p = 0.043; mPFS: 6.9 vs. 4.0 months, p < 0.001; mOS: 18.7 vs. 12.2 months, p = 0.005). The baseline GRα/GRβ ratio was an independent factor for RR (odds ratio [OR] = 0.451, 95% CI 0.208–0.978; p = 0.044), PFS (HR = 1.584, 95% CI 1.094–2.295; p = 0.015), and OS (HR = 1.761, 95% CI 1.195–2.595; p = 0.004).

Conclusions

Baseline GRα/GRβ ratio in PBMC may play a role in predicting the efficacy of first-line pemetrexed-containing chemotherapy in stage IV non-sq NSCLC patients.

http://ift.tt/2hn7yLV

Synthetic lethality in malignant pleural mesothelioma with PARP1 inhibition

Abstract

Malignant pleural mesotheliomas (MPM) are most often surgically unresectable, and they respond poorly to current chemotherapy and radiation therapy. Between 23 and 64% of malignant pleural mesothelioma have somatic inactivating mutations in the BAP1 gene. BAP1 is a homologous recombination (HR) DNA repair component found in the BRCA1/BARD1 complex. Similar to BRCA1/2 deficient cancers, mutation in the BAP1 gene leads to a deficient HR pathway and increases the reliance on other DNA repair pathways. We hypothesized that BAP1-mutant MPM would require PARP1 for survival, similar to the BRCA1/2 mutant breast and ovarian cancers. Therefore, we used the clinical PARP1 inhibitors niraparib and olaparib to assess whether they could induce synthetic lethality in MPM. Surprisingly, we found that all MPM cell lines examined, regardless of BAP1 status, were addicted to PARP1-mediated DNA repair for survival. We found that niraparib and olaparib exposure markedly decreased clonal survival in multiple MPM cell lines, with and without BAP1 mutations. This clonal cell death may be due to the extensive replication fork collapse and genomic instability that PARP1 inhibition induces in MPM cells. The requirement of MPM cells for PARP1 suggests that they may generally arise from defects in HR DNA repair. More importantly, these data demonstrate that the PARP1 inhibitors could be effective in the treatment of MPM, for which little effective therapy exists.

http://ift.tt/2hjoB58

Superactive human leptin antagonist (SHLA), triple Lan1 and quadruple Lan2 leptin mutein as a promising treatment for human folliculoma

Abstract

Purpose

There are no data showing a direct correlation between obesity and increased blood leptin levels with folliculoma. Moreover, folliculoma is not the best studied among other ovarian cancer types. We investigated whether oestradiol can modulate ObR expression in some oestrogen-responsive tissues and that leptin exerts its activity not only via the leptin receptor but also through cross talk with other signalling systems. We hypothesise that blocking ObR expression could be a novel treatment for gonadal ovarian cancer.

Methods

We evaluated the effect of SHLA, Lan1 and Lan2 blockers on cell proliferation (BrdU incorporation assay), ObR and ERα/β gene expression (qPCR), oestradiol secretion (ELISA) and cell cycle protein expression (Western blot) in the non-cancerous cell line HGrC1 and two granulosa cancer cell lines: the juvenile form (COV434) and the adult form (KGN).

Results

ObR gene expression in cancer cell lines was 50% higher than in the non-cancer cells. Lan-1 and Lan-2 decreased ObR expression in COV434, while it had no effect in KGN cells. Higher ERβ expression in non-cancer and higher ERα expression in both cancer cell lines was noted. SHLA and Lan-1 changed the ratio towards greater expression of ERβ, characteristic of non-cancer granulosa cells. All ObR antagonists in HCrC1 and KGN but only Lan-2 in COV434 reversed leptin-stimulated proliferation. In both non-cancer and cancer granulosa cells, leptin acts as a cyclinD/cdk4, cyclin A/cdk2 and E2F inhibitor.

Conclusion

These results indicate that SHLA and Lan2 are promising leptin receptor inhibitors that can eliminate the negative effects of leptin. These compounds should be considered in further ex vivo studies on the cancer microenvironment.

Graphical abstract

http://ift.tt/2hmkIc2