Osteomyelitis of a sacral neurocentral synchondrosis: a case report of another metaphyseal equivalent

Abstract

Pelvic osteomyelitis may occur in a metaphyseal equivalent, defined as a portion of flat or irregular bone that is adjacent to cartilage. The pelvic bone is known to have several metaphyseal equivalents and of these, the sacroiliac joint is the most frequent site of involvement. However, a sacral neurocentral synchondrosis has not been recognized as a metaphyseal equivalent, and there have been no previous reports describing this as the site of origin of sacral osteomyelitis. We here report two cases of sacral osteomyelitis originating in a neurocentral synchondrosis, another metaphyseal equivalent. We, as pediatric radiologists, should recognize a sacral neurocentral synchondrosis as another metaphyseal equivalent, especially in infants and younger patients.

https://ift.tt/2RC0bB5

Impact of extremely low-frequency magnetic fields on human postural control

Abstract

Studies have found that extremely low-frequency (ELF, < 300 Hz) magnetic fields (MF) can modulate standing balance; however, the acute balance effects of high flux densities in this frequency range have not been systematically investigated yet. This study explores acute human standing balance responses of 22 participants exposed to magnetic induction at 50 and 100 mTrms (MF), and to 1.5 mA alternating currents (AC). The center of pressure displacement (COP) was collected and analyzed to investigate postural modulation. The path length, the area, the velocity, the power spectrum in low (< 0.5 Hz) and medium (0.5–2 Hz) bands have computed and showed the expected effect of the positive control direct current (DC) electric stimulation but failed to show any significant effect of the time-varying stimulations (AC and MF). However, we showed a significant biased stabilization effect on postural data from the custom experimental apparatus employed in this work, which might have neutralized the hypothesized results.

https://ift.tt/2BQEEzo

Reflux symptoms in professional opera soloists

Professions distinguished by repeated vocal stress carry a high risk of developing gastroesophageal reflux symptoms (GERS), which may affect vocal performance.

https://ift.tt/2zKi5uR

2-Methoxy-5((3,4,5-trimethosyphenyl)seleninyl) phenol reverses EGF-induced cell migration and invasion through down-regulation of MDM2 in breast cancer cell lines

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Corrigendum

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Re: Omental infarction: a case of a whole omental infarct

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25, 50 & 75 years ago

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Issue information ‐ TOC

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Referees

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What’s left on the list? ‘Just a hernia...’

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Index acute cholecystectomy: what’s the problem?

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Issue information ‐ JEB

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Response to Re: Effect of a See and Treat clinic on skin cancer treatment time

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Refining the management of acute appendicitis: towards improving cost efficiencies

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Acute stress modifies oscillatory indices of affective processing: Insight on the pathophysiology of schizophrenia spectrum disorders

Stress is considered a key precipitating factor in the development and maintenance of psychopathology, including schizophrenia spectrum disorders (SCZ) (Corcoran et al., 2003; Venkatasubramanian et al., 2010; Garner et al., 2011), in part through modification of affective frontal and limbic networks (Arnsten, 2011). SCZ disorders are considered some of the most disabling psychopathologies (Chaudhury et al., 2006), resulting from a combination of genetic and environmental insults (Ross et al., 2006).

https://ift.tt/2EeNcm4

Correction: Treatment effects of systematic two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: rationale and design of a prospective, randomised and multicentre DEFINITION II trial

Zhang J, Gao X, Han Y, et al. Treatment effects of systematic two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: rationale and design of a prospective, randomised and multicentre DEFINITION II trial. BMJ Open 2018;8:e020019. doi: 10.1136/bmjopen-2017-020019.

The sample size estimation in Statistical Analysis Part should be:

From previous studies, we hypothesized that the rate of a 1-year TLF would be 7% in the systematic two-stent technique group and 14% in the provisional stenting group. Accordingly, a total sample size of 600 is needed to detect a power of 0.8 (Type error = 0.2, = 0.05, 2-tailed). Because of the considerable uncertainty, the enrolment is extended to 660 patients (10% increment).

Instead of:

From previous studies, we hypothesized that the rate of a 1-year TLF would be 15% in the systematic two-stent technique group and 25% in the provisional stenting group. Accordingly, a total sample size of...

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Identifying patient-important outcomes in medication-assisted treatment for opioid use disorder patients: a systematic review protocol

Introduction

Illicit opioid use has become a national crisis in Canada, with over 65 000 people seeking treatment for opioid use disorder (OUD) in Ontario and British Columbia alone. Medication-assisted treatment (MAT) is a common treatment for OUD. There is substantial variability in treatment outcomes used to evaluate effectiveness of MAT, making it difficult to establish clinically and scientifically relevant treatment effect. Furthermore, patients are often excluded from the process of determining these outcomes. The primary objective of this review is to examine outcomes currently used to measure MAT effectiveness and to identify patient-relevant outcomes to enhance effectiveness of treatment options. This review refers to patient-important outcomes as those outcomes patients consider important to or markers of treatment success.

Methods and analysis

MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, National Institutes for Health Clinical Trials Registry and WHO International Clinical Trials Registry Platform databases will be searched. We will search databases from inception to the date the search is ran. Studies of interest include those evaluating the effectiveness of MAT for patients with OUD, with or without consultation with patients regarding what they consider to be important as an indicator of treatment success. Results will be analysed using thematic analysis and qualitative analysis where possible. This will result in comprehensive synthesis of all outcomes and measures found related to OUD treatment effectiveness.

Ethics and dissemination

We are collaborating with Canadian Addiction Treatment Centres which provide MAT to patients with OUD who will participate in disseminating study results. Dissemination strategies will involve sharing study results through workshops, presentations, peer-reviewed publications, study reports, community presentations and resources in primary care settings.

PROSPERO registration number

CRD42018095553.

https://ift.tt/2FVdb3s

Can process mining automatically describe care pathways of patients with long-term conditions in UK primary care? A study protocol

Introduction

In the UK, primary care is seen as the optimal context for delivering care to an ageing population with a growing number of long-term conditions. However, if it is to meet these demands effectively and efficiently, a more precise understanding of existing care processes is required to ensure their configuration is based on robust evidence. This need to understand and optimise organisational performance is not unique to healthcare, and in industries such as telecommunications or finance, a methodology known as 'process mining' has become an established and successful method to identify how an organisation can best deploy resources to meet the needs of its clients and customers. Here and for the first time in the UK, we will apply it to primary care settings to gain a greater understanding of how patients with two of the most common chronic conditions are managed.

Methods and analysis

The study will be conducted in three phases; first, we will apply process mining algorithms to the data held on the clinical management system of four practices of varying characteristics in the West Midlands to determine how each interacts with patients with hypertension or type 2 diabetes. Second, we will use traditional process mapping exercises at each practice to manually produce maps of care processes for the selected condition. Third, with the aid of staff and patients at each practice, we will compare and contrast the process models produced by process mining with the process maps produced via manual techniques, review differences and similarities between them and the relative importance of each. The first pilot study will be on hypertension and the second for patients diagnosed with type 2 diabetes.

Ethics and dissemination

Ethical approval has been provided by East Midlands–Leicester South Regional Ethics Committee (REC reference 18/EM/0284). Having refined the automated production of maps of care processes, we can explore pinch points and bottlenecks, process variants and unexpected behaviour, and make informed recommendations to improve the quality and efficiency of care. The results of this study will be submitted for publication in peer-reviewed journals.

https://ift.tt/2rjQko7

Understanding and evaluating new models of Child and Adolescent Mental Health Services in South-East England: a study protocol for an observational mixed-methods study

Introduction

Increased demand for Child and Adolescent Mental Health Services (CAMHS), alongside concerns that services should be better commissioned to meet the needs of the most vulnerable, has contributed to a requirement to transform services to improve accessibility, quality of care and health outcomes. Following the submission of government-mandated transformation plans for CAMHS, services in England are changing in how, where and by whom they are delivered. This protocol describes the research methods to be applied to understand CAMHS transformations and evaluate the impact on the use of mental health services, patient care, satisfaction, health outcomes and health resource utilisation costs.

Methods and analysis

A mixed-methods approach will be taken in an observational retrospective study of CAMHS provided by a large National Health Service (NHS) mental health trust in South-East England (Oxford Health NHS Foundation Trust). Quantitative research will include descriptive analysis of routinely collected data, with difference-in-differences analysis supplemented with propensity score matching performed to assess the impact of CAMHS transformations from 2015 onwards. An economic evaluation will be conducted from a healthcare perspective to provide commissioners with indications of value for money. Qualitative research will include observations of services and interviews with key stakeholders including CAMHS staff, service users and guardians, to help identify mechanisms leading to changes in service delivery, as well as barriers and enabling factors in this phase of transformation.

Ethics and dissemination

This project has been registered with NHS Oxford Health Foundation Trust as a service evaluation. Informed consent will be sought from all stakeholders partaking in interviews according to good clinical practice. A local data sharing protocol will govern the transfer of quantitative data. Study findings will be published in professional journals for NHS managers and peer-reviewed scientific journals. They will be discussed in seminars targeting CAMHS providers, managers and commissioners and presented at scientific conferences.

https://ift.tt/2G073Hk

Geriatrician-led evidence-based Falls Prevention Clinic: a prospective 12-month feasibility and acceptability cohort study among older adults

Objective

We assessed the feasibility and acceptability of delivering a geriatrician-led evidence-based Falls Prevention Clinic to older adults with a history of falls.

Design

12-month prospective cohort study.

Setting

Vancouver Falls Prevention Clinic, Vancouver, British Columbia, Canada (www.fallsclinic.ca).

Participants

188 community-dwelling older adults aged ≥70 years who received a baseline assessment at the Vancouver Falls Prevention Clinic due to having had at least one fall resulting in medical attention in the previous 12 months. Fifty-six per cent of participants were also participating in a randomised controlled trial.

Measurements

Feasibility was ascertained by measuring demand (clinic attendance). Acceptability was measured by compliance with recommendations, completion of monthly fall calendars and patient experience.

Results

The attendance was 65% of those eligible and invited. This indicates feasibility for demand. 155 received at least one of the following clinical management recommendations from four domains (compliance reported in %): (1) medication changes (78%); (2) exercise prescription (58%); (3) referrals to other healthcare professionals (78%); and/or (4) lifestyle modifications (35%) excluding exercise. Overall compliance to all recommendations was 69%. Patient experience was related to factors impacting patient perceived physical benefit and attributes influencing patient satisfaction.

Conclusion

This study demonstrated the feasibility and acceptability of a multifactorial intervention approach based on best available evidence-based medicine.

https://ift.tt/2rkbqmi

Nonverbal synchrony as a behavioural marker of patient and physician race-related attitudes and a predictor of outcomes in oncology interactions: protocol for a secondary analysis of video-recorded cancer treatment discussions

Introduction

Racial disparities in cancer treatment contribute to racial disparities in mortality rates. The quality of patient–physician communication during clinical interactions with black patients and non-black physicians (racially discordant) is poorer than communication quality with white patients (racially concordant). Patient and physician race-related attitudes affect the quality of this communication. These attitudes are likely expressed through subtle non-verbal behaviours, but prior research has not examined these behaviours. Nonverbal synchrony, the coordination of physical movement, reflects the preinteraction attitudes of participants in interactions and predicts their postinteraction perceptions of and affect towards one another. In this study, peer reviewed and funded by the National Institute of Minority Health and Health Disparities (R21MD011766), we will investigate non-verbal synchrony in racially concordant and discordant interactions to better understand racial disparities in clinical communication.

Methods and analysis

This secondary analysis includes racially concordant (n=163) and racially discordant (n=68) video-recorded oncology interactions, patient and oncologist self-reported race-related attitudes, perceptions of the interaction and observer ratings of physician patient-centred communication and patient and physician affect and rapport. In aim 1, we will assess and compare non-verbal synchrony between physicians and patients in racially concordant and discordant interactions. In aim 2, we will determine the influence of non-verbal synchrony on patient and physician affect and communication. In aim 3, we will examine possible causes (ie, race-related attitudes) and consequences (ie, negative perceptions) of non-verbal synchrony in racially discordant interactions. In aim 4, we will develop and test a mediational model linking physician and patient race-related attitudes to non-verbal synchrony and, in turn, interaction outcomes.

Ethics and dissemination

The parent and current studies were approved by the Wayne State University Institutional Review Board. Since only archival data will be used, ethical or safety risks are low. We will disseminate our findings to relevant conferences and journals.

https://ift.tt/2G18MMn

Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review

Objective

Older patients with hip fractures who are undergoing surgery are at high risk of significant mortality and morbidity including postoperative delirium. It is unclear whether different types of anaesthesia may reduce the incidence of postoperative delirium. This systematic review will investigate the impact of anaesthetic technique on postoperative delirium. Other outcomes included mortality, length of stay, complications and functional outcomes.

Design

Systematic review of randomised controlled trials and non-randomised controlled studies.

Data sources

Bibliographic databases were searched from inception to June 2018. Web of Science and ZETOC databases were searched for conference proceedings. Reference lists of relevant articles were checked, and clinical trial registers were searched to identify ongoing trials.

Eligibility criteria

Studies were eligible if general and regional anaesthesia were compared in patients (aged 60 and over) undergoing hip fracture surgery, reporting primary outcome of postoperative delirium and secondary outcomes of mortality, length of hospital stay, adverse events, functional outcomes, discharge location and quality of life. Exclusion criteria were anaesthetic technique or drug not considered current standard practice; patients undergoing hip fracture surgery alongside other surgery and uncontrolled studies.

Results

One hundred and four studies were included. There was no evidence to suggest that anaesthesia type influences postoperative delirium or mortality. Some studies suggested a small reduction in length of hospital stay with regional anaesthesia. There was some evidence to suggest that respiratory complications and intraoperative hypotension were more common with general anaesthesia. Heterogeneity precluded meta-analysis. All findings were described narratively and data were presented where possible in forest plots for illustrative purposes.

Conclusions

While there was no evidence to suggest that anaesthesia types influence postoperative delirium, the evidence base is lacking. There is a need to ascertain the impact of type of anaesthesia on outcomes with an adequately powered, methodologically rigorous study.

PROSPERO registration number

CRD42015020166.

https://ift.tt/2rlgqHp

Observational study of the status of coronary risk biomarkers among Negritos with metabolic syndrome in the east coast of Malaysia

Objectives

To determine the prevalence of metabolic syndrome (MS), ascertain the status of coronary risk biomarkers and establish the independent predictors of these biomarkers among the Negritos.

Settings

Health screening programme conducted in three inland settlements in the east coast of Malaysia and Peninsular Malaysia.

Subjects

150 Negritos who were still living in three inland settlements in the east coast of Malaysia and 1227 Malays in Peninsular Malaysia. These subjects were then categorised into MS and non-MS groups based on the International Diabetes Federation (IDF) consensus worldwide definition of MS and were recruited between 2010 and 2015. The subjects were randomly selected and on a voluntary basis.

Primary and secondary outcome measures

This study was a cross-sectional study. Serum samples were collected for analysis of inflammatory (hsCRP), endothelial activation (sICAM-1) and prothrombogenesis [lp(a)] biomarkers.

Results

MS was significantly higher among the Malays compared with Negritos (27.7%vs12.0%). Among the Malays, MS subjects had higher hsCRP (p=0.01) and sICAM-1 (p<0.05) than their non-MS counterpart. There were no significant differences in all the biomarkers between MS and the non-MS Negritos. However, when compared between ethnicity, all biomarkers were higher in Negritos compared with Malays (p<0.001). Binary logistic regression analysis affirmed that Negritos were an independent predictor for Lp(a) concentration (p<0.001).

Conclusions

This study suggests that there may possibly be a genetic influence other than lifestyle, which could explain the lack of difference in biomarkers concentration between MS and non-MS Negritos and for Negritos predicting Lp(a).

https://ift.tt/2rnetu2

Diagnostic accuracy of the Geriatric Depression Scale-30, Geriatric Depression Scale-15, Geriatric Depression Scale-5 and Geriatric Depression Scale-4 for detecting major depression: protocol for a systematic review and individual participant data meta-analysis

Introduction

The 30-item Geriatric Depression Scale (GDS-30) and the shorter GDS-15, GDS-5 and GDS-4 are recommended as depression screening tools for elderly individuals. Existing meta-analyses on the diagnostic accuracy of the GDS have not been able to conduct subgroup analyses, have included patients already identified as depressed who would not be screened in practice and have not accounted for possible bias due to selective reporting of results from only better-performing cut-offs in primary studies. Individual participant data meta-analysis (IPDMA), which involves a standard systematic review, then a synthesis of individual participant data, rather than summary results, could address these limitations. The objective of our IPDMA is to generate accuracy estimates to detect major depression for all possible cut-offs of each version of the GDS among studies using different reference standards, separately and among participant subgroups based on age, sex, dementia diagnosis and care settings. In addition, we will use a modelling approach to generate individual participant probabilities for major depression based on GDS scores (rather than a dichotomous cut-off) and participant characteristics (eg, sex, age, dementia status, care setting).

Methods and analysis

Individual participant data comparing GDS scores to a major depression diagnosis based on a validated structured or semistructured diagnostic interview will be sought via a systematic review. Data sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO and Web of Science. Bivariate random-effects models will be used to estimate diagnostic accuracy parameters for each cut-off of the different versions of the GDS. Prespecified subgroup analyses will be conducted. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Ethics and dissemination

The findings of this study will be of interest to stakeholders involved in research, clinical practice and policy.

PROSPERO registration number

CRD42018104329.

https://ift.tt/2FWSLab

Pregnancy-associated cancers and birth outcomes in children: a Danish and Swedish population-based register study

Objectives

This study aims to estimate the association between pregnancy-associated maternal cancers, diagnosed both prenatally and postnatally, and birth outcomes.

Design

Population-based register study.

Setting

National registers of Denmark and Sweden.

Participants

A total of 5 523 365 children born in Denmark (1977–2008) and Sweden (1973–2006).

Primary and secondary outcome measures: gestational age, birth weight, size for gestational age, Apgar score, caesarean section and sex were the outcomes of interest. ORs and relative risk ratios (RRR) with 95% CIs were estimated using logistic regression and multinomial logistic regression, respectively.

Results

In this study, 2% of children were born to mothers with a diagnosis of cancer. Children whose mothers received a prenatal cancer diagnosis had higher risk of being born preterm (RRR: 1.77, 95% CI 1.64 to 1.90); low birth weight (RRR 1.84, 95% CI 1.69 to 2.01); low Apgar score (OR 1.36, 95% CI 1.20 to 1.56); and by caesarean section (OR: 1.69, 95% CI 1.59 to 1.80). Associations moved towards the null for analyses using postnatal diagnoses, but preterm birth (RRR: 1.13, 95% CI 1.09 to 1.17) and low birth weight (RRR: 1.14, 95% CI 1.09 to 1.18) remained statistically significant, while risk of caesarean section became so (OR: 0.95, 95% CI 0.91 to 0.98). Additionally, statistical significance was reached for large for gestational age (RRR: 1.06, 95% CI 1.01 to 1.11), high birth weight (RRR: 1.04, 95% CI 1.01 to 1.06) and caesarean section (OR: 0.95, 95% CI 0.91 to 0.98).

Conclusions

Results suggest an association between pregnancy-associated cancers and adverse birth outcomes in the offspring. While this is strongest for prenatally diagnosed cancers, some smaller associations exist for postnatally diagnosed cancers, indicating that cancer itself could affect fetal development, or that cancer and adverse birth outcomes share risk factors. Future studies on maternal cancer during pregnancy should consider including some postnatal years in their exposure window.

https://ift.tt/2rjJiQn

Non-standard treatment for uncomplicated Chlamydia trachomatis urogenital infections: a systematic review

Objectives

To review the literature for non-standard treatment options for uncomplicated Chlamydia trachomatis (CT) infections in adolescents and adults.

Design

Systematic review.

Data sources

Ovid MEDLINE/PubMed, Ovid EMBASE, Cochrane Trials & Systematic Review Databases, CINAHL Plus with Full Text, Web of Science Core Collection, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and Health Canada Trials Database were searched for studies in English or French from 1 January 2006 to 6 August 2017. Keywords included CT, anti-infective or anti-bacterial agents, therapy/pharmacotherapy/management.

Review methods

Included were primary research studies. Outcome measures included clinical or microbiological cure, treatment failure and adverse events. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were assessed for risk of bias using the Revised Cochrane Risk of Bias V.2.0 tool for randomised and the Newcastle-Ottawa Quality Assessment Scale for non-randomised studies.

Funding source

Public Health Agency of Canada.

Results

Of the 6899 records identified through the database search, 11 studies were included. One randomised controlled trial reported that delayed release doxycycline was non-inferior to azithromycin. Two studies examined higher doses of azithromycin but reported no additional benefit. One study looked at a 5-day azithromycin treatment regimen and reported a high cure rate. Two studies reported efficacy of sitafloxacin, and a single study supports the use of levofloxacin. Two phase 2 studies reported efficacy of single-dose rifalazil in both men and women. Only one retrospective study was identified that examined treatment in pregnant women and reported that efficacy with single-dose azithromycin exceeded that of amoxicillin and erythromycin. A single study examining the efficacy of a beta-lactam antibiotic was stopped early due to high treatment failures.

Conclusions

The paucity of existing data highlights the need for further adequately powered studies to evaluate rifalazil, delayed release doxycycline, levofloxacin and other agents for the treatment of uncomplicated CT infections.

PROSPERO registration number

CRD42017073096.

https://ift.tt/2G06LAe

Cumulative network-meta-analyses, practice guidelines and actual prescriptions of drug treatments for postmenopausal osteoporosis: a study protocol for cumulative network meta-analyses and meta-epidemiological study

Introduction

Cumulative network meta-analysis (NMA) is a method to provide a global comparison of multiple treatments with real-time update to evidence users. Several studies investigated the ranking of cumulative NMA and the recommendations of practice guidelines. However, to the best of our knowledge, no study has evaluated the cumulative NMA ranking and prescription patterns. Here, we present a protocol for a meta-epidemiological investigation to compare the results of cumulative NMA with the recommendations in postmenopausal osteoporosis practice guidelines and with the actual prescriptions.

Method and analysis

We will use the data of primary trials from the upcoming postmenopausal osteoporosis clinical practice guideline of the Endocrine Society. We will conduct cumulative NMA using all eligible trials and generate hierarchy of treatment rankings by using the surface under the cumulative ranking curve. We will search practice guidelines in relevant society websites. Two review authors will extract the practice recommendations. We will use data from the Medical Expenditures Panel Survey, a US representative sample of the non-institutionalised population, to determine the prescription patterns.

Ethics and dissemination

Because all data will be retrieved from public databases, institutional review board approval is not required. We will publish our findings in a peer-reviewed journal and present key findings at conferences.

Trial registration number

UMIN000031894: Pre-results.

https://ift.tt/2rngKFD

Household structure and its association with sexual risk behaviours and sexual health outcomes: evidence from a British probability sample survey

Objectives

Economic and social changes over the last 20 years have led to changes in the living situations of young people in Britain. A person's home-life context might influence their sexual behaviour, with implications for their sexual healthcare needs; we investigated this hypothesis.

Methods

Britain's third National Survey of Sexual Attitudes and Lifestyles, a probability sample survey undertaken in 2010–2012, interviewed 15 162 men and women aged 16–74 years in Britain (with 3869 aged 16–24 years). We examined household structure by gender and age group. We then focused on sexually experienced young people (aged 16–24 years), and used multivariable models to explore associations between household structure, sexual risk behaviours and sexual health outcomes, independent of confounders including age, relationship status, employment and area of residence.

Results

Young people were most likely to be living with parents (women 57.1% (95% CI 54.5% to 59.6%) and men 68.7% (95% CI 65.4% to 71.8%)) or non-relatives (women 10.5% (95% CI 8.5% to 12.9%) and men 12.6% (95% CI 10.1% to 15.6%)). Among the 81.3% of young people who were sexually experienced, compared with young women living with parents (reference category), young women living alone or with non-relatives had a higher likelihood of reporting ≥2 sexual partners (adjusted OR 1.54 (95% CI 1.03 to 2.31); 1.76 (95% CI 1.03 to 3.00), respectively). Women living alone were also more likely to have had unsafe sex (2.04 (95% CI 1.38 to 3.02)). Despite these differences in sexually transmitted infection (STI) risk, there was no difference in sexual healthcare-seeking behaviour. Young men and women living with partners reported lower levels of sexual risk behaviours.

Conclusions

Our study suggests household structure may influence the sexual behaviour of young people in Britain. Given changes in their living arrangements, the role of household structure in sexual health research should be further investigated, and also considered as a possible marker for STI risk in clinical consultations.

https://ift.tt/2FWSxjl

Establishment of trauma treatment teams within a regional severe trauma treatment system in China: study protocol for a national cluster-randomised trial

Introduction

The implementation of first aid processes for patients with trauma in China faces significant challenges. These challenges include long response times of prehospital first aid services, lack of information exchange between prehospital first aid services and in-hospital emergency services, lack of a professional rescue team in the majority of hospitals, and lack of standardised training for prehospital and in-hospital emergency personnel. The purpose of the trial is to guide the establishment of an urban trauma treatment system in China, highlight the construction of a trauma treatment system tailored to the Chinese context and improve levels of medical treatment by selecting approximately 100 counties across China as pilots to establish a regional trauma treatment system.

Methods and analysis

A cluster-randomised controlled trial will be performed in 98 county-level research institutes. Included research institutes will be randomised into an experimental group and a control group. Patients in both experimental and control groups will receive basic treatments. A trauma treatment team will be established in the experimental group. The primary outcome measure is in-hospital mortality rate of patients. The secondary outcome measures include mortality rate of patients within 30 days after trauma attack and within 30 days after discharge, the time between arrival in the institution and receiving consultation, and the time from admission to the start of surgery. The effects of establishment of trauma treatment teams on the treatment of severe trauma will be evaluated in all counties.

Ethics and dissemination

The procedures have been approved by The Medical Ethics Committee of Peking University People's Hospital (No.2017PHB098-01) and conform to the Declaration of Helsinki. Data will be collected and analysed in accordance with participant privacy laws and regulations. Results will be disseminated through policy briefs, workshops, peer-reviewed publications and conferences.

Trial registration number

NCT03363880; Pre-results.

https://ift.tt/2rlyelR

Prognostic accuracy of different disseminated intravascular coagulation criteria in critically ill adult patients: a protocol for a systematic review and meta-analysis

Introduction

Disseminated intravascular coagulation (DIC) is a common and serious condition that can lead to poor outcomes in critically ill patients. To make a correct diagnosis and improve the outcome of patients with DIC, several organisations have put forward DIC scoring systems. However, which criteria is the best to use for diagnosing DIC remains a continuing controversy even though many studies have been conducted to validate the diagnostic accuracy of each DIC scoring system.

Methods and analysis

We will conduct a systematic review and meta-analysis of the diagnostic accuracy of DIC criteria for the prediction of mortality in critically ill adult patients. The primary objective is to assess the predictive values of the DIC criteria of Japanese Association for Acute Medicine, International Society on Thrombosis and Haemostasis, Japanese Ministry of Health and Welfare, Korean Society on Thrombosis and Hemostasis and Chinese Diagnostic Scoring System for 28-day mortality. We will search electronic bibliographic databases such as MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Two reviewers will independently screen titles and abstracts, perform full article reviews and extract study data. We will report study characteristics and assess methodological quality using the Quality of Diagnostic Accuracy Studies-II tool. If pooling is appropriate, we will compute parameter estimates using bivariate random-effects and hierarchical summary receiver operating characteristic models to produce summary receiver operating curves, summary operating points (pooled sensitivity and specificity) and 95% confidence regions around the summary operating points. Clinical and methodological subgroup and sensitivity analyses will be performed to explore heterogeneity.

Ethics and dissemination

This systematic review will help physicians diagnose DIC accurately and improve their clinical practice in critically ill settings. Approval from an ethics committee is not required. The findings will be disseminated through publication in a peer-reviewed journal.

PROSPERO registration number

CRD42017079350.

https://ift.tt/2FWSu79

How common are neurocognitive disorders in patients with chronic kidney disease and diabetes? Results from a cross-sectional study in a community cohort of patients in North Wales, UK

Objective

Chronic kidney disease (CKD) affects nearly 9% of global populations and is strongly associated with older age. Neurocognitive disorders (NCDs), which include mild cognitive impairment and dementia, are rising as a result of ageing populations throughout the world. This investigation's aim is to report the frequency of mild to major NCD in a clinical cohort of adults with mild to moderate CKD and diabetes.

Setting

Glan Clwyd District general Hospital, North Wales, UK.

Participants

We enrolled 178 patients with CKD and diabetes, aged 55 years and over with an estimated glomerular filtration rate <60 >15 mL/min/1.73 m², attending a specialist renal and diabetic outpatient clinic.

Outcome measures

Frequency of mild and major NCD and the association with the stage of CKD was assessed in all patients attending the specialist clinic. The diagnosis of NCD was based on patient and informant interview, case note review, neuropsychological assessment and application of Diagnostic and Statistical Manual of Mental Disorders version 5.

Results

This investigation found 86/178 (48%) of the cohort with an NCD ranging from mild (n=49) to major symptoms (n=37). No association was found with NCD and the stage of CKD. Mild and major NCD was associated poorer outcomes in several cognitive domains, including, language, executive, memory, fluency and attention function (p<0.05).

Conclusions

This is the first UK investigation to report that cognitive changes occur in a significant number of older adults with CKD and diabetes. The unexpected finding was that prior to cognitive assessment, not any of the cohort had a pre-existing diagnosis of cognitive impairment, suggesting that the current prevalence and incidence rates of NCD in the general population are possibly significantly underestimated. Our findings also suggest that the cognitive function of patients with CKD should be screened and monitored routinely as part of their overall care management.

https://ift.tt/2rkQfR3

Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol

Introduction

Opioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms.

Methods and analysis

We will form a cohort of all adult residents in New South Wales (NSW), Australia, who initiated prescribed opioids from 2002 using Pharmaceutical Benefits Scheme dispensing records. This cohort will be linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use.

Ethics and dissemination

This study has received full ethical approval from the Australian Institute of Health and Welfare Ethics Committee, the NSW Population and Health Services Research Committee and the ACT Health Human Research Ethics Committee. This will be the largest postmarketing surveillance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. Project findings will be disseminated at scientific conferences and in peer-reviewed journals. We will also conduct targeted dissemination with policy makers, professional bodies and peak bodies in the pain, medicine and addiction fields through stakeholder workshops and advisory groups. Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely collected Data (RECORD) Statement.

https://ift.tt/2G99APE

Resource use, characteristics and outcomes of prolonged non-invasive ventilation: a single-centre observational study in China

Objective

To report the resource use, characteristics and outcomes of patients with prolonged non-invasive ventilation (NIV).

Design

A single-centre observational study.

Setting

An intensive care unit of a teaching hospital.

Participants

Patients who only received NIV because of acute respiratory failure were enrolled. Prolonged NIV was defined as subjects who received NIV ≥14 days. A total of 1539 subjects were enrolled in this study; 69 (4.5%) underwent prolonged NIV.

Main outcome measures

Predictors of prolonged NIV and hospital mortality.

Results

The rate of do-not-intubate (DNI) orders was 9.1% (140/1539). At the beginning of NIV, a DNI order (OR 3.95, 95% CI 2.25 to 6.95) and pH ≥7.35 (2.20, 1.27 to 3.82) were independently associated with prolonged NIV. At days 1 and 7 of NIV, heart rate (1.01 (1.00 to 1.03) and 1.02 (1.00 to 1.03], respectively) and PaO₂/FiO₂<150 (2.19 (1.25 to 3.85) and 2.05 (1.04 to 4.04], respectively) were other independent risk factors for prolonged NIV. When patients who died after starting NIV but prior to 14 days were excluded, the association was strengthened. Regarding resource use, 77.1% of subjects received NIV<7 days and only accounted for 47.0% of NIV-days. However, 18.4% of subjects received NIV 7–13.9 days and accounted for 33.4% of NIV-days, 2.9% of subjects received NIV 14–20.9 days and accounted for 9.5% of NIV-days, and 1.6% of subjects received NIV≥21 days and accounted for 10.1% of NIV-days.

Conclusions

Our results indicate the resource use, characteristics and outcomes of a prolonged NIV population with a relatively high proportion of DNI orders. Subjects with prolonged NIV make up a high proportion of NIV-days and are at high risk for in-hospital mortality.

https://ift.tt/2FXOxPR

SYCP2 expression is a novel prognostic biomarker in luminal A/B breast cancer

Future Oncology, Ahead of Print.


https://ift.tt/2RABa9E

Treatment patterns and outcomes among patients with recurrent/metastatic squamous cell carcinoma of the head and neck

Future Oncology, Ahead of Print.


https://ift.tt/2QevO7l

FranceCoag: a 22-year prospective follow-up of the national French cohort of patients with inherited bleeding disorders

Abstract

FranceCoag is an ongoing open prospective multicentre cohort project aimed at improving epidemiological knowledge about inherited bleeding disorders in France. The main objective of this article was to evaluate the project's progress as of the 30th December 2016. Between 1994 and this date, of the 10,047 patients included in the study, 384 (3.8%) were reported by clinicians to have died and 159 (1.6%) to be lost to follow-up. Among the remaining 9504 patients still being followed up, 5748 (60.5%) had haemophilia A, 1300 (13.7%) haemophilia B, 1980 (20.8%) von Willebrand Disease while 476 (5.0%) had another clotting factor deficiency (Factor I, II, V, combined V and VIII, VII, X, XI and XIII). The median age of the population was 32 years (Inter-quartile range (IQR) 18–50 years) at data extraction on December 30th, 2016. The subgroup of children (i.e., < 18 years old) with severe haemophilia and comprehensive information available since the first exposure to treatment was identified as the PUPs (Previously Untreated Patients) cohort. Data for the 643 children included in the PUPs' cohort had been collected since their birth. Follow-up data were collected by the clinicians in haemophilia treatment centres (HTC) every 12.9 months on median (IQR 11.4–21.3). In the PUPS cohort, data were updated every 6.2 months on median (IQR 3.7–11.7). A unique patient number assigned at study inclusion was kept at individual HTC by participating clinicians. The data collected included demographic, clinical, therapeutic and biological items on standard electronic forms. As of December 30th 2016, a plasma and serum samples was available for 2581 patients (27.1%).

https://ift.tt/2EcAJzl

First Italian birth after cryopreserved ovarian tissue transplantation in a patient affected by non-Hodgkin's lymphoma

International Journal of Hematologic Oncology, Ahead of Print.


https://ift.tt/2EeVKJM

The Molecular Profiling Lottery: More Accuracy, Less Precision, and No Cost

The concept of complete molecular profiling to select investigational treatment options is appealing; theoretically allowing the matching of patients to investigational drugs specifically targeted to molecular features of each patient's cancer. While some patients do benefit from such a strategy, the vast majority do not.

https://ift.tt/2rmXOGS

MGMT Promoter Methylation Cutoff with Safety Margin for Selecting Glioblastoma Patients into Trials Omitting Temozolomide. A Pooled Analysis of Four Clinical Trials.

Purpose: The methylation status of the O6-methylguanine DNA methyltransferase (MGMT) gene promoter is predictive for benefit from temozolomide in glioblastoma. A clinically optimized cutoff was sought allowing patient selection for therapy without temozolomide, while avoiding to withhold it from patients who may potentially benefit. Experimental Design: Quantitative MGMT methylation-specific PCR data were obtained for newly diagnosed glioblastoma patients screened or treated with standard radiotherapy and temozolomide in four randomized trials. The pooled dataset was randomly split into a training and test dataset. The unsupervised cutoff was obtained at a 50% probability to be (un)methylated. Receiver operating characteristics (ROC) analysis identified an optimal cutoff supervised by overall survival (OS). Results: For 4041 patients valid MGMT results were obtained, whereof 1725 were randomized. The unsupervised cutoff in the training dataset was 1.27 (log2[1000x(MGMT+1)/ACTB]), separating unmethylated and methylated patients. The optimal supervised cutoff for unmethylated patients was -0.28 (AUC=0.61), classifying "truly unmethylated" (≤-0.28) and "grey zone" patients (>-0.28, ≤1.27), the latter comprising ~10% of cases. In contrast, for MGMT methylated patients (>1.27) more methylation was not related to better outcome. Both methylated and grey zone patients performed significantly better for OS than truly unmethylated patients (HR=0.35, 95% CI: 0.27-0.45, p<0.0001; HR=0.58, 95% CI: 0.43-0.78, p<0.001), validated in the test dataset. The MGMT assay was highly reproducible upon retesting of 218 paired samples (R2=0.94). Conclusions: Low MGMT methylation (grey zone) may confer some sensitivity to temozolomide treatment, hence the lower safety margin should be considered for selecting unmethylated glioblastoma patients into trials omitting temozolomide.

https://ift.tt/2FYKMtj

Autologous dendritic cell-cytokine induced killer cell immunotherapy combined with S-1 plus cisplatin in patients with advanced gastric cancer: A prospective study

Purpose: We have assessed the combination of DC-CIK with S-1 plus cisplatin chemotherapy in advanced gastric cancer(AGC) and the role of mutational analysis of circulating tumor DNA(ctDNA) and T cell receptor (TCR) repertoire in predicting clinical outcomes. Experimental Design: Consecutive patients (n=63) with advanced gastric cancer were allocated to treatment with S-1 alone, S-1 plus cisplatin, DC-CIK combined with S-1 or DC-CIK combined with S-1 plus cisplatin. The primary endpoints were progression-free survival (PFS) and overall survival (OS) at 1 year; the secondary endpoints were disease control rate and analysis of ctDNA and TCR repertoire. Results: The DC-CIK infusions were well tolerated with no serious adverse events. The disease control rates (CR+PR+SD) were 5.6%, 33.3%, 47.1% and 76.9% in the S-1 alone, the S-1 plus cisplatin, DC-CIK combined with S-1 and DC-CIK combined with the S-1 plus cisplatin groups respectively (P=0.001). After adjusting for competing risk factors, treatment with DC-CIK combined with S-1 plus cisplatin was confirmed to be an independent predictor of PFS and OS (P=0.001). A decrease in the frequency and number of mutations in ctDNA was observed in 19 patients (63.3%) following the DC-CIK infusions. Decreased ctDNA mutational frequency and restored TCR repertoire were associated with improved PFS and OS (P =0.001). Conclusion: DC-CIK combined with S-1 plus cisplatin provided a favorable PFS and OS in patients with AGC and the combination therapy was safe with tolerable toxicities. Clinical efficacy correlated with decreases in ctDNA mutational profiles and restored TCR repertoire.

https://ift.tt/2FWIpHl

Anti-CTLA-4 immunotherapy does not deplete FOXP3+ regulatory T cells (Tregs) in human cancers-Letter

The potential role of anti-CTLA-4 antibodies in depleting intratumoral T-regulatory cells (iTregs) is still a matter of debate. In fact, if on one hand a recent study showed that ipilimumab and tremelimumab do not reduce Tregs in bladder, prostate and melanoma human cancers, on the other hand several other reports described opposite results. Basically, the depletion of iTregs may concern only CTLA-4+ iTregs and the evaluation of this population by immunohistochemistry may be challenging because CTLA-4 is highly express in the cytoplasm rather than on the membrane of these cells. In addition, the depletion of iTregs may occur selectively in patients with response to CTLA-4 inhibitors, a minority of the population treated with these drugs. The depletion of iTregs appears as a rapid phenomenon both in humans and mice, therefore biopsies should be performed early after the initiation of anti-CTLA-4 agents. Finally, the characterization of FCR repertoire and of the intratumoral innate immune cells able to perform antibody-derived cell-cytotoxicity should be reported to better evaluate the Tregs depleting properties of CTLA-4 inhibitors.

https://ift.tt/2rmXHuW

Genetic, epigenetic and immunologic profiling of MMR-deficient relapsed glioblastoma

Purpose: In-depth characterization of recurrent glioblastoma (rGBM) might contribute to a better understanding of the mechanisms behind tumor progression and enable rGBM treatment with targeted drugs. Experimental Design: In this study, GBM samples were collected at diagnosis and recurrence from adult patients treated with Stupp protocol. Expression of mismatch repair (MMR) proteins was evaluated by IHC, followed by whole exome sequencing (WES) of tumor samples showing loss of MSH6 reactivity. Established genetic, epigenetic and immunologic markers were assessed by standard methods and correlated with loss of MMR proteins and patient survival. Results: Expression of MMR proteins was partially or completely lost in 25.9% rGBM samples. Specifically, 12 samples showed partial or total MSH6 expression reduction. Conversely, 96.4% of GBM samples at diagnosis expressed MMR markers. WES disclosed lack of variants in MMR genes in primary samples, whereas two MSH6 negative rGBM samples shared a c.3438+1G>A* splicing MSH6 variant with a potential loss of function effect. MSH6 negative rGBM specimens had high tumor mutational burden (TMB), but no microsatellite instability. In contrast, GBM samples with partial loss of MMR proteins disclosed low TMB. MMR-deficient rGBM showed significant telomere shortening and MGMT methylation and are characterized by highly heterogeneous MHC class I expression. Conclusions:Multi-level profiling of MMR-deficient rGBM uncovered hypermutated genotype uncoupled from enriched expression of immune-related markers. Assessment of MHC class I expression and TMB should be included in protocols aiming to identify rGBM patients potentially eligible for treatment with drugs targeting immune checkpoint inhibitors.

https://ift.tt/2FYE0nj

Many Patients Withhold Information From Clinicians

TUESDAY, Dec. 4, 2018 -- Many patients intentionally withhold information from clinicians, according to a study published online Nov. 30 in JAMA Network Open. Andrea Gurmankin Levy, Ph.D., from Middlesex Community College in Middletown, Connecticut,...

https://ift.tt/2Ph1TpK

Radiological Society of North America, Nov. 25-30

The 104th Scientific Assembly and Annual Meeting of the Radiological Society of North America The annual meeting of the Radiological Society of North America was held from Nov. 25 to 30 in Chicago and attracted approximately 55,000 participants from...

https://ift.tt/2zJojLo

HHS Issues Draft Strategy for Reducing Health IT Burden

TUESDAY, Dec. 4, 2018 -- The U.S. Department of Health and Human Services has developed a draft strategy to reduce the health information technology (IT) burden, and the strategy is open for public comment through Jan. 28, 2019. The authors of the...

https://ift.tt/2Pj8e44

Exposure to Phthalates May Impact Timing of Puberty in Girls

TUESDAY, Dec. 4, 2018 -- Exposure to certain endocrine-disrupting chemicals may impact the timing of puberty in children, according to a study published online Dec. 4 in Human Reproduction. Kim G. Harley, Ph.D., from the University of California in...

https://ift.tt/2zH2T1c

Marathon Runners Show Markers of Cardiac Strain

TUESDAY, Dec. 4, 2018 -- Running a marathon can increase cardiac strain in amateur runners, according to a research letter published online Dec. 3 in Circulation. Beatriz Lara, Ph.D., from Camilo José Cela University in Villafranca del Castillo,...

https://ift.tt/2PlT9P8

Acquisition of the recurrent Gly101Val mutation in BCL2 confers resistance to venetoclax in patients with progressive chronic lymphocytic leukemia [Research Briefs]

The BCL2 inhibitor, venetoclax, induces high rates of durable remission in patients with previously treated chronic lymphocytic leukemia (CLL). However, despite continuous daily treatment, leukemia recurs in most patients. To investigate the mechanisms of secondary resistance, we analyzed paired pre-venetoclax and progression samples from 15 patients with CLL progression enrolled on venetoclax clinical trials. The novel Gly101Val mutation in BCL2 was identified at progression in seven patients, but not at study entry. It was first detectable after 19-42 months of therapy, and its emergence anticipated clinical disease progression by many months. Gly101Val reduces the affinity of BCL2 for venetoclax by ~180-fold in surface plasmon resonance assays, thereby preventing the drug from displacing pro-apoptotic mediators from BCL2 in cells and conferring acquired resistance in cell lines and primary patient cells. This mutation provides new insights into the pathobiology of venetoclax resistance and provides a potential biomarker of impending clinical relapse.

https://ift.tt/2rmYOuw

Cancer Research Driven by Patients and Technology [News in Brief]

Count Me In supports large-scale research efforts on breast, prostate, gastroesophageal cancers.

https://ift.tt/2G1vofQ

Investigation of the Developmental Requirements of Drosophila HP1 and Insulator Protein Partner, HIPP1

Drosophila Suppressor of Hairy-wing [Su(Hw)] is a multifunctional zinc finger DNA binding protein. Transcriptional regulation by Su(Hw) is essential in the ovary and testis, where Su(Hw) functions primarily as a repressor. Recently, the HP1a and Insulator Partner Protein 1 (HIPP1) was found to extensively co-localize with Su(Hw) and other insulator binding proteins in euchromatic regions of the genome, and with Heterochromatin Protein 1a (HP1a) in heterochromatic regions. As HIPP1 is the homologue of the human co-repressor Chromodomain Y-Like (CDYL), we tested its requirement in establishing transcriptional repression in flies. To this end, we generated multiple Hipp1 null alleles and a tagged derivative of the endogenous gene (Hipp1^GFP), using CRISPR mutagenesis. We show that HIPP1 is a widely expressed nuclear protein that is dispensable for viability, as well as female and male fertility. We find that HIPP1 and HP1a display minimum co-localization in interphase cells, and HP1a-dependent transcriptional repression of several reporter genes is HIPP1-independent, indicating that HIPP1 is not essential for HP1a-dependent heterochromatin formation. Despite Su(Hw) having a major role in promoting HIPP1 occupancy in euchromatin, we show that HIPP1 is dispensable for the transcriptional and insulator functions of Su(Hw), indicating that HIPP1 is not a critical Su(Hw) cofactor. Further studies are needed to clarify the role of HIPP1 in Drosophila development.

https://ift.tt/2rloB6H

Wrong way go back: lessons learned from a misguided chest drain

https://ift.tt/2BRoFkG

International publication trends in hepato‐pancreato‐biliary surgery: emergency compared to oncology

Studies relating to hepato‐pancreato‐biliary surgery show an oncological focus compared to benign, emergency and trauma. Quantitatively oncology topics are published favourably, whereas emergency‐ and trauma‐related hepato‐pancreato‐biliary articles appear static, in keeping with baseline trends over the last five decades. Further analysis could delineate whether publishing in trauma subspecialty journals compensate for this trend.

Background

There is growing interest in publishing trends given the increasing amount of research publication across various specialities. Studies relating to hepato‐pancreato‐biliary (HPB) surgery show an oncological focus compared to benign, emergency and trauma.

Methods

Analysis of ISI JCR impact factors in the Web of Knowledge and the Scimago Journal Rank through Scopus was performed to select four readily available, relevant and frequently read journals from the surgery category. A total of 5265 articles between 2012 and 2016 were categorized relating to emergency or oncology topics. A secondary analysis of PubMed MeSH term was performed to scrutinize trends of publishing over the period 1960–2016.

Results

Of the 5265 articles screened, 2062 related to HPB surgery. Of these, 49% (1007 of 2062) were oncology related. This trend towards oncology‐related topics is continued in HPB subspecialty journals where 51% (679 of 1320) of articles are oncology related. Emergency‐ and trauma‐related topics accounted 10% (198 of 2062) overall, whereas in subspecialty journals, they account for 8% (111 of 1320). Secondary analysis of MeSH term trends demonstrated a now stable trend over the last 20 years of liver and pancreatic trauma to oncology ratio of 1:10 publications, and biliary trauma to oncology publishing ratio of 1:5.

Conclusions

Quantitatively oncology topics are published favourably, whereas emergency‐ and trauma‐related HPB articles appear static. This is in keeping with baseline trends over the last five decades. Further analysis could delineate whether publishing in trauma subspecialty journals compensate for this trend.

https://ift.tt/2KWLtC8

Roll-your-own cigarette use and smoking cessation behaviour: a cross-sectional population study in England

Objectives

Roll-your-own (RYO) cigarettes have become popular in the UK and reduce the cost of smoking, potentially mitigating the impact of tax increases on quitting. We examined whether RYO cigarette use was associated with reduced motivation to quit smoking, incidence of quit attempts and quit success.

Design

Cross-sectional survey.

Setting

England.

Participants

38 590 adults who reported currently smoking or having stopped within the past 12 months.

Main outcome measures

Motivation to quit smoking, quit attempt in the last year, motives for quitting and quit success were regressed onto RYO cigarette use, adjusting for sociodemographic variables and level of cigarette addiction. Mediation by weekly spending on smoking was tested.

Results

Compared with manufactured cigarette smokers, RYO smokers had lower odds of high motivation to quit (OR=0.77, 95% CI 0.73 to 0.81) or having made a quit attempt (OR=0.87, 95% CI 0.84 to 0.91). Among those who had attempted to quit smoking, quit success did not differ by cigarette type (OR=1.00, 95% CI 0.89 to 1.12), but RYO smokers were less likely to report cost of smoking as a motive to quit (OR=0.68, 95% CI 0.61 to 0.74). Spending on smoking mediated the association between RYO use and quit attempts (β=–0.02, SE=0.003, 95% CI –0.03 to –0.02).

Conclusions

In England, compared with smokers of manufactured cigarettes, RYO cigarette smokers appear to have lower motivation to quit and lower incidence of quit attempts but similar success of quit attempts. The lower cost of RYO smoking appears to mediate the lower incidence of quit attempts among RYO users.

https://ift.tt/2E0f5NK

The Importance of Physical Activity Exercise among Older People

https://ift.tt/2ASU84h

Diagnostic performance of several biomarkers for identification of cases of non-communicable diseases among Central Africans

Background: This study determined the diagnostic performance of new biomarkers for a composite diagnosis of non-communicable diseases (NCDs) among Central Africans.
Methods:  This case-control study was conducted at LOMO Medical Centre, Kinshasa, DR Congo (DRC) between January – December, 2008. The cases comprised 226 participants with concurrent presence of at least 2 or more of NCDs. Anthropometric parameters and blood pressure were measured while blood samples were assayed for biomarkers. The receiver operating characteristics curve and the logistic regression model were applied.
Results: Serum selenium (Se) had specificity and sensitivity of 72.4% and 91.1%, respectively with an area under the curve (AUC) of 0.802; Nitric oxide (NO) (specificity: 72.4%; sensitivity: 93.0%) (AUC = 0.800); Thyroid stimulating hormone (TSH) levels > 6 Mu/L (specificity: 75%; sensitivity: 65%) (AUC = 0.0.727); serum calcium levels of ≥ 110g/L (specificity: 76%; sensitivity: 75%) (AUC = 0.822); and daily salt intake of ≥10 g/day (specificity: 75%; sensitivity: 67%) (AUC = 0.653) in the diagnosis of all NCDs, which were all highly significant (<0.0001).  
Conclusion: Serum Se, NO, calcium, TSH and daily salt intake had high diagnostic performance as biomarkers for identification of patients with concurrent NCDs in the study population.

Keywords: Non-communicable diseases, diet, new biomarkers, Central Africa.

https://ift.tt/2zIjnq5

HMGA1 variant IVS5-13insC is associated with insulin resistance and type 2 diabetes: an updated meta-analysis

Background: High-mobility group A1 (HMGA1) polymorphism has been suspected as a gene variant associated with type 2 diabetes (T2D). However, conflicting outcomes have been reported.
Objective: This meta-analysis aimed to predict the association between the HMGA1 variant IVS5-13insC and T2D.
Methods: Statistical analyses were performed using Stata/SE 12.0 software.
Results: A total of 11 case-control studies in 6 articles were included. Results suggested that the HMGA1 variant IVS5-13insC was associated with an increased risk of insulin resistance (OR = 0.61, 95% CI 0.56 to 0.66, P < 0.0001), T2D (OR = 0.67, 95% CI 0.61 to 0.73, P < 0.0001), particularly for Caucasians with increased risks of T2D (OR = 0.56, 95% CI 0.49 to 0.65, P < 0.0001) compared with wild-type subjects.
Conclusion: This meta-analysis indicated that the HMGA1 variant IVS5-13insC can be a risk factor of T2D development, particularly among Caucasians. Significant risks were also found (Asian: OR = 0.74, 95% CI: 0.63 to 0.86, P < 0.0001, Hispanic-American: OR = 0.81, 95% CI: 0.65 to 1.01, P < 0.0001) in non-Caucasian population. However, ethnical studies should be conducted to reveal whether the HMGA1 variant IVS5-13insC is associated with an increased risk of T2D.

Keywords: HMGA1, type 2 diabetes, insulin resistance, variant, meta-analysis.

https://ift.tt/2zIjQIR

Tuberculosis prevalence among university freshmen in Zhengzhou, China, during 2004-2013

Background: Tuberculosis (TB) is a major public health concern worldwide, and spreads more easily in densely populated areas such as school campuses.
Objectives: The aim of this study was to determine the prevalence of positive TB skin tests among freshmen, i.e. newly-enrolled college students, in Zhengzhou City, China.
Methods: We reviewed the data of purified protein derivative (PPD) skin tests in 656,212 freshmen in 2004-2013.
Results: A positive test showed a diameter of swelling ≥ 5 mm. The PPD positive rate was 40.69 %, with a prevalence of 146.29 per 100,000. During the 10-year study period, the rate of students with positive PPD test increased from 34.19 % in 2004 to 40.69 % in 2013. The positive PPD rate was significantly higher in males than in females (41.68 % vs 39.61 %, P<0.0001), and in rural compared with urban areas (42.04 % vs 38.03 %, P<0.0001).  
Conclusion: These findings indicated a high prevalence of PPD positivity among participants during the study period, with an increasing trend. Therefore, this population needs to be targeted by TB prevention and control programs.

Keywords: Tuberculosis; PPD test; freshmen; positive rate; prevalence.

https://ift.tt/2Pj6Q13

Association of hyperuricemia with metabolic syndrome among university workers: sex and occupational differences

Background: The relationship between metabolic syndrome (MetS) and hyperuricemia is not fully understood.
Objective: To examine the association of hyperuricemia with MetS and the component of MetS that is mostly influenced by hyperuricemia among university workers.
Methods: Anthropometric measurements, blood pressure, glucose, lipid profiles, renal function tests were measured in 1198 male and 1075 female (22-60 years old) workers on annual medical examination.
Results: Hyperuricemia was 3-fold higher in males (odds ratio, OR, 2.938, 95% confidence interval, CI, 1.909-4.522, P<0.01) than females after adjustment for age, body mass index (BMI) and renal function. Overall, individuals with hyperuricemia were 3.9-fold likely to have MetS OR, 3.903; CI (2.439-6.245), P<0.01, and dyslipidemia, 2.5 times (OR, 2.501; 95% CI, 1.776-3.521, P<0.01) after adjustment for age, BMI, sex and renal function. However, no associations were found in individuals with hypertension (OR, 1.427; 95% CI, 0.996-2.205, P=0.052) and hyperglycemia (OR, 1.476; 95% CI, 0.989-2.202, P=0.057). Administrative work positively associated (OR, 1.895; 95% CI, 1.202-2.925, P<0.05) with hyperuricemia in males and not females.
Conclusion: Male workers with hyperuricemia, especially those working in administration were at risk of metabolic syndrome. It is important to screen, prevent and treat metabolic syndrome in individuals diagnosed with hyperuricemia at the workplace.

Keywords: Hyperuricemia, metabolic syndrome, uric acid, workers.

https://ift.tt/2zGUefc

A comparison of risk of hypotension using standard doses of remifentanil versus dexmedetomidine infusions in adult patients undergoing surgery under general anaesthesia at the Aga Khan University Hospital, Nairobi

Background: Remifentanil and dexmedetomidine are common agents used in general anaesthesia, monitored anaesthesia care and critical care. When combined with inhaled or intravenous anaesthetic agents intra-operatively, they provide analgesia, lower general anaesthetic requirements and provide sedation and analgesia in the peri-operative period if indicated. Pharmacodynamically, they cause hypotension and bradycardia which are reversible if well managed. Past studies of these drugs have shown a significant proportion of patients with hypotension when compared with similar agents or in isolation. This study compares these two drugs on the effect of hypotension when used as adjuncts to general anaesthesia at low dose standard rate of infusions.  
Objective: To compare the proportion of hypotension episodes in a group of adult patients receiving dexmedetomidine infusion at 0.4mcg/kg/hr versus a group receiving remifentanil infusion at 0.2mcg/kg/min, severity of hypotension and physician interventions in each group.
Methods: One hundred and four patients scheduled for elective surgery under general anaesthesia were randomized into two groups:
Control group; received remifentanil infusion at 0.2mcg/kg/min Intervention group; received dexmedetomidine at 0.4mcg/kg/hr.
General anaesthesia was standardized in both groups. The patients were blinded to the study. Baseline blood pressures of all patients were determined prior to induction. The patient's demographic characteristics were recorded. The number of patients who developed hypotension, the frequency of hypotension and the physician interventions were recorded and analysed.  
Results: The age and gender characteristics were different between the two groups (p values <0.023 and 0.05 respectively) however they did not affect the proportion of patients with hypotension. The weight, baseline pressures and ASA status of the patients within the groups were similar. The operative procedures varied within the groups. General surgery did not influence the outcome of hypotension in both arms.  The duration of surgery in remifentanil group exceeded that of Dexmedetomidine p value<0.0005 however the time to the first episode of hypotension was similar between the groups. The episodes of hypotension were fewer in the dexmedetomidine arm and the proportion of patients with hypotension were higher in the remifentanil arm, p value<0.001, R.R 0. = 0.5938, 95% C.I=   0.329-0.819  
The physician interventions administered were similar between the two groups except the use of ephedrine between the groups.  
Conclusion: Among this population, at standard infusion rates, the proportion of patients that risk hypotension was greater in those undergoing elective surgery receiving remifentanil at 0.2mcg/kg/min than in dexmedetomidine at 0.4mcg/kg/hr under isoflurane based anaesthesia.

Keywords:  Risk of hypotension, remifentanil versus dexmedetomidine infusions, general anaesthesia, Aga Khan University Hospital, Nairobi.

https://ift.tt/2PkSpd9

Audit of insulin prescription patterns and associated burden among diabetics in a tertiary health institution in Nigeria

Background: Insulin is one of the most important anti-diabetic agents in the management of diabetes even among type 2 diabetic.
Objective: There was need to assess insulin adherence, mode of insulin delivery and burden of insulin usage among diabetics.
Methods: A cross-sectional, prospective questionnaire, orally administered at a Diabetes Clinic of a University Teaching Hospital, SouthWest, Nigeria. Participants were consecutive patients with diabetes who were 18 years or older presently on insulin either alone or in combination with other anti-diabetic agents for at least 3 months. Baseline demographic and insulin treatment information were obtained.
Results: Two hundred and thirteen (213) participants were studied. Of these, 21 (9.9%) had T1DM and 192 (90.1%) had T2DM, (means age, 58.6 ± 13.1 years, mean duration of diabetes, 7.0 ± 6.9 years). Insulin adherence was noted in 72.8% with better adherence among those who self-injected insulin compared to those who were injected by health care professionals (HCPs) or relations. Among the respondents, 80.8% were on human insulin and pre-mixed insulin was the most commonly used form of insulin (52.6%). Most participants (52.6%) were taking 10-20 units per day, only 22 (10.3%) were on >40units/day. Reuse of insulin needle was found in 74.6% of the participants.  Major reasons for insulin omission were non-availability of insulin and patients being tired of insulin injection.
Conclusion: The insulin adherence among diabetics in this study was high. Non-availability of insulin, insulin injection pain and being tired of continual insulin usage were some of the reasons for non-adherent to insulin usage.

Keywords: Adherence, diabetes, burden, insulin injection, omission.

https://ift.tt/2zRHG59

Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, SouthWestern Nigeria

Background: Irrational antibiotic prescriptions for children is a global concern requiring periodic evaluation and monitoring.  
Objectives: To assess appropriateness of antibiotic prescribing for under-five children, as well as evaluating mothers' usage of antibiotics for their under-five and reason(s) for use.
Method: Cross-sectional review of out-patient case-notes of under-five using principles of antibiotic prescribing and a questionnaire-guided interaction with under-five mothers.
Results: Nearly all (445;98.9%) antibiotic prescriptions were based on signs and symptoms indicative of bacterial infection. Only 3(0.7%) had the initial antibiotic regimen modified. Nine (2.0%) had documented evidence of sensitivity test requested before antibiotic prescribing. Presence of infection or need for antibiotic therapy was established in 190(42.2%). Majority (324;72.0%) of mothers had administered antibiotics to their under-five. Of these, 157(48.5%) were prescribed by physicians and 79(24.4%) were self-recommended. Educational status of mothers significantly influenced antibiotic usage.
Conclusion: Antibiotic prescriptions for under-fives was largely based on symptoms indicative of bacterial infections, thereby corroborating the widespread empirical antibiotic prescribing. Considerable number of mothers engaged in self-recommendation of antibiotics for their under-fives. Thus, there is a need for continuous enlightenment of prescribers and mothers on rational use of antibiotics, while microbiological confirmation of clinical diagnosis is encouraged for evidence-based antibiotic prescribing.

Keywords: Antibiotic prescription, under-five children, mothers/caregivers.

https://ift.tt/2Pi4qjn

E-Selectin and markers of HIV disease severity, inflammation and coagulation in HIV-infected treatment-naïve individuals

Background: E-selectin has been shown to play a role in atherosclerosis and to be increased in HIV-infected individuals due to chronic immune activation. There is a paucity of studies on E-selectin in HIV-infected treatment-naïve individuals.
Objectives: This study aimed to determine whether E-selectin levels were increased in HIV-infected treatment-naïve individuals and whether these correlated with markers of disease severity, inflammation and coagulation to determine if this population is at risk for cardiovascular disease (CVD).
Methods: E-selectin levels were determined in 114 HIV-infected treatment-naive and 66 HIV-negative individuals, compared between groups and correlated with markers of disease severity, inflammation and coagulation.
Results: There were statistically significant differences (p<0.01) in levels of WCC, CD4+ count, %CD38/8, albumin, IgG, hsCRP and D-dimer between groups and no statistically significant differences in E-selectin (p=0.84) and fibrinogen (p=0.65) levels. E-selectin correlated with age (p=0.02) and gender (p=0.01).
Conclusion: E-selectin was a poor marker in this setting. There was no correlation with any of the markers of disease severity, inflammation and coagulation. E-selectin is most likely raised in an acute inflammatory setting, rather than chronic stage of HIV-infection. We recommend that other markers be utilized to identify patients at increased risk of CVD; as these were significantly increased untreated in individuals.

Keywords: E-selectin, inflammation and coagulation in HIV-infected treatment-naïve individuals.

https://ift.tt/2PeKBJT

Impact of weight reduction on insulin resistance, adhesive molecules and adipokines dysregulation among obese type 2 diabetic patients

Background: Type 2 diabetes mellitus is usually related to vascular problems and is associated with impairment in endothelial function characterized by impaired endothelial-dependent vasodilation and increased platelet adhesion. There is limitation in clinical studies that have addressed the beneficial effects of weight reduction in modulating biomarkers of endothelial dysfunction and adipokines dysregulation for obesity associated with type 2 diabetes mellitus.
Objective: This study was designed to detect the effects of weight loss on insulin resistance, adhesive molecules and adipokines dysregulation in obese type 2 diabetic patients.
Methods: Eighty obese patients with type 2 diabetes mellitus, their age ranged from 35-55 years and their body mass index ranged from 31-37 kg/m2  were equally assigned into 2 groups:  the weight reduction group received aerobic exercises in addition to diet regimen, where the control group received medical treatment only for 12 weeks.
Results: There was a 24.04%, 19.33%, 22.78% ,12.28%, 9.35%, 22.53% & 10.12 % reduction in mean values of Homeostasis Model Assessment-Insulin Resistance Index (HOMA-IR), Leptin, Adiponectin, Resistin, intercellular cell adhesion molecule -1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin & body mass index (BMI) respectively in addition to 26.20% & 24.58% increase in the mean values of adiponectin & the quantitative insulin-sensitivity check index (QUICKI) respectively in group (A) at the end of the study. The mean values of leptin, resistin, insulin, HOMA-IR, ICAM-1, VCAM-1, E-selectin & BMI were significantly decreased in addition to significant increase in the mean values of adiponectin & QUICKI in group (A) those that received aerobic exercise training in addition to diet regimen. While the results of group (B) those that received no treatment intervention were not significant. In addition, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment (P<0.05).
Conclusion: Within the limit of this study, 10% reduction in body mass index modulates insulin resistance, adhesive molecules and adipokines dysregulation among obese type 2 diabetic patients.

Keywords: Type 2 Diabetes, obesity, adhesive molecules, adipokines, insulin resistance, weight reduction.

https://ift.tt/2zIjLF3

Interferon- γ receptor-1 gene promoter polymorphisms and susceptibility for brucellosis in Makkah region

Background: Genetic polymorphisms that affect the production levels of certain cytokines and/or their receptors may determine the risk, severity or protection in some infectious diseases like brucellosis.
Objectives: The aim of this study was to investigate the association of certain known Interferon-γ Receptor-1 (IFN-γ R1) gene promoter polymorphisms and the susceptibility to infection with Brucellosis in Saudi population.
Methods: A cases-control association study was conducted in 69 individuals with human brucellosis and 94 healthy individuals. Genotyping of IFN-γ R1 – 56 C>T and IFN-γ R1 – 611 A>G polymorphism in both patients and healthy controls was done by PCR- restriction enzyme length polymorphisms (PCR-RFLP) and PCR- confronting two primer pairs (PCR-CTPP) methods and were assessed for potential associations with susceptibility for human brucellosis and their mode of penetrance.
Results: Interestingly, we have designed a PCR-CTPP system to be used for genotyping of    IFN-γ R1 – 611 A > G polymorphism. The PCR-CTPP is an accurate method for genotyping of SNPs. Moreover, it is time-saving, inexpensive and easy to perform.
Conclusion: Both tested polymorphisms, IFN-γ R1 – 56 C>T and IFN-γ R1 -611 A>G polymorphism had no role in genetic susceptibility to human brucellosis in the study population. The PCR-CTPP can be used for genotyping IFN-γ R1 – 611 A > G polymorphism and other types of mutation.

Keywords: Brucellosis; susceptibility; IFN-γ R1 gene promoter polymorphisms.

https://ift.tt/2Pin9vd

Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt

Background: The prevalence of type 2 diabetes mellitus (DM) is increasing rapidly in Egypt and considered one of the major health problems in the Eastern Mediterranean region.
Objectives: To measure the prevalence of diabetes and detect the undiagnosed cases of diabetes mellitus among patient with tuberculosis.
Methods: Study Design: Nationwide population-based study. To diagnose DM among TB patients, we used a fasting blood sugar level of ≥ 126 mg/dl and a post-prandial blood glucose test result of ≥ 200 mg/dl.
Results: Screening for DM among 1435 TB patients' with no history of DM detected 30 new cases of DM, with a case detection rate of 2.09%. The highest screening yields were among TB patients aged ≥ 40 years, females and those with pulmonary TB. The number needed to screen (NNS) TB patients for detecting one new case of DM was 48 while the lowest values were for older age (NNS=27) and females (NNS=29).
Conclusion: Older age and being females and those with pulmonary type of TB were more prone to the double burden of TB and DM. Identifying cases with double burden of diseases will improve the proper management of both diseases and prevent complications.  

Keywords: Screening test, diabetes mellitus, tuberculosis.

https://ift.tt/2zIjFNH

Levels of heavy metals in urine samples of school children from selected industrial and non-industrial areas in Dar es Salaam, Tanzania

Objectives: The levels of lead, zinc, iron, copper and cadmium metals in the urine samples of selected school children in industrial and non-industrial areas in Dar es Salaam were investigated.
Methods: Urine samples were collected from 120 children in industrial areas and 120 children in non-industrial areas then digested in concentrated acids and analysed using atomic absorption spectrophotometry (AAS).
Results: The concentrations of the heavy metals in the urine samples ranged from below detection limit/non-detectable (ND) to 1.92 mg/L for lead, ND to 2.55 mg/L for zinc, ND to 8.98 mg/L for iron and ND to 0.05 mg/L for copper. Cadmium was not detected. Significant differences were found between the concentrations of heavy metals in urine of pupils from the industrial areas and those from non-industrial areas. The mean concentrations of lead and copper in samples from industrial areas were significantly higher than those found in non-industrial areas (p < 0.002), while the mean concentrations of zinc and iron found in samples from non-industrial areas were significantly higher than those found in industrial areas (p < 0.0001).
Conclusion: The contamination levels were generally high in samples from both areas indicating exposure from various sources. The findings indicate public health risks.

Keywords: Heavy metals, children urine, industrial areas, non-industrial areas, Tanzania.

https://ift.tt/2Ph3gVf

Association of FokI, TaqI, BsmI and ApaI polymorphisms with diabetic retinopathy: a pooled analysis of case-control studies

Background: To assess synthetically the association between polymorphisms in the vitamin D receptor (VDR) gene (FokI, BsmI, ApaI, and TaqI) and diabetic retinopathy (DR).
Methods: Pubmed, Embase, ISI Web of Science, Google-scholar and CBMDisc, CNKI and Chongqing VIP databases were searched. A meta-analysis was performed.
Results: Six studies with 636 cases and 1,035 controls were included in this meta-analysis. The outcomes showed that the FokI polymorphism (F allele) of VDR gene had no statistical protective relationship with DR in overall studies. Interestingly, stratification analysis showed that the FokI polymorphism (Fallele) was significantly associated with decreased DR risk in the Chinese population, among included studies without publication bias, during a comparison analysis between normal subjects and DR patients, and among articles published after 2010. However, the TaqI, BsmI and ApaI polymorphisms of VDR gene had no significant association with the risk of DR.
Conclusion: This meta-analysis of case-control studies revealed that the VDR-FokI polymorphism (F allele) decreased the risk of DR in Chinese people, among included studies without publication bias, during a comparison analysis between normal subjects and DR patients, and among articles published after 2010. Further rigorous and prospective studies with large sample size are needed to confirm our findings.

Keywords: Diabetic retinopathy; polymorphism; Vitamin D receptor.

https://ift.tt/2zJWAdD

Interface of non-communicable diseases and infections in Africa

Nil

https://ift.tt/2PgnjmZ

Effects of gender, age and treatment duration on lipid profile and renal function indices in diabetic patients attending a teaching hospital in South-Western Nigeria

Background: Type 2 Diabetes Mellitus (T2DM) is associated with diabetic nephropathy and hyperlipidemia. Gender, age, medication adherence, lifestyle, culture and socioeconomic status could be sources of diversity in T2DM leading to differences in predisposition, development and clinical presentation.
Objectives: Therefore, this study aimed to investigate the influence of gender, age and treatment duration on kidney and lipid-related biochemical indices of T2DM patients attending Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria (EKSUTH).
Methods: Blood from diabetic patients and healthy subjects was analysed for fasting blood glucose (FBG), renal function parameters and lipid profile. Influence of age, gender and treatment duration on indices was assessed using standard baseline values.     
Results: Dyslipidemia was pronounced among female diabetics while the incidence of diabetes was found to be higher in middle-age. The percentage of diabetics with high levels of FPG, urea, creatinine, cholesterol, triglyceride and low density lipoprotein-cholesterol after 9-10 years of treatment were lower compared with the percentage after 5-6 years of treatment.    
Conclusion: Gender, age and treatment duration influenced clinical course of T2DM among patients presenting at EKSUTH but long term treatment appeared to improve T2DM among patients.

Keywords: Fasting blood glucose, dyslipidemia, creatinine, atherogenic index, diabetes, Ekiti State.

https://ift.tt/2zIjulv

Knowledge, attitude, willingness of HIV counseling and testing and factors associated with it, among long distant drivers in Enugu, Nigeria: an opportunity in reduction of HIV prevalence

Background: Long distance truck drivers (LDTDs) have been one of the key forces in the spread of HIV/AIDS across the African continent.
Objective: We set out to assess  the knowledge of HIV transmission route, preventive measures, attitude to HIV Counseling and Testing (HCT), willingness  and factors associated with willingness to screen for HIV among long distance truck drivers in Enugu, Nigeria.
Method: This was a cross-sectional study of 500 long distance truck drivers aged 19-65 years. They were interviewed with a semi-structured questionnaire on aspects of HCT. Data was analyzed using cross tabulations to examine associations and chi square test for various variables.
Result: A good number of the respondents have wrong ideas of transmission route, ranging from 28.4% to 90.4%. Significantly high number of those with tertiary education will engage in incorrect preventive measures like using antibiotics after sex, and seeking protection from a traditional healer compared to those with no formal education ( χ 2 = 3.2, p = 0.02; χ 2 = 2.3, p = 0.01 respectively).. Those with tertiary education and those that were divorced showed a generally good attitude towards HCT and mostly agreed that HCT should be made compulsory compared to others (χ2 = 29.8, p< 0.001; χ2 = 10.1, p < 0.001 respectively). There was a significantly high willingness to screen among 302 (60.4%) of the participants. There was also significant association between marital status, educational level and willingness to screen ( χ2 = 174.4, p < 0.001; χ2 = 10.6, p < 0.001 respectively).
Conclusion:  A high number of LDTD had wrong knowledge of transmission route, better educational level did not affect incorrect knowledge of preventive measures, educational and marital statuses affected attitude to HCT, willingness to screen was high with marital status and educational level significantly associated with it.  We recommend routine HCT at the work places of truck drivers to correct the anomalies discovered above.

Keywords: HIV counselling, testing, Nigeria, screening, sub-Saharan Africa, truck drivers, willingness.

https://ift.tt/2Pi4orL

Influenza virus A (H1 and H3) and B co-circulation among patient presenting with acute respiratory tract infection in Ibadan, Nigeria

Background: Influenza is an acute respiratory disease that continues to cause global epidemics and pandemics in human with significant mortality and morbidity.
Objectives: This study was designed to identify the circulating influenza virus in Ibadan, Nigeria during the 2006/2007 season.
Methods: Throat swab samples were collected from patients presenting with acute respiratory tract infection at the Out-Patient Departments of major hospitals in Ibadan over a period of seven months from November 2006 to May 2007. Isolation of influenza virus was performed using Madin-Darby Canine Kidney cell line and 10 days old chicken embryonated egg. Isolates was identified by haemagglutination and haemagglutination-inhibition assays using selected CDC Influenza reference antisera (A, B, subtype H1 and H3).
Results: Out of 128 patients tested, 21(16.4%) yielded positive for virus isolation. Identification of the isolates showed that 19(14.8%) were positive for influenza virus out of which 11(8.6%) and 8(6.2%) were influenza A and B viruses respectively. Influenza A virus 6(4.7%) were subtype H1; 4(3.1%) were co-subtype H1 and H3; and 1(0.8%) was not inhibited by subtype H1 and H3.
Conclusion: The circulation of influenza virus A and B in this study is important to contributing knowledge and data to influenza epidemiology and surveillance in Nigeria.     

Keywords: Influenza A, haemagglutination, isolation, Nigeria.

https://ift.tt/2Ph3god

Walking as a feasible means of effecting positive changes in BMI, waist, and blood pressure in black South African women

Background: In the context of a growing obesity pandemic in sub-Saharan African countries little is known on how to address the problem /disease in the region.
Methods: A randomised controlled trial of walking to decrease obesity was conducted using 115 women employed at the University of Venda, Limpopo province. 49 of these participants were randomly selected into an intervention group, which walked for 30 minutes, 3 days per week for a period of 12 weeks on treadmills located in the university gym. The control group were instructed to continue with usual activities. Baseline and follow-up body mass index (BMI), waist circumference, blood pressure (BP), body size discrepancy (measured by a feel-minus-ideal (FID) index), and physical activity were collected on all participants.
Results: The absolute changes in BMI, waist, systolic and diastolic BP in the intervention group was -0.80, -1.50, -4.02 and -2.37, respectively. In contrast, the absolute changes for these were +1.05, +1.73, +4.64 and +4.94, respectively in the control group. The results of the FID analysis showed that most had a desire for thinness.
Conclusion: Our data demonstrates that positive changes in BMI, waist, and BP were observed in the intervention group, indicating the potential scalability of the intervention.

Keywords: Exercise, blood pressure, obesity, intervention.

https://ift.tt/2zJWym1

Resistance development and insecticide susceptibility in Culex pipiens pipiens, an important vector of human diseases, against selection pressure of temephos and its relationship to cross-resistance towards organophosphates and pyrethroids insecticides

Background: Culex pipiens pipiens is an important vector of human diseases.
Objective: To determine the insecticide resistance development in Culex pipiens pipiens against selection pressure of temephos..
Methods: A field population of Culex pipiens pipiens was collected from Northwestern Tunisia with a medium level of temephos resistance (LC50 = 0.0069). It was subjected to six generations of temephos pressure selection to evaluate its relationship to cross-resistance towards organophosphates (OPs) and pyrethroids (PYR) insecticides.
Results: The selection was initiated at the dose 0.0266, 0.0748 and 0.0069 which were increased during successive generations up to 0.1488, 3.8747 and 0.0086 after sixth generation for temephos, chlorpyrifos and permethrin insecticides, respectively. It is important to noted that high cross-resistance to chlorpyrifos insecticide (OP) was detected (51.88×). However, little or no cross-resistance to the pyrethroid permethrin (PYR) was recorded (1.24×). Contrary to metabolic resistance, it seemed that acetylcholinesterases AChE 1 was fixed under pressure selection.  
Conclusion: The high cross-resistance to temephos and chlorpyrifos is reasonable because they belong to the same class of insecticide (OP). However, the little cross-resistance to the pyrethroid permethrin could support its use alternately for Culex pipiens pipiens control.

Keywords: Culex pipiens pipiens, temephos selection, Tunisia.

https://ift.tt/2PjoYYE

GATA4 molecular screening and assessment of environmental risk factors in a Moroccan cohort with tetralogy of Fallot

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect (CHD) with an incidence of 1/3600 live births. This disorder was associated with mutations in the transcription factors involved in cardiogenesis, like Nk2 homeobox5 (NKX2-5), GATA binding protein4 (GATA4) and T-BOX1 (TBX1). GATA4 contributes particularly to heart looping and differentiation of the second heart field.
Objectives: The aim of this study was to screen a Moroccan cohort with tetralogy of Fallot for GATA4 mutations, and to assess environmental risk factors that could be involved in the occurrence of this disorder.
Methods: Thirty-one non-syndromic TOF patients, enrolled between 5th April 2014 and 18th June 2015, were screened for GATA4 mutations using direct sequencing of GATA4 coding exons. Statistical assessment of different risk factors, which is a retrospective study, was carried out using Chi-square and Fisher's exact tests.
Results: We identified seven exonic variants in nine patients (two missense and five synonymous variants); in addition of eight intronic variants. Assessment of environmental risk factors shows significant association of maternal passive smoking with TOF in the Moroccan population.
Conclusion: The present study allowed, for the first time, the molecular and environmental characterisation of Moroccan TOF population. Our findings emphasise particularly the strong association of passive smoking with the emergence of tetralogy of Fallot.

Keywords: Tetralogy of Fallot, GATA4, molecular screening, risk factors.

https://ift.tt/2QaiL6I

An Appraisal of the 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke

Intervent Neurol 2019;8:55–59

https://ift.tt/2Ebrorz

Impact of comorbidities and body mass index in patients with myelofibrosis treated with ruxolitinib

Abstract

Comorbidities defined by the Charlson comorbidity index (CCI) and body mass index (BMI) are significantly associated with outcome in patients who receive continuous treatment with tyrosine kinase inhibitors. We evaluated the impact of CCI and BMI on responses, drug-related toxicities, and outcome in a cohort of 402 patients with myelofibrosis (MF) treated with ruxolitinib in 23 European Hematology Centers. Comorbidities were evaluable in all 402 patients. A higher (≥ 3) CCI did not correlate with a lower spleen reduction at any time (p = 0.68) or symptoms' response (p = 0.11), but influenced the onset of anemia during the first 3 months of treatment and later (p = 0.02 and p = 0.03, respectively) in patients without anemia baseline. BMI was evaluable in 380 patients and did not correlate with differences in spleen and symptoms response (p = 0.57 and p = 0.49, respectively). A higher CCI and a lower BMI correlated also with a reduced overall survival (p < 0.001 and p = 0.02, respectively). The achievement of a spleen response at 6 months could counterbalance the negative impact of comorbidities, while patients who were underweight when starting ruxolitinib and did not achieve a spleen response at 6 months were projected to the worse outcome. In MF patients treated with ruxolitinib, BMI and comorbidities did not influence the achievement of spleen/symptom responses, but they contributed to the early identification of patients who deserve a strict monitoring during treatment.

https://ift.tt/2KWwfgD

Survival After Cardiac Arrest With Instantaneous Rigorlike Stiffness: A Case Report

Instantaneous rigor is the immediate appearance of rigor mortis after cardiac arrest. To our knowledge, no previous reports exist on resuscitation of such patients. A young athlete suddenly collapsed with cardiac arrest during a marathon; his legs stiffened with instantaneous rigorlike stiffness. This stiffening provoked hyperkalemia, rhabdomyolysis, and multiple organ failure. We decided to amputate both legs, with venoarterial extracorporeal membrane oxygenation support. The patient recovered and was discharged without neurologic impairment.

https://ift.tt/2UieQTI

Usefulness of Magnetic Resonance Imaging in the Diagnosis of Juxtaglomerular Cell Tumors: A Report of 10 Cases and Review of the Literature

Juxtaglomerular cell tumors (JCTs), a rare but potentially curable cause of hypertension, are difficult to diagnose because they may be missed or misidentified as a cyst by computed tomography (CT). Their magnetic resonance imaging (MRI) pattern has not been well described. We report the clinical, biological, and radiologic features of 10 patients with JCTs. Eight were women, and median age was 24.5 years. All had severe hypokalemic hypertension related to marked secondary hyperaldosteronism. Median plasma renin and aldosterone concentrations were 392 (minimum-maximum [min-max], 70.5-4,800) mIU/L and 1,490 (min-max, 671-2,492) pmol/L, respectively.

https://ift.tt/2AP8LWe

Are Topical Nonsteroidal Anti-Inflammatory Drugs Useful for Analgesia in Patients With Traumatic Corneal Abrasions?

Topical nonsteroidal anti-inflammatory drugs versus placebo or standard of care to reduce the use of rescue oral analgesics at 24 hours or complications.

https://ift.tt/2APeRWs

Post-Trial Sustainability and Scalability of the Benefits of a Medical Home for High-Risk Children with Medical Complexity

To assess the sustainability of the benefits relative to usual care of a medical home providing comprehensive care for high-risk children with medical complexity (≥2 hospitalizations or ≥1 pediatric intensive care unit [PICU] admission in the year before enrollment) after we made comprehensive care our standard practice and expanded the program.

https://ift.tt/2EdtZB5

Unusual presentation of a life-threatening intraperitoneal haemorrhage after elective inguinal hernia repair

Kenrick Kai Chi Chan<br />Nov 28, 2018; 11:e226676-e226676<br />

https://ift.tt/2UgSXEn

Unusual case of Lemierres syndrome

Issrah I Jawad<br />Nov 28, 2018; 11:e226948-e226948<br />

https://ift.tt/2UfIY2k

Case of steroid-resistant Crohns-associated bronchiolitis in the setting of quiescent gastrointestinal disease treated with infliximab

Cher Shiong Chuah<br />Nov 28, 2018; 11:e226934-e226934<br />

https://ift.tt/2UihokK

Polymicrobial anaerobic infection with a deep abscess in the supraspinous fossa following a subacromial corticosteroid injection

John G Skedros<br />Nov 28, 2018; 11:e226598-e226598<br />

https://ift.tt/2APbuyX

A dogs dinner: an interesting case presenting as gastroenteritis

Caroline Elliott<br />Nov 28, 2018; 11:e226131-e226131<br />

https://ift.tt/2UgqY7L

Toxic shock syndrome: the great masquerader

Sagnik Biswas<br />Nov 28, 2018; 11:e226123-e226123<br />

https://ift.tt/2AQsvIS

'Hearing hooves, finding zebras: the differential diagnosis of cardiac arrest precipitated by chest pain in the postpartum woman

Gareth Squire<br />Nov 28, 2018; 11:e227048-e227048<br />

https://ift.tt/2UgT031

Recognising the return of nutritional deficiencies: a modern pellagra puzzle

Elisabeth Ng<br />Nov 28, 2018; 11:e227454-e227454<br />

https://ift.tt/2AQhA1P

Augmented reality game-related injury

Kate Gemma Richards<br />Nov 28, 2018; 11:e224012-e224012<br />

https://ift.tt/2UgqVJ7

Inflammatory fibroid polyp of the duodenum: is endoscopic resection a feasible therapeutic choice?

Faisal Inayat<br />Nov 28, 2018; 11:e226972-e226972<br />

https://ift.tt/2AQbHSn

Tumour lysis syndrome: a rare side effect of imatinib therapy for GIST

Juliann Ondecker<br />Nov 28, 2018; 11:e226647-e226647<br />

https://ift.tt/2UgqVc5

Skull base aspergillosis in an immunocompetent elderly man with early response to steroid

Pamela Sarkar<br />Nov 28, 2018; 11:e226998-e226998<br />

https://ift.tt/2AQhxmF

Eagles syndrome: a piercing matter

Matthew Zammit<br />Nov 28, 2018; 11:e226611-e226611<br />

https://ift.tt/2UgHkO2

Traumatic rosette cataract

Rohan Bir Singh<br />Nov 28, 2018; 11:e227465-e227465<br />

https://ift.tt/2AUkt1U

Successful outcome after spontaneous first trimester intra-amniotic haematoma and early preterm premature rupture of membranes

Spyros Bakalis<br />Nov 28, 2018; 11:e224596-e224596<br />

https://ift.tt/2Uihkl0

Cervicofacial necrotising fasciitis by clindamycin-resistant and methicillin-resistant Staphylococcus aureus (MRSA) in a young healthy man

Cong Ran<br />Nov 28, 2018; 11:e226975-e226975<br />

https://ift.tt/2ARUtnB

Chronic meningoencephalitis with mixed pathology mimics progressive supranuclear palsy

Marian L Dale<br />Nov 28, 2018; 11:e227119-e227119<br />

https://ift.tt/2ARUnML

Acute subretinal abscess in Staphylococcus aureus septicaemia with endophthalmitis showcased by multimodal retinal imaging and with 2-year follow-up

Rita Prajapati<br />Nov 28, 2018; 11:e227288-e227288<br />

https://ift.tt/2ARUgAP

Dysphagia due to massive retropharyngeal and pre-vertebral abscess

Thomas Hendriks<br />Nov 28, 2018; 11:e228162-e228162<br />

https://ift.tt/2Ugfh19

Meropenem-induced liver injury and beta-lactam cross-reactivity

Timothy Tattersall<br />Nov 28, 2018; 11:e227124-e227124<br />

https://ift.tt/2AOGzmd

NAEMSP® 2019 Annual Meeting Will Reunite Governor with Lifesaving First Responders

OVERLAND PARK, Kan. — The National Association of EMS Physicians (NAEMSP) has several inspiring and informative presentations lined up for its 2019 Annual Meeting, which will take place January 7-12 in Austin, Texas. The conference will reunite its keynote speaker, former Pennsylvania Governor Tom Ridge, with the first responders who resuscitated him after his cardiac arrest in November...

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