Thursday, 7 December 2017

Steatocystoma Multiplex: A Case Report of a Rare Disease Diagnosed in a Trauma Patient


Steatocystoma Multiplex is a rare, benign skin disorder that can manifest itself in the head and neck region and can be significantly disfiguring. There is minimal reference of this condition in oral and maxillofacial surgery literature. Steatocystoma Multiplex is characterized by multiple lesions of the skin in more than one location. The distribution of steatocystomas typically include the regions of the body that contain sebaceous follicles, most notably the face, anterior chest wall, and limbs [1, 2].However, steatocystomas can occur anywhere and have been reported on the oral mucosa and in the subdermal tissue. The prevalence of these lesions is not currently known, which is likely due to the fact that they are rarely reported. The lesions are smooth and round macroscopically, ranging in size from a few millimeters to several centimeters. This case report describes the work-up and diagnosis of a 35-year-old male with Steatocystoma Multiplex who was clinically triaged by the Emergency Department at Nassau University Medical Center on two separate occasions as having other epithelial pathologies.

On January 22, 2015, a 35-year-old African American male presented to Nassau University Medical Center status post-assault with the chief complaint of pain to the right malar region. The previous medical history of this patient included well-controlled hypertension and multiple lumps throughout the body described as neurofibromas, suggestive of neurofibromatosis type I (“NF1”). Evaluation of the patient’s chief complaint by examination and computed tomography revealed a moderately displaced right zygomaticomaxillary complex (“ZMC”) fracture. Subsequent evaluation of the patient revealed asymptomatic, non-inflamed, well-circumscribed, yellowish, raised lesions located throughout the body with increased frequencies in the head and neck.

The overlying epithelium was normal in appearance, with the largest lesion approximately 2 centimeters in diameter. The patient stated these lesions initiated around the time of puberty and that he believed they were related to his acne. In addition, he stated his mother had similar lesions on her cheeks, but they were significantly smaller and fewer in frequency. Routine laboratory tests and chest imaging were within normal limits (Figure 4). The patient elected to undergo an open reduction and internal fixation of his right ZMC fracture. A biopsy of a lesion was performed through the existing incision in the right lateral brow region and submitted for histological evaluation. The histologic diagnosis of the lesion was reported as a steatocystoma, but unfortunately not conveyed to the patient as he failed to follow-up.

Reading Glasses to Prevent Myopia




Preliminary experimental design using reading glasses at the U.S. Naval Academy at Annapolis are discussed. The conclusion is that (+) add lenses, used as reading glasses during study, can prevent the development of myopia for college students in pilot training.

Cheng et al. (2011, 2014) and Gwiazda et al. and Hyman et al. (2003, 2005,2014) present a comprehensive listing of modern studies to date in terms of using (+) Add reading glasses to prevent or slow the progression of myopia. Brown & Berger (1979), Brown & Young (1981), Schaeffel & Howland (1988), Medina & Fariza (1993), and Greene, Brown, Medina & Graupner (1996) use first order control theory to predict myopia development as a function of time. Thorn, Gwiazda & Held (2005) present a mathematical model of myopia development using the Gompertz function. Hung & Ciuffreda (2007) develop IRDT, incremental retinal defocus, to explain myopia during the growth phase. Medina et al. (2015, 2016) and Greene & Medina (2015, 2016) use control theory to explain myopia development, solved with digital and analog computer techniques to evaluate first-order equations. Viikari (2011) and Goldschmidt (2003) present comprehensive reviews of juvenile myopia, and various techniques used to control this myopia progression. Theories are many and varied, in terms of the causes of myopia. Figure 1a and 1b below show the nearwork demand problem, typical of college students, and the proposed optical solution to the problem, namely, custom reading glasses. 

Work done during the past twenty years has demonstrated that the accommodation system is a superb example of a physiological control system. It is a complex, sophisticated, and accurate system. We can logically expect that the normal eye will show equal competence in the design of its long-term control system. 

Wednesday, 6 December 2017

Chemistry, Origin, Antitumor and Other Activities of Fungal Homo-Dimeric Alkaloids



Homo-dimeric alkaloids produced by fungi, lichenized fungi and fungal endophytes are a structurally unique class of natural products with extensive biological activities that are presented in this article. More than 100 selected fungal metabolites have been confirmed to exhibit antitumor, antimicrobial, antibacterial, and other activities.

Alkaloids are nitrogen-containing metabolites found mainly in plant species; they are also found in fungi, microorganisms and marine invertebrates. Studies on bioactive alkaloids, done with respect to both their biological activity and the role of alkaloids in the introduction of new drugs, have gained considerable importance during the past fifty years, and have been received a prominent position in the field of organic and medicinal chemistry.

Homo-dimeric alkaloids produced by fungi are a structurally unique class of natural products with extensive biological activities that are presented in this article. This mini-review article is intended to provide an overview of the properties of homo-dimeric alkaloids produced by fungi, fungal endophytes, and lichenized fungi.

All dimeric alkaloids are complex molecules consisting of two structurally similar monomers linked by bonds that can be weak or strong, covalent or intermolecular. The term homodimer is used when the two monomer molecules are identical. The alkaloidal pigment necatarone, its dehydrodimer, which prevails in aged fruiting bodies, and its 10-deoxydehydrodimer are major pigments of the green-brown flesh and cap skin of Lactarius turpis.

endophytic fungus C. globosum. The culture broth of Chaetomium fusiforme, from liverwort Scapania verrucosa, afforded two azaphilone alkaloids called chaetofusins A and B. Both compounds have shown antifungal activity.

Tuesday, 5 December 2017

Medico Legal Case Commentary: Interface Between Clinical Opinion and Legal Case Reporting in Personal Injury Litigation

                            http://www.mathewsopenaccess.com/case-reports-vol-1-iss-1.html


The history of clinical and medico-legal report case preparation is summarised. The development of an innovative medico-legal commentary is described as a method of exploring the interface between clinical opinions and legal case reports in the field of UK civil and criminal litigation. A pilot study to develop the process of documenting psychologically-relevant commentaries is illustrated with a subsequent plan for its development outlined.

The science of medicine and its related professions has an interesting relationship with the laws of evidence. Medical experts attempt to show the relevance of their clinical experience to litigation and occasionally the court room, drawing on their work in assessment and treatment within a clinical setting. Clinically, concepts of ‘proof’ and ‘causation’ exist but not to the same level of evidential stringency as they do in litigation. Effective treatment is predominantly linked to more accurate current symptoms assessment than to background history taking, although of course the latter is also important a motivated ‘patient’ with current symptoms can utilise therapeutic intervention to good effect despite its chronicity. However, as the clinician moves into the medical-legal context, the issues of causation, attribution and reliability come much more into sharp focus and, here, they have had much to learn from the legal colleagues. Whereas clinicians thrive on multiplicity of disease theories and treatments, lawyers typically aim for uniformity and avoidance of disparity, regarding numerous medical viewpoints as contradictory and confusing.

Clinicians are experienced in preparing clinical reports in order to communicate individual patient care findings to other clinicians, their patients and other appropriate organisations. These reports typically include symptom description, development and causation, diagnosis, course and duration, and prognosis and treatment. Guidelines for psychological clinical case reports, in particular, are available in the literature. Clinicians also communicate their clinical findings to other clinicians via case reports published in professional journals. Guidelines are frequently available on how to prepare these reports. When working in a medico-legal context either in civil or criminal proceedings, clinicians acting as ‘expert witnesses’ produce medico-legal reports attesting to the extent of physical or psychological injuries which may or may not have caused by a negligent act of another or others (e.g. road accident, work accident, medical accident). In the purely clinical report, emphasis is placed more on diagnosis and treatment. In the medico-legal report, requiring a more independent and impartial stance, greater emphasis may well be placed on causation and attribution, in addition to diagnosis, treatment and prognosis.  

Monday, 4 December 2017

Lung Cancer Drug, Nivolumab (Opdivo), Targets 'Hidden' HIV in French Patient

                                                            mathewsopenaccess.com



For a situation that specialists say is an initial, a lung malignancy medicate unmasked and after that assaulted the sort of HIV-tainted cells that standard antiretroviral treatment has been not able touch. The finding was accounted for on Dec. 1, which is likewise World AIDS Day, in the Annals of Oncology. While one AIDS master said the discoveries were promising, she noticed the medication did not "cure" the patient of HIV. The potential achievement fixates on the experience of a solitary 51-year-old French man, who has been getting treatment in Paris for cutting edge arrange non little cell lung disease for as far back as year. The patient - who is likewise HIV-positive - had experienced both surgery and chemotherapy for tumors that had at first been analyzed in 2015, preceding he encountered a backslide in 2016. 

Along these lines, French clinicians gave him the disease treatment nivolumb The medication is usually utilized for cutting edge melanoma and kidney growth, and additionally non-little cell lung malignancy. At the point when the patient started his nivolumab treatment, his HIV status - first analyzed in 1995 - was portrayed as "imperceptible." However, similar to all HIV patients in his circumstance, that implied just that all popular action identified with HIV was torpid. Such lethargy is far desirable over a dynamic viral status. However, it isn't a cure, in light of the fact that the patient's body isn't totally evident of the infection. Truth be told, torpid repositories of HIV-contaminated cells regularly prowl all through the safe arrangement of such patients, covered up (from both the insusceptible framework and antiretroviral treatment) over a variety of organs, for example, the bone marrow, genital tract and even the mind. 

Ought to antiretroviral treatment be stopped for reasons unknown, these shrouded cells start to duplicate and spread. "Inert HIV repositories are set up amid the most punctual phase of HIV contamination and over the span of the infection," contemplate creator Dr. Jean-Philippe Spano clarified in a news discharge. "At the point when an inactively contaminated cell is reactivated, the cell starts to deliver HIV once more." In any case, "progressively, specialists have been investigating the utilization of specific medications that seem to reactivate the inert HIV-tainted cells," noted Spano, who is leader of the medicinal oncology office at Pitie-Salpetriere Hospital AP-HP. "This could have the impact of making them obvious to the safe framework, which could then assault them." Enter nivolumab. The French malignancy understanding began accepting the growth sedate once like clockwork, beginning in December 2016. Spano's group noticed that the patient's beforehand imperceptible HIV status ended up plainly perceptible, as his HIV levels climbed. The ascent proceeded up until 45 days following the dispatch of his tumor treatment, and was joined by a comparable knock in the action of his T-cells, which fill in as the body's contender cells when an invulnerability risk is identified.

Tuesday, 28 November 2017

Healthy and Tasty: Focus Group Research on Vegetable Consumption among Children Aged 9 to 12



Focus groups were used to explore attitudes to vegetable consumption among children aged between 9 and 12. Group meetings were used to gather data concerning habitually consumed foods (both in the home and at school), preferred meals, most consumed vegetables, motives for vegetable consumption and non-consumption, the perceptions of vegetable-eating and non-vegetable-eating children, and children’s suggested vegetable-based products. Major vegetable consumption drivers and barriers were analysed from the children’s perspective. The focus group data showed that certain sensory factors (taste, appearance and texture) are powerful consumption drivers. The identity and the creativity of the person who prepares the meals as well as vegetable consumption habits in the home were also found to have a major impact on attitudes towards consuming vegetable among these children.

The most recent Global Burden of Disease analysis estimated that 4,9 million deaths per year were attributable to insufficient fruit intake and 1,8 million were attributable to insufficient vegetable intake. A low consumption of fruits and vegetables (FV) has been associated with increased risk of developing certain types of cancer and cardiovascular disease, as well as increased risk of stroke, obesity and diabete. Currently, a minimum daily FV intake of 400 g is recommended and the promotion of FV in the diet has become a priority for several governments in recent years. Low FV intake among children increasingly has become a cause for concern in many countries, like the USA, where children do not consume the five daily servings recommended. In the UK, only 20% of children aged between 5 and 15 consume the recommended amount of FV on a daily basis, the intake of vegetables being particularly low, with an average of one serving per day. In Germany, 70% of children consume fewer than two servings of vegetables per day. There are lots of researches from US and Europe that allow to see the low intake of FV and their reasons but in other places like Uruguay, are limited. Fruit and vegetable consumption in Uruguayan households amounts to an average of 246 grams per capita per day in urban areas and is dependent on income level. In Montevideo, 28% of preschool children (between 3 and 5 years of age) do not consume vegetables (fresh and/or cooked) and 72% of them only do so once or twice a week.

their family environment, which is believed to influence consumption through a variety of mechanisms, including exposure to more FV, the availability of FV in the home and the FV consumption model provided by parents. Daily exposure to a vegetable provided by parents has been found to significantly improve a child’s liking for that vegetable, whereas exposure to a variety of vegetables, as opposed to just one, has been found much more effective at increasing the probability of the child’s consuming a new vegetable. Actions performed by parents at meal times have also been found to influence vegetable consumption. 

Monday, 27 November 2017

The Right Way to Use Resistance Bands

                                                              mathewsopenaccess.com


Stretchy protection groups go anyplace and can be utilized by practically anybody. They're likewise as viable as they are economical. Be that as it may, it's essential to utilize them appropriately to get their entire being preparing and coordination benefits. As you extend a protection band, you'll begin to feel increasingly strain - that is the thing that powers your muscles to work and create. Purchase an arrangement of groups that is shading coded by level of protection. It's fine to begin with basic lengths of stretchy material and advance to a tube style with handles in the event that you need assortment later on. When in doubt, 5-foot lengths are sufficiently long for generally works out. 

To begin, wrap one end of the versatile band solidly around each hand. You need only the appropriate measure of strain for the scope of movement of the activity you're doing. Keeping up the pressure all through each activity gets more muscle bunches working and causes you create coordination and adjust. Increment protection by diminishing the length of the band between your hands. As you get more grounded and the activities wind up noticeably less demanding to do, change to a band with more prominent strain. To take advantage of this sort of exercise, consider having a physical advisor or a guaranteed quality and molding mentor outline a routine for you. 

Make certain to routinely check your groups and supplant them when you see any tears. While you can hurl protection groups into your work tote or a bag, they aren't immune. Sun, water and different sorts of climate introduction can dissolve them, so attempt to keep them out of the components when not being used.

Friday, 24 November 2017

America versus India: Who is Less Burned Out?




Burnout is fast being recognized as a syndrome causing significant negative consequences for patients, doctors and health institutions. Whereas the rates of burnout in the West for orthopaedic surgeons are high with roughly one in two orthopaedic surgeons burned out; we found that the burn out rate in Indian orthopaedic surgeons is much lower at one in four. Nonetheless, there is a need for a four-tiered approach to tackle the burnout epidemic.

Burnout is a syndrome of emotional exhaustion, depersonalisation and a reduced sense of personal accomplishment among individuals who work with people in some capacity. Two common symptoms of burnout are treating patients and colleagues as objects rather than as human beings and feeling emotionally depleted. Doctors and other health care workers are believed to be particularly susceptible to burnout compared to the general public. Burnout syndrome has gained traction in the medical community in the last two decades, in part due to its consequences. Burnout leads to increased rates of depression, health problems, suicide, alcohol and drug abuse among doctors. Patients are less satisfied with the care they receive from physicians experiencing burnout and institutions are less productive and there is increased absenteeism.

The use of a validated instrument to measure burnout, the Maslach Burnout Inventory, allows for cross-study and crosscountry comparison. In their nationwide cross-sectional study, Shanafelt et al found a burnout rate of 50% for orthopaedic surgeons in America, placing them in the top five list of most burned out specialties. Of note, orthopaedic department chairs had the lowest sense of personal accomplishment among all specialty department chairs.

In our study (unpublished; Shetty and co-workers) of burnout among Indian orthopaedic surgeons, we found a surprisingly low rate of burnout (23%). With a heavier workload, less time for professional development activities and high stress levels, the burnout rate for Indian surgeons was hypothesized to be more than their American counterparts. The low litigation rate and the strong cultural and family bonds in the Indian population may offset the work variables to some extent. A rider here is that the Indian data was accumulated from surgeons attending the annual orthopaedic society meeting, which may lead to bias.  

Thursday, 23 November 2017

Smoggy Air May Spawn Weaker Sperm

                                                          mathewsopenaccess.com


Men who experience difficulty considering may have the air they inhale to fault, another investigation by Chinese specialists recommends. Minuscule particles noticeable all around called particulate issue (PM2.5) may influence the nature of sperm, which thus can make it hard to treat a lady's egg, the analysts said. PM2.5 remains for particulate issue with a distance across 2.5 micrometers or less. That is around 3 percent of the distance across of a human hair. "Air contamination is related with a critical drop fit as a fiddle and size, which may bring about a noteworthy number of couples with barrenness," said lead scientist Xiang Qian Lao. He is an aide teacher in the School of Public Health and Primary Care at the Chinese University of Hong Kong. Lao advised, be that as it may, that this examination can't demonstrate that PM2.5 makes the harm sperm, just that the two are related. "You can't finish up it is a causal relationship in this examination, yet existing confirmation from toxicology and different investigations bolster that the relationship is possibly causal," he said. Precisely how air contamination may influence sperm isn't clear, Lao said. Numerous segments of fine particulate issue, for example, substantial metals and polycyclic sweet-smelling hydrocarbons, have been connected to sperm harm in trial examines, he said. The impact of air contamination on sperm is little, Lao stated, but since contamination is so boundless around the world, numerous men could be influenced. 

Furthermore, in light of the fact that decreasing air contamination may enhance the nature of sperm, "we call for worldwide methodologies to diminish air contamination for development of regenerative wellbeing," Lao said. Unusual sperm brings about barrenness on the grounds that the sperm can't enter the egg, clarified Dr. Tomer Singer, chief of regenerative endocrinology and fruitlessness at Lenox Hill Hospital in New York City. "We have seen a pattern over the most recent quite a few years where the convergence of the sperm, the motility and the state of the sperm have been breaking down," Singer said. "It's been hard to pinpoint what has been the guilty party." This investigation gives solid confirmation to help a relationship between air contamination introduction and strange semen, said Dr. Manish Vira, bad habit seat of urologic investigate at Northwell Health's Arthur Smith Institute for Urology in New Hyde Park, N.Y. Nonetheless, reports from the United States have not discovered comparative outcomes, recommending that the negative effect might be seen just in regions with to a great degree poor air quality, he said. Vira called air contamination a worldwide wellbeing crisis and said this new examination recommends that weakened fruitfulness might be among the wellbeing results. "The following stage is to relate air contamination levels with pregnancy rates to decide whether the progressions found in semen mean debilitated fruitfulness," Vira said. For the examination, Lao and his associates gathered information on about 6,500 Taiwanese men 15 to 49 years of age. The majority of the men had partaken in a restorative examination program in the vicinity of 2001 and 2014. The program included surveying the nature of their sperm, including the aggregate number, shape, size and development (motility). 

Introduction to PM2.5 levels was assessed from the personal residences of each man for three-month time frames more than two years. It takes three months for sperm to be produced, Lao said. The specialists found a relationship between presentation to PM2.5 and unusual sperm. In particular, each 5 micrograms of PM2.5 per cubic meter of air more than two years was related with an about 1.3 percent drop fit as a fiddle and size. It was likewise connected with a 26 percent expanded danger of being in the last 10 percent of ordinary sperm size and shape, in the wake of representing other conceivable effects on sperm quality, for example, smoking, drinking, age and weight.

Wednesday, 22 November 2017

Can Ultrasound Elastography Substitute Tissue Biopsy in the Diagnosis of Malignancy?




We casually judge a material as “hard” or “soft” by applying pressure while touching it. In medicine, clinicians palpate the patient’s body to determine if certain tissue feels normal, unusually hard or unusually soft, to get possible signs of disease or disorder. However, palpation is highly subjective and therefore can be unreliable. For example, lesions that are very small and those that are located deep into the body may not be detectable by palpation alone. Also, the degree of hardness between different pathologies may not be distinct enough that can be appreciated by our sense of touch despite extensive training and experience. Although in some cases, abnormal growths can be easily judged as hard tumor or cystic tumor based on their hardness and on their echo pattern during conventional ultrasound imaging, to differentiate one type of solid tumor to the others based on degree of hardness can be difficult. Such distinction is particularly important in clinically differentiating deadly malignant tumors from the benign ones because early detection and intervention of malignant lesions can be life-saving. A newly introduced ultrasound technology provides a noninvasive way to accurately diagnose a malignant tumor based on its characteristic hardness. This technology is being utilized in a diagnostic procedure that grades tissue elasticity using ultrasound, more often called “ultrasound elastography”.

Use of ultrasound in diagnosis has been one of the oldest of the “modern technologies” available to medicine today. Imaging 1 Received Date: 10 Feb 2016 Accepted Date: 16 Mar 2016 Published Date: 21 Mar 2016 Copyright © 2016 Feril LB Citation: Feril LB. (2016). Can Ultrasound Elastography Substitute Tissue Biopsy in the Diagnosis of Malignancy? M J Canc. 1(1): 004. Ultrasonography, or imaging by ultrasound, is one of the most commonly utilized diagnostic procedures today. This is despite the introduction of many other alternative diagnostic methods. The reasons include ultrasound being non-ionizing (unlike X-rays and CT scans), non-invasive (unlike tissue biopsies), less expensive and more commonly available (unlike MRI and genetic tests). In addition, new ultrasound technologies have also made ultrasonography more reliable and agile, thus offering additional diagnostic capabilities. 

One of these new technologies is the so-called “ultrasound elastography”. ABSTRACT with the use of ultrasound, also called ultrasonography or echography, is considered one of the safest and cost-effective real-time imaging that is widely used today not only for diagnosis but also as an instrument useful in interventional medicine. The imaging works when ultrasound waves, usually at frequencies between 2 and 10 MHz, is applied on the part of the body and the reflected sound waves (or echo), collected by the receiver and then analyzed by the computer, give a picture of tissue along its path. The varying tissue densities will results in varying impedances that will in turn give a varying echo signals and hence the formation of an image. Some tissue will have characteristic echo patterns that will help guide sonographers to identify landmark structures and detect possible anatomical anomalies and other abnormalities.

Tuesday, 21 November 2017

Adrenal Suppression and Cushing’s Syndrome Secondary to Ritonavir and Inhaled Budesonide




A 65 year old male with HIV and COPD developed Cushing’s syndrome and adrenal suppression after receiving low-dose inhaled budesonide and ritonavir. Discontinuation of ritonavir led to improvement in Cushingoid complications, however evidence of adrenal suppression still persisted 6 months later. Low-dose budesonide is often viewed as a safer alternative to fluticasone when inhaled corticosteroid therapy is required in a patients on ritonavir. Our case illustrates that patients receiving low-dose budesonide and ritonavir should also be considered at high risk of Cushingoid complications.

Ritonavir-based inhibition of the hepatic cytochrome P450 CYP3A4 isoenzyme can be used to pharmacologically boost the levels of other protease inhibitors in antiviral regimens for human immunodeficiency virus (HIV) and more recently, Hepatitis C. However, a consequence of CYP3A4 inhibition is the accumulation of other substrates that are metabolized by the CYP3A4 system, including many of the inhaled corticosteroids (ICS) used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). This can lead to iatrogenic Cushing’s syndrome and has been frequently reported in patients with combined use of inhaled/intranasal fluticasone and ritonavir. As a result, budesonide is a preferred ICS in patient’s taking ritonavir because of its reported shorter halflife, lower lipophilicity and reduced systemic absorption. Although iatrogenic Cushing’s syndrome with the use of ritonavir and budesonide has been documented, these patients typically received doses of inhaled budesonide as high as 1600 micrograms or 800 micrograms twice a day. We describe a case that illustrates the risk of iatrogenic Cushing’s syndrome even when budesonide is administered at low doses (160 micrograms twice a day), highlighting the need for careful monitoring of these patients.

A 65 year-old African American male with HIV, GOLD Stage IV chronic obstructive pulmonary disease (COPD), chronic Hepatitis B and hypertension, presented with a sixmonth history of fatigue, weakness and mild persistent leukocytosis. The patient’s anti-retroviral regimen consisted of emtricitabine 200 mg, tenofovir 300 mg, darunavir 800 mg and ritonavir 100 mg once daily. In addition, the patient was taking inhaled albuterol as required and daily inhaled tiotropium bromide for control of his COPD. Budesonideformoterol (80/4.5 micrograms) two puffs, twice a day was added one year prior to his presentation to improve control of COPD related symptoms. Physical examination was notable for uncontrolled hypertension (155/94 mmHg), and newonset proximal myopathy of the upper and lower extremities with power grading of 4 out of 5. No hepatosplenomegaly or systemic lymphadenopathy was present. Laboratory tests revealed a white blood count of 15,000 cells/ ml (71% neutrophils), hemoglobin of 14.6 g/dL, platelets of 263/µL, creatinine of 1.2 mg/dL. His hemoglobin A1C was found to be 8.2%, increased from 6.5% five months prior. His CD4 count was 942 cells/µL with an HIV viral load of < 20 copies/mL. 

Monday, 20 November 2017

How to Spot the Virus That Puts Some Babies in the Hospital

                                                                  mathewsopenaccess.com
   

Is your child's stuffy nose and hack only a frosty or something more genuine? It could be respiratory syncytial infection (RSV), the main source of newborn child hospitalization in the United States, specialists say. RSV causes manifestations like those of different infections, including stuffy or runny nose, fever, hacking, wheezing, loss of hunger and peevishness. For most minimal ones, RSV isn't not kidding. Be that as it may, it is the most widely recognized reason for bronchiolitis and pneumonia in youngsters under age 1. Every year, more than 140,000 infants and youthful youngsters in the United States are hospitalized as a result of RSV. 

"By age 2, 90 to 100 percent of kids have had no less than one disease caused by RSV," said Dr. Octavio Ramilo, head of the division of irresistible illnesses at Nationwide Children's Hospital in Columbus, Ohio. Newborn children can be hit hard. "Infants under 3 months of age are extremely inclined to get more wiped out for two reasons: their lungs are little and accordingly unfit to deal with a ton of aggravation, and the white cells of their invulnerable frameworks that ensure us against diseases are not prepared yet," Ramilo said in a clinic news discharge. 

Those with a serious RSV disease may reject their container, experience difficulty dozing and inhale more quickly than expected. Guardians who presume RSV should converse with their kid's specialist and go to the crisis office. Most kids recoup without anyone else in about seven days, however a hack can wait, as per Dr. Asuncion Mejias, central examiner at Nationwide's Center for Vaccines and Immunity. 

"Be that as it may, for high-hazard gatherings, for example, youthful newborn children, patients with conditions like interminable lung malady and intrinsic coronary illness, and patients with bargained invulnerable frameworks, RSV can turn out to be significantly more genuine rapidly," Mejias included. A cool fog vaporizer can enable kids to inhale and youths more established than a half year ought to be given a lot of fluids, for example, water and organic product juice. The individuals who are more youthful ought to be bosom or container encouraged little sums all the more regularly, the healing center's site recommends. To help forestall RSV, wash your hands frequently, don't share dishes and eating utensils, and purify hard surfaces. Specialists likewise recommend guardians restrain extremely youthful babies' presentation to individuals (even kin), particularly amid winter, when RSV is more typical.

Friday, 17 November 2017

Prolactin in Female Domestic Dogs: A Mini-Review



Prolactin is a luteotrophic agent, acting from mid-luteal phase in both pregnant and non-pregnant animals. Its role in stimulating and maintaing the corpus luteum, allowing the gestation period to be maintained, as well as the role in preparing and maintaining lactation (in concert with estrogens, progesterone, corticosteroids, somatropin and insulin) in the bitch has been recognized. Prolactin seems to be also involved in ensuring maternal behaviour, including the preparations for delivery and the care of the litter thereafter.Among domestic animals, the dog (Canis familiaris) is a monoestric species, with a long oestrous cycle (12 months in most non-domesticated species; 7 ± 1.5 months in the dog) and with a period of about 4 months of anestrus, in which there is no ovarian activity. Reproduction and pregnancy in dogs are regulated by many hormones, among which prolactin. Prolactin (PRL) is a single-chain peptide hormone, composed of almost 200 amino acids, produced by the lactotrotropic cells of the anterior pituitary. Prolactin secretion is pulsatile and this pulse rate is probably a result of the combined effect of different hypothalamic factors. 

Dopamine activatesprolactin synthesis. Also thyrotropin-releasing factor (TRH), serotonin, vasoactive intestinal peptide (VIP), and estrogen substances activate prolactin synthesis, but about 100 times less than dopamine does. Gamma-aminobutyric acid (GABA) inhibits the synthesis of prolactin with an inhibitory effect 100-fold lower than the activating effect of prolactin. In dogs, prolactin is secreted in a pulsatile fashion and most prolactin is released during the second half of the luteal phase. Prolactin is an essential luteotropin in the dog from mid-luteal phase in both pregnant and non-pregnant animals. It appears to act by sustaining corpus luteum lifespan and function rather than by direct stimulatory effects on progesterone secretion. Indeed, prolactin stimulates and maintains the corpus luteum of the ovary, which is the source of progesterone, allowing the gestation period to be maintained from the second half of the pregnancy. However, prolactin does not act alone; during pregnancy, prolactin, estrogen and progesterone stimulate the development of the mammary gland. Originally, the observation in the bitch that PRL blood values rise during the second half of pregnancy, while progesterone values were simultaneously declining, led to the conclusion that PRL might have an anti-luteotropic effect. The use of PRL inhibiting drugs, i.e. dopamine agonists like bromocriptine and cabergoline during the second half of pregnancy have shown that PRL must have a luteotrophic effect as their use results in an immediate sharp drop in the blood PRL concentrations followed by a drop in levels of blood progesterone. In addition, using the same PRL-inhibitors in the treatment of dogs with clinical anoestrus (abnormally prolonged anoestrous period) reliably induces a fertile oestrus. In pregnant bitches, the plasma prolactin concentration starts to rise about 1 month after ovulation, which is when the plasma progesterone concentration begins to decline. Also in healthy cyclic bitches, most prolactin is released during the second half of the luteal phase. The changes in growth hormone (GH) and prolactin release during the luteal phase may promote the physiological proliferation and differentiation of mammary gland tissue in the bitch. In the early part of the luteal phase progesterone-induced mammary GH initiates proliferation of the mammary epithelium, whereas in the late luteal phase, when progesterone concentrations decrease, prolactin release increases and promotes lobulo-alveolar differentiation. Hence, the declining plasma progesterone concentrations during the second half of the luteal phase appear to influence prolactin secretion. In monogastric animals, such as dogs, cats, primates and women, prolactin is also fundamental during the preparation and maintenance of lactation after birth. As a matter of fact, after delivery and during lactation, prolactin levels continue to be elevated. Prolactin allows the growth and differentiation of the mammary gland, maintains segregation of breast milk, reduces fertility during the lactation period, facilitates immunological regulation in the female, as well as an exchange of water and electrolytes during pregnancy. 

The tactile stimulationof the nipple or breast in the mother after birth inhibits the release of dopamine into the hypothalamus, increasing the concentration of prolactin in blood. On the other hand, high concentrations of prolactin inhibit the secretion of gonadotropin-releasing hormone (LH, luteinizing hormone and FSH, follicle-stimulating hormone), which prevents gonadotropins to act on the gonads. Thanks to this mechanism, fertility levels are reduced during lactation, preventing females to become pregnant while feeding their offspring. In pregnant bitches, plasma prolactin levels exceed 100 ng/ ml. Weaning, which can be defined as the phase of maternal care during which lactation decreases most rapidly, causes a decrease in prolactin blood values. The use of potent prolactin inhibitors, mostly dopamine agonists like bromocriptine, metergoline and cabergoline, has confirmed that prolactin is the luteotropic hormone from day 30 of pregnancy onward and that prolactin is essential for the preparation, commencement and maintenance lactation, as well as for the activation maternal of maternal and sexual behavior. Prolactin seems to be involved in ensuring maternal behaviour, including the preparations for delivery and the care of the litter thereafter, although it is not yet clear how it shares these effects with oxytocin. Prolactin secretion is under the tonic inhibitory control of hypothalamic dopaminergic neurons and the stimulatory action of estrogens, with a number of other hypothalamic hormones playing a modulatory role in the control of prolactin secretion. In most vertebrates, neuroendocrine functions are organized in regular cycles of different periodicity. Hormone secretion patterns are mainly regulated endogenously, although they are also under environmental influence.

Thursday, 16 November 2017

Millions Could Miss Out on a Potential Alzheimer's Breakthrough

                                                            mathewsopenaccess.com
Regardless of the possibility that analysts were to locate a momentous new treatment for Alzheimer's disease,millions of individuals won't not profit by it, new research uncovers. That is on account of the U.S. social insurance framework doesn't be able to rapidly execute a recently affirmed treatment on a boundless scale, as indicated by a report from the RAND Corporation. For example, there aren't sufficient specialists to determine every one of the general population to have early indications of dementia who might be great contender for such a treatment, the scientists clarified. Moreover, scanners used to identify the malady are hard to come by, and there aren't sufficient treatment focuses that could control the treatment to patients. 

An expected 5.5 million Americans are right now living with Alzheimer's ailment. By 2040, that number is relied upon to bounce to 11.6 million, as per the investigation creators. "While huge exertion is being put into creating medications to moderate or piece the movement of Alzheimer's dementia, little work has been done to prepare the restorative framework for such a progression," said contemplate lead creator Jodi Liu. She is an approach specialist at RAND, a charitable research gathering. "While there is no sureness an Alzheimer's treatment will be endorsed soon, our work proposes that human services pioneers should start considering how to react to such a leap forward," Liu clarified in a RAND news discharge. 

No less than 10 treatments as of now experiencing clinical trials are viewed as promising, as indicated by the investigation creators. RAND scientists trust enough advance has been made to propose that a conceivable treatment to moderate the impacts of the sickness might be accessible inside a couple of years. For the examination, Liu and her associates broke down how patients would have the capacity to get a recently endorsed treatment and how such a treatment progress would influence the U.S. medicinal services framework. 

For example, if another treatment were affirmed for use starting at 2020 and screening started in 2019, around 71 million Americans matured 55 and more seasoned would should be screened for mellow intellectual weakness, the specialists said. Follow-up exams and imaging tests likewise would be expected to affirm an Alzheimer's analysis. The examination creators assessed that 2.4 million individuals would be prescribed for the new treatment. In light of those estimations, the interest for the new treatment would surpass the U.S. human services framework's accessible assets. That would bring about holds up of over year and a half for each period of conclusion and treatment - a hold up that wouldn't drop to more like one month until 2030, the investigation creators anticipated.

Wednesday, 15 November 2017

The Diversity of Pulp Stem Cells, Tools for Regenerative Biodentistry

                             http://www.mathewsopenaccess.com/dentistry-Vol-1-Iss-1.html



Since the publication of Spallanzani, it is known that following surgical amputation, the tail of the urodele amphibians Xenopus tadpole regenerates. Restoration of tails, legs and jaws also occurs in the salamander after surgical removal. At the same period, Trembly split hydra heads and obtained multiheaded individuals. By bisecting a hydra, two complete animals were produced. During many years, a gap persisted between the biological regenerative capacities and what was requested for surgical therapies. This gap was gradually reduced, and now nearly disappeared. Successive steps highlight the fundaments of regenerative biodentistry. Implantations of stem cells and surgical approaches in dentistry are derived from epithelio-mesenchymal assembly of embryological tissues. After reactivation of the concepts ahead of clinical applications, new treatments guiding organ repair and regeneration in mammals pave the way for biodentistry improvements. Indeed, applied to the field of human therapies the replacement of lost teeth by tissueengineered dental recombinants appears as a fascinating goal. 

The initially aim of dental tissue engineering was to generate a whole tooth, or within some limits took into consideration, to concentrate on the regeneration of a missing part. The aim of dental tissue engineering may been limited to enamel repair, but this is still at an experimental stage. Or a more realistic objective was to heal the dental pulp, and consequently to provide a contribution to dentin mineralization as a substitute to endodontic therapy. Restorative approaches of root canal treated tooth have relatively limited long-term survival and many failures are associated to diverse complications such as transversal or longitudinal fissures followed by subsequent fractures, and/or chronic periapical inflammation. Substitutive therapies to endodontic treatments have been suggested and innovative strategies have been envisioned, including metallic implants or bridges. However, during the last decades, advances in the understanding of tooth development, as well as stem cell biology permit to consider the biological replacement of lost dental tissues and provide the foundation of novel opportunities in dental tissue engineering. Developing dental substitutes appear not only as a fascinating goal in restorative dentistry, but raises also the question of technical feasibility. It is clear that many open questions take origin from a series of interrogations and the answers that are given are still confusing. 

What is exactly our goal? Are we willing to create or recreate a whole tooth? Are we willing to regenerate only a small part of dental tissues? Our aim may be limited to the healing and regeneration of a dental pulp? But will it be possible to use the newly formed pulp as a support for pulp mineralization, playing a role as a potential substitute for endodontic treatment? Each attempt to provide an efficient clinical answer implicates another strategy. Alternatively, it seems sometimes mandatory to evaluate the value of another method, another technic or to test another biomaterial. Consequently, any improvement needs firstly the identification of the question to be answered, and afterward the development of adapted cellular or biological materials. The present approaches imply stem cells, scaffolds, structural and signaling molecules, transcription and growth factors. In this review we concentrate exclusively on the current knowledge related to pulp stem cells and we discuss their potential functions and implications in regenerative dentistry. 

Tuesday, 14 November 2017

Comparison between canine and molar swine tooth: tissue and stem cell view



Dental tissues are an abundant and rich source for easily and continually obtaining of mesenchymal stem cells (MSC), which are able to differentiate in vitro into several types of tissues, such as fat, cartilage, bone, among others. In swine, canine teeth display continuous growth, suggesting it could represent a different niche of stem cells. In this study, we compare dental pulp mesenchymal stem cell (sDPSC) niches from canine and molar teeth in swine. Tooth tissues were obtained and characterized by histological, microscopy and cellular analyses. Tissues were submitted to immunohistochemistry analysis and showed expression for mesenchymal stem cells markers, such as CD73, CD90, CD105 and for pluripotent markers (Oct-4, Nanog and Sox-2). Molar and canine sDPSC were also cultured and characterized according to MSC properties, such as plastic adherence capability, fibroblast-like morphology and cell surface antigen profile. sDPSC displayed an exponential growth pattern by MTT assay and increased in-vitro differentiation potential for adipogenic and osteogenic lineages. Tumorigenic test indicated these cells were unable to generate tumor in nude mice. Thus far, stem cells derived from canine and molar teeth in swine did not expose significant differences related to cell or plasticity markers and they indicate to be safe for animal cellular therapy use since they are devoid of tumorigenic disposition.

Currently, stem cell research is extensively investigated, leading to an expansion in different applications and approaches in regenerative medicine. Most of the expertise in stem cells is applied to human stem cells. However, information on animal stem cells is of extreme relevance for veterinary research for use in cell therapy. Mesenchymal stem cells (MSC) have been greatly studied due to their regenerative potential, immunomodulatory signaling properties and cellular plasticity.

MSC-like populations derived from dental tissue are one of the 5 different types of stem cells found in specialized tissues already isolated and characterized, being the postnatal dental pulp stem cells’ (DPSC), exfoliated deciduous teeth stem cells (SHED) ,apical papilla (SCAP), periodontal ligament stem cells (PDLSC) and dental follicle precursor cells’ (DFPC). Regenerative potential of dental pulp stem cells has been associated to dentin formation. Several studies in different niches of human dental pulp stem cells have reported relevant features like multipotentiality, clonogenicity, proliferation and cell therapy potential. In addition, therapeutic application of these cells was previously reported for dental tissue regeneration. 

Monday, 13 November 2017

Obesity to Blame for Epidemic of Knee Dislocations, Complications

                                                        mathewsopenaccess.com

Abundance weight can cause disengagement of your knee and may even prompt an inconvenience that outcomes in removal of your leg. Another investigation characteristics a surge in disjoined knees to the U.S. Weight pestilence. "Corpulence enormously expands the confusions and expenses of care," said consider lead creator Dr. Joey Johnson, an orthopedic injury individual at Brown University's Warren Alpert Medical School. "As the rate of weight builds, the rate of knee disengagements increments. The aggregate number of patients who are large is expanding, so we are seeing a greater amount of these issues," Johnson clarified. 

Knee separations result from numerous torn tendons. Vehicle crashes or physical games, for example, football, are basic causes. For the examination, the analysts dissected more than 19,000 knee separations across the country in the vicinity of 2000 and 2012. Over that time, individuals who were stout or seriously large spoke to a developing offer of knee disengagement patients - 19 percent in 2012, up from 8 percent in 2000. Stoutness is additionally connected to more extreme knee separations, longer doctor's facility stays and higher treatment costs, as per the examination distributed as of late in the Journal of Orthopedic Trauma. 

What's more, the odds that a knee separation would likewise harm the fundamental corridor behind the joint and down the leg were twice as high for corpulent patients than for those whose weight was typical, the discoveries appeared. This serious inconvenience of knee separation - known as vascular damage - can prompt leg removal if not treated, the investigation creators said. Patients with vascular damage found the middle value of 15 days in the doctor's facility, contrasted and around one week for different patients. Their normal hospitalization costs were quite recently finished $131,000 and $60,000, separately. The investigation creators said specialists ought to be particularly careful for vascular damage in large patients whose knees are separated. 

"That subset of hefty patients who come in with grumbling of knee torment should be deliberately assessed so as not to miss a conceivably calamitous vascular damage," said examine co-creator Dr. Christopher Born, a teacher of orthopedics at Brown. Lessening weight rates could help turn around the developing number of knee disengagements, the specialists proposed.

Friday, 10 November 2017

Low-Fat Diet, Low-Carb Diet -- or 'Low Both'?


                                                           mathewsopenaccess.com


Low-carb diets are frequently thought of as prevailing fashion counts calories that may yield a quick starting weight reduction, yet aren't supportable or essentially solid. However, when there's scholarly research behind the approach, it merits investigating. An investigation from Tulane University stood out as truly newsworthy for demonstrating that a low-starch count calories (think Atkins and South Beach, to give some examples) is more powerful at getting in shape and bringing down coronary illness chance than a low-fat eating regimen. 

Study members were separated into two gatherings. One gathering took after an eating regimen with under 40 grams of starches a day while the other started a better eating routine with under 30 percent of every day calories originating from fat. Following one year, the low-carb bunch had lost a normal of about 8 pounds more than the low-fat gathering and saw a lift in their great cholesterol levels. On the off chance that you need to attempt this approach, a carb counter will enable you to settle on fitting decisions. As a rule, your reasonable carbs will originate from non-bland vegetables that have not very many absorbable or "net carbs." That's the quantity of carbs once the fiber is retreated. 

With regards to natural product, berries are among those with the most noteworthy supplements among low-carb decisions. Grains are all starch, even the better-for-you entire grains. These are as yet the best decisions in the class, be that as it may. White flour-and sugar-based sustenances have the most carbs, as well as the minimum nutritious ones. (Removing those sustenances alone could bring about some weight reduction.) Fat sources check, as well. While the low-carb weight watchers got 41 percent of their calories from fat, these were most sound fats from plants like olive or canola oil, as opposed to spread or other immersed fats. Simply recall that despite everything you'll have to check every one of your calories to remain inside rules for weight reduction.

Wednesday, 8 November 2017

Stress Ulcer Prophylaxis

                              http://www.mathewsopenaccess.com/EMedicine-current-issue.html





Stress ulcer is a broad spectrum of the pathologic condition of the acute, erosive, inflammatory change on the upper gastrointestinal tract (UGIT) which is associated with critical illness. Stress ulcer is also called stress-related mucosal damage (SRMD) Stress ulcer can cause profound upper gastrointestinal bleeding (UGIB) which result in death, thus now stress ulcer prophylaxis (SUP) become the standard care in the intensive care unit (ICU). The author tried to retrace the historical concept regarding stress ulcer.At 1842, Curling reported 8 patients who died from UGIB during hospital stay ranged from few days to nearly one month. They initially admitted with a major burn. Upper GI tract ulceration (especially in the duodenum) was found at postmortem examination. At 1867, Billroth reported a fatal peptic hemorrhage after a thyroid operation. Till, 1950, similar autopsy reports were followed continuously.

At 1950, Hans Selye used the term “stress ulcer” at first and this term became popular. Although the cause of a stress ulcer was not clear, the association between adrenocortical axis adaptation against stress and UGIT ulcer was suggested by H.Selye. At 1966, Fogelman reported 88 cases with stress ulcer, and the mortality was 58% (51/88) [surgery (n = 30), mortality 53%, trauma (n = 20), mortality 45%, and miscellaneous (n = 38), mortality 68%)]. Until then, the surgical approach was regarded as the primary treatment considering that most stress ulcers were single site ulcers.At 1969, Skillman collected the data of 150 consecutive ICU patients, wherein 8 patients (5.3%) experienced the massive hemorrhage because of the acute multiple gastric ulcers. In addition, gastric secretory studies indicated that increased acid secretion may be an important cause for the stress ulcer evolution. Followed studies also showed the similar results with excessive gastrin stimulation of parietal cells.

At 1978, Hastings and Skillman performed a randomized controlled trial (RCT) whether neutralization of gastric acid by the use of H2 receptor blocker or antacid drugs prevent stress ulcer or not. Significant UGIB was 4% (2/51) among the intervention group while it was 25% (12/49) among the control group.However, because gastric acidity is a defensive mechanism to pathogenic organisms, acid-suppressive treatment may be associated with increased pathologic colonization in the UGIT. This implies the increased chance for the nosocomial infection. Especially, hospital-acquired pneumonia (HAP) and C.difficile infection have become the major concerns. Gastric acid is an important defense against the acquisition of C.difficile spores. Herzig reported that acid-suppressive medication is associated with HAP occurrence [4.9% in 32,922 acid-suppression group vs. 2.0% in 30,956 no acid–suppression group, propensity-matched odd ratio. 

Monday, 6 November 2017

Eat Well, Age Well

                                                   mathewsopenaccess.com



A sound eating routine may convert into a more beneficial maturity, scientists report. The researchers took after near 1,000 men and ladies in England, who were conceived in March 1946, all through their adulthood. The individuals who ate more natural products, vegetables and entire grain oats - and less exceptionally handled nourishments - all through adulthood improved the situation on three trial of physical capacity in their mid 60s than those with less good dieting propensities. 

The investigation likewise found that those whose dietary patterns enhanced amid adulthood improved the situation on two of the tests, seat rise speed and standing equalization time. The third test was planned up-and-go speeds. "Enhancing the nature of your eating routine can beneficially affect wellbeing, whatever your age," said think about creator Sian Robinson, a teacher of wholesome the study of disease transmission at the University of Southampton. 

"In any case, this investigation recommends that settling on great dietary decisions all through adulthood - by eliminating profoundly prepared nourishments and joining more organic product, vegetables and entire grains into your eating regimen - can have a critical valuable impact on quality and physical execution further down the road, guaranteeing a significantly more beneficial maturity," Robinson said in a college news discharge. The investigation was distributed as of late in The Journals of Gerontology: Series A. 

While the examination didn't demonstrate circumstances and end results, Cyrus Cooper, executive of the college's Medical Research Council Lifecourse Epidemiology Unit, stated, "The connection between dietary examples and slightness in more established individuals will open the way to powerful intercessions against the age-related decrease in musculoskeletal capacity, which is such a developing reason for inability in maturing populaces around the world."






Friday, 3 November 2017

Red Blood Cell Transfusion in Open Heart Surgery: Are we all Ready for Bloodless Medicine and Surgery?



A Danish scientist, Niels Jerne, 1984 Nobel Prize winner in medicine mentioned that “our own blood is like our digital prints: there are not two types of blood that are identical”. It is very interesting that he said so in response to why did he refuse to receive blood transfusion (BT). This assumption resumes quite nicely why most patients present at least mild allergic reaction to BT. The red blood cell membrane is extremely complex and has over 400 antigens already described. Hence, the more people know about BT reactions, disease transmission, and negative influence in clinical outcomes, the more they reject red blood cell transfusión in the context of surgery. Besides, it is getting more difficult to find qualified blood donors since less people meet the requirements for blood transfusion donors. This fact has resulted in a shortage of blood supply in blood banks worldwide which makes it necessary to seek out new treatment options. This compelling fact and evidence has impulse scientific medicine to look for newer drug agents, techniques, medical products and methods, as alternative procedures to BT. Although, alternatives to BT and other treatment options exist and there are medicine based evidence of their good results, they are seldom utilized. However, it is not the aim of this editorial to elaborate on the numerous alternatives that exist to BT. There are several clinical and surgical strategies that can be used to optimize hemoglobin and hematocrit levels and coagulation status. Additionally, these measures minimize blood loss, and improve anemia tolerance. In order to improve clinical outcomes in open heart surgery, and to diminish morbidity and mortality, as well as, reducing hospital costs, these treatment strategies should be incorporated into medical practice worldwide.


Despite of all this interesting facts, about 14 million units of blood are donated annually in the USA, and about 4 million people receive BT every year. There is a great variation in the incidence of BT utilization in different hospitals. For example, blood transfusion administration in surgical and critical care settings varies among 30% to 100% of patients. Open heart surgery is still associated with the risks of bleeding and thrombotic events despite contemporary medical maneuvers. More than five decades ago, it was arbitrarily decided to transfuse patients with a hemoglobin level of 10 g/dl or less, and since then is relatively frequent to observe a medical indication of BT in a similar situation. It is not infrequent to observe a decrease in plasma hemoglobin values under 10 g/dL in the immediate period after open heart surgery. Although it seems that there is a clear evidence of “winds of change”, it is still believed by many physicians that patients would benefit from a BT that increases the hemoglobin levels beyond 10 g/dL and the hematocrit levels beyond 30%. The transfused whole blood is an excellent plasma volume expander and stays in the intravascular space much longer than any other volume expander. It is undeniable that BT induces an increase in the plasma volume, a hemodynamic improvement, and an increase in the cardiac output and diuresis. However, there is strong medicine based evidence that these mentioned clinical improvements are not correlated with decreased morbidity and lesser mortality in open heart surgery.

This is not an isolated finding. Similar results were demonstrated in several observational studies showing clear association between red blood cell transfusion and adverse outcomes in open heart surgery. This negative influence is because BT is in essence a transplant of allogeneic cells, consisting of the infusion of multiple foreign antigens in great quantities in the recipient´s circulation, resulting in several inflammatory and immunological reactions. This adverse association between BT and cardiac surgery has been shown through decades in several studies and clinical observations [22-32]. Indeed, Denton Cooley demonstrated similar findings almost four decades ago. Therefore, these negative outcomes with BT should be a call of attention to our routine medical practice pointing directly to the risks of BT. Therefore, unnecessary blood transfusions should be avoided to further reduce the risk for ischemic events and other complications. The evidence that BT carries significant risks points out to avoid BT when possible. Moreover; it was also shown that a single unit of red blood cell transfusion to a cardiac surgery patient is associated to a decreased survival at 10 years after the BT. The guidelines emphasize that the benefits of transfusion have not been adequately demonstrated and that existing evidence is an imperfect guide to transfusion decisions, hence it was suggested a transfusion trigger of hemoglobin less than 7 g/dL in postoperative cardiac surgery patients with a class IIa level of indication  

Thursday, 2 November 2017

Exposure of Pediatric Population to Global WASH-Borne Hazards



Global pediatric population, particularly children under five years of age, are highly vulnerable to water, sanitation, and hygiene (WASH)-borne hazards and diseases such as diarrhea, dysentery, hepatitis, schistosomiasis, infant botulism, stunting, and other neglected tropical diseases (see for example, Baker et al., 2016, Fuller et al., 2016; Kobayashi, et al., 2014; Uddin et al., 2014; Boisson et al., 2016; Uddin et al., 2012. In 2013, 0.578 million children (<5 years) died due to the diarrheal disease that is the second leading cause of child-death around the world (Liu et al., 2015). It has been noted that young children, particularly in the Global South, are highly exposed to unplanned and unsafe disposal of human feces including child-feces (Isunju et al., 2011; George et al., 2016). A recent study conducted by Freeman et al. (2016) revealed that ‘safe’ disposal of child feces is practiced by only 1.1% of households by using burial/disposal to toilets.

Meeting the Sustainable Development Goals by 2030 in water, sanitation, and health and to reduce the exposure of millions of world’s pediatric population, global WASH-borne hazards need to be addressed and reduced comprehensively to ensure the child-health protection. Despite many initiatives, millions are still dying, affecting diseases and caused disabilities, due to various WASH-borne hazards around the world, particularly in the Global South. Local grass-root level approaches, which are child-friendly, can be re-invented to identify the key problems and to implement appropriate solutions. This issue cannot be solved overnight. Scientific communities, policy makers and other related stakeholders are suggested to give much attention into this issue for solving the problems, saving our planet and to reduce the WASH-borne deaths of millions of our children around the world. Political willingness, good governance, corporate social responsibilities, and socio-cultural interests to improve the situation are required in many parts of the low- and middle-income regions to make the world better place for our pediatric population.  

Wednesday, 1 November 2017

Computation of the “Gray Zone” Based on Experimental Data and Its Effect on the Trueness in HIV Results in the Blood, Cells and Tissues Banks



A screening test is recognized as a technique “used to evaluate large populations of individuals for the presence of a disease or analyte”. The physician interprets the HIV result tested in a screening immunoassay as the in vivo condition/true result. Based on this result a clinical decision is taken. However, there is a chance for some binary results (positive/negative) in medical laboratory tests to be false. This situation represents a serious risk of incorrect clinical decision with impact on the patient safety. This could also be viewed not only at healthcare but also at other stages, such as on the validation of components in human blood components, cells, and tissues banks. 


The risk to the customer significantly increases in these banks when compared to a hospital laboratory where typically negative results from individuals in groups of risk are retested on a second collection due to the chance of a seroconversion window period occurs. On the banks’ scenario, the collection of a second sample occurs only on the vigilance and surveillance when a post-transfusion or post-transplant infection is reported, so, it is not related directly to post-transfusion or post-transplant infection safety but indirectly with the corrective actions/preventive actions (CAPA) development. Let consider a result equal to the cutoff and the condition: positive if equal or higher than the cutoff. In this case, a true positive result of a Gaussian distribution is 50% false negative in an infinite number of determinations. It could be interpreted that true positive results close to the decision value have a significant statistical chance to be classified as false. 

The “gray zone” is understood as the area around the cutoff where numerical results are classified as indeterminate. Further testing is required to a final classification. In this condition, the numerical results have a trinary classification: positive/indeterminate/negative. Adopting the ratio of the screening immunoassays s/co as the expression of the division of the sample raw data (s) by the cutoff (co): negative results are those with an s/co lower than the cutoff (1 s/co) minus the “gray zone”, indeterminate are those in the “gray zone”, and positive those equal or higher than the cutoff. Therefore, it is well recognized that the use of a “gray zone” in the classification of screening immunoassays results reduces the chance of positive samples with low concentrations of measurand to be classified as negative. The numerical results in the “gray zone” are presumed to be sporadic principally in tests with high diagnostic sensitivity. Currently, the use of the “gray zone” in screening immunoassays is not systematically required to classify the numerical results in an ordinal scale in commercial tests. Its use is also not claimed by ISO 15189, intended to the accreditation of medical laboratory tests. Probably, the manufacturer interprets the “gray zone” importance as minor to tests highly reactive to weak concentrations of measurand (antibodies and or antigens tested under stable laboratory conditions), and poorly reactive when the measurand is absent. Nevertheless, the impact of wrong medical decisions has a strong social impact, principally when related to the post-transfusion/posttransplant infection. 

Tuesday, 31 October 2017

Pathological Changes in Pulmonary Vasculature after Atrial Fibrillation Ablation

                          http://www.mathewsopenaccess.com/cardiology-Vol-1-Iss-2.html



A well-known complication of radiofrequency ablation is pulmonary vein stenosis. We present a complex case of a patient with pulmonary vein occlusion, which developed within a few months after radiofrequency ablation for atrial fibrillation. The pathologic changes seen on lung biopsy, which developed in the months after the ablation are similar to those seen in pulmonary arterial hypertension. A 67-year-old Caucasian male with a history of rheumatoid arthritis and radiofrequency ablation for atrial fibrillation presented with hypoxic respiratory failure and hemoptysis. In the preceding months he had been treated for recurrent pneumonia and high dose corticosteroids for a histopathologic diagnosis of pulmonary capillaritis. A contrast-enhanced computed tomography of the chest revealed total occlusion of the left inferior, left superior, and right superior pulmonary veins with patent flow only through the right inferior pulmonary vein from the right lower lobe. Surgical specimens revealed vascular remodeling similar to Group 1 pulmonary arterial hypertension. This case is important because of the impressive radiographic imaging and histopathological changes seen in a patient with pulmonary veins stenosis and radiofrequency ablation.

We present the case of a patient with known rheumatoid arthritis (RA) who underwent radiofrequency ablation (RFA) for atrial fibrillation (AF). Less than a year after the ablation the patient developed significant pulmonary vein occlusion involving three out of four pulmonary venous outflow tracts. The surgical lung specimens demonstrated marked vascular remodelling and other pathological changes consistent with an occlusive pulmonary vasculopathy.

This case is a 67 year-old Caucasian male who presented with a chief complaint of “coughing up blood.” He had three-month history of hemoptysis and acute-on-chronic hypoxic respiratory failure. His past medical history consisted of RA and AF, having undergone RFA nine months prior to the onset of symptoms. His RA had been treated with methotrexate, sulfasalazine and hydroxychloroquine. In the three months prior to his admission, he had been treated for recurrent pneumonia. Admission physical exam revealed hypoxia with left sided basilar crackles and respiratory accessory muscle use. Contrastenhanced computed tomography of the chest revealed total occlusion of the left inferior, left superior, and right superior pulmonary veins with patent flow only through the right inferior pulmonary vein from the right lower lobe .