Showing papers in "Clinical Medicine & Research in 2017"
TL;DR: The use of moisturizer is discussed both for skin health maintenance as well as a definitive or adjuvant therapy for many kinds of dermatitis.
Abstract: Moisturizer is a major component of basic daily skin care, particularly in presence of epidermal barrier alteration and reduced epidermal water content. It is an important part of a dermatologist’s strategy to maintain skin health as well as treating various dermatoses which co-exist with skin dryness and are linked to impaired skin barrier function, such as in atopic disorders as well as other types of dermatitis. Mastering the knowledge regarding mechanism of action, application, dosage, adverse effects as well as specific clinical usage of moisturizers is a must for a dermatologist in order to support their use, particularly for evidence-based, therapeutic purposes. This review discusses the use of moisturizer both for skin health maintenance as well as a definitive or adjuvant therapy for many kinds of dermatitis.
124 citations
TL;DR: The present series confirms the favorable course of pulmonary MALT lymphoma in Sjögren’s patients, and the overall imaging and pathologic features are in accordance with pulmonary Malt lymphoma not associated with primary Sj Ögren's syndrome.
Abstract: To describe clinical features and outcomes of seven patients with pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma in the setting of underlying primary Sjogren's syndrome from a single center, we reviewed medical records of consecutive patients with pulmonary MALT lymphoma evaluated at our facility from January 1, 1999 to December 31, 2015 for clinical features, laboratory, pathologic and radiographic findings, management, and outcomes. Out of 13 patients with pulmonary MALT lymphoma, 7 (54 %) met the criteria for Sjogren's syndrome. The mean age at lymphoma diagnosis was 66 years; male-female ratio was 1:6. One-third of patients were asymptomatic at the time lymphoma was discovered. When symptomatic, patients reported nonspecific pulmonary complaints such as cough and dyspnea. All patients had positive antinuclear antibody and anti-SSA/Ro antibody. Rheumatoid factor was positive in six cases. A monoclonal gammopathy was present in three patients; the remaining four had polyclonal hypergammaglobulinemia. The radiologic, morphologic, and immunohistochemical features of primary Sjogren's syndrome-associated pulmonary MALT lymphomas did not differ significantly from pulmonary MALT lymphoma cases in general. All treatment modalities used resulted in complete and sustained response. One patient died 11 years after initial diagnosis with no lymphoma but of another cause. The remaining six patients are still alive and disease-free to date. The present series confirms the favorable course of pulmonary MALT lymphoma in Sjogren's patients. The overall imaging and pathologic features are in accordance with pulmonary MALT lymphoma not associated with primary Sjogren's syndrome. Further studies should be carried out in order to better understand pulmonary MALT lymphomagenesis, treatment, and outcomes in Sjogren's patients.
33 citations
TL;DR: This study showed ANC attendance, utilization of maternity waiting home (MWH) service, planned status of the pregnancy, distance and cleanliness of the toilet during delivery service were significant predicators of mothers’ satisfaction with the service.
Abstract: Assessment of client satisfaction has become an administrative and a practical reality; it is important measure of the quality of services. Satisfaction studies provide feedback on how well the service is functioning according to clients’ perception and what changes might be required to meet clients’ expectation. Satisfaction affects service utilization; satisfied mothers will have optimum utilization of delivery service. This study assessed satisfaction with institutional delivery service and factors affecting their satisfaction, among mothers who gave birth in public health centers of Omo Nada district, south west Ethiopia. A facility based cross-sectional study was conducted on 391mothers who gave birth in selected public health centers of Omo Nada district, south west of Addis Ababa. The total sample was allocated to four health centers, based on expected pregnancy in their catchment area. Sample mothers were selected using systematic random sampling, list of mothers registered on delivery registration books of each health center were used as a sampling frame. Pre-tested structured questionnaire was used, 5 data collectors with diploma were recruited. Collected data were entered in to EPIDATA 3.0, and exported to SPSS version 16. Bivariate and multivariate logistic regression analyses were conducted. The overall satisfaction with institutional delivery service was 255(65.2%). Major satisfaction was recorded with supportiveness of the provider and cleanliness of delivery room. According to multivariate logistic regression analysis result, mothers who had ANC follow up had two fold increased satisfaction, [AOR= 2.05, 95% CI 1.33, 4.75]. Those who planned their pregnancy were 2.85 times more likely satisfied than those did not, [AOR=2.85 with 95%CI 1.56, 5.21]. This study showed ANC attendance, utilization of maternity waiting home (MWH) service, planned status of the pregnancy, distance and cleanliness of the toilet during delivery service were significant predicators of mothers’ satisfaction with the service. Utilization of MWH and ANC attendance during pregnancy significantly increases mothers’ satisfaction with institutional delivery service. On the other hand, mothers with unplanned pregnancy showed decreased satisfaction.
27 citations
TL;DR: These anthropometric measurements showed excellent accuracy in predicting overweight and obesity with high specificity and sensitivity in school-age children in resource-poor settings.
Abstract: BACKGROUND In resource-poor settings, anthropometric parameters are evaluated as potential alternatives to the body mass index (BMI) for detecting overweight and obesity in children. To this end, the mid-upper-arm circumference (MUAC) and the mid-upper-arm circumference-to-height ratio (AHtR) were evaluated as proxies to BMI in Thai school-age children. STUDY DESIGN An observational, cross-sectional study was performed on school-aged children. PARTICIPANTS Children in grades 1 through 6 at all public elementary schools in the Ongkharak district, Nakhon Nayok, Thailand during May and June 2013 were included. This is a rural district with low per capita income. METHODS Weight, height, and MUAC were measured in school-age children and analyzed to identify optimal cut-off values for MUAC and AHtR for detection of overweight and obesity in comparison to BMI. Receiver operating characteristic (ROC) curve analysis determined the validity of MUAC and AHtR use. RESULTS Data from 3,618 children, aged 6.0-12.99 years, were analyzed. MUAC correlated with age and height (P < 0.001), but especially with body weight (r = 0.888 to 0.914) and BMI (r = 0.859 to 0.908) in both genders, while AHtR correlated with body weight and BMI (P < 0.001), but not with age. Cut-off values of MUAC for obesity diagnosis ranged from 18.9 to 25.5 cm for boys and from 19.8 to 25.4 cm for girls. Accuracy was excellent for both boys (AUC = 0.952-0.991) and girls (AUC = 0.917-0.990). Cut-off of MUAC for overweight diagnosis ranged from 17.2 to 22.4 cm for boys (AUC = 0.883-0.965) and from 18.0 to 23.2 cm for girls (AUC = 0.905-0.931). AHtR cut-off values for obesity and overweight diagnosis at 0.16 and 0.145, respectively, were determined with excellent diagnostic accuracy (AUC ranged from 0.920 to 0.975). CONCLUSION MUAC and AHtR were reliable tools to detect overweight and obesity in Thai school-age children. Cut-off points for MUAC were age and gender specific, while AHtR at 0.16 and 0.145 were the optimal values for both genders, independent of age. These anthropometric measurements showed excellent accuracy in predicting overweight and obesity with high specificity and sensitivity.
26 citations
TL;DR: Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program.
Abstract: This study sought to re-characterize trends and factors affecting electronic dental record (EDR) and technologies adoption by dental practices and the impact of the Health Information Technology for Economic and Clinical Health (HITECH) act on adoption rates through 2012. A 39-question survey was disseminated nationally over 3 months using a novel, statistically-modeled approach informed by early response rates to achieve a predetermined sample. EDR adoption rate for clinical support was 52%. Adoption rates were higher among: (1) younger dentists; (2) dentists ≤ 15 years in practice; (3) females; and (4) group practices. Top barriers to adoption were EDR cost/expense, cost-benefit ratio, electronic format conversion, and poor EDR usability. Awareness of the Federal HITECH incentive program was low. The rate of chairside computer implementation was 72%. Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program. Patient portal adoption among dental practices in the United States remained low.
20 citations
TL;DR: The presence of high secondary metabolites in the leaves are good indication that if the plant is subjected to further research such as identification and characterization of plant, bioactive compounds with strong biological activities may be isolated and novel compounds may also be identified.
Abstract: The proximate analysis and the phytochemical constituents were investigated in Magnifera, Morinda lucida, Parquetina nigrescens, Oscmium gratissimum, Chenopodium ambrosioides and Veronia amygaldalina using standard reference methods. The proximate analysis in % showed that Chenopodium ambrosioides had the highest amount of ash content of 17.30 and moisture content of 89.40 while Magnifera indica had the lowest amount of ash content 12.04 and moisture content 68.40. Veronia amygaldalina had the highest amount of protein 30.02 and carbohydrate 54.00 while Parquetina nigrescens had the least amount of protein 25.06 and carbohydrate 40.23. Parquetina nigrescens had the highest amount of crude fibre of 25.05 while Chenopodium ambrosioides had the highest amount of crude fat 18.22. The moisture content was found to be 89.40%, ash content 17.30, fat 18.22%, protein 30.02%, crude fibre 25.05% and carbohydrate 54.00%. The phytochemical constituents indicated flavonoid 28.58% alkaloid 25.84% and tannin 2.94% in Magnifera indica, Veronia amygaldalina and Morinda lucida respectively. The presence of high secondary metabolites in the leaves are good indication that if the plant is subjected to further research such as identification and characterization of plant, bioactive compounds with strong biological activities may be isolated and novel compounds may also be identified.
20 citations
TL;DR: The potential benefit of creating clinically-applicable integrated care models to support holistic management of an escalating diabetic population by targeting modifiable risk factors including periodontitis is being recognized by the health industry.
Abstract: Escalating prevalence of both diabetes and periodontal disease, two diseases associated with bi-directional exacerbation, has been reported. Periodontal disease represents a modifiable risk factor that may reduce diabetes onset or progression, and integrated models of cross-disciplinary care are needed to establish and manage glycemic control in affected patients. An ad-hoc environmental scan of current literature and media sought to characterize factors impacting status of integrated care models based on review of the existing evidence base in literature and media surrounding: (1) current cross-disciplinary practice patterns, (2) epidemiological updates, (3) status on risk assessment and screening for dysglycemia in the dental setting, (4) status on implementation of quality metrics for oral health, (5) care model pilots, and (6) public health perspectives. The survey revealed: escalating prevalence of diabetes and periodontitis globally; greater emphasis on oral health assessment for diabetic patients in recent medical clinical practice guidelines; high knowledgeability surrounding oral-systemic impacts on diabetes and growing receptivity to medical-dental integration among medical and dental providers; increasing numbers of programs/studies reporting on positive impact of emerging integrated dental-medical care models on diabetic patient healthcare access and health outcomes; a growing evidence base for clinically significant rates of undiagnosed dysglycemia among dental patients reported by point-of-care pilot studies; no current recommendation for population-based screening for dysglycemia in dental settings pending a stronger evidence base; improved definition of true periodontitis prevalence in (pre)/diabetics; emerging recognition of the need for oral health quality indicators and tracking; evidence of persistence in dental access disparity; updated status on barriers to integration. The potential benefit of creating clinically-applicable integrated care models to support holistic management of an escalating diabetic population by targeting modifiable risk factors including periodontitis is being recognized by the health industry. Cross-disciplinary efforts supported by high quality research are needed to mitigate previously- and newly-defined barriers of care integration and expedite development and implementation of integrated care models in various practice settings. Implementation of quality monitoring in the dental setting will support definition of the impact and efficacy of interventional clinical care models on patient outcomes.
20 citations
TL;DR: Poor blood pressure control was associated with poor adherence to antihypertensive medications & the presence of diabetes, but elderly people (≥ 60years) were found to be associated with good BP control, and duration of hypertension, type or number of antihyertensive medications used were not associated with BP control.
Abstract: Hypertension is a common health problem worldwide. It doubles risk of stroke, myocardial infarction, chronic kidney diseases and peripheral arterial disease. Good control of hypertension is important to decrease these complications. For Good control, life style modification (low salt diet, exercise, weight reduction and cessation of smoking) and Different antihypertensive medications are used. The medicines have to be taken adherently and one has to be consistent in life style modifications. Here the blood pressure control status of hypertensive patients on treatment was assessed. Cross sectional study was conducted collecting data using a pretested questionnaire among all hypertensive patients on treatment at the cardiovascular follow up clinic of University of Gondar Hospital from March 1, 2016 to October 30, 2106. A consecutive of 310 hypertensive patients on pharmacologic therapy for at least 6 months were included. Good blood pressure control was defined as BP < 150/90 for those aged 60 years or above and <140/90 if younger than 60 years. Data was entered and analyzed by using SPSS version 20. Results are depicted descriptively using tables and graphs. Logistic regression was used to evaluate associations.A total of 310 participants (118 males & 192 females) were evaluated. Poor blood pressure control was observed in 115 (37%) of the study participants. Presence of diabetes mellitus (OR: 3.6; CI (1.46-8.8)) and poor adherence to antihypertensive drugs (OR: 6.6; CI (1.5-28.5)) were associated with poor BP control. However duration of hypertension, type or number of antihypertensive medications used were not associated with BP control. Patient older than 60years had good BP control. More than one third of patients have poor BP control. Poor blood pressure control was associated with poor adherence to antihypertensive medications & the presence of diabetes. However, elderly people (≥ 60years) were found to be associated with good BP control.
18 citations
TL;DR: It is concluded that treatment strategies for APS should be tailored cautiously when using NOACs, as several reports on the failure of newer anticoagulants in APS as well as cases and clinical trial results reporting efficacy.
Abstract: We present the case of a patient with primary APS who had a recurrence of thrombotic event while on treatment with rivaroxaban and had to be restarted on warfarin. The current literature on recurrence of thrombotic events in patients with antiphospholipid syndrome (APS) treated with newer oral anticoagulants (NOAC) is also reviewed. Relevant case reports and case series were identified by searching the Medline database using the key words antiphospholipid syndrome, anticoagulants and names of the NOACs, and data on individual patients was abstracted. We identified several reports on the failure of newer anticoagulants in APS, as well as cases and clinical trial results reporting efficacy. We conclude that treatment strategies for APS should be tailored cautiously when using NOACs.
17 citations
TL;DR: Researchers have established that some of metal complexes were biologically active and used as anticancer agents, anti-HIV, metal-mediated antibiotics, antibacterials, antivirals, antiparasitics, antiarthritics, antidiabetics and radio-sensitizing agents appear in therapeutic medicinal inorganic chemistry.
Abstract: Ninety elements occur naturally on earth. Out of these, nine are radioactive and among the remaining eighty one that could support life, sixty one are metals. Our bodies have approximately 3% metal. Researchers have been established that some of metal complexes were biologically active. A significantly rising interest in the design of metal complexes as drugs and diagnostic agents is currently observed in the area of scientific inquiry, specifically termed medicinal inorganic chemistry. Investigations in this area focus mostly on the speciation of metal species in biological media based on possible interactions of these metal ions with diverse biomolecules. In an effort to contribute to future development of new therapeutics or diagnostic agents metallo pharmaceuticals used as anticancer agents, anti-HIV, metal-mediated antibiotics, antibacterials, antivirals, antiparasitics, antiarthritics, antidiabetics and radio-sensitizing agents appear in therapeutic medicinal inorganic chemistry. The medicinal uses and applications of metals and metal complexes are of increasing clinical and commercial importance.
15 citations
TL;DR: There is need to educate the blood donors on avoiding risky lifestyle while also intensifying voluntary blood donor motivation strategy and increase community surveillance of the infections.
Abstract: Africa has the highest prevalence of transfusion transmitted infections. The World Health Organization recommends universal and quality-controlled screening of blood donations for the major transfusion-transmissible infections (TTIs): human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis. Therefore a retrospective study was conducted to assess the effect of strategies in our blood bank to improve blood safety on the seroprevalence of HIV, HCV, HBV and syphilis infections among the donors over a seven year period. Existing data in the blood bank was used to determine number of the blood donors who were infected with HIV, HCV, HBV and syphilis. The test methods used to screen the donors were identified. The trend of prevalence of the transfusion transmitted infections among the blood donors from 2009 to 2015 was also determine. A total of 41,445 blood donors were screened. Voluntary blood donors constituted 11.1% of the donor population. The overall seroprevalence rate for the TTI was 12.3%. The prevalence was highest for HBV (8.5%) followed by HIV (1.8%), HCV (1.4%) and least for syphilis (0.5%) respectively. The infections showed significant inter-year variation (p<.001). A decreasing trend was observed for HBV among the blood donors while increase in prevalence of HIV, HCV and syphilis was observed from 2012 to 2014 and decreased in 2015. The prevalence of syphilis has risen from 0% in 2009 to 0.9% in 2015. The seroprevalence for TTI is high but is less compared to report from a previous study in same blood bank. The increasing infection rate for syphilis and sporadic surges in rates for HIV, HCV may suggest that the selection criteria is not effectively eliminating blood donors with risky lifestyle. There is need to educate the blood donors on avoiding risky lifestyle while also intensifying voluntary blood donor motivation strategy and increase community surveillance of the infections.
TL;DR: A rare case of recurrent hemobilia after transarterial embolization in a man presented with Quincke’s triad after cholecystectomy is reported.
Abstract: Hemobilia is a potentially life-threatening clinical issue, the etiology of which iatrogenesis is playing increasingly more prominent role. Nowadays the most frequent etiology of hemobilia has shifted toward iatrogenesis owing to increasingly more frequent performance of liver procedures, either open or minimally invasive. Here we report a rare case of recurrent hemobilia after transarterial embolization. A man, aged 57 years, presented with Quincke's triad after cholecystectomy. Computed tomography imaging revealed a pseudoaneurysm of the right hepatic artery. Transarterial embolization failed, and hemobilia recurred. The patient underwent open ligation of the right hepatic artery. Transarterial embolization is a definitive treatment of hemobilia due to vascular issues. The choice of embolizing agent is crucial in transarterial embolization.
TL;DR: The overall incidence of PBC in a Midwestern population of the United States has remained relatively stable over the last two decades, and patients have better prognosis, and the survival of P BC cases has improved.
Abstract: Background Primary biliary cholangitis (PBC) is a rare disease with incidence that varies with time and geography. Only two studies have assessed PBC incidence in the United States, with the most recent appearing over a decade ago. The objective of the present study was to assess PBC incidence in the United States in a more recent era. Methods The incidence of PBC was assessed in a population-based cohort in rural, Midwestern Wisconsin over two decades spanning from June 1992 through June 2011. Cases were initially identified in the electronic medical record and then manually verified for inclusion according to the American Association for the Study of Liver Disease criteria for PBC. Additional data were abstracted for verified cases. Results A total of 79 cases of PBC were identified over the 20-year period for an overall age- and sex-standardized incidence of 4.9 cases per 100,000 person-years. Incidence was higher in females, but changes over time were not significant. After a mean 7.3 years follow-up, all-cause mortality of those with PBC was 29%, and estimated 10-year survival was 76%. Conclusions The overall incidence of PBC in a Midwestern population of the United States has remained relatively stable over the last two decades. Patients have better prognosis, and the survival of PBC cases has improved.
TL;DR: With the advent of more accurate subcutaneous glucose monitoring systems, the role of improved glucose control with newer systems deserves consideration for widespread adoption.
Abstract: Perioperative glucose control is highly important, particularly for patients undergoing cardiac surgery. Variable glucose levels before, during and after cardiac surgery lead to increased post-operative complications and patient mortality. [1] Current methods for intensive monitoring and treating hyperglycemia in the Intensive Care Unit (ICU) usually involve hourly glucose monitoring and continuous intravenous insulin infusions. With the advent of more accurate subcutaneous glucose monitoring systems, the role of improved glucose control with newer systems deserves consideration for widespread adoption.
TL;DR: More than half of the nurses in East Gojjam Zone Public hospitals northwest Ethiopia 2016 were occupationally stressful, and all subscales of expanded nursing stress scale were positively correlated with over overall occupational stress.
Abstract: Background: Occupational stress has been reported to affect job satisfaction among nurses, thus compromising nursing care and placing patients’ lives at risk. Nursing has been identified and reported by a number of studies as a stressful occupation. Occupational stress is a serious condition for nursing professionals that is directly associated with impaired and inappropriate performance and working within clinical settings. Objective: To assess the level of occupational stress and associated factors among nurses in East Gojjam Zone Public hospitals northwest Ethiopia 2016. Method: Institutional based cross-sectional study design was employed. Sampling method was simple random sampling and data were collected from March 8 to 23, 2016. Source population of the study were all nurses who work at public hospitals in East Gojjam zone public hospitals and sample size was 181 nurses from the four hospitals. After nurses were proportionally allocated to size from the four hospitals, data were collected through pretested self-administered structured questionnaire. Results: A total of 178 nurses were voluntarily agreed to participate in the study with a response rate of 98.3%. The study finding showed that 57.3% of nurses were occupationally stressful. Workload subscale was the most sources of stress followed by death and dying and uncertainty concerning treatment. Sex and work experience of respondents were significantly associated with occupational stress. All subscales of expanded nursing stress scale were positively correlated with over overall occupational stress. Conclusion: More than half of the nurses were occupationally stressful. Recommendation: The Amhara regional health bureau and study hospitals should develop stress reduction management programs.
TL;DR: Assessment of the acceptance and factors associated with acceptance of long acting reversible contraceptive methods (LARCs) among reproductive age women in Adama Town, Oromia regional state, Ethiopia, 2016 found current LARCs acceptance is low and health professionals should teach both the clients and their partners about the benefits and disadvantage of L ARCs.
Abstract: The global population is expected to reach between 7.5 and 10.5 billion by the year 2050. Ethiopia is the second most populous country in Sub-Saharan Africa next to Nigeria. Total Fertility Rate of Ethiopia is 4.1 children per women; contraceptive prevalence rate is 29% for all child bearing age women. The prevalence of long acting reversible contraceptive methods (LARCs) in Ethiopia was very low (4.2%). The cause for low prevalence of LARCs is not known. Thisstudy assessed the acceptance and factors associated with acceptance of long acting reversible contraceptive methods (LARCs) among reproductive age women in Adama Town, Oromia regional state, Ethiopia, 2016. Institution-based cross-sectional study was employed. A total of 644 women attending family planning clinics in health facilities in Adamatownin March 2016 were randomly selected. Structured, pretested and interviewer administered questionnaire was used to collect data. Univariateand Multivariable logistic regression analysis was employed to identify factors associated with acceptance of LARCs methods. Adjusted Odds ratios (AOR) with 95% confidence interval (CI) were used to assess the association among study variables. The acceptance of LARCs methods was found 27.9% Respondents` age (25-34 years) (AOR, 0.19; 95% CI: 0.07, 0.54) were negatively associated, occupation (govern employed) (AOR, 8.80; 95% CI: 1.38, 56.13), Supportive partners attitude (AOR, 30.26; 95% CI: 10.52, 87.03), time taken to arrive the health facility (AOR, 5.68; 95% CI: 2.11, 15.27), partners discussion (AOR, 23.23; 95% CI: 8.55, 63.08) and ever using LARCs before (AOR, 5.50; 95% CI: 2.11, 14.31) were found to have significant and positive association with acceptance of LARCs. CurrentLARCs acceptance is low (27.9%). Regional Health Bureau, Adama Town Health Office and other stakeholders should continue promotion of LARCs. Health professionals should teach both the clients and their partners about the benefits and disadvantage of LARCs. Partners should discus on benefits of using LARCs.
TL;DR: This study identified that having end-stage renal disease with complications increases the probability of death, and the family history of experiencing ESRD is a driver for being E SRD patient.
Abstract: Background: Chronic kidney disease (CKD) with diagonesised end-stage renal disease (ESRD) is common public health problems worldwide. This study was aimed to investigate socio-economics and clinical characteristics determinants among end-stage renal disease (ESRD) population. Method: This study is a retrospective cohort design which was conducted during May 2012 to April 2016 and included 500 ESRD patients at Adama Hospital Medical College. Retrospectives data were gathered by reviewing patients’ medical and surgical wards history. The Cox PH regression and parametric survival (Weibull, Log-logistic and log normal) models were molded and compared for examining survival analysis of ESRD patient using R statistical package software. Results: The study participants are 500 ESRD patients, 72.40% were alive at the end of this study, while 27.40% were died. The survival time of ESRD Majority of patients (66.20%) were female. Log-normal model had fitted the ESRD data set best relatively among possible candidate models. The age at the time of admission to ESRD (HR=0.94, p-value < 0.05), female (HR=0.54, p-value <0.05) and family history (HR=0.45, p-value<0.05) had significantly shorter survival time of ESRD patients to mortality. Conclusion: parametric survival model with baseline hazard lognormal distribution was found appropriate to our dataset. This study identified that having ESRD with complications increases the probability of death. The family history of experiencing ESRD is a driver for being ESRD patient. Female patients had greater risk of death than males in this study. Age specific follow-up is necessary to reduce the mortality related to ESRD.
TL;DR: The outcome of this pilot study suggests that this approach to survey studies will accomplish targeted enrollment in a cost effective manner, and future studies are needed to validate this approach in the context of other survey studies.
Abstract: Objective To effectively achieve a robust survey response rate in a timely manner, an alternative approach to survey distribution, informed by statistical modeling, was applied to efficiently and cost-effectively achieve the targeted rate of return. Design A prospective environmental scan surveying adoption of health information technology utilization within their practices was undertaken in a national pool of dental professionals (N=8000) using an alternative method of sampling. The piloted approach to rate of cohort sampling targeted a response rate of 400 completed surveys from among randomly targeted eligible providers who were contacted using replicated subsampling leveraging mailed surveys. Methods Two replicated subsample mailings (n=1000 surveys/mailings) were undertaken to project the true response rate and estimate the total number of surveys required to achieve the final target. Cost effectiveness and non-response bias analyses were performed. Results The final mailing required approximately 24% fewer mailings compared to targeting of the entire cohort, with a final survey capture exceeding the expected target. An estimated $5000 in cost savings was projected by applying the alternative approach. Non-response analyses found no evidence of bias relative to demographics, practice demographics, or topically-related survey questions. Conclusion The outcome of this pilot study suggests that this approach to survey studies will accomplish targeted enrollment in a cost effective manner. Future studies are needed to validate this approach in the context of other survey studies.
TL;DR: The study indicates that the community awareness about zoonotic tuberculosis and its means of transmission was very low and necessitates detail study on epidemiological and socioeconomic significance of the disease in the community so as for effective implementation of TB control and prevention measures.
Abstract: A questionnaire based cross-sectional study was conducted from October, 2015 to April, 2016 to assess awareness of the community towards the zoonotic importance of bovine tuberculosis in Bako town and its surrounding villages. About 480 randomly selected human populations were interviewed. Awareness of respondents about zoonotic importance of bovine tuberculosis has significantly different in different categories of the variables including educational level (p=0.001), occupation (p=0.007) and age (p=0.041) of the respondents. 58.1% (280) of population have a knowledge of zoonotic tuberculosis transmission through consumption of raw milk, whereas 7.9% (38), 4.4% (21) and 9.2% (44) aware only zoonotictuberculosis transmission through uncooked meat, inhalation and contact, respectively. However, 20.2% (97) of respondents were having no awarenesson the transmission routes of zoonotic TB. From the respondents, 63 (13.1%) were consume raw milk, even though most of the participants (170, 59%) were consuming boiled milk. Those consume both raw and boiled milk were accounted for 58 (20.1%). The ways of community milk usage was significantly different in different types of respondent’s occupation and in different districts (p=0.000). This study indicates that the community awareness about zoonotic tuberculosis and its means of transmission was very low. Therefore, it necessitates detail study on epidemiological and socioeconomic significance of the disease in the community so as for effective implementation of TB control and prevention measures.
TL;DR: The results showed that anesthetics exerted the protective effects on the injury of ischemia reperfusion injury through the regulation of inflammatory factors.
Abstract: Current evidence indicates that anesthetics produce important effects to protect myocardium against ischemia-reperfusion (I/R) injury. The imbalance between pro- and anti-inflammatory cytokines might contribute to the mechanism of progression of I/R injury. To investigate experimental methodology of inflammatory factors in myocardial I/R with anesthetics preconditioning. This paper discusses the methods from the several aspects, including animal species, methods for model preparation, patterns of common anesthetics intervention, and the results of the intervention inflammatory factors including TNF-α, IL-1, IL-6, IL-8, IL-10 together with nuclear transcription factor NF-kB which regulates inflammation were explored in I/R models. The results showed that anesthetics exerted the protective effects on the injury of ischemia reperfusion injury through the regulation of inflammatory factors.
TL;DR: A 30-year-old man with his second double lung transplant for cystic fibrosis presented with 4 months of worsening diffuse bony pain and swelling and was diagnosed with voriconazole-induced periostitis deformans (VIPD), which was discontinued and symptoms and ALP improved within 3 months.
Abstract: doi:10.3121/cmr.2017.1357 A 30-year-old man with his second double lung transplant for cystic fibrosis presented with 4 months of worsening diffuse bony pain and swelling. He had been receiving oral voriconazole intermittently over 4 years (200mg PO bid) for pulmonary aspergillosis. Examination demonstrated asymmetrical swelling of the phalanges and restricted range of motion in the hips, without clubbing, joint tenderness or tenosynovitis. Hand radiographs showed multifocal, asymmetrical periosteal reaction in the metacarpal shafts and phalanges (Figure 1). MRI demonstrated marked periosteal thickening of the phalangeal diaphyses, with preserved medullary cavities and congruent joints (Figure 2). Bone scan confirmed multifocal osteoblastic activity in the axial and appendicular skeleton (Figure 3). Laboratory findings included an elevated alkaline phosphatase (ALP) [673 IU/L; normal range 35-125] and bone-specific ALP (BS-ALP) [203 mcg/L; normal range 0-20]. Calcium, vitamin D, parathyroid hormone, urate, creatinine, and inflammatory markers were normal. Serum voriconazole and beta-crosslinks (a marker of bone resorption) were normal. Given the elevated ALP, periostitis, osteophytic reactions and lack of clubbing, he was diagnosed with voriconazole-induced periostitis deformans (VIPD). Voriconazole was discontinued and symptoms and ALP improved within 3 months.
TL;DR: The cases of three men from Ethiopia who were seen and are being treated by American doctors who traveled there on a medical mission are described.
Abstract: Subcutaneous phaeohyphomycosis is a chronic fungal infection usually found on the lower extremity and feet of agricultural workers in the tropics. It can present with various skin manifestations, verrucous to nodular plaques, and is caused by multiple species of fungi. Laboratory confirmation requires skin samples for pathology and fungal cultures. Cure, often difficult in resource-poor countries, requires months of antifungal therapy. We describe the cases of three men from Ethiopia who were seen and are being treated by American doctors who traveled there on a medical mission.
TL;DR: Findings indicated that CML might benefit NSCLC metastasis through promoting invasion and migration.
Abstract: Effects of carboxymethyllysine (CML), an advanced glycation end-product (AGE), at 1, 2, 4, 8 or 16 μmol/l upon invasion and migration of A549 cells, non-small cell lung cancer (NSCLC) cells, were investigated. Results showed that CML at used test doses did not affect A549 cell growth. However, CML at 4-16 μmol/l enhanced both invasion and migration, and stimulated the release of reactive oxygen species, interleukin-6 and tumor necrosis factor-alpha in A549 cells. CML at 2-16 μmol/l increased protein expression of AGE receptor, p47phox, intercellular adhesion molecule-1, fibronectin, kappa-B (NF- κB) p65 and p-p38 in A549 cells. CML only at 4-16 μmol/l increased matrix metalloproteinase-2 expression in A549 cells. These findings indicated that CML might benefit NSCLC metastasis through promoting invasion and migration.
TL;DR: The authors came to the conclusion that the detection of serum TSH, blood lipid ratio and Hcy were of great value in the transformation from subclinical hypothyroidism to hyp Timothyroidism and the prediction of hypothy thyroid disease and the cause of cardiovascular diseases.
Abstract: To investigate the correlation between hypothyroidism and subclinical hypothyroidism in serum thyroid hormones, blood lipid profile, blood lipid ratio and homocysteine, the authors calculated the ratio of blood lipid and carried on statistical analysis through measuring the level of serum thyroid hormones, blood lipid, homocysteine among 60 patients with hypothyroidism, 140 patients with subclinical hypothyroidism and 60 controls. As a result, firstly, the levels of serum TSH in hypothyroidism group and subclinical hypothyroidism group were significantly higher than those in the control group (P <0.001).The difference between the subclinical hypothyroidism group and the control group had statistical significance (P <0.05).What’s more, the patients, who were hypothyroidism, were significantly lower than those in the control group in the levels of serum FT3 and FT4. Moreover, compared with the hypothyroidism and subclinical hypothyroidism, on the one hand, the levels of serum FT3 and FT4 obviously decreased, on the other hand, the levels of serum TSH and Hcy were significantly increased (P <0.01). As to the correlation of thyroid hormones with blood lipid ratio and non-HDL-C, TC showed the highest correlation and the sequences were non-HDL-C, LDL-C and LCI. In the end, the authors came to the conclusion that the detection of serum TSH, blood lipid ratio and Hcy were of great value in the transformation from subclinical hypothyroidism to hypothyroidism and the prediction of hypothyroidism and the cause of cardiovascular diseases.
TL;DR: This case demonstrates the importance, when evaluating a patient presenting with anisocoria, of knowing the chemical ingredients of the homeopathic eye drops, which often are not listed.
Abstract: A woman, aged 70 years, developed anisocoria after applying homeopathic eye drops (Similasan Pink Eye Relief) to her left eye. Her pupil was dilated for two weeks and did not respond to light or near stimuli for one week. Both 0.1% and 1% pilocarpine failed to constrict her left pupil, and magnetic resonance imaging of her brain did not reveal any abnormality. The eye drops she had used contain belladonna extracts which have a natural atropine component. This case demonstrates the importance, when evaluating a patient presenting with anisocoria, of knowing the chemical ingredients of the homeopathic eye drops, which often are not listed.
TL;DR: A case of fibrillary glomerulonephritis in a patient with asymptomatic Sjogren’s syndrome is described, highlighting electron microscopy findings in FGN and poor prognosis.
Abstract: Renal involvement in primary Sjogren's syndrome (pSS) varies in severity and prevalence. Although previously felt to be uncommon, kidneys can be involved in 25% to 30% of pSS patients. Fibrillary glomerulonephritis (FGN) is a rare primary glomerular disease that can occur in association with another autoimmune condition or malignancy. The diagnosis relies on renal biopsy findings of haphazardly arranged fibrils in all glomerular compartments and distinction from other forms of fibrillary glomerulopathies such as renal amyloidosis and immunotactoid glomerulopathy. FGN responds poorly to immunosuppressive therapy and has a poor prognosis. Here, we describe a case of FGN in a patient with asymptomatic pSS. We describe the diagnostic work-up, clinical course, treatment utilized, and 1-year follow-up. There is one other case in the literature of FGN in a patient with pSS. The rarity of this association and distinction of FGN from other forms of renal involvement in pSS is important as it impacts therapy and prognosis. The case highlights electron microscopy findings in FGN and poor prognosis.
TL;DR: A patient with a long history of SCCH is reported in whom pamidronate 60 mg intravenously every 3 months for 3 years failed to reduce symptom severity and improve radiologic findings.
Abstract: Sternocostoclavicular hyperostosis (SCCH) is an infrequent chronic inflammatory disorder of the axial skeleton of unknown origin. SCCH goes often unrecognized due to a low level of awareness for the disorder. It typically presents with relapsing and remitting pain in the shoulder, neck, and anterior chest wall area with occasional swelling and tenderness of the sternoclavicular area. The diagnosis is confirmed radiologically by sclerosis and hyperostosis of the sternoclavicular joints. There have been several reports in which intravenous bisphosphonates and tumor necrosis factor-inhibitors have shown reasonable efficacy in the treatment of this disorder. We report a patient with a long history of SCCH in whom pamidronate 60 mg intravenously every 3 months for 3 years failed to reduce symptom severity and improve radiologic findings.
TL;DR: Lower socioeconomic status in patients with acute coronary syndrome was considered as a risk factor for increased in-hospital mortality, stroke, impaired left ventricular function, and heart failure, and it was revealed that the lower socioeconomic status was statistically significant associated with increase of acute coronary Syndrome mortality.
Abstract: Cardiovascular problems are still the leading cause of deaths globally Socioeconomic inequality continues to pose a challenge to health care suppliers and can greatly affect the clinical outcome of medical problems, especially in the cardiovascular field This study aimed to assess the in-hospital outcome of patients with acute coronary syndrome admitted in the coronary care unit and to determine the relation between socioeconomic status (SES) and in-hospital outcome of acute coronary syndrome A prospective observational study was conducted on 301 patients presented with acute coronary syndrome during the period from August 2015 to May 2016 A questionnaire was used to assess their socioeconomic status Admitted patients with acute coronary syndrome (ACS) were classified into 31 (103%) patients with non-ST segment elevation myocardial infarction (NSTEMI), 162 (538%) with ST segment elevation myocardial infarction STEMI and 108 (359%) with unstable angina (UA) According to patients SES, they were classified as 77 with high SES, 74 with middle SES, 84 with low SES, and 66 with very low SES The study revealed that the lower socioeconomic status was statistically significant associated with increase of acute coronary syndrome mortality (P <0001), the incidence of impaired left ventricular function, heart failure and stroke was associated While, lower socioeconomic status was significantly associated decrease in the incidence of coronary angiography and percutaneous intervention No significant change in the incidence of arrhythmia and major bleeding between socioeconomic status classes Lower socioeconomic status in patients with acute coronary syndrome was considered as a risk factor for increased in-hospital mortality, stroke, impaired left ventricular function, and heart failure To the best of author’s knowledge, this study considered first report in Egypt discussing the in-hospital outcome of patients with ACS and to determine the relation between SES and in-hospital outcome of ACS patients
TL;DR: It is concluded that Isolation of hepatitis C positive patients as an infection control policy is mandatory to control HCV seroconversion in Egypt.
Abstract: The prevalence of hepatitis C virus (HCV) infection in hemodialysis units (HD) is higher than among normal population. Seroconversion was included in many previous studies which constitute a great problem against infection control policies. The aim of this study was to evaluate seroconversion rate and the effect of isolation of hepatitis C positive patients as infection control method. This is controlled prospective study that included 90 patients for 2 years. Isolation policy of hepatitis C positive patients was implemented in the second year of the study. The prevalence of HCV was 48.9% among hemodialysis patients. Seroconversion rate decreased from 15.2% in the first year to 5.1%in the second year after application of isolation. The duration of hemodialysis in months, positive history of blood transfusion and the amount of transfused blood were considered significant factors affecting seroconversion. so we concluded that Isolation of hepatitis C positive patients as an infection control policy is mandatory to control HCV seroconversion in Egypt.
TL;DR: There was a significant increase in the frequency of frailty among CAP patients (50%), compared with control patients (22%).
Abstract: Frailty is at the core of geriatric syndromes that are characterized by multiple morbidities and mobility limitations. The purpose of this case-control study was to assess the frailty scale and muscle mass on the acute phase in hospitalized elderly patients with community-acquired pneumonia (CAP). Thirty-two elderly patients, aged 75 years or older, who were hospitalized with CAP, and 32 control patients hospitalized without CAP were recruited. Frailty scale and muscle mass were assessed using the Reported Edmonton Frail Scale (REFS) and rectus femoris (RF) thickness by ultrasound, respectively. There was a significant increase in the frequency of frailty among CAP patients (50%), compared with control patients (22%). Frailty scale correlated inversely with RF thickness and activity status. Based upon the piece-wise linear regression analysis between REFS and RF thickness decreased rapidly with the pre-frailty status among CAP patients. Elderly patients with CAP exhibit a significant impairment of activity status with frailty due to decreased thickness of RF prior to admission.