id
stringlengths 47
47
| source
stringclasses 2
values | text
stringlengths 19
659k
|
|---|---|---|
<urn:uuid:4be3953a-8161-4a06-8c2a-509e142ea697> | wiki | Http request failed |
<urn:uuid:18cb7a6c-ba90-4963-b876-f0a1d876185f> | wiki | {"error":{"status":"Bad Request","code":400,"type":"job","message":"job: job is not running, current state: FAILED, state info: Cluster error (0): DeadlineExceeded Pod was active on the node longer than the specified deadline"},"requestID":"f918e157d5e710e7f72063bcd2d11c3f"} |
<urn:uuid:d0d0c7b9-b219-40ac-a50a-ce72d281d156> | wiki | Opioids exert their therapeutic effects by specifically interacting with opioid receptors predominantly located in the brain and spinal cord. These receptors play a crucial role in the management of chronic pain, and various oral opioids are employed to alleviate this condition. The synergistic combination of opioids with other analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), facilitates the modulation of pain on distinct receptors, thereby reducing the opioid requirements by up to 30 percent and enhancing pain relief while minimizing the risk of adverse effects.
A diverse array of opioids exists, including codeine, morphine, and pethidine, which can be classified according to their efficacy. Low-efficacy opioids, such as codeine and propoxyfene, are effective in managing mild to moderate pain, although studies have shown that paracetamol and NSAIDs in optimal doses exhibit superior efficacy. In cases where paracetamol with or without an NSAID fails to alleviate pain, the addition of codeine or propoxyfene to the regimen may be beneficial. Many pharmaceutical manufacturers formulate combination products that simultaneously target multiple receptor sites, thereby achieving a more comprehensive blockade of pain.
Codeine and propoxyphene, like all opioids, may induce sedation, and codeine is also recognized for its efficacy as a cough suppressant, even at lower doses than those employed for pain relief. Other opioids, such as dihydrocodeine, tilidine, and tramadol, are effective in managing moderate to severe pain, and can be administered orally. Notably, tramadol is associated with reduced sedation and respiratory depression, and caution is advised when combining these agents with other central nervous system depressants, including sleeping tablets, sedatives, and alcohol.
Strong opioids, including morphine and pethidine, are primarily administered by injection and are effective in managing severe pain. Interestingly, strong opioids have been found to be less effective in alleviating postoperative headaches, whereas simple paracetamol exhibits superior efficacy in this regard.
The side effects of opioids vary in severity and primarily affect the central nervous system, including drowsiness, decreased alertness, sedation, euphoria, dysphoria, dependence, and addiction. Respiratory side effects, such as depression of breathing and cough, can be severe in individuals with pre-existing respiratory conditions, and caution is warranted. Other side effects may include nausea, vomiting, constipation, gallbladder constriction, difficulty in passing urine, and itching. Prolonged use of opioids can lead to a decline in efficacy.
It is essential to avoid combining different opioids, as this can increase the risk of adverse effects without enhancing the efficacy of the medication. The codeine levels in combination-type medications are often too low to provide adequate pain relief but may still induce drowsiness. The efficacy and safety of opioids should be carefully evaluated, and patients should be monitored closely to minimize the risk of adverse effects.
References:
Odendal, C. L. (2010). Reviewed by Prof CL Odendal, senior specialist at the department of anaesthesiology at the University of the Free State, April 2010. |
<urn:uuid:445439fb-cc29-4af3-8885-44f06042ffbc> | wiki | Dementia is a condition characterized by the brain's impaired functioning, leading to cognitive and behavioral impairments. It is predominantly caused by Alzheimer's disease, a progressive disorder marked by the gradual degeneration of brain cells. The etiology of Alzheimer's remains largely unknown, although various risk factors have been identified, including advanced age, a family history of the disease, severe head trauma, and vascular-related conditions.
Individuals suffering from Alzheimer's disease typically exhibit significant deterioration in communication and behavior, primarily resulting from the loss of acetylcholine, a neurotransmitter essential for intercellular communication. The disease's pathophysiology is multifactorial, involving a complex interplay between genetic, environmental, and lifestyle factors.
The affected brain exhibits a marked reduction in cellularity, with significant brain shrinkage resulting from the progressive decline of brain cells. Under microscopic examination, two distinct abnormalities are observed: beta-amyloid plaques, which impede communication among brain cells and contribute to cell destruction, and tau knots, which disrupt the brain's internal support and transport system, leading to impaired nutrient delivery.
The progressive nature of Alzheimer's disease is disheartening, with early symptoms such as memory problems and difficulties with speech articulation potentially serving as diagnostic indicators. Unfortunately, the disease is currently incurable, although medication can alleviate some symptoms. Prevention is the most effective approach, which can be achieved through adopting a healthy lifestyle, including a smoke-free environment, moderate alcohol consumption, a balanced diet, regular exercise, and routine health checkups. |
<urn:uuid:d09e09cc-3478-49aa-a51f-6fe6c05ab96b> | wiki | {"error":{"status":"Bad Request","code":400,"type":"job","message":"job: job is not running, current state: FAILED, state info: Cluster error (0): DeadlineExceeded Pod was active on the node longer than the specified deadline"},"requestID":"98e61836636b84a527b34aa562cb5d8f"} |
<urn:uuid:be258b03-aea2-4f74-8d52-9d8c597f291a> | wiki | The human respiratory system has long been a subject of scientific inquiry, with numerous studies aimed at understanding the fate of inhaled contaminants within the body. Despite significant progress, a comprehensive model of the respiratory system remains elusive, particularly for toxic contaminants and sensitive populations such as children, the elderly, and those with diseases.
To address this challenge, researchers have developed a three-dimensional modeling program utilizing publicly available human physiology data. This model, which includes the extrathoracic region, upper airways, tracheobronchial tree, and alveolar region, enables the simulation of virtually any variation of airway geometries and disease states. The model's dynamic morphology allows for the integration of morphological changes created by respiratory disease, exposure to toxins, or stressors, and age.
The development of this model was preceded by numerous mathematical and flow models that investigated the deposition of particles in the human lung. However, these models were limited by their lack of morphological realism. Recent advances in three-dimensional modeling and computational fluid dynamics (CFD) have enabled the creation of more accurate and realistic models of the respiratory system.
One of the key challenges in modeling the respiratory system is the complexity of the airway network. The human lung contains over 16 million airways, which must be represented in a three-dimensional computer simulation. To address this challenge, researchers have developed a method of generating lung morphologies using anatomic data. This method involves abstracting the task of creating a complex lung model to the knowledge-based parameterization of its constituent airways.
The model's ability to simulate inhalation, deposition, and exhalation of contaminants makes it an invaluable tool for researchers studying the effects of toxic substances on the human respiratory system. The model's flexibility and ability to integrate morphological changes created by respiratory disease, exposure to toxins, or stressors, and age, will be critical in investigating sensitive populations.
The development of this model was supported by the US Environmental Protection Agency, and the researchers acknowledge the contributions of Dr. Ted B. Martonen and Dr. James S. Brown, who provided valuable guidance and mentorship throughout the project. The model's potential applications extend beyond research, with the possibility of predicting dose from exposure to hazardous particulate-based contaminants and targeting pharmaceuticals to specific locations in the respiratory system.
The researchers declare that they have no competing interests and have ensured that the views expressed in this paper reflect their own and do not necessarily represent the views or policies of the US Environmental Protection Agency. |
<urn:uuid:0cf76a15-ddc2-4f94-a141-61dcd0c4e9b8> | wiki | An early warning and response system for the prevention and control of communicable diseases is a component of the broader network for epidemiological surveillance and disease control established by the Community in 1998. This mechanism is designed to alert authorities to potential public health threats at the community level, enabling swift action to mitigate the risks. The system's provisions ensure the protection of personal data, particularly during contact tracing operations on a European scale.
Commission Decision 2000/57/EC of 22 December 1999 on the early warning and response system for the prevention and control of communicable diseases, adopted under Decision No 2119/98/EC of the European Parliament and of the Council, outlines the framework for this mechanism. The decision stipulates that the system is reserved for community-level events with the potential to become public health threats, and that member states must notify such events, collect and exchange relevant information, and coordinate countermeasures.
The system's scope includes the notification and coordination of measures taken to address events posing a health threat, as well as the simultaneous notification of the World Health Organization (WHO) in cases of international emergencies. The events that trigger the system's activation include outbreaks of communicable diseases spanning multiple member states, spatial or temporal clustering of disease cases, and the appearance or resurgence of a communicable disease requiring coordinated community action.
Competent authorities in each member state are responsible for collecting and exchanging information on these events, as well as measures taken to address them. Personal data may be exchanged during contact tracing operations, but this is subject to strict guidelines to ensure the protection of sensitive information. The decision establishes procedures for information exchange, consultation, and cooperation among member states and the commission, which are applied at three levels: information exchange, potential threat, and definite threat.
The system's coordination of measures involves the rapid exchange of information among member states and the commission, as well as the adoption of further measures to address the public health threat. The commission supports member states in coordinating their efforts to mitigate the threat and protect the population. The system is deactivated after agreement among the member states concerned, which informs other member states and the commission.
In the event of an outbreak, member states are required to provide information to concerned professionals and the general public, as well as inform them of the measures adopted. The decision provides for the transposition of its provisions in member states and outlines the entry into force and amending acts. |
<urn:uuid:0680b1d1-d091-4d5f-a9d5-03e555ee86bb> | wiki | Human Cytomegalovirus Genomics: A Comprehensive Review of Current Research
Human cytomegalovirus (HCMV) is a complex virus that infects a wide range of animal species, including humans and non-human primates, and rodents. As a member of the Beta-herpesvirinae subfamily of the Herpesviridae family, HCMV shares a common gene content and organization with other viruses in this subfamily, including the Roseolovirus genus, which comprises HHV-6A, HHV-6B, and HHV-7. These viruses exhibit a restricted host range and relatively long replication cycles, with HCMV displaying a genome of approximately 235,000 base pairs, containing over 200 open reading frames (ORFs) that are likely to encode proteins. A comprehensive genomic map of an HCMV clinical isolate, FIX (VR1814), has been generated, revealing the organization and expression of the viral genome. The viral genome is highly regulated, with a cascade of immediate early (IE), early (E), and late (L) transcription occurring after infection of cultured fibroblasts. HCMV replicates in and spreads through various cell types within an infected host, with some cells becoming quiescent and entering latency. Notably, HCMV does not induce a global shutdown of cellular mRNA accumulation, allowing the host cell to continue synthesizing and processing its own mRNAs. The large size of the viral genome and its complex interaction with the host cell make genomic technologies an essential tool for studying HCMV. The application of genomics to pathogen-infected cells and organisms is still in its infancy, but genomic studies have begun to provide new insights into the pathogen-host cell interaction. This review aims to summarize the current state of knowledge from genomic studies of HCMV-infected cells, considering the implications of the results and discussing future research directions. |
<urn:uuid:b12c4556-e685-4aef-bf79-c8579215883c> | wiki | A 48-year-old male patient presented with a two-year history of persistent, high-pitched tinnitus and progressive hearing loss in both ears, accompanied by difficulties in hearing in quiet environments but marked impairments in speech comprehension in noisy settings. Notably, the patient had no prior significant illnesses, accidents, or atypical drug use, nor any notable ear problems. Over the past eight years, he had worked in a noisy textile mill, where he occasionally wore hearing protective devices, although no other hazardous noises, such as gunfire or motorbikes, were encountered off the job.
The diagnosis of noise-induced hearing loss (NIHL) falls within the purview of an audiologist, whose primary responsibility is to identify and quantify hearing loss, as well as rehabilitate individuals with hearing impairments. Audiometric assessments involve measuring auditory thresholds in decibels relative to a normal hearing level or 0 dB HL for pure tones as a function of frequency, resulting in the generation of an audiogram, a frequency-intensity graph. The audiogram provides critical information, including: (1) whether hearing loss is present, (2) its severity, (3) its nature (conductive, sensorineural, or mixed), and (4) whether the use of hearing aids can benefit the individual.
A typical normal audiogram and one from an individual with NIHL are depicted in Figure 16–5. Noise-induced hearing loss characteristically presents as bilateral symmetrical loss that is progressive in nature, provided continuous exposure to hazardous noise levels. Initially, the loss typically occurs at frequencies between 3,000 and 6,000 Hz, with the maximum loss centered at 4,000 Hz. The audiometric configuration is characterized by a downward slope, with greater loss in the high-frequency region (3,000–6,000 Hz) than in the low- and mid-frequency regions (250–2,000 Hz). As NIHL accumulates following further exposure, the 4,000-Hz loss increases in magnitude, and adjacent frequencies also become increasingly affected. The progressive nature of NIHL may ultimately result in moderate to severe impairment across most of the usable hearing frequency range (250–8,000 Hz) unless preventive measures are taken to reduce the degree of hazard imposed by the noise.
A definitive diagnosis of permanent NIHL may be indicated by the audiometric configuration of the hearing loss, specifically the 4,000-Hz notch. However, a premature diagnosis would be premature without considering additional factors, including: (1) the duration, type, and time-weighted average of the individual's noise exposure, (2) the individual's hearing both before and after exposure, (3) the individual's age and general health, and (4) the presence of any other disorders that may result in similar hearing impairments. |
<urn:uuid:449745c0-56a8-4329-94df-fe17b0e171d1> | wiki | The European Commission has published new guidelines for quality assurance in colorectal cancer screening, aiming to promote safe, equitable, reliable, and cost-effective services that maximize benefits to those attending screening while minimizing adverse effects. These guidelines, similar to those developed for breast and cervical cancer screening, provide guiding principles and evidence-based recommendations for quality assurance in colorectal cancer screening, which should be followed by Member States to ensure successful implementation of screening programs.
Colorectal cancer is the second most common newly diagnosed cancer in the EU, accounting for one out of seven new cancers and one out of eight cancer deaths, with approximately 330,000 new cases and 150,000 deaths occurring annually. The burden of cancer is increasing due to an aging population, resulting in a significant economic burden on society. Furthermore, colorectal cancer is the second most common cause of cancer death in the EU, with many deaths potentially being avoided through early detection and effective use of screening tests followed by appropriate treatment.
The EU is publishing guidelines on colorectal cancer screening due to the adoption of a Council Recommendation on cancer screening in December 2003, which sets out principles of best practice in the early detection of cancer. Member States are invited to implement nationwide population-based screening programs for breast, cervical, and colorectal cancer, with appropriate quality assurance. The guidelines aim to assist Member States in implementing these programs in the most effective way possible.
The recommended test for colorectal cancer screening in the EU is the faecal occult blood test (FOBT) for men and women aged 50–74 years, with over 135 million individuals in the EU falling within the recommended age range. Organized, population-based screening programs are recommended, as they include public health organizations responsible for program implementation, quality assurance, and evaluation, thereby providing equal chances of benefiting from screening and reducing health inequalities.
Quality assurance in cancer screening is crucial due to the large number of individuals participating in screening programs who do not have detectable cancer. Only those with pre-cancerous lesions or early cancer can benefit directly from early detection, while others are exposed to the risks associated with screening tests, such as unnecessary examinations, treatment, or anxiety resulting from false-positive screening tests. Therefore, high-quality screening must be ensured to minimize risks and maximize benefits.
The new EU Guidelines for colorectal screening and diagnosis provide similar standards for colorectal screening, building upon the European quality assurance guidelines for breast and cervical cancer screening. Implementing screening programs in line with these guidelines requires careful preparation, coordinated activities, and decisions of responsible authorities, taking time, typically 10 years or more, to achieve successful implementation nationwide. Throughout the process, the advice and assistance of experts familiar with the process in other countries are essential to avoid common pitfalls and unnecessary delays in achieving high-quality screening. |
<urn:uuid:b667482e-969b-44ee-8195-fb98c7ae85e3> | wiki | Computational Toxicology is a burgeoning and innovative discipline that encompasses a diverse array of methodologies and approaches aimed at comprehensively understanding and safeguarding human health and the environment from the deleterious effects of exposure to pollutants in the atmosphere, water, soil, and food. The daunting task of assessing the risks posed by tens of thousands of chemicals has traditionally hindered the evaluation of every chemical with rigorous testing strategies, instead relying on standard toxicity tests that have been limited to a paltry number of substances. However, the burgeoning field of computational biology, with its subdisciplines such as genomics, proteomics, and metabonomics, offers the prospect of developing a more nuanced understanding of the risks posed by a vast array of chemicals. The application of computational biology's tools to assess the risks that chemicals pose to human health and the environment is referred to as Computational Toxicology.
The U.S. Environmental Protection Agency (EPA) defines Computational Toxicology as the application of mathematical and computational models to predict adverse effects and elucidate the underlying mechanisms through which a given chemical induces harm. The EPA's computational toxicology initiative has three strategic objectives: to enhance our understanding of the intricate relationships between the source of a chemical in the environment and adverse outcomes; to develop predictive models for screening and testing; and to improve quantitative risk assessment. Computational toxicology encompasses a range of computational disciplines, including computational chemistry, computational biology, and systems biology, which involve the application of mathematical modeling and reasoning to understand biological systems and explain biological phenomena.
The development of "omic" technologies has given rise to three distinct scientific disciplines: genomics, proteomics, and metabonomics, which involve the study of genes, proteins, and metabolites, respectively. Recent technological advances have enabled the development of molecular profiles using genomic, proteomic, and metabolomic methods to identify the effects that chemicals may have on living organisms or the environment. The use of "omic" technology to study toxicological questions is referred to as toxicogenomics. The EPA has prepared a Framework for a Computational Toxicology Research Program, which outlines the research priorities and objectives for this emerging field.
The Framework for a Computational Toxicology Research Program, U.S. EPA, provides a comprehensive outline for the development of computational models and methods for assessing the risks posed by chemicals. The EPA has also published several reports and guidelines on the application of toxicogenomics to cross-species extrapolation, intellectual property concerns, and toxicity testing for environmental agents. These resources provide a valuable framework for researchers and policymakers seeking to advance our understanding of the risks posed by chemicals and to develop effective strategies for mitigating those risks. |
<urn:uuid:df1fb071-ce74-4942-bf2d-50be0da17597> | wiki | A significant outbreak of varicella occurred in a town of approximately 5,430 inhabitants in Spain between December 2004 and April 2005, primarily affecting a primary school and day-care center. Notably, although the varicella vaccine is not part of the standard infant vaccination schedule, a subset of children had received prior vaccinations prior to the outbreak.
The primary objective of this study was to assess the effectiveness of the varicella vaccine in a partially vaccinated population of children during an outbreak. To achieve this, a cohort study was conducted, where cases were identified through notification by healthcare professionals and active searches. The study collected data on the current disease, history of varicella, previous vaccinations, age, school year, and other sociodemographic factors.
The study's results showed that participation rates were high, with 96.5% of children in the school and 91.2% in the day-care center participating. Among 269 children with no prior history of varicella and documented vaccination records, 35.7% had received prior vaccinations. During the outbreak, a total of 148 cases of varicella were observed, resulting in an overall attack rate of 54.4%, with 22.9% in vaccinated children and 72.8% in unvaccinated children.
The relative risk (RR) of varicella in vaccinated children was found to be 0.31, with a 95% confidence interval (CI) of 0.21–0.46. The overall adjusted vaccine effectiveness against varicella was 69.5%, with 96.9% effectiveness against mild and severe forms. Notably, only the time since vaccination was associated with vaccine failure, suggesting that the vaccine's effectiveness waned over time.
In conclusion, the study found that the varicella vaccine was effective in preventing the disease, particularly in moderate and severe forms, but the low proportion of vaccinated children in the population allowed the outbreak to occur. |
<urn:uuid:6337c38a-d2ef-4c52-bc27-9b48e0783771> | wiki | Http request failed |
<urn:uuid:34bd99f2-bd51-442e-865a-8b6cabf7e955> | wiki | The relationship between dietary fat intake and cancer has been a subject of extensive research, with several studies indicating a significant link between high-fat diets and an increased risk of various types of cancer. Specifically, high-fat diets have been shown to elevate the risk of pancreatic cancer, colon cancer, breast cancer, and cancer of the small intestine.
A study involving women found that those consuming 40% of their calories from fat had a 15% higher risk of developing breast cancer compared to those with a diet consisting of only 20% fat. Notably, the type of fat consumed did not appear to have a significant impact on the risk, with both saturated and monounsaturated fats contributing to an increased risk. The more fat consumed, the higher the risk of cancer.
Research has also highlighted the potential carcinogenic effects of saturated fat from red meat, with studies demonstrating a significant increase in the risk of pancreatic cancer, colon cancer, and cancer of the small intestine. Furthermore, red meat has been linked to an elevated risk of stomach and esophageal cancers, in addition to its well-established association with cardiovascular disease.
In contrast to the studies focusing on dietary fat intake, research has suggested that excessive body fat may also contribute to an increased risk of certain cancers. High-fat diets can lead to weight gain, and excess body fat has been linked to an elevated risk of cancer. The mechanisms underlying this relationship are not yet fully understood, but studies are ongoing to investigate the potential carcinogenic effects of animal fats.
To mitigate the risk of cancer, obesity, and other health problems, it is recommended to limit fat intake to between 20 and 35% of total daily calories. In addition to reducing fat consumption, incorporating a diet rich in fresh fruits and vegetables can help lower cancer risk, as these foods are low in fat and high in antioxidants, which have been shown to possess anti-cancer properties. |
<urn:uuid:5924143d-e80a-4a70-a61c-f28255642ea2> | wiki | Approximately 15% of couples worldwide experience infertility after one year of regular sexual intercourse, with approximately 40% of cases attributed to male factors, yet a significant proportion of cases remain unexplained, accounting for up to 30% of cases. The male factor is a long-standing suspect in cases of unknown infertility etiology, supported by cytogenetic evidence demonstrating that 0.2% of azoospermic men, who appear phenotypically normal, exhibit Y-chromosome microdeletions. This evidence is further substantiated by karyotyping, which reveals autosomal translocations in 1.3% of infertile couples. The failure of most clinical treatments to correct abnormal sperm parameters has led researchers to suspect that many cases of male infertility may be genetically determined. Observations of sperm counts in various species, including studies of naturally occurring deletions in Drosophila, have prompted an intense search for human spermatogenesis genes that may be deficient in some infertile males. Recent advancements in molecular methodology have enabled the careful mapping of Y-chromosome microdeletions in men with azoospermia and oligozoospermia, revealing a frequency that varies between 1-35% in Western populations, depending on inclusion criteria. In contrast, a Y-chromosome microdeletion frequency range of 7.6-17% has been reported in Japanese males. These studies have identified three "azoospermic factor" regions (AZF) on the Y-chromosome long arm, namely AZFa, AZFb, and AZFc, where deletions occur. The AZFc region contains the most frequently deleted gene cluster, known as the DAZ gene. Several studies have found that AZFc deletions are associated with successful retrieval of sperm during testicular sperm extraction (TESE), whereas deletions in AZFa and AZFb are not. Histologically, these deletions are associated with various spermatogenetic alterations, including Sertoli cell-only syndrome (SCOS), maturation arrest, and hypospermatogenesis. Recent research has shown that embryo characteristics following intracytoplasmic sperm injection (ICSI) using sperm obtained from men with Y-chromosome microdeletions are not adversely affected by the deletion. The central concern was that vertical transmission of the microdeletion via ICSI might be passed from father to son or by natural conception. However, few studies have been conducted in Japanese males, and none in African males, prompting the investigation of the frequency of Y-chromosome microdeletion, as well as selected embryo features and reproductive outcomes in Japanese and African azoospermic and oligozoospermic men who underwent IVF+ICSI. |
<urn:uuid:61205bf2-0dc9-4e26-8d72-f9faf84aa628> | wiki | Randomized trials are typically conducted to assess the long-term effects of interventions on children, with the ultimate goal of determining whether the intervention can be successfully replicated in real-world settings. Upon completion of the trial, intent-to-treat analyses are employed to evaluate the overall efficacy of the intervention, as well as to examine the specific conditions under which the intervention effect varies across individual children, families, or service providers. To further understand the sustained impact of the intervention, children are typically followed for a period of one year or more beyond the conclusion of the intervention services. Furthermore, mediation analyses are utilized to elucidate the underlying mechanisms by which the intervention exerts its effects.
Conducting a randomized preventive trial necessitates substantial investment in both time and resources, involving a multi-faceted process that commences with the development of a theoretical framework for the intervention, followed by the establishment of partnerships with local communities and the design, selection, and recruitment of a representative sample. Random assignment to either the intervention or control conditions is then carried out, with data collection adhering to the protocols specified by the design. The analysis of data and the reporting of results are the final stages of the process.
Randomized trials can be categorized into two primary types: efficacy trials and effectiveness trials. Efficacy trials are designed to assess the impact of an intervention under ideal conditions, typically in a controlled research laboratory setting, where the intervention is delivered by trained researchers. These trials often examine the effects of the intervention on hypothesized mediators and proximal targets, and can provide valuable insights into the potential benefits of the intervention. In contrast, effectiveness trials are conducted in real-world settings, where the intervention is delivered by practitioners in institutions and communities, and are designed to assess the impact of the intervention in a more realistic and practical context.
Effectiveness trials are often concerned with addressing concerns that youth assigned to the control or standard setting may not receive the intervention, and therefore may not benefit from its potential advantages. However, these concerns can be mitigated through the use of specific design elements, such as the randomization of youth to either the intervention or control conditions, and the collection of data on the delivery of the intervention. |
<urn:uuid:93d8be28-4662-4b6d-89c9-e9091e1078a6> | wiki | The longevity of dogs is a fascinating phenomenon, but it is essential to approach this topic with caution, as the characteristics of long-lived dogs cannot be generalized to broader families. In rare instances, when the proportion of long-lived dogs is statistically significant and extensive within a lineage, such as in the case of Jotunheim's dogs, the significance can be extended. However, within a lineage of long-lived dogs, there are also short-lived dogs, albeit with relatively smaller proportions, due to the normal distribution of frequencies.
It is crucial to acknowledge that long-lived dogs from non-healthy lineages can produce a high proportion of non-healthy dogs, as they are carriers of deleterious genes. Moreover, the incidence of genetic diseases, such as Dilated Cardiomyopathy (DCM), can be higher in the offspring of long-lived sires compared to short-lived sires. The transmission of genetic diseases is influenced by both the sire and dam sides, but popular sires with a higher number of offspring can be considered independent of dam input. Interestingly, a comparison of the incidence of DCM in the offspring of two contemporary popular sires, Eick v.d. Rappenau and Prinz v. Norden Stamm, revealed that life span is only one variable in the complex equation of survival.
An analysis of the European Dobermann population structure, based on a sample of 129 litters born in 2009, revealed that the overall sample is related by ascendancy with only three major ancestors in three significant clusters. The main group, comprising 79.5% of litters, includes conformation dogs and/or ZTP, grouped into two clusters related to two popular sires: Graaf Quirinus v. Neerlands Stam and Prinz v. Norden Stamm. Cluster 2 includes dogs related to both Graaf Quirinus v. Neerlands Stam and Prinz v. Norden Stamm, while Cluster 3, comprising 20.5% of litters, includes pure working dogs related to Bingo v. Ellendonk and much less to Graaf Quirinus v. Neerlands Stam and Prinz v. Norden Stamm.
The population structure of the population born in 2009 illustrates the "fetish power" of pedigree for breeders, and the clusters' size shows that conformation is the primary goal of most breeders. The coefficient of inbreeding (COI) on a seven-generation pedigree of the sample litters born in 2009 shows a positive biased distribution of frequencies, with a skewness of +0.926, indicating that endogamy is a dominant practice in matings. The average COI in the sample is 9.31%, which is significantly higher than the average COI in the general population.
A comparison of the average COI between groups revealed no significant difference, but dogs related to Bingo v. Ellendonk (Cluster 3) showed higher fitness, as measured by average litter size, than dogs in the other two clusters. Significant differences in a Student t-test were observed, indicating that selection for utility is an advantage in terms of genetic fitness over the selection for anatomical traits.
The application of general rules for reducing COI for increasing diversity implies that dogs in Cluster 3 (minority) must mate with dogs in Cluster 1 or 2, which can lead to a loss of available diversity. Despite the high average COI of this group, the genetic advantage of dogs related to Bingo v. Ellendonk may be lost when they mate with dogs in Cluster 1 or 2.
The analysis of the population structure and fitness for the population born in 2009 suggests that average life span (LSP) may differentially affect dogs of both functional groups: working dogs related to Bingo v. Ellendonk and show-dogs related to Graaf Quirinus v. Neerlands Stam and/or Prinz v. Norden Stamm. The inability to perform the analysis of average life span on the same sample of dogs born in 2009 led to a statistical analysis on a separate sample including 281 records of dogs born between 1990 and 2008 belonging to both groups.
A comparison of the average COI between groups revealed a significant difference, with Bingo v. Ellendonk-related dogs having a higher average COI (12.54%) than Graaf Quirinus v. Neerlands Stam and/or Prinz v. Norden Stamm group (10.41%). The Kaplan-Meier survival curves for dogs related to both groups showed that the difference between groups is significant, with the survival factor being lower for show-dogs group in all age classes. The average life expectancy is +1.437 years higher for BvE-related dogs (Average LSP = 8.08 years) than for GQvNS and/or PvNS group (Average LSP = 6.64 years).
An analysis of variance from bivariate correlations for litter size revealed no significant correlations in both cases. A paradigm in conservation science predicts that isolated populations will experience reductions in individual genetic fitness due to inbreeding depression. However, it is also true that inbreeding and purging can positively affect fitness and life expectancy in this cluster of dogs related to Bingo v. Ellendonk specifically.
The genetic advantages of fitness and life expectancy of dogs related to Bingo v. Ellendonk are linked to the accomplishment of both simultaneous conditions: dogs strong related by kinship with Bingo v. Ellendonk and selected for working. |
<urn:uuid:1e5be050-329e-4bb8-b484-00a08173f620> | wiki | 22q11 Deletion Syndrome: Neuropsychological and Neuropsychiatric Correlates
A comprehensive clinical study of 100 individuals with 22q11 Deletion Syndrome (22q11DS) aimed to investigate the prevalence and characteristics of Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (AD/HD), Learning Disability (LD), and executive function deficits.
The study included 100 participants, predominantly females (58%), aged between 1 and 35 years, with confirmed 22q11DS through Fluorescence In Situ Hybridization (FISH) analysis. These cases were initially referred to a multidisciplinary team for routine assessments, resulting in 92 cases, and an additional eight cases were directly referred to a Child Neuropsychiatric Clinic for learning and/or behavioral issues.
The neuropsychological evaluation utilized a custom-designed test battery to assess developmental/intellectual levels, visuomotor development, executive functions, and mentalization skills. Neuropsychiatric assessments comprised structured and semi-structured interviews with parents, psychiatric evaluations, physical examinations, and age-appropriate neurological assessments. Parents completed standardized questionnaires, including the Autism Spectrum Screening Questionnaire, Conners Brief Parent Rating Scale, Child Behavior Checklist, and Five To Fifteen (FTF) questionnaires.
Comprehensive diagnoses of ASD and AD/HD were made by a psychiatrist, taking into account the results of various examinations, including interviews, medical evaluations, observations, and FTF questionnaires. The study revealed a prevalence of ASD and/or AD/HD with or without LD of 44%, with 21% exhibiting AD/HD alone, 14% ASD alone, and 9% a combination of both diagnoses. Notably, 23% had LD alone, indicating that 33% did not meet criteria for any of these diagnoses. Autistic disorder was found to be relatively rare, occurring in only 5% of the participants.
Psychiatric diagnoses were predominantly observed among adults, with 51% meeting criteria for LD. The mean IQ was 71, with a normal distribution around this mean. Notably, females had higher IQs compared to males, and there was a negative trend for IQ with increasing age. An overrepresentation of girls was observed only in the group without ASD/AD/HD/LD. In the school-age and adult groups, verbal IQ was significantly higher than performance IQ, whereas in the youngest group, the lowest results were observed in the "Hearing and Speech" subscale of the Griffiths' Mental scale, indicating a delay in expressive language in early years.
The study found that intellectual and visuomotor impairments were directly related to 22q11DS, whereas the presence of ASD/ADHD had a negative impact on planning ability in children. The ability to sustain attention was critically impaired in school-age children with 22q11DS. According to the questionnaires, a variety of behavioral problems were reported, with a characteristic combination of initiating difficulties and a "lack of mental energy" observed in the majority.
In conclusion, the study highlights the prevalence and characteristics of ASD, AD/HD, and LD in individuals with 22q11DS. The vast majority of participants exhibited behavior and/or learning problems, with over 40% meeting criteria for ASD, AD/HD, or both. The study emphasizes the importance of neuropsychiatric assessment, including neuropsychological testing, in all cases of 22q11DS to provide essential information about strengths and difficulties, crucial for optimal support. |
<urn:uuid:1b74f2a4-6e62-40e3-ac65-ae90b0f03a44> | wiki | Researchers at New York University have devised an innovative approach to scrutinize the progression of osteoarthritis in the knee joint, leveraging the examination of sodium ions in cartilage. This novel method, published in the Journal of Magnetic Resonance, may offer a non-invasive means of diagnosing osteoarthritis in its nascent stages.
The concentration of sodium ions, dispersed throughout the body, serves as a marker for the location of glycosaminoglycans (GAGs) in cartilage tissues. GAGs, molecular entities that constitute the building blocks of cartilage and participate in numerous vital functions, play a pivotal role in the diagnosis and monitoring of various diseases, as well as the efficacy of therapeutic interventions. The loss of GAGs in cartilage typically heralds the onset of osteoarthritis and inter-vertebral disc degeneration.
However, existing techniques for GAG monitoring, based on traditional magnetic resonance imaging (MRI), are hampered by limitations: they fail to directly map GAG concentrations or necessitate the administration of contrast agents to reveal the location of these concentrations. In contrast, researchers have sought to exploit the inherent presence of sodium ions in cartilage, utilizing special MRI techniques that are non-invasive.
This approach was previously developed at the University of Pennsylvania and Stanford University, but these methodologies were unable to isolate sodium ions in different parts of the knee area, specifically distinguishing between the signals of slow-motion sodium ions in cartilage and those of free sodium ions in synovial fluid and joint effusion. The NYU research team aimed to improve upon this method by focusing on the differences in the properties of sodium ions in the two environments.
Sodium ions are ubiquitous, yet MRI images often fail to discern whether the measured sodium concentration resides in cartilage or elsewhere in the knee joint. To address this issue, the researchers focused on the distinctive magnetic properties of sodium ions in different tissues. By exploiting these characteristic properties, the research team developed a novel method to isolate two pools of sodium ions, thereby obtaining images that display sodium signals exclusively from regions with cartilage tissue.
This innovative sodium MRI method not only offers a non-invasive means of diagnosing osteoarthritis in its early stages but also enables the calibration of other, less direct measures of cartilage assessments. The research was conducted by a multidisciplinary team consisting of Alexej Jerschow, Jae-Seung Lee, Ravinder Regatte, Guillaume Madelin, and Souheil Inati, representing NYU's Department of Chemistry, Radiology Department at NYU School of Medicine, and the National Institute of Mental Health, respectively. |
<urn:uuid:bf91e79c-de4b-4cd9-b63f-76ba098d026a> | wiki | Http request failed |
<urn:uuid:c1cf9f4e-adcd-42ef-b338-df3849cccea8> | wiki | Internal Medicine is a specialized field of practice that focuses on the primary and/or specialty care of adult patients, drawing from primary care as its foundation. Practitioners of Internal Medicine provide comprehensive care in both outpatient and inpatient settings, addressing a wide range of disease states, from simple to complex, and offering continuous academic stimulation.
This page aims to address frequently asked questions regarding the specialty of Internal Medicine, the requisite training, and future prospects. The Internist is typically the first point of contact for adults seeking medical attention, providing general medical care, disease prevention, screening, patient education, and follow-up care.
In addition to managing acute illnesses in the outpatient setting, Internists also care for patients in the hospital, managing complex medical conditions and providing critical care services. They often serve as experts in complex medical diseases, receiving referrals from other medical specialties, such as family practice, surgery, and pediatrics. Internists are trained to perform various procedures and can work independently, meeting the unique needs of the geriatric population, including those in skilled nursing homes, residential facilities, and the patient's home.
In essence, the Internist provides comprehensive care for all medical needs of adult patients, encompassing simple to complex conditions, across various settings, and through a range of procedures. Internal Medicine is more than a single organ system or a set of procedures; it encompasses a holistic approach to health promotion, disease prevention, and ongoing care, particularly for patients with advanced disease.
Internists serve as valuable resources, offering in-depth knowledge and information on disease processes and management, enabling them to consult with family physicians and provide expert assistance in patient care. Although the Internist's practice is rooted in primary care, the complexity and severity of illness are generally greater than those in family practice, making the management of critically ill patients an area of expertise.
The Internist's training enables them to provide continuity of care to adult patients across various settings, including the home, ambulatory setting, hospital, and critical care unit. This skillset is particularly beneficial in meeting the special needs of the elderly. Internal Medicine residency provides a foundation for lifelong learning, requiring three years of post-graduate training, followed by additional years of subspecialization, if desired.
The field of Internal Medicine offers a wide range of opportunities, with general Internal Medicine specialists comprising 40 percent of primary care physicians in the United States. As the healthcare environment continues to evolve, the demand for primary care providers, including Internists, remains high, with opportunities for career growth and development. Internists are among the most highly compensated primary care specialties, offering a challenging yet rewarding field that will continue to be in demand as the population ages. |
<urn:uuid:f2615aa0-0cda-443e-9227-e59a5f77cd9e> | wiki | Parkinson's disease, the second most prevalent neurodegenerative disorder, affects over four million individuals worldwide, with the predicted number doubling by 2030. Characterized by a progressive, severe, and irreversible loss of specific dopamine-producing neurons in the midbrain, this condition ultimately leads to debilitating motor dysfunction. Despite the development of multiple therapies, none can replace the lost cells, prompting the exploration of alternative approaches, including cell transplantation. However, this method has faced significant challenges, including the lack of an appropriate cell source that can match the lost cells in terms of function and safety.
In 2011, a groundbreaking discovery was made, enabling the derivation of nearly unlimited numbers of authentic, engraftable midbrain dopamine-producing neurons from human embryonic stem cells. Subsequent studies have demonstrated the efficacy of these cells in reversing motor deficits in three independent Parkinson's disease models, with an excellent safety profile, exhibiting no evidence of tumor or excessive growth in any of the tested animals.
The investigators anticipate submitting an Investigational New Drug application to the US Food and Drug Administration by the end of 2017, paving the way for a clinical trial in Parkinson's patients. This project brings together a multidisciplinary team of scientists, neurologists, surgeons, industry leaders, ethicists, trial experts, and patient advocates, leveraging the expertise and resources of Memorial Sloan Kettering's Center for Cell Engineering and the Center for Stem Cell Biology.
A collaborative effort between Memorial Sloan Kettering, Weill Cornell Medical College, Northwestern University, and Rush University Medical Center has secured a contract from New York State Stem Cell Science, valued at nearly $15 million over four years, to develop a stem-cell-based therapy for Parkinson's disease. NYSTEM, a state-funded initiative, aims to accelerate scientific knowledge in stem cell biology, promote the development of therapies and diagnostic methods, and alleviate disease, ultimately improving human health. This contract has enabled the creation of a multidisciplinary consortium with the goal of developing an optimized, clinical-grade source of human dopamine-producing neurons for cell therapy in Parkinson's disease by 2017. |
<urn:uuid:99b1e86c-e254-4e1d-b713-7113d0f3f35d> | wiki | Low oxygen levels can silence the BRCA1 tumor suppressor gene, thereby contributing to the progression of cancer, according to a study published in the August 2011 issue of the journal Molecular and Cellular Biology. This silencing is a critical step in the malignant pathway to breast cancer, and researchers are exploring ways to re-activate this and other tumor suppressor genes to combat cancer.
Hypoxia, or low oxygen levels, is a common feature of human tumors, primarily due to the lack of blood vessels in newly emerging tumors. As tumors grow, they develop a variable and incomplete blood supply, leading to genetic instability and a higher likelihood of malignant properties. The silencing of the BRCA1 gene is thought to be a later step in this process, as it is less likely to occur in the absence of a tumor.
Understanding the mechanism of reduced gene expression is crucial for developing strategies to interfere with the silencing process. Research has shown that the silencing of BRCA1 is accompanied by a change in histones, specifically methylation, which is a common feature of reduced gene expression. The histone-lysine demethylase enzyme, LSD1, is also implicated in this process, and blocking its activity may lead to the re-activation of BRCA1.
Furthermore, cell stress caused by hormones or environmental toxins may also contribute to the silencing of BRCA1, and researchers are investigating this hypothesis.
In a separate study published in the July 2011 issue of the journal Clinical and Vaccine Immunology, researchers found that alcoholism suppresses the immune system, leading to a high risk of serious and life-threatening infections. The study showed that dendritic cells, a critical component of the immune system, are severely impaired in alcohol-fed mice, leading to reduced antigen presentation and cytokine production.
The researchers also found that the type of milk feeding, whether breast milk or formula, influences the composition of the gut microbiota, which may play a role in the development of celiac disease. A study published in the August 2011 issue of the journal Applied and Environmental Microbiology found that breast-feeding protects against celiac disease, and that the intestinal microbiota is less diverse in breast-fed infants.
In another study published in the August 2011 issue of the same journal, researchers found that garlic-derived organosulfur compounds have greater antimicrobial activity than phenolic compounds, and that these compounds can freely penetrate bacterial membranes and combine with sulfur-containing proteins and enzymes.
These findings have significant implications for the prevention and treatment of various diseases, including cancer, celiac disease, and bacterial food-borne illnesses. Further research is needed to fully understand the mechanisms underlying these processes and to develop effective strategies for prevention and treatment. |
<urn:uuid:50050349-ed0a-4d0e-8c22-c58958c243c2> | wiki | Listeriosis is a general term encompassing a range of disorders caused by the bacterium Listeria monocytogenes, a Gram-positive organism characterized by its ability to move via flagella. Research suggests that approximately 1-10% of humans may harbor L. monocytogenes in their intestines, with the bacterium being found in at least 37 mammalian species, 17 avian species, and possibly some fish and shellfish species. L. monocytogenes is remarkably resilient, capable of withstanding freezing, drying, and heat without forming spores. Most L. monocytogenes species exhibit pathogenic properties to varying degrees.
The Centers for Disease Control and Prevention (CDC) has provided comprehensive information regarding Listeria, including its effects on human health. Listeriosis is a serious infection caused by consuming food contaminated with L. monocytogenes, primarily affecting individuals with weakened immune systems, pregnant women, newborns, and the elderly. However, individuals without these risk factors can also be affected, albeit rarely. By adhering to simple recommendations, the risk of listeriosis can be significantly reduced.
Symptoms of listeriosis typically include fever, muscle aches, and gastrointestinal symptoms such as nausea or diarrhea. In severe cases, infection can spread to the nervous system, resulting in symptoms like headache, stiff neck, confusion, loss of balance, or convulsions. Pregnant women may experience a mild, flu-like illness, but infections during pregnancy can lead to miscarriage, stillbirth, premature delivery, or newborn infection.
According to the CDC, approximately 2,500 individuals in the United States become seriously ill with listeriosis each year, resulting in 500 deaths. High-risk groups include pregnant women, newborns, persons with weakened immune systems, and individuals with certain medical conditions such as cancer, diabetes, or kidney disease. The risk of listeriosis is significantly higher in these populations, with pregnant women being approximately 20 times more likely to contract the disease than healthy adults.
Listeria can contaminate food from animal sources, such as meats and dairy products, as well as processed foods that become contaminated during processing. The bacterium has been found in a variety of raw foods, including uncooked meats and vegetables, as well as in unpasteurized milk and foods made from unpasteurized milk. Cooking and pasteurization can effectively kill L. monocytogenes, but contamination may occur after cooking and before packaging in certain ready-to-eat foods.
Listeriosis can be contracted through the consumption of contaminated food, with babies potentially being born with the disease if their mothers consume contaminated food during pregnancy. Healthy individuals may consume contaminated foods without becoming ill, but those at high risk can contract listeriosis after eating even a few bacteria. By avoiding high-risk foods and handling food properly, individuals can reduce their risk of developing listeriosis.
Prevention of listeriosis involves following general guidelines for food safety, such as thoroughly cooking raw food, washing raw vegetables, and keeping uncooked meats separate from vegetables and cooked foods. Pregnant women and individuals with weakened immune systems require additional precautions, including avoiding unpasteurized milk and foods made from unpasteurized milk, and not consuming hot dogs, luncheon meats, or deli meats unless reheated until steaming hot.
Diagnosis of listeriosis typically involves a blood or spinal fluid test to cultivate the bacteria. If symptoms persist, individuals should consult their doctor, who may recommend a blood test during pregnancy to determine if symptoms are due to listeriosis.
In the event of consuming a food recalled due to Listeria contamination, individuals who have not developed symptoms and are not in a high-risk group do not require testing or treatment. However, individuals in high-risk groups who consume contaminated food and develop symptoms within 2 months should contact their physician.
Prompt treatment with antibiotics can often prevent infection of the fetus or newborn in pregnant women, while babies with listeriosis receive the same antibiotics as adults. However, even with prompt treatment, some infections result in death, particularly in the elderly and individuals with other serious medical problems.
Government agencies and the food industry have taken steps to reduce Listeria contamination, including monitoring food regularly and intensifying plant inspections when necessary. The Coordinating Center for Infectious Diseases (CCID) is studying listeriosis in several states to measure the impact of prevention activities and recognize trends in disease occurrence. |
<urn:uuid:a8b41b29-1eb7-4f79-86ff-bf447cb0b411> | wiki | The phenomenon of near-death experience may be attributed to the brain's propensity to blur the distinction between wakefulness and sleep, according to a recent study.
Historically, the enigmatic nature of the experience, wherein individuals perceive vivid lights, extraordinary sensations, or a sense of detachment from their bodily form, has remained a subject of intrigue. The present research posits that this phenomenon may have a physiological basis, arising from the confluence of sleep and wake states. While some neurologists contend that the phenomenon is too complex to be studied scientifically, others interpret it as evidence of life after death.
The study revealed that individuals who have experienced near-death experiences were more likely to exhibit REM intrusion, a phenomenon wherein aspects of the dream state of sleep bleed into wakefulness. In the present study, 60% of the 55 participants reported experiencing REM intrusion, characterized by auditory or visual hallucinations, or feelings of paralysis upon falling asleep or awakening. The authors suggest that the brain's arousal system may predispose certain individuals to experience both near-death experiences and REM intrusion, as these phenomena share common features.
The heightened activity of the visual centers in the brain during REM sleep may contribute to the visions of light and sensations of 'being dead', thereby simulating a near-death experience. Furthermore, stimulation of the vagus nerve, which connects the brain stem to the lungs, heart, and intestines, has been hypothesized to be responsible for the near-death experience phenomenon. This hypothesis is supported by the association between increased vagus nerve activity and the fight or flight response, commonly observed in perilous situations. The brain's arousal system also regulates alertness and attention during waking hours, in addition to sensitizing the brain to various stimuli. |
<urn:uuid:869e43c7-fcf2-4451-93ba-81950069d7b7> | wiki | Http request failed |
<urn:uuid:5419e569-3613-4a11-9baf-094cdc2111ee> | wiki | The Carney complex (CNC) is a hereditary disorder characterized by a triad of lentigines, cardiac myxomas, and endocrine abnormalities, including acromegaly, thyroid and testicular tumors, and adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome due to primary pigmented nodular adrenocortical disease (PPNAD). Lentigines, which are small, brown to black macules typically located around the upper and lower lips, on the eyelids, ears, and genital area, are a hallmark of the disorder. Cardiac myxomas, which can develop in any cardiac chamber and may be multiple, are a significant manifestation of CNC, and their removal is essential. Endocrine abnormalities, including acromegaly, thyroid adenomas or carcinomas, testicular tumors, and ovarian cysts, are also characteristic of the disorder.
The Carney complex is caused by mutations in the PRKAR1A gene, which encodes the regulatory subunit (R1A) of protein kinase A. Heterozygous inactivating mutations of PRKAR1A have been detected in approximately 45 to 65% of CNC index cases, and may be present in about 80% of CNC families presenting mainly with Cushing's syndrome. The PRKAR1A gene is a key component of the cAMP signaling pathway, and its mutations have been implicated in endocrine tumorigenesis. Genetic analysis should be proposed to all CNC index cases, and first-degree relatives of patients with CNC should also be screened for PRKAR1A mutations.
Regular screening for manifestations of the disease is essential for patients with CNC or a genetic predisposition to CNC. Clinical work-up for all manifestations of CNC should be performed at least once a year in all patients, and should start in infancy. Cardiac myxomas require surgical removal, while treatment of other manifestations may include follow-up, surgery, or medical treatment depending on the location of the tumor, its size, and the presence of clinical signs of tumor mass or hormonal excess. Bilateral adrenalectomy is the most common treatment for Cushing's syndrome due to PPNAD.
The Carney complex is a genetically heterogeneous disease, and linkage analysis has shown that at least two loci are involved: 2p16 and 17q22-24. The CNC1 gene, located on 17q22-24, has been identified as the regulatory subunit (R1A) of protein kinase A. The disease can be diagnosed when at least two of the manifestations listed in Table 1 are present, and a germline PRKAR1A mutation or a first-degree relative affected by CNC may be sufficient for diagnosis. The disease can also be diagnosed in asymptomatic patients if they have a germline PRKAR1A mutation or a first-degree relative affected by CNC.
In summary, the Carney complex is a rare genetic disorder characterized by a triad of lentigines, cardiac myxomas, and endocrine abnormalities. The disorder is caused by mutations in the PRKAR1A gene, and regular screening for manifestations of the disease is essential for patients with CNC or a genetic predisposition to CNC. |
<urn:uuid:608ed417-ba68-4852-9873-d4c7d09b2a76> | wiki | The reproductive lifespan of mares extends well into their late teens or early twenties, with fertility gradually diminishing each year. However, the likelihood of a previously barren mare becoming pregnant again is significantly higher than that of a similarly aged mare that has not been bred. Conversely, a maiden mare, regardless of age, is notoriously challenging to conceive. Peak fertility in horses occurs at approximately 6-7 years of age, with fertility declining at around 15 years of age as mares become increasingly difficult to breed and the rate of pregnancy loss increases.
A young, healthy mare has a 50-60% chance of becoming pregnant during a given estrous cycle when mated to a fertile stallion, whereas an older mare may have a 30-40% or lower chance of achieving pregnancy. Older mares often require more breeding cycles to establish a pregnancy, as opposed to younger mares.
Prior to the breeding season, a veterinarian is recommended to perform a reproductive evaluation on an older mare. This evaluation may consist of a simple ultrasound examination and uterine culture for mares without a history of infertility, whereas mares with a history of barrenness may require a more comprehensive assessment, including an assessment of perineal anatomy, vaginal speculum examination, digital examination of the cervix, cytology and culture of the uterus, endometrial biopsy, and ultrasonographic evaluation of the reproductive tract.
Older mares are susceptible to various clinical problems that may adversely affect fertility, including poor perineal anatomy, increased predisposition to uterine infections, persistent post-mating inflammation, increased uterine scar tissue deposition, endometrial cyst formation, and higher incidence of ovulation failure. Progressive tilting forward of the upper part of the vulva over the pelvic brim with advanced age can significantly impair a mare's ability to become pregnant or remain pregnant, particularly in mares with poor body condition.
Alterations in perineal conformation can compromise the vulva's ability to act as a barrier against ascending infection and facilitate aspiration of air into the vagina, known as windsucking. Affected mares may benefit from a Caslick's operation, a minor surgical procedure designed to decrease the size of the vulva opening and reduce aspiration and bacterial infections.
As mares age, changes within the lining of the uterus, such as the laying down of scar tissue, accumulation of inflammatory cells, development of endometrial cysts, and destruction of uterine glands, occur. These changes are more pronounced in older mares that have had multiple foals and in older maiden mares. Diagnosis of endometrial damage or degeneration is made by evaluation of a uterine biopsy, which also provides an estimation or prognosis of the mare's ability to become pregnant and carry a foal to term.
A grade is assigned to the biopsy, with Grade I indicating a normal healthy endometrium and Grades II and III containing moderate to severe pathologic changes. The prognosis for fertility decreases as the severity of endometrial abnormalities increases.
Older mares are also more susceptible to persistent post-mating endometritis or inflammation, which can result from reduced uterine clearance and retention of inflammatory fluid in the uterine lumen for extended periods. This can create an environment incompatible with embryo survival.
Management strategies to increase the probability of getting an older mare in foal include breeding to a stallion of proven fertility, frequent ultrasound examinations to optimize breeding time, confirm ovulation, and monitor the uterus for fluid accumulation post-breeding, and insemination once as close to ovulation as possible.
Therapeutic techniques that may be beneficial include correction of perineal defects with a Caslick's procedure, administration of an ovulation-inducing agent to help predict when ovulation will occur and optimize insemination time, uterine lavage and/or oxytocin administration after breeding to remove accumulated uterine fluid, and administration of exogenous progesterone to support the ensuing pregnancy. |
<urn:uuid:52491725-8a0b-4201-a8a5-426754273d4a> | wiki | Ventricular Fibrillation: A Potentially Life-Threatening Heart Rhythm Disorder
Ventricular fibrillation (VF), also known as ventricular fibrillation, is a severely abnormal heart rhythm that can be fatal if left untreated. Characterized by uncontrolled twitching or quivering of muscle fibers, this arrhythmia occurs when the heart's lower chambers fail to pump blood effectively, resulting in cardiac arrest.
The most common cause of VF is a heart attack, although it can also be triggered by various factors, including electrocution, heart muscle disease, and ischemia. Congenital heart disease, heart surgery, and sudden cardiac death are additional risk factors that can contribute to the development of VF. Notably, many individuals with VF have no prior history of heart disease, yet they may possess underlying risk factors for cardiovascular disease, such as smoking, high blood pressure, and diabetes.
Upon experiencing a VF episode, a person may suddenly collapse or become unconscious due to the cessation of blood flow to the brain and muscles. The symptoms preceding collapse may include chest pain, rapid heartbeat, and shortness of breath. In the event of a VF episode, it is essential to seek immediate medical attention, as this condition is a medical emergency that requires prompt treatment to save a person's life.
Diagnosis of VF typically involves a thorough physical examination, including listening to the heart with a stethoscope and monitoring the heart rhythm with a cardiac monitor. The presence of a disorganized heart rhythm and the absence of palpable pulses in the neck and groin area are characteristic signs of VF. Treatment for VF typically involves delivering a quick electric shock through the chest using an external defibrillator, followed by cardiopulmonary resuscitation (CPR) and further medical evaluation.
In addition to CPR, various medications and procedures may be employed to control the heartbeat and heart function. For individuals with heart muscle damage, a heart transplant may be necessary. Furthermore, an implantable cardioverter-defibrillator (ICD) may be recommended for those who survive a VF attack and are at risk for future episodes. Moderate hypothermia therapy may also be used to improve outcomes in individuals who remain in a coma after treatment.
The prognosis for individuals experiencing a VF episode is generally poor, with a high risk of death within a few minutes or days. The survival rate for those who experience a VF episode outside of a hospital setting ranges between 2% and 25%. The most common complication of VF is sudden death, which can occur within 1 hour after symptoms begin. For survivors of VF, potential complications include nerve problems, reduced mental perception, and other cardiovascular issues.
In light of the potential risks associated with VF, it is essential for individuals to be aware of the signs and symptoms of this condition and to take prompt action in the event of a suspected VF episode. Public places, such as airplanes and public transportation, often have automated external defibrillators, and individuals may also purchase these machines for personal use. Furthermore, taking a CPR course can empower family members and friends of VF survivors and patients with heart disease to provide critical care in emergency situations. |
<urn:uuid:2310f2c1-5832-4fd4-b56b-f3d481e5b65b> | wiki | Idiopathic Vestibular Disease in Felines: A Comprehensive Overview
Idiopathic vestibular disease in cats is a complex condition characterized by an abnormal head posture, often accompanied by a tilting of the head to one side, and is typically indicative of a serious underlying disorder affecting the vestibular system. This sensory system, located in the inner ear, plays a crucial role in maintaining the cat's balance and orientation, and its dysfunction can lead to a range of debilitating symptoms, including stumbling, lack of coordination, and constant falling.
The vestibular system serves as a vital component of the feline's sensory apparatus, providing essential information regarding the cat's spatial orientation, movement, and position relative to the environment. Any disruption to this system can result in a range of symptoms, including abnormal head posture, erratic eye movements, and a general inability to focus.
The etiology of idiopathic vestibular disease in cats remains largely unknown, although various factors have been identified as potential contributors to the condition. These include ear injuries, brain diseases, metabolic disorders, neoplasia, nutritional deficiencies, and toxicity, among others. In some cases, an underlying infection or inflammation of the central and inner ear canal may also play a role in the development of the disease.
A comprehensive diagnostic evaluation is essential in determining the underlying cause of idiopathic vestibular disease in cats. This typically involves a thorough physical examination, including a blood chemical profile, complete blood count, urinalysis, and electrolyte panel, as well as a detailed history of the cat's health leading up to the onset of symptoms. In some cases, further testing, such as X-rays, computed tomography (CT), and magnetic resonance imaging (MRI), may be necessary to confirm the presence of a middle ear disease or to rule out other potential causes.
Nutritional status is also an important factor in the management of idiopathic vestibular disease in cats. A thorough evaluation of the cat's diet, including supplements and additional foods, may be necessary to identify any potential deficiencies or imbalances. In some cases, a thiamine deficiency may be present, which can be treated with supplements.
In addition to a comprehensive diagnostic evaluation, a range of treatment options may be available to manage idiopathic vestibular disease in cats. These may include fluid replacement therapy, medication, and in some cases, surgery. In severe cases, hospitalization may be necessary to provide supportive care and to manage symptoms.
The prognosis for cats with idiopathic vestibular disease varies widely depending on the underlying cause of the disease. In some cases, complete recovery may be possible, while in others, the condition may persist. Regular follow-up examinations with a veterinarian are essential to monitor the cat's progress and to adjust treatment as necessary.
In conclusion, idiopathic vestibular disease in cats is a complex and multifaceted condition that requires a comprehensive diagnostic evaluation and a range of treatment options. By working closely with a veterinarian and providing regular follow-up care, it is possible to manage the condition and improve the cat's quality of life. |
<urn:uuid:68db3993-871b-4cf7-8c1c-7e1a4c45f182> | wiki | A thyroid nodule is a distinct lump within the thyroid gland, which is discernible from the surrounding glandular tissue. The majority of thyroid nodules are identified during a physical examination, typically performed by a medical professional as part of a routine assessment. In some instances, thyroid nodules are discovered incidentally during a chest X-ray or ultrasound examination of the neck.
It is essential to note that the vast majority of thyroid nodules are benign, comprising approximately 90-95% of all detected nodules. These benign nodules can be categorized into several subtypes, including fluid-filled sacs, cysts, and colloid nodules, which are essentially benign tumors that arise from normal thyroid tissue. A small percentage of benign thyroid tumors can be overactive, leading to excessive production of thyroid hormone, but these are exceedingly rare and unlikely to be malignant.
The evaluation of a thyroid nodule is primarily conducted through a thorough physical examination by a medical professional, who may employ various techniques to assess the nodule. One such technique is the use of ultrasound, which can aid in the diagnosis by providing valuable information on the nodule's size, shape, and composition. Another diagnostic tool is the fine needle aspiration biopsy, which involves the insertion of a small needle into the nodule to collect a sample of tissue for microscopic examination.
During the fine needle aspiration biopsy, the skin over the nodule is numbed to facilitate the procedure, and the needle is inserted multiple times to collect a sufficient sample of tissue. The collected tissue is then examined under a microscope by a pathologist, who can determine the likelihood of cancer based on the presence or absence of abnormal cells. The pathologist's report may categorize the nodule as one of the following:
1. Inadequate specimen: This occurs in approximately 10-15% of fine needle aspiration biopsies, where the sample collected is insufficient for a definitive diagnosis. In such cases, the biopsy is repeated, and consideration is given to surgical removal of the nodule if the initial sample is inadequate.
2. Benign: The pathologist may report that the nodule appears to be non-cancerous, although a small percentage of cases may involve a false negative diagnosis, where the nodule is actually malignant despite the pathologist's initial assessment.
3. Atypia of Undetermined Significance: This refers to the presence of abnormal cells in the biopsy sample that do not definitively indicate cancer but are not characteristic of benign nodules. In such cases, the biopsy is typically repeated to confirm the diagnosis.
4. Suspicious for cancer: The pathologist may report that the biopsy sample is suspicious for cancer, although the likelihood of cancer is still relatively low. In such cases, surgery is recommended to determine the presence or absence of cancer.
5. Uncertain: The pathologist may report that the biopsy sample cannot definitively determine whether the nodule is benign or malignant, in which case surgery is often recommended due to the relatively high probability of cancer.
It is essential to note that the diagnosis of a thyroid nodule is not a definitive assessment, and further evaluation and monitoring may be necessary to determine the presence or absence of cancer. Regular follow-up appointments, thyroid ultrasounds, and repeat biopsies may be required to monitor the nodule's size and composition over time. |
<urn:uuid:3181b8aa-3295-4674-a445-a1c87ddf80b7> | wiki | Immunotherapy, the discipline of harnessing the human immune system to combat its own cancers, has been hailed as a breakthrough by Science, with a novel approach yielding unprecedented success in the clinic. This approach involves genetically modifying patients' own cancer-fighting T cells to enhance their potency, proliferative capacity, and specificity, resulting in the development of two major types of engineered T cells: chimeric antigen receptors (CARs) and antigen-specific T cell receptors (TCRs).
Recent studies have demonstrated the remarkable efficacy of these T cells in targeting acute and chronic lymphoblastic leukemias, as well as melanomas, with CARs exhibiting exceptional homing abilities and killing capabilities. A notable example of this success was reported by the teams of Carl June and Michel Sadelain at the American Society of Hematology (ASH), where 45 of 75 leukemia patients achieved complete remission following CAR therapy.
The CAR/TCR approach has been so successful that it has paved the way for the initiation of clinical trials for a broader range of cancers, including epithelial, colorectal, lymphoma, kidney, glioblastoma, pancreatic, and mesothelioma. These trials are being sponsored by prominent institutions, including the National Cancer Institute (NCI), the University of Pennsylvania, Memorial Sloan Kettering, and the pharmaceutical giant Novartis.
The development of CARs and TCRs has been built upon the foundation of the successful tumor-infiltrating lymphocyte (TIL) approach, which involves collecting T cells from patients' melanoma tumors, expanding them, and reinfusing them. This approach has yielded impressive results, with 40% of patients experiencing durable complete tumor regressions lasting beyond five years.
However, the limitations of TILs, such as the time-consuming process of tumor collection and the requirement for specialized laboratories, have led to the development of CARs and TCRs. These engineered T cells possess impressive homing abilities and killing capabilities, but they also face significant challenges, including the scarcity of tumor-specific antigens and the potential for collateral damage.
Researchers are working to address these challenges by designing smarter T cells that can discriminate between tumor cells and normal cells. For instance, the CAR/TCR approach has been modified to include chimeric co-stimulatory receptors (CCR), which enable T cells to target two antigens on tumors simultaneously, resulting in increased precision.
The development of CARs and TCRs has far-reaching implications for the treatment of various cancers, with potential applications in lung, ovarian, and prostate cancers. As researchers continue to refine this approach, they are working towards the creation of personalized T cells that can target individual tumors, offering a promising new direction in the fight against cancer. |
<urn:uuid:0a924b4e-1843-4dbf-81e2-e3df0cb03029> | wiki | Rickets is a debilitating bone disorder prevalent among children, characterized by the development of weak bones, bowed legs, and other bone deformities. The condition arises from a deficiency in essential nutrients, including calcium, phosphorus, and Vitamin D, which are crucial for the growth and development of healthy bones.
Although considered a disease of the past, rickets persists globally and has been observed to be on the rise in the United States. The condition can be inherited, requiring specialized medical care, whereas the majority of cases are attributed to nutritional deficiencies.
Breast milk is often insufficient in Vitamin D, leading to the prevalence of rickets in exclusively breastfed infants. Other contributing factors include low calcium intake, inadequate sun exposure, darker skin, poor diet, lactose intolerance, and excessive fluoride consumption.
Children suffering from rickets may exhibit a range of symptoms, including weak muscle tone, delayed growth, and bowed legs, as well as stooped posture and chest deformities. A thorough physical examination by a healthcare professional, accompanied by specific tests such as X-rays, can aid in the diagnosis of rickets.
The body's reliance on calcium for bone health necessitates a constant calcium level in the blood. Insufficient calcium intake can lead to the depletion of calcium from bones, resulting in weakened and fragile bones. Blood tests can determine the levels of calcium, phosphorus, and Vitamin D in the blood, allowing for an accurate diagnosis of rickets.
Supplementation with adequate Vitamin D and calcium is essential for the healing process. Vitamin D supplementation of 1000-2000 IU per day, coupled with calcium intake of 1000-1500 mg/day, can help alleviate the symptoms of rickets. In cases of inherited rickets, treatment by an expert in endocrinology is often necessary.
Recovery from rickets can take several months, with outcomes generally favorable. However, in advanced cases, surgery may be required to correct severe bone deformities. Permanent problems, such as chest or pelvic deformities, can also arise from untreated rickets.
Prevention of rickets is crucial, and key recommendations include ensuring adequate Vitamin D and calcium intake. Infants should receive 400 IU of Vitamin D daily, while nursing mothers should take 4000 IU to increase Vitamin D levels in breast milk. Children and adolescents should consume 1000-1500 IU of Vitamin D daily, and infants require approximately 400 mg of calcium daily. A balanced diet rich in dairy and other calcium-rich foods can provide adequate calcium intake.
In conclusion, rickets remains a serious nutritional disorder resulting from calcium or Vitamin D deficiency, necessitating prevention through adequate nutrition and supplementation. |
<urn:uuid:bde0ea8c-e0bc-4e4c-b6ab-2a4f70642022> | wiki | The notion of comparing current autism prevalence to that of studies conducted 30 years ago is akin to comparing apples to sheep, as the diagnostic criteria employed during those periods were not equivalent. Moreover, even with the same subjective diagnostic criteria, the diagnosed groups of autistics may be inequivalent over time, rendering it impossible to ascertain a real increase in autism prevalence.
A study conducted in California, utilizing the California Diagnostic and Statistical Manual (DDS) data, revealed that the proportion of certain characteristics of CDDS autistic clients decreased as the caseload rose above what would be expected from changes in the population of the state. This finding supports the expanding criteria hypothesis, which posits that the diagnoses are not equivalent over time. Consequently, it is not possible to assert that a real increase in autism prevalence has occurred.
Regional differences in administrative prevalence between regional centers in California are substantial, with the Westside RC exhibiting a 500% difference in autism prevalence compared to the Central Valley RC. However, despite this disparity, there is no difference in the prevalence of mental retardation between the two regional centers. This suggests that regional prevalence differences may not be real, and therefore, state-wide prevalence changes over time could also not be real.
The hypothesis that regional prevalence differences may be due to environmental factors, such as pollution, appears to be improbable. Caseload growth patterns, which indicate the highest annual caseload growth in California occurred in the 2002-2003 timeframe, further support this notion. Notably, the Central Valley regional center, which has the lowest prevalence of autism in the state, has an annual caseload growth of 24%, whereas the Westside regional center, with the highest prevalence, has a growth rate of just over 8%.
Evidence from prevalence studies suggests that the huge increases in autism prevalence often claimed to have occurred seem to vanish when compared apples with apples. A systematic review of prevalence studies by Williams et al. (2005) revealed that 61% of the variation among prevalence studies may be explained by a model that includes diagnostic criteria used, age of children screened, and study location.
The notion that an environmental trigger capable of producing an epidemic of autism might also result in an epidemic of epilepsy is supported by the CDDS data, which shows that the prevalence of epilepsy among autistics is considerably higher than that of the general population. However, the epilepsy caseload grows at about the same pace as the population in the state of California, and the prevalence of epilepsy does not appear to depend on degree of urbanization.
Furthermore, the mental retardation argument, which posits that an epidemic-causing environmental trigger would result in an increase in the prevalence of mental retardation, is not supported by the data. The mental retardation caseload increases at about the rate that should be expected from population growth, and the average IQ score has actually risen over time, rendering fears of an epidemic of neurological disorders unfounded.
The institutionalization argument, which posits that an autism epidemic would result in an increase in the prevalence of institutionalized individuals with developmental disabilities, is also not supported by the data. The number of institutionalized individuals registered with CDDS decreased from 10.6 per 10,000 persons in 1992 to 9.97 per 10,000 in 2005, adjusting for population growth. This trend suggests a decrease in the prevalence of institutionalized individuals with developmental disabilities, which is a positive trend. |
<urn:uuid:4b4f1596-51ad-4d19-abd7-0a2716e3999f> | wiki | The announcement of the isolation of human embryonic stem (ES) cells by James A. Thomson at the University of Wisconsin at Madison in 1998 sparked significant scientific and ethical interest, as it potentially offered an endless supply of transplantable tissue. Concurrently, John Gearhart at Johns Hopkins University, Baltimore, Md., announced the isolation of human embryonic germ (EG) cells from five- to nine-week-old aborted fetuses, raising both promise and contentious policy questions.
The medical promise of these cells lies in their potential to provide an endless supply of transplantable tissue, thereby offering the possibility of treating a wide range of diseases and disorders. However, the origin of these cells, primarily from human embryos and fetal tissue, raises fundamental ethical and policy concerns.
The isolation of ES cells was made possible by the use of "spare embryos" created in fertility clinics through in vitro fertilization, which are no longer needed for transfer to a woman. These embryos, typically five to seven days old, are referred to as blastocysts, and the inner cell mass within them is destined to become the fetus. In contrast, EG cells were isolated from five- to nine-week-old aborted fetuses, which are referred to as embryonic germ cells due to their origin from a small set of stem cells that were set aside in the embryo and prevented from differentiating.
ES and EG cells possess two remarkable properties: they are in principle immortal, allowing for indefinite division and manipulation by researchers, and they are pluripotent, capable of differentiating into various cell types. However, the derivation of these cells raises significant ethical concerns, particularly with regards to the moral status of the embryo and the fetus.
In the United States, the policy issues primarily concern the use of federal funds for research involving human embryos and fetal tissue. The National Bioethics Advisory Commission (NBAC) has debated the ethics of ES and EG research and recommended a partial lifting of the embryo research ban, allowing for federal funding of research using surplus embryos.
The use of human fetal tissue in research has been a contentious issue, with laws in the United States prohibiting the use of federal funds for this research until 1993, when President Bill Clinton lifted the ban. Restrictions exist to ensure that fetal tissue for research is obtained in a manner that respects the women from whom it is taken and that research does not encourage abortion.
The policy situation with respect to human embryonic stem cells is complex, with the U.S. government currently prohibiting federal funding of human embryo research. Private corporations have taken the lead in funding research on ES cells, and lawyers for the U.S. National Institutes of Health have provided a legal opinion that states it is legal to fund research on human ES cells so long as federal funds are not used to support the derivation of those cells.
The ethical problems associated with ES cells are largely connected to the question of the moral status of the embryo. The derivation of ES cells raises fundamental questions about the moral status of the embryo, with some arguing that creating embryos for research does not recognize the special status of the human embryo. The NBAC has recommended that funding be available only for research on surplus embryos, and the use of ES cell research implicates the cloning debate, with some countries forbidding the use of cloning to create a human being.
Overall, the isolation of human embryonic stem and germ cells has sparked significant scientific and ethical interest, raising fundamental questions about the moral status of the embryo and the potential for medical benefit. |
<urn:uuid:004ac54e-6811-4ad1-b9d8-afa969828f50> | wiki | Research conducted since the late 1970s has extensively investigated the health implications of diethylstilbestrol (DES) exposure during pregnancy, with a particular focus on its association with breast cancer in women who were prescribed the hormone replacement during their gestation. The initial studies conducted in the 1970s and 1980s revealed a modestly elevated risk of breast cancer among DES-exposed women, although the findings were not uniformly statistically significant, thereby raising questions regarding the causal relationship between DES exposure and the increased incidence of breast cancer. Furthermore, other investigations suggested a heightened risk of endometrial and ovarian cancer among women who had been prescribed DES during pregnancy, a concern that was further exacerbated by the fact that exposure to hormones can have a profound impact on the development of various types of cancer, including breast, uterine, and cervical cancer.
In an effort to elucidate the long-term cancer risks associated with DES exposure, researchers conducted a comprehensive study that served as a follow-up to previous investigations. The study drew upon the medical records of women who had participated in earlier research on DES exposure during pregnancy, as well as those of women who had not been prescribed the hormone replacement. A total of 2,019 women who had been prescribed DES during pregnancy and 1,978 women who had not been prescribed the hormone replacement were included in the study. Additionally, researchers analyzed the medical records of women from earlier studies who had died, with a view to determining the proportion of deaths that were attributable to cancer. This enabled the researchers to examine the medical records of 3,844 DES-exposed women and 3,716 unexposed women, thereby facilitating a comparison of cancer rates between the two groups. Furthermore, the researchers also compared the cancer rates of DES-exposed women to those of unexposed women in the general population, as well as to the rates of cancer in women whose DES exposure status was unknown.
The study revealed that women who had been prescribed DES during pregnancy were at a 20%-30% higher risk of developing breast cancer compared to unexposed women and those in the general population. Conversely, the study found no increased risk of endometrial or ovarian cancer among DES-exposed women. The findings of this study indicated that approximately 16% of women who had been prescribed DES during pregnancy developed breast cancer, a rate that was significantly higher than that observed among women who had not been prescribed the hormone replacement, with approximately 13% of women in the general population developing breast cancer. In essence, the study revealed that one in six women who had been exposed to DES during pregnancy were likely to develop breast cancer, compared to one in eight women who had not been exposed to DES during pregnancy. Notably, the increased risk of breast cancer was not found to be interactive with other risk factors, such as the use of hormone replacement therapy (HRT), the use of birth control pills, or a family history of breast cancer. This suggests that DES exposure, in addition to HRT or family history, did not increase the risk of breast cancer to a greater extent than that caused by DES exposure alone. |
<urn:uuid:98456fd8-7483-446b-b3bc-04b92d227b59> | wiki | In individuals with a healthy immune system, the initial encounter with a virus triggers a primary antibody response, which is followed by a rapid secondary antibody response upon subsequent infections with the same or a similar virus. Antibodies play a crucial role in preventing viral infections, including influenza, by neutralizing the virus and preventing its replication. However, reinfection can occur if an individual is exposed to the same virus before the primary antibody response has fully matured.
A recent study in Chile reported three cases of confirmed 2009 influenza H1N1 infection, which demonstrated the potential for reinfection. The first patient, who had laboratory-confirmed infection, experienced a rapid resolution of symptoms with oseltamivir treatment within 48 hours. However, 20 days later, the patient developed a second bout of laboratory-confirmed influenza, which was also treated with oseltamivir. A similar pattern of reinfection was observed in the second and third patients, who acquired laboratory-confirmed influenza in hospital and were successfully treated with oseltamivir.
The high likelihood of reinfection in these individuals can be attributed to a combination of factors, including the rapid onset of infection within three weeks of the primary adaptive response, and the high level of circulation of the pandemic strain. Furthermore, the possibility of nosocomial transmission, where patients acquire infections while in hospital, may have contributed to the reinfections observed in patients two and three.
Interestingly, reinfection can also occur after immunization with influenza vaccine, particularly if the individual is exposed to the virus before the primary antibody response has matured, which typically takes 3-4 weeks. This is more likely to occur during pandemic influenza, when the circulation of the virus is more extensive than in non-pandemic years.
The study's findings highlight the importance of continued vigilance and vaccination efforts during pandemic influenza, as well as the need for further research into the mechanisms of reinfection and the development of effective strategies to prevent it. |
<urn:uuid:9f4ed933-bbdf-4aa2-8c91-d52920b8f22f> | wiki | Vesicoureteral Reflux: A Comprehensive Overview
Vesicoureteral reflux (VUR) is a condition characterized by the abnormal flow of urine from the bladder back into the ureters, a phenomenon that is most commonly diagnosed in infancy and childhood following the occurrence of a urinary tract infection (UTI). Approximately one-third of children who experience a UTI are found to possess VUR, a condition that can precipitate infection due to the presence of urine in the urinary tract, thereby providing a conducive environment for bacterial growth. Conversely, in some instances, the infection itself may be the underlying cause of VUR.
The presence of VUR can lead to a range of complications, including swelling in the ureter and kidney, known as hydroureter and hydronephrosis. This condition is further categorized into two primary types: primary VUR, which occurs when a child is born with an impaired valve at the junction of the ureter and bladder, and secondary VUR, which arises from a blockage in the urinary system, potentially caused by an infection in the bladder that leads to ureteral swelling and subsequent reflux.
Infection is the most prevalent symptom of VUR, with other manifestations, such as bedwetting, high blood pressure, proteinuria, and kidney failure, becoming more apparent as the child matures. The diagnosis of VUR is typically facilitated through a combination of urine analysis and cultures, as well as imaging tests, including kidney and bladder ultrasound, voiding cystourethrogram (VCUG), intravenous pyelogram, and nuclear scans.
The primary objective of VUR treatment is to prevent kidney damage from occurring. Infections are promptly treated with antibiotics to prevent the infection from spreading to the kidneys. Antibiotic therapy is often effective in correcting reflux caused by infection. In cases where primary VUR is present, surgery may be necessary to correct the condition, typically involving the severing of the ureter from the bladder and reattachment at a different angle to prevent urine backflow. More recently, minimally invasive procedures, such as injecting a bulking agent into the bladder wall, have been employed to treat VUR, offering a less invasive alternative to traditional surgical methods.
The treatment of VUR is typically managed within the Division of Pediatric Urology at Hopkins Children's, a specialized facility equipped to address the unique needs of children with this condition. |
<urn:uuid:b6cc288b-73c6-4fce-94a1-ff31974237fe> | wiki | During the first trimester, women may experience a range of physical changes, including spotting or light vaginal bleeding, which can be a sign of implantation of the fertilized egg into the uterine lining. Additionally, breast tenderness and swelling may occur, often accompanied by fatigue and sleep disturbances.
Furthermore, many women experience morning sickness, characterized by nausea and vomiting, as well as indigestion and heartburn. To alleviate these symptoms, it is recommended to avoid greasy and fried foods, eat smaller, more frequent meals, and maintain a healthy weight. Drinking plenty of fluids, consuming fiber-rich foods, and engaging in regular exercise can also help prevent constipation, a common issue during pregnancy.
As the body undergoes various physiological changes, women may experience increased urination due to the growing uterus's pressure on the bladder. Moreover, the body's increased need for calcium can lead to cramps in the legs or feet, particularly at night.
In the second trimester, breast growth accelerates, and nipples may darken and become more prominent. Many women experience increased blood circulation, resulting in a healthier and more radiant appearance. However, weight gain becomes a significant concern, with the American College of Obstetricians and Gynecologists recommending an average gain of 25 to 35 pounds for most women.
Dizziness and lightheadedness are common complaints during this period, caused by the growth of more blood vessels, pressure on blood vessels, and increased food intake. Softening of the gums due to increased blood circulation may lead to minor bleeding when brushing or flossing teeth. Regular dental check-ups are essential to monitor gum health.
Pressure from the expanding uterus on veins returning blood from the legs can cause leg cramps, particularly at night. A thin, white vaginal discharge consisting mainly of cells from the vaginal lining and normal vaginal moisture may also be noticed.
In the third trimester, nipples may produce colostrum, the first milk for the baby, and women may experience shortness of breath due to the growing uterus's pressure on the lungs. Lower back pain and discomfort are common complaints, and sleeping difficulties may arise due to the baby's movements, frequent urination, and increased metabolism.
The growing uterus may also contribute to heartburn, and pressure on veins returning blood from the feet and legs can lead to swollen feet and ankles. Drinking plenty of water, avoiding caffeinated drinks, and maintaining a healthy diet can help alleviate swelling. Increased blood circulation may cause small reddish spots on the face, neck, upper chest, or arms, resembling spider legs. Varicose veins and swollen veins in the rectum may also develop, often accompanied by rectal itching, pain, and bleeding.
Stretch marks, characterized by pink, red, or purple streaks along the abdomen, breasts, upper arms, buttocks, or thighs, may appear due to skin stretching. While creams and lotions can help moisturize the skin, they do not prevent stretch marks from forming. Most stretch marks fade after delivery, leaving behind very light lines. |
<urn:uuid:4051a403-2252-4ecc-9fa7-5a402a294ba1> | wiki | Prenatal Testing for Genetic Disorders: A Comprehensive Approach
The decision to undergo prenatal testing for genetic disorders is a personal one, typically made in conjunction with a healthcare provider. This process involves sharing detailed medical and family histories to determine the suitability of testing for a particular condition. Personal beliefs and values also play a significant role in this discussion.
Prenatal testing can be broadly categorized into two types: screening tests and diagnostic tests. Screening tests aim to assess the risk of a specific condition, taking into account factors such as age, medical history, and genetic predisposition. These tests do not provide a definitive diagnosis but rather serve as a guide for further evaluation. The most common screening tests focus on detecting chromosomal abnormalities, particularly Down syndrome, which is characterized by an extra copy of chromosome 21. Affected individuals may exhibit physical malformations and intellectual disabilities.
Two primary screening tests are available during the first trimester: early ultrasound and serum screening. The early ultrasound, typically performed between weeks 11 and 14, measures the thickness of skin at the back of the fetus's neck and assesses two maternal serum markers. In some cases, additional ultrasound elements, such as the developing nasal bone, may be evaluated. The second trimester screening, offered between weeks 16 and 20, involves routine ultrasounds to detect fetal anatomical abnormalities, including heart malformations. This test may also reveal variations of normal that increase the risk of conditions like Down syndrome.
The second trimester maternal serum tests, also known as the "triple test" or "quad test," measure the levels of specific substances in a woman's blood during pregnancy. These tests, typically performed between weeks 15 and 18, assess the risk of chromosomal problems and neural tube defects, such as spina bifida or anencephaly.
Diagnostic tests, on the other hand, provide a definitive diagnosis by analyzing genetic material directly. These tests require a sample of cells from the fetus and are typically considered for women with a higher-than-average risk of genetic disorders, as determined by prior screening tests. The risks and benefits of diagnostic testing are carefully discussed with the healthcare provider.
Diagnostic tests for genetic conditions include chorionic villus sampling and amniocentesis. Chorionic villus sampling involves taking a small tissue sample from the developing placenta, usually between weeks 10 and 12, to analyze the genetic makeup of the fetus. Amniocentesis, performed between weeks 15 and 20, involves inserting a needle into the uterus to retrieve a sample of amniotic fluid, which contains skin cells from the fetus. Amniotic fluid can also be tested for a protein called AFP, which is present at higher levels if the fetus has a neural tube defect.
It is essential to note that serum marker measurements and ultrasound exams are screening tests, not diagnostic tests. An abnormal result from a screening test does not necessarily indicate a problem, and most babies of women with an increased risk on serum marker screening have no issues. An abnormal screening test, however, warrants further evaluation through diagnostic testing, such as amniocentesis or chorionic villus sampling. |
<urn:uuid:ce29336a-9db4-48b7-bf0b-f6f09f68e15b> | wiki | Researchers at the French National Institute for Medical Research (INSERM) have engineered a chimeric protein, TAT-Tpr-Met, which enhances cell survival, migration, and proliferation, thereby improving the engraftment of stem cells in solid tissues. The findings, published in the September 2009 issue of Experimental Biology and Medicine, demonstrate that this cell-permeable form of the hepatocyte growth factor receptor can significantly increase the number of hepatic stem cells integrated into the liver of mice. TAT-Tpr-Met is the result of the fusion of Tpr-Met, an autoactivated tyrosine kinase, with the protein transduction domain from the human immunodeficiency virus (HIV)-TAT, enabling the protein to enter cells in a highly efficient manner. Upon entry, TAT-Tpr-Met remains stable for an extended period, recapitulating several effects observed with the hepatocyte growth factor (HGF). The activating signal induced by TAT-Tpr-Met originates from within the cells, rendering it independent of the extracellular environment and allowing it to persist even when cells are transplanted in vivo. This property was exploited to enhance the engraftment of cells that had been pretreated with TAT-Tpr-Met, resulting in a twofold increase in engraftment compared to untreated cells.
A research team led by Guillaume Kellermann, a graduate student in Biotechnology at the University of Paris VII, in collaboration with Lyes Boudechice, a veterinarian surgeon, Dr. Anne Weber, and Dr. Michelle Hadchouel, conducted the studies in six-week-old mice. Dr. Kellermann noted that previous studies had demonstrated that cells engraft more readily with HGF, but unlike other strategies, the proposed method is free from viruses and DNA, making it potentially safer for human applications. However, further studies are necessary to assess the long-term effects of this approach before considering its clinical potential.
Stem cells possess a vast potential for therapeutic applications, but their ability to engraft in solid tissues remains a significant challenge. The engineered chimeric protein addresses this limitation by promoting the survival, migration, and proliferation of stem cells, thereby enhancing their engraftment. The protein is subsequently degraded within cells, rendering it a safer alternative to other strategies that rely on modified viruses. Dr. Steven R. Goodman, Editor-in-Chief of Experimental Biology and Medicine, commended the authors for their innovative approach, which utilizes the fusion protein TAT-Tpr-Met to increase hepatic stem cell engraftment into the liver. The fact that this approach does not require the use of viruses or DNA makes it a promising strategy for future clinical applications. |
<urn:uuid:785a6ea5-75a8-4596-93ff-197a212b8cf9> | wiki | The analogy of water flowing through a hose can effectively illustrate the principles of electrical current. The flow rate of water, analogous to electrical current, is limited by the diameter of the hose, similar to how electrical resistance restricts the flow of electrical current. Increasing the pressure of the water, akin to increasing the voltage, can overcome this resistance and allow for a greater flow rate, just as higher voltage can increase the electrical current. The relationship between pressure, flow rate, and resistance is governed by the equation: current = pressure/voltage.
In the context of electrosurgery, the flow of electrical current is analogous to the flow of water through a hose. The diameter of the hose, or the resistance of the tissue, limits the flow of electrical current, and increasing the voltage or pressure can overcome this resistance. The type of current used in electrosurgery, direct or alternating, is similar to the flow of water in a hose, with direct current being constant and alternating current changing direction.
The waveform of the electrical current, cutting or coagulation, is analogous to the flow of water through a hose, with cutting current being a smooth, continuous flow and coagulation current being a burst of high-pressure water. The cutting current waveform is more efficient at producing a high average power, allowing for a smooth cutting action without extensive thermal damage.
The electrical circuit used in electrosurgery is analogous to a closed water pipeline, with the electrodes serving as the "hose" and the tissue as the "water". The type of circuit used, bipolar or unipolar, determines the flow of electrical current and the resulting tissue effect. The bipolar circuit is similar to a closed pipeline, with the current flowing from the active electrode to the ground electrode and back to the generator, while the unipolar circuit is similar to an open pipeline, with the current flowing from the active electrode to the ground electrode and back to the generator.
The effects of electrical energy on tissue are analogous to the effects of water on a hose. The heat generated by electrical energy is similar to the heat generated by water flowing through a hose, with the temperature of the tissue increasing as the current density increases. The type of tissue affected by electrical energy is similar to the type of water affected by a hose, with some tissues being more susceptible to damage than others.
The healing process of electrosurgical wounds is analogous to the healing process of a hose. The amount of tissue damage caused by electrical energy is similar to the amount of damage caused by a hose, with higher current densities and longer exposure times causing more damage. The rate of tissue destruction is similar to the rate of water flow through a hose, with increasing levels of power and current density causing more damage.
The use of electrosurgery in infertility surgery is analogous to the use of a hose to irrigate a garden. The goal of electrosurgery is to minimize tissue damage and promote healing, just as the goal of irrigation is to provide the right amount of water to the plants. The type of current used, cutting or coagulation, is similar to the type of water used, with cutting current being more efficient at producing a high average power.
The potential complications of electrosurgery are analogous to the potential complications of a hose. The explosion of combustible gases, interference with pacemakers and monitors, and accidental burns are similar to the potential complications of a hose, such as bursting, kinking, and clogging. The importance of proper grounding and monitoring is similar to the importance of proper maintenance and inspection of a hose.
The monitoring of the return electrode is analogous to the monitoring of a hose. The use of a return electrode monitor (REM) system is similar to the use of a pressure gauge to monitor the pressure of a hose, with the goal of ensuring proper connection and preventing alternate site burns. The calibration of the REM system is similar to the calibration of a pressure gauge, with the goal of ensuring accurate readings and preventing false alarms. |
<urn:uuid:61a6e4a9-cda8-4d16-ad69-616d0fac52f0> | wiki | Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder characterized by difficulties in social interactions, communication, and repetitive behaviors, which can be challenging to diagnose due to its heterogeneous nature and the presence of comorbid medical conditions. The diagnosis of ASD is often overlooked, with 50% to 70% of children with Autism Spectrum Disorder (ASD) exhibiting some level of intellectual disability. This may be attributed to clinicians' reluctance to make the diagnosis in children who are difficult to assess or discuss with parents, or the lack of assessment of cognitive functioning as part of the clinical evaluation.
A comprehensive diagnostic evaluation is essential to accurately diagnose ASD, which can be distinguished from other disorders through its unique social interaction deficits. The diagnosis of ASD is not mutually exclusive with other neurodevelopmental disorders, and comorbid conditions such as attention deficit hyperactivity disorder (ADHD), anxiety disorders, and mood disorders are common. Additionally, ASD can be associated with various neurological diseases, resulting in syndromic autism, which may exhibit autistic features despite the presence of a primary neurological disorder.
Medical comorbidities, such as epilepsy, sleep disorders, and Tourette syndrome, are frequent in ASD and require recognition and treatment as part of symptom management. Epilepsy, which affects up to one-third of individuals with ASD, is thought to result from an imbalance of neural excitation and inhibition. Sleep disorders, which affect up to two-thirds of children with ASD, can manifest as insomnia, parasomnias, breathing disorders, and movement disorders. The relationship between polymorphisms in biological clock genes and autism has been suggested, although the effects of sleep disorders are difficult to separate from the effects of neurodevelopmental disability.
In addition to medical comorbidities, individuals with ASD may experience tics, which are complex motor behaviors that can be distinguished from common ASD stereotypies. Behavioral and pharmacological interventions are only indicated when tics limit function and comfort. Evidence-based ASD treatment must be intensive and individualized, with learning opportunities that are an integral part of educational and social interactions.
Pharmacological agents can help alleviate symptoms associated with ASD, such as irritability, impulsivity, anxiety, and cognitive disorganization. However, these medications do not directly address core symptoms of social reciprocity or communication. Atypical antipsychotics, such as risperidone and aripiprazole, have been approved for the treatment of irritability in autism, although they are associated with weight gain. Selective serotonin reuptake inhibitors (SSRIs) have been used to treat impulsivity, difficulty in shifting attention, anxiety, and repetitive behaviors, although a large, multisite, placebo-controlled trial of citalopram did not find significant differences on the Clinical Global Impression Improvement (CGI-I) scale or the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS).
Alternative treatments, such as melatonin, ω-3 fatty acids, methyl B12, and the casein-/gluten-free diet, are under investigation, although most have limited published studies to guide treatment selection and raise concerns about safety. The study of autism is progressing rapidly, with early identification and intervention becoming increasingly possible and effective. Further delineation of the gene-environment interaction theories of etiology is being achieved through large, collaborative studies. Community organizations, school personnel, and treatment providers are gaining increasing skill at personalizing treatments for patients with autism, with significant improvements in outcome. |
<urn:uuid:91f620c4-ab84-4982-be15-b2c61faa6043> | wiki | In most sub-Saharan African countries, a notable decline in infant and under-five mortality has been observed over the past few decades, with Benin being one of the countries that has demonstrated a significant reduction in childhood mortality. This study examines the socioeconomic factors and maternal and child care interventions that have likely contributed to the decline in infant and under-five mortality in Benin, utilizing data from three DHS surveys conducted in 1996, 2001, and 2006.
Utilizing survival analysis on the 2006 data set, the study identifies the key factors that have a substantial impact on infant and child mortality in Benin, and subsequently estimates the proportion of change in mortality rates between the surveys based on the changes in these factors. The analysis reveals that mother's education, vaccination, the preceding birth interval, the age of mother at birth, the multiplicity of birth, birth weight, medical antenatal care, antenatal tetanus toxoid injections, and bed net possession are all significant predictors of infant mortality, accounting for approximately 57 percent of the reduction in infant mortality. The results for under-five mortality analysis are similar, with the addition of the mother's marital status to the list of significant health conditions. The changes in these factors over time explain approximately 60 percent of the actual decline in under-five mortality between the 2001 and 2006 surveys.
Notably, the removal of any change in bed net possession reveals the extent to which bed net ownership has contributed to the decline in mortality rates. Without an increase in bed net possession, infant and under-five mortality would have increased by 8 percent, primarily due to a decline in vaccination levels. Conversely, the increased possession of bed nets has been shown to decrease mortality rates by approximately 21 percent. Furthermore, the study indicates that in areas where half of the households possess bed nets, infant mortality is 40 percent lower and under-five mortality is 36 percent lower compared to areas where no households have bed nets.
The analysis and previous studies suggest that bed net use is strongly associated with the reduction in childhood mortality, emphasizing the need to continue increasing bed net distribution. Additionally, ensuring increasing coverage of vaccinations and improving healthcare services such as medical delivery, medical antenatal care, and antenatal tetanus toxoid injections are crucial in further reducing the risk of infant and under-five mortality. Furthermore, efforts to prevent short birth intervals and births to young adolescent mothers are also essential in reducing infant and under-five mortality. |
<urn:uuid:7a4947d9-1d02-472a-9ab3-65c6ca0af432> | wiki | Http request failed |
<urn:uuid:47a379a8-6967-411a-82f9-bd7798a70315> | wiki | Children and adolescents with emotional disturbance (ED) exhibit chronic and diverse academic, emotional, behavioral, and/or medical difficulties that pose significant challenges for their education and treatment in schools. Historically, children with ED have received fragmented and inadequate interventions and services that often yielded unfavorable school and community outcomes. Numerous child/family, diagnostic, and organizational barriers limit access to appropriate and effective treatment. Given this information, two U.S. Presidential commissions (U.S. Surgeon General Report, 2000; President's Freedom Commission on Mental Health, 2003) have called for the transformation of the mental health system emphasizing the early identification and intervention of children at risk for and with ED in school and public health care settings. In this manuscript, three school-based prevention and intervention programs for children at risk for and with ED are presented as examples of exemplary programs. These programs were selected based on a review of over 26 published school-based outcome studies with this population and the availability of at least three published outcome studies (including follow-up data) for each.
Children with emotional disturbance (ED) are one of the most underidentified and untreated child clinical subpopulations. As indicated in the Surgeon General's report on mental health (U.S. Department of Health and Human Services, 2000), one in five children display a diagnosable mental disorder each year and approximately 5% have an ED that significantly impacts their daily functioning at home and school. Similarly, children with ED represent about 5% of youth diagnosed with mental disorders and about 1% of those children diagnosed with ED are treated. Research has found that the number of students classified as ED varies by state and school district.
The identification of children with ED is hindered by vague diagnostic/eligibility criteria which impacts access to effective school-based interventions. Scholars have attributed the identification problem, in part, to the Individual Disability Education Act definition (IDEA, 1997, 2005). According to IDEA, ED is one of 12 disability categories that is defined as "a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree which adversely affects school performance: (a) an inability to learn which cannot be explained by intellectual, sensory, or health factors, (b) an inability to build or maintain satisfactory interpersonal relationships with peers and teachers, (c) inappropriate types of behavior or feelings under normal circumstances, (d) a general pervasive mood of unhappiness or depression, (e) a tendency to develop physical symptoms or fears associated with personal or school problems."
The five ED criteria in IDEA are not supported by research on the subtypes of children with emotional and behavioral disorders. In addition, there is a clause requiring "adverse educational performance" which may be interpreted by some professionals to exclude children who have marginal grades, but who exhibit social and behavioral difficulties at school. Also, IDEA includes an exclusionary criterion of "social maladjustment" which is not fully defined and thus may mislead some professionals to exclude children diagnosed with conduct disorder.
Research has found that conduct disorders often co-occur with attention deficit hyperactivity disorder (ADHD), reading disabilities, depressive disorders, and anxiety disorders. Nelson (1992) asserted that the field does not have evidence to differentiate between conduct disorders and other emotional and behavioral disorders. In fact, students with ED who exhibit disruptive behavior or symptoms of conduct disorder constitute the largest subgroup of youth placed in ED classrooms.
Historically, there has been a reliance on restrictive educational and out-of-home placements for children with ED. However, with the advent of managed care, the use of restrictive placements has decreased, and as a result, schools and community agencies have increasingly become the "system of care" for children with ED. Treatment outcomes acquired in restrictive placements are often temporary and limited in scope. Many restrictive placements also do not successfully transition children back into their homes, schools, and neighborhoods.
Despite national initiatives, parents and schools struggle to educate and treat children with ED. Described by some as "mad, bad, sad, and can't add," these children are prone to academic failure, family/peer rejection, restricted educational placements, and in some cases out-of-home placements and hospitalizations. As Osher, Osher, and Smith (1994) stated, educating children with ED "is one of the most stressful, complex, and difficult challenges facing public education today, and perhaps one of our greatest failures."
Research has shown that children with ED have lower grades than other disability groups, significant academic and language deficits, and high grade retention and absenteeism rates. Research has also shown that children with ED are more likely to drop out of school, receive school suspensions and expulsions, fail one or more courses, not graduate, and have difficulties socially integrating at school than other disability groups.
Numerous personal, diagnostic, and organizational barriers interfere with treatment success for children with ED in school and home. For example, youngsters with ED represent a complex mix of emotional, behavior, educational, and medical/neurological difficulties that make the diagnostic, teaching, and learning process difficult. School and family treatments are further complicated by high rates of family psychopathology, inadequate parenting skills, and limited support systems and resources. In addition, lack of knowledge of services and programs offered by other agencies, differential use of terminology between agencies, and ineffective interagency collaboration often interfere with treatments.
Limited or poor school preservice and inservice training on internalizing and externalizing symptoms in the classroom and behavioral techniques, such as the use of aversive techniques, physical restraints, and positive behavioral techniques, are also found. Other barriers may include limited placement options, such as access to intermediate levels of care, and support services, such as respite for parents and teachers.
Despite these barriers, innovations in school-based programming continue. In the past decade, new school prevention and intervention programs have emerged from school, agency, and/or university partnerships and offer promising new approaches for educating and treating children with ED.
The purpose of this paper is to present exemplary school prevention and intervention programs for children and adolescents at risk for and with ED. Three school-based prevention and intervention programs are described for their mission and objectives, treatment components, required materials and training, and outcome findings.
Considerations for future school prevention and intervention programs are offered. Finally, priorities for training school personnel are proposed.
School Prevention and Intervention Programs
To enhance the reader's appreciation of the variety of school prevention and intervention programs for children with ED, a descriptive overview of three model programs is provided. A comprehensive literature review of over 26 published school-based outcome studies from 1998 to 2005 in over 12 peer-reviewed journals was completed. Each study was reviewed on several variables, such as sample characteristics, treatment components, and outcome findings.
Three programs were selected based on five criteria: (a) each program was designed specifically for children at-risk for or with ED, (b) each program focused on academic and behavior outcomes, (c) outcome data for each program was available, (d) each program had at least three published outcome studies (including follow-up data), and (e) each program was nominated by experts in the field of school psychology and child mental health.
Two prevention programs, First Step to Success and Parent Teacher Action Research (PTAR), and one intervention program, Integrated Mental Health Program (IMHP), were selected. The choice of these programs does not represent a special status, but rather were selected to illustrate examples of well-designed data-driven school prevention and intervention programs for children at risk for and with ED.
First Step to Success is a home and school prevention program for at-risk kindergartners with early signs of antisocial behavior such as difficulties with peer and teacher relationships, aggressive and disruptive behavior, and internalizing behaviors such as anxiety, inattention, and withdrawn behavior in the classroom. The primary objective is to train at-risk children to interact appropriately with peers and adults at school to prevent the development of long-term and more serious antisocial behavior patterns.
First Step includes three modules: a proactive universal screening process, consultation-based school intervention with the child, peers, and teacher (CLASS), and intensive parent training focused on improving academic performance and adjustment. The centerpiece of First Step is proactive universal screening, a multi-stage process that evaluates at-risk kindergarteners for emerging antisocial behavior patterns and identifies children who would most benefit from the program.
The First Step program uses a trainer-of-trainers model in which program consultants receive intensive training and on-going supervision from project coordinators. Training consists of standardized lectures, videotaped demonstrations, and role-playing, group discussion, and detailed feedback by the program coordinators.
PTAR is a primary prevention program that provides whole-class social skills instruction and universal screening to all students. Based on 50 years of educational action research, PTAR offers a structure for parents and regular education teachers to work as collaborative partners in identifying goals and designing and implementing action plans.
PTAR allows teachers' choice of social skills curricula and the PTAR team's choice of interventions for an individual child. This flexible approach permits the PTAR team to customize a program around the child's needs. The team includes individuals involved in the child's life at home and school, such as regular education teachers, parents, parent liaison, and a PTAR staff member.
The Integrated Mental Health Program (IMHP) is an intervention program for elementary school-aged children with ED. IMHP is a half-day self-contained classroom program that provides comprehensive school-based psychological, educational, and family services. Services are coordinated and implemented across the self-contained classroom, regular education classroom, and home setting.
IMHP is designed to improve the psychological functioning, behavioral control, and academic performance for children with ED. An innovative feature of IMHP is that behavior management strategies are implemented in the self-contained classroom, regular education classroom, and home.
The IMHP program emphasizes a team model that embraces the contributions of all members involved, such as parents, psychologists, professional teachers, special education teachers, social workers, and community providers. The program focuses on the involvement and consistent implementation of interventions and services among parents |
<urn:uuid:78c00fd8-ddd9-45e8-96ab-88fb24e6e30e> | wiki | The implementation of security practices as outlined by the committee, coupled with its site visit findings, can be significantly enhanced by the integration of existing, yet underutilized, technologies within healthcare computing environments. Notably, the committee's site visits revealed that the protection of patient information could be substantially improved by adopting these technologies, including the deployment of robust cryptographic tools for authentication, standardized methods for authorization and access control, network firewall tools, enhanced software management procedures, and the effective utilization of vulnerability assessment tools. The discussion that follows highlights instances in which other underutilized technologies could further augment security, while obstacles to their adoption are addressed in a subsequent section.
Authentication, in the context of healthcare computing environments, refers to the process of verifying the identity of an entity that initiates a request or response for information. This process is pivotal in determining access to sensitive healthcare information, mirroring its significance in regulating legal and financial transactions. Authentication typically relies on one or more of four fundamental criteria, which are contingent upon the user's integrity in safeguarding their unique identifier, password, or other authentication characteristic. The classical method of authentication in computing environments involves assigning a unique identifier to each user and associating a secret password with each account. While this approach can be effective, it is susceptible to several limitations, including the sharing of accounts with others, the potential for users to forget their passwords or select easily guessable ones, and the risk of password compromise if users write them down in insecure locations. |
<urn:uuid:edf3879a-66e3-449e-aeb0-8806128bc384> | wiki | The eighth meeting of the Presidential Commission for the Study of Bioethical Issues, convened at the University of California, San Francisco, focused on the development of policies and programs to guide the ethical use of human genome sequencing, a rapidly advancing technology poised to revolutionize the field.
Since the cost of genome sequencing has decreased dramatically, from nearly $3 billion in 2008 to an anticipated $1,000 within the next year or two, the potential for widespread adoption is substantial. Currently, only a handful of specialized centers offer this service, with approximately 10,000 individuals having undergone genome sequencing in 2011, and an estimated 100,000 expected to do so in 2012.
The prospect of genome sequencing has the potential to significantly improve diagnoses, identify unknown causes of diseases, and facilitate personalized medicine, as exemplified by the case of Retta Beery, whose twins, Alexis and Noah, were diagnosed with a rare genetic condition through genome sequencing at the Human Genome Sequencing Center at Baylor College.
However, the sheer volume of data generated by genome sequencing poses significant challenges, as noted by Dr. Daniel Masys, who emphasized that our ability to acquire person-specific DNA data far exceeds our understanding of its meaning. To address this issue, researchers will need to conduct sophisticated studies of vast amounts of data from millions of people, a scale of research never seen before.
The question of who will interpret genome data and how patients will understand the potential risks and benefits of making their genome data available to others remains a pressing concern. Commission Chair Amy Gutmann, Ph.D., noted that the lack of clear guidelines and regulations could lead to "snake oil salesmen" exploiting patients' fears and misconceptions.
Furthermore, the potential for misuse of genome data, including commercial exploitation and unauthorized access to sensitive information, raises significant concerns about privacy and security. Dr. Jane Kaye, director of the Centre for Law, Health and Emerging Technologies at the University of Oxford, U.K., argued that the concept of "consent for governance" is essential, where patients are educated about the rules of the game and agree to release their data, thereby relinquishing some control over its use.
The discussion also highlighted the need for clear guidelines on informed consent, as patients may not be aware of the potential uses of their genome data in future research. Dr. Kaye likened this situation to the concept of "Hotel California," where patients can check out, but never truly leave, once they have released their data.
In a more practical context, the chief of the New York County District Attorney's Forensic Sciences/Cold Case Unit, Melissa Mourges, J.D., discussed the successful use of forensic DNA databases in convicting a criminal, highlighting the potential benefits of genome sequencing in law enforcement and public health.
The Commission's report, expected to be completed by late 2012, will address these pressing concerns and provide recommendations for the development of policies and programs to guide the ethical use of human genome sequencing. |
<urn:uuid:eeed2cdc-7d13-4920-b256-b6e259e87612> | wiki | Schizoaffective Disorder: A Complex Mental Illness Characterized by Psychotic and Mood Symptoms
Schizoaffective disorder is a rare and serious mental illness affecting approximately 1 in 1,000 individuals, characterized by the co-occurrence of symptoms of both schizophrenia and mood disorders. This condition renders individuals antisocial, leading to social isolation and avoidance by those around them. The symptoms of schizoaffective disorder can vary significantly between patients, but typically manifest as a combination of psychotic symptoms, such as hallucinations and paranoia, and mood changes, ranging from euphoria to depression.
The symptoms of schizoaffective disorder often fluctuate in intensity, with patients experiencing episodes of severe symptoms followed by periods of improvement. Researchers have debated the classification of schizoaffective disorder, with the majority of current thinking suggesting that it should be regarded as a subtype of schizophrenia. To diagnose schizoaffective disorder, an individual must exhibit a combination of schizophrenia symptoms, such as delusions and hallucinations, and major depressive or manic symptoms, occurring concurrently for at least two weeks.
Shared Symptoms with Schizophrenia
Delusions, paranoia, and cognitive deficits are common symptoms shared with schizophrenia and schizoaffective disorder. Delusions and hallucinations, which distort an individual's perception of reality, are characteristic of both conditions. People with schizoaffective disorder may experience delusions and hallucinations simultaneously or separately, and may exhibit paranoid thoughts and feelings, leading to mistrust of others, including family, friends, and clinicians.
Cognitive deficits, which affect an individual's ability to process and organize thoughts, are also a shared symptom of both conditions. Patients with schizoaffective disorder may struggle to express their ideas in a logical and organized manner, exhibit difficulty concentrating, and experience challenges in completing tasks.
Shared Symptoms with Mood Disorders
Schizoaffective disorder can be classified into two subtypes, defined by the presence of mood symptoms. The bipolar subtype is characterized by the presence of manic symptoms, including high energy levels, euphoria, and irritability, while the depressive subtype is marked by depressive symptoms, including sadness, loss of appetite, and suicidal thoughts.
Manic symptoms, which are characterized by high energy levels, rapid speech, and restlessness, are a hallmark of the bipolar subtype. Depressive symptoms, which include feelings of sadness, loss of interest in activities, and suicidal thoughts, are a defining feature of the depressive subtype.
Treatment of Schizoaffective Disorder
The treatment of schizoaffective disorder typically involves a combination of medication and psychosocial intervention. Antipsychotic medications, such as olanzapine, risperidone, and clozapine, are commonly prescribed to alleviate symptoms of psychosis, including delusions and hallucinations. However, these medications can have significant side effects, and individuals taking clozapine require close monitoring for seizures, heart problems, and a drop in white blood cell count.
Mood-stabilizing medications, such as lithium and divalproex, may be used to treat depressive symptoms, while antidepressants, such as citalopram and fluoxetine, may be prescribed to alleviate depressive symptoms. Therapy and other forms of support, including individual and group counseling, can also play a crucial role in the recovery process, helping individuals to develop life skills, address concerns about the future, and develop strategies for coping with problems in the real world.
Despite the challenges associated with schizoaffective disorder, research suggests that individuals with this condition can recover and function with proper treatment and support. However, the research on schizoaffective disorder lags behind that of other mental illnesses, highlighting the need for further study and understanding of this complex condition. |
<urn:uuid:c62e6c41-d03e-4fa9-887a-a8c95bb15677> | wiki | Http request failed |
<urn:uuid:c3aec09a-6cba-4975-892b-260349c7c684> | wiki | Hemorrhage is a condition characterized by an estimated blood loss of more than 500 milliliters, which can manifest as either a slow, prolonged bleeding or a sudden gushing. This condition often occurs due to the uterus failing to clamp down and restrict blood flow, resulting in uterine atony, which accounts for approximately 90 percent of postpartum hemorrhage cases. Uterine atony can be caused by factors such as prolonged labor, precipitous delivery, or the presence of uterine fibroids.
Postpartum hemorrhage is a significant concern, affecting approximately 2-5 percent of vaginal deliveries and 6-7 percent of cesarean sections. The risk of hemorrhage can be increased by factors such as cold temperatures, which elevate catecholamine levels, and undisturbed eye-to-eye and skin-to-skin contact between the mother and baby during the postpartum period.
Monitoring vaginal bleeding after the placenta is delivered is crucial, with a three-second interval between bleeding episodes being a useful indicator of excessive bleeding. Hemorrhage can also be caused by insufficient vitamin K levels, slow clotting at the placental site, or the placenta partially detaching from the uterine wall.
Hereditary abnormalities of blood clotting and low hemoglobin levels may also contribute to the risk of postpartum hemorrhage. Uterine atony is a major cause of postpartum hemorrhage, and its prevention begins during pregnancy. Nettle or Alfalfa leaf infusion or tea taken throughout pregnancy can increase available vitamin K and hemoglobin levels, reducing the risk of postpartum hemorrhage.
The three main keys to avoiding postpartum hemorrhage are good nutrition and supplements as needed, knowing the mother, and not rushing the delivery of the placenta. Monitoring lochia flow and vital signs, as well as providing care to the perineum, are also essential in preventing postpartum hemorrhage.
In the event of postpartum hemorrhage, management involves non-pharmacologic measures such as fundal massage, nipple stimulation, and uterine re-positioning. Herbal therapies like Blue Cohosh or Motherwort may be used in combination with hemostatic herbs to control bleeding. Bimanual compression and uterine exploration may be necessary to diagnose and treat the underlying cause of the hemorrhage.
Shock and hypotension require immediate attention, with oxygen administration and anti-shock compression being essential interventions. In some cases, pharmaceutical oxytocics or ergonovine may be administered, but these should be used judiciously and with careful monitoring. Follow-up postpartum care should include complimentary therapies for anemia and addressing any underlying conditions that may have contributed to the hemorrhage. |
<urn:uuid:23ac870d-93ac-4e6d-8e7d-77ffe72f548d> | wiki | Diffusion magnetic resonance imaging (MRI) is a relatively novel technique in the field of neuroscience, exhibiting considerable promise as a diagnostic tool for neurological disorders. The image depicted, taken from the brain of a patient who suffered a stroke in the thalamus and midbrain, illustrates the devastating impact of such an event, with resultant damage to specific axons, some of which are visible at the periphery of the image.
A recent study has revealed a correlation between a diet rich in protein and a lower risk of stroke, with the analysis of data from numerous large-scale trials encompassing over 250,000 participants. However, the findings do not establish a causal relationship between protein intake and stroke risk, and the researchers caution against drawing definitive conclusions regarding the potential benefits of a high-protein diet.
The scientific community remains divided on the optimal proportions of macronutrients, including carbohydrates, proteins, and fats, that contribute to overall health. Some researchers argue that diets heavy in carbohydrates are linked to rising rates of diabetes and obesity, while others contend that high-protein diets increase the risk of cancer, comparable to smoking. Conversely, several lines of research suggest that diets rich in fat are a contributing factor to heart disease and stroke.
To investigate the role of protein in stroke risk, Dr. Xinfeng Liu, a neurologist at the Jinling Hospital in China, and colleagues conducted a comprehensive review of published studies on stroke and protein consumption, identifying seven prospective trials that specifically examined the risk of stroke. These studies demonstrated a consistent association between higher protein intake and reduced stroke risk, with a dose-dependent response observed, where increased protein consumption corresponded to lower stroke risk.
The study revealed that for every 20 grams of protein consumed per day, the risk of stroke decreased by 26%. While the precise mechanisms underlying this relationship remain unclear, the researchers propose that dietary protein may exert favorable effects on blood pressure, which in turn reduces stroke risk. Furthermore, the protein diet was found to lower triglycerides, total cholesterol, and non-HDL cholesterol levels.
Notably, the study distinguished between various types of protein sources, with high fish consumption linked to the lowest stroke risk, whereas high red-meat consumption was associated with increased stroke risk. In contrast, diets rich in vegetable protein appeared to offer less protection against stroke, potentially due to the higher protein intake associated with these diets, which may have obscured the trend.
The findings also suggest that the benefits of a high-protein diet may be attributed to the concomitant presence of other nutrients, such as potassium, magnesium, and dietary fiber, rather than the protein itself. The study's authors emphasize the need for further research to fully elucidate the relationship between protein intake and stroke risk. |
<urn:uuid:ee66026d-271f-47b3-953a-2b8bccd8ca42> | wiki | The migration of leukocytes from the bloodstream into tissues is a crucial mechanism for the continuous surveillance of foreign antigens, as well as for the rapid accumulation of leukocytes at sites of inflammatory responses or tissue injury. This process, known as leukocyte emigration, is a dynamic and multi-step phenomenon involving an adhesion cascade. A variety of adhesion molecules are expressed on both resting and stimulated endothelial cells and leukocytes, facilitating their interaction and subsequent migration.
However, defects in these adhesion molecules have been implicated in the development of recognized clinical syndromes. Three distinct leukocyte adhesion deficiency (LAD) syndromes have been delineated, with a fourth category of newly-described defects also being reviewed:
LAD I is characterized by a deficiency or defect in the beta 2 integrin family, which plays a critical role in the adhesion and migration of leukocytes. LAD II, on the other hand, is marked by the absence of fucosylated carbohydrate ligands for selectins, which are essential for the binding of leukocytes to endothelial cells. LAD III is distinguished by a defect in the activation of all beta integrins, including beta 1, beta 2, and beta 3, which are essential for the adhesion and migration of leukocytes. |
<urn:uuid:bb896ef4-1ff9-4353-8814-f8fdbd3da062> | wiki | The increasing prevalence of tropical diseases among Western clinicians and radiologists has necessitated the utilization of ultrasound as a diagnostic tool, particularly in regions where the signs and symptoms of these diseases are unclear. The ultrasonographic features of various tropical diseases are often unfamiliar to examiners, potentially leading to unnecessary or even harmful diagnostic investigations. The widespread distribution and relatively low cost of ultrasound machines in developing countries have facilitated their use in population studies and individual diagnosis of tropical diseases.
In response to this need, the World Health Organization (WHO) has introduced a standardized classification system for ultrasonographic images of cystic echinococcosis, aimed at achieving comparable results worldwide and linking disease status with distinct morphological types of echinococcosis cysts. Furthermore, WHO has established guidelines for the puncture, aspiration, injection of ethanol, and re-aspiration of such cysts, thereby reducing the risk of complications.
Ultrasound is also instrumental in diagnosing schistosomiasis-induced periportal fibrosis and bladder abnormalities, as well as distinguishing liver abscesses from other focal lesions such as cysts or neoplasms. In cases of amoebic abscesses, invasive procedures are generally not required, and ultrasound-guided puncture can provide adequate material for microscopy and culture. The ultrasonographic features of helminths, flukes, and filariae can be observed directly, and the condition can also be assessed in terms of hypoechogenic splenic foci and ultrasonographic abnormalities due to tropical hypereosinophilia.
The classification of cysts and development of less invasive procedures for cystic echinococcosis are ongoing areas of research. Novel methods are also being explored for the assessment of polycystic and alveolar echinococcosis. The WHO is evaluating ultrasound protocols for schistosomiasis in terms of interobserver reliability, relation to clinical disease status, and predictive power. Additionally, a WHO expert group is developing a standardized protocol for Asian schistosomiasis, while an international consensus on an algorithm for managing amoebic liver abscesses is also warranted. |
<urn:uuid:88a16233-12bc-4af7-bb10-7e6c2cfbd9cc> | wiki | Bunyaviridae is a family of viruses that comprises the genus Hantavirus, which comprises at least four serogroups, with nine viruses associated with two major, sometimes overlapping, clinical syndromes: Hemorrhagic Fever with Renal Syndrome (HFRS) and Hantavirus Pulmonary Syndrome (HPS).
The viruses causing HFRS are Hantaan, Seoul, Dobrava (Belgrade), and Puumala, while those causing HPS are Sin Nombre, Black Creek Canal, Bayou, and New York-1. Hantaviruses are widely distributed across the globe, with wild rodents serving as the primary reservoir, shedding the virus throughout their lives in urine and feces. Transmission between rodents is the primary mode of transmission, with human transmission occurring through the inhalation of aerosols of rodent excreta. Recent evidence suggests that human-to-human transmission may occur rarely.
Laboratory diagnosis of hantavirus infection is established through serologic tests and reverse transcriptase-polymerase chain reaction (RT-PCR). Serologic tests include enzyme-linked immunosorbent assay (ELISA), Western blot, and strip immunoblot assays. The growth of the virus is technically challenging and requires a biosafety level 3 laboratory.
HFRS is characterized by a flu-like illness that may progress to shock, bleeding, and renal failure, with a mortality rate of 6 to 15%. The disease begins with a sudden onset of high fever, headache, backache, and abdominal pain, followed by subconjunctival hemorrhages, palatal petechiae, and a truncal petechial rash. Renal failure develops after the 4th day, with approximately 20% of patients becoming mentally obtunded. Seizures or severe focal neurologic symptoms occur in 1% of patients. The rash subsides, and patients develop polyuria and recover over several weeks.
Diagnosis of HFRS is ultimately based on serologic testing or PCR. Death can occur during the diuretic phase, secondary to volume depletion, electrolyte disturbances, or secondary infections. Recovery usually takes 3 to 6 weeks but may take up to 6 months. Overall, mortality is 6 to 15%, with almost all cases occurring in patients with the more severe forms. Residual renal dysfunction is uncommon except in the severe form that occurs in the Balkans.
Treatment for HFRS involves the administration of intravenous ribavirin, with a loading dose of 33 mg/kg (maximum, 2.64 g), followed by 16 mg/kg q 6 h (maximum, 1.28 g q 6 h) for 4 days, then 8 mg/kg q 8 h (maximum, 0.64 g q 8 h) for 3 days. Supportive care, which may include renal dialysis, is critical, particularly during the diuretic phase.
HPS is characterized by a flu-like illness that rapidly develops into noncardiogenic pulmonary edema and hypotension, with a mortality rate of 50 to 75%. The disease begins with a nonspecific flu-like illness, with acute fever, myalgia, headache, and gastrointestinal symptoms. Two to 15 days later, patients rapidly develop noncardiogenic pulmonary edema and hypotension. Mild cases of HPS can occur.
Diagnosis of HPS is established through serologic testing or RT-PCR. Patients who survive the first few days improve rapidly and recover completely over 2 to 3 weeks, often without sequelae. Mortality is 50 to 75%. Treatment for HPS is supportive, with mechanical ventilation, meticulous volume control, and vasopressors being required for severe cardiopulmonary insufficiency. IV ribavirin is ineffective. |
<urn:uuid:bf7e62cc-9c08-47ee-bae1-68b708c44597> | wiki | The On the Road to Quitting program is a comprehensive initiative designed to empower individuals to overcome the psychological and emotional barriers that hinder their ability to quit smoking, thereby fostering a stronger sense of motivation and self-confidence.
A transient ischemic attack (TIA), also known as a mini-stroke, is a temporary ischemic stroke that occurs when blood flow to the brain is briefly interrupted, resulting in a temporary loss of symptoms within 24 hours. This condition is characterized by a transient disruption in cerebral blood flow, which, if prolonged, may lead to permanent brain tissue damage. Approximately 15% of strokes are preceded by a warning TIA, emphasizing the importance of recognizing symptoms to prevent potential stroke.
The risk of stroke is significantly higher in individuals over the age of 65, with approximately 1 in 15 persons experiencing a TIA, often without being diagnosed due to the transient nature of the symptoms. The likelihood of stroke increases within the first 3 months following a TIA, particularly within the initial few days, with the risk of stroke ranging from 1 in 20 to 1 in 10 within the first month.
TIAs and strokes are often associated with atherosclerosis, a condition characterized by the hardening of arteries, or coronary artery disease. Individuals who have experienced a TIA are more susceptible to death from heart attack than stroke. The underlying causes of TIA and ischemic stroke are identical, with ischemia referring to the reduction of blood and oxygen supply to cells.
Ischemic stroke occurs when the arteries supplying the brain become occluded, often due to the narrowing of arteries, which disrupts blood flow and leads to the formation of blood clots. These clots may originate from the carotid arteries in the neck or the heart, traveling to the brain and lodging in a narrowed section of a brain artery. Emboli, or free-floating particles, and thromboembolism, or free-drifting clots, are the primary causes of stroke and TIA.
The risk factors for TIA are identical to those for stroke, including atherosclerosis and coronary artery disease. Other risk factors, such as hypertension, diabetes, and high cholesterol, contribute to the likelihood of stroke and TIA. The symptoms of a TIA vary depending on the location of the blockage, with the most common sites being the carotid artery system and the vertebrobasilar system.
In the case of a TIA, symptoms may manifest in the eye on the side of the blocked arteries, or they may affect the opposite side of the body. For instance, a blockage in the left carotid artery may result in temporary blindness in the left eye or paralysis of the right side of the face, arm, and leg. The symptoms of TIA can be subtle, with many individuals experiencing blurring or dimming of vision, such as amaurosis fugax.
The vertebrobasilar system is another common site for blockages, which can cause symptoms on both sides of the body or in both eyes. The balance control centre of the brain may be affected, leading to vertigo, dizziness, imbalance, and poor coordination, as well as double vision and slurred speech. TIAs can occur alone or in a series, with some individuals experiencing multiple episodes within a year or even daily.
The symptoms of TIA are identical to those of stroke, making it challenging to distinguish between the two conditions. A TIA is essentially a stroke, and the blockage may either dissolve quickly or remain in place, leading to cell death. According to statistics, it is more likely to be a real stroke, emphasizing the importance of prompt medical attention. Individuals experiencing TIA symptoms should seek immediate medical attention, rather than delaying treatment at a doctor's office, as the risk of a full-scale stroke is significant. Furthermore, individuals with TIA symptoms should never attempt to drive themselves, as the risk of sudden blindness, paralysis, or blackout is substantial. |
<urn:uuid:8e947697-9204-4665-82ca-cc50bca7af48> | wiki | A groundbreaking genome-wide study, spearheaded by researchers at the Yale School of Medicine, has unveiled three novel genetic variants that substantially increase an individual's susceptibility to developing this perilous and often-deadly brain aneurysm. Conducted on an unprecedented scale, the study, which was published in the April 4 online edition of the journal Nature Genetics, involved a staggering 20,000 subjects and shed new light on the genetic underpinnings of this devastating disorder, which affects approximately 500,000 individuals worldwide annually.
The study, the second major publication by Yale researchers within the past 15 months, has significantly expanded the known regions of the genome that contribute to the development of intracranial aneurysms, thereby bolstering the understanding of this complex disease. According to Murat Gunel, professor of neurosurgery, genetics, and neurobiology at Yale and senior author of the paper, the findings provide critical insights into the causes of intracranial aneurysms, thereby paving the way for the development of a diagnostic test that can identify individuals at high risk prior to the onset of symptoms.
The ambitious international collaboration, led by Gunel and Richard Lifton, Sterling Professor and chair of the Department of Genetics at Yale, involved 69 authors from 32 institutions in 10 countries, who collectively analyzed 5,891 aneurysm patients from Japan and Europe and 14,181 unaffected subjects. By scrutinizing the entire genome, the researchers identified genetic variants that were more frequently shared among aneurysm patients than among unaffected individuals, thereby establishing a correlation between these variants and an increased risk of developing an aneurysm.
Furthermore, the study revealed that individuals carrying all of the identified risk variants are approximately five to seven times more likely to suffer an aneurysm than those who do not carry any of these variants. Gunel and Lifton attributed the success of the study to the significant advancements in genomics technology and the cooperation from nearly 70 international researchers, who recruited thousands of subjects and collected DNA samples.
While the findings of this study have significantly advanced our understanding of the genetic risks associated with intracranial aneurysms, the researchers caution that considerable work remains to be done. According to Gunel, the five identified findings account for approximately 10 percent of the genetic risk of developing an aneurysm, a significant increase from our previous understanding, yet still a long way from a comprehensive understanding of this disease.
Lifton concurs, stating that while much remains to be discovered, the study provides fundamental new clues about the causes of this catastrophic disease, which point to new opportunities for early diagnosis and therapeutic intervention. The median age of occurrence for aneurysmal hemorrhagic stroke is 50 years, and typically, there are no warning signs, resulting in severe brain damage or death in the majority of cases. Without a diagnostic test to identify aneurysms prior to these events, physicians are left to respond after the fact, once the damage has largely been done.
Gunel expressed optimism, stating that the study has achieved the first steps necessary to attain a decade-long goal of early diagnosis and biology-based treatments of aneurysms. Other Yale authors, including Katsuhito Yasuno, Kaya Bilguvar, Nikhil Nayak, Ali K Ozturk, Emilia Gaal, Matthew State, and Shrikant Mane, contributed to the study, which was funded by the Yale Center for Human Genetics and Genomics, the Yale Program on Neurogenetics, a Clinical & Translational Science Award, the National Institutes of Health, the Howard Hughes Medical Institute, and a grant from the European Commission, VIth Framework Programme. |
<urn:uuid:20651817-8ea3-4d7f-9d8c-742f47ee06e4> | wiki | SurvNet Electronic Surveillance System for Infectious Disease Outbreaks, Germany: A Comprehensive Approach to Surveillance and Control.
The Robert Koch Institute (RKI) implemented the SurvNet electronic surveillance system in 2001 to monitor infectious disease outbreaks in Germany. Since its inception, SurvNet has captured 30,578 outbreak reports, with a median duration of 7 days and a range of 1 to 73 days. The system has proven to be a valuable tool for outbreak surveillance, enabling the timely and comprehensive reporting of outbreaks, and facilitating the identification of emerging infectious diseases.
The SurvNet system is designed to minimize the workload of local health departments and capture outbreaks even when the causative pathogens have not yet been identified. The system organizes the electronic transmission of case-based datasets from peripheral databases in each local health department to databases of the respective state health department and finally to the RKI. The system transmits data to the RKI on all cases in Germany but without identifiable information on the persons involved.
The SurvNet system has several key features that make it an effective tool for outbreak surveillance. Firstly, it allows for the electronic transmission of data, which enables rapid information exchange between institutions in charge of conducting, coordinating, or reporting control measures. Secondly, it provides a standardized system for documenting qualitative descriptions of outbreaks, which enables the identification of emerging infectious diseases. Finally, it allows for the linkage of single case records to create outbreak reports, which enables the identification of multicounty and multistate outbreaks.
The SurvNet system has been used to monitor a wide range of infectious diseases, including foodborne illnesses, respiratory infections, and gastrointestinal infections. The system has also been used to monitor the spread of emerging infectious diseases, such as SARS and avian influenza.
The SurvNet system has several advantages over traditional outbreak surveillance systems. Firstly, it is more sensitive, with a higher rate of outbreak detection compared to other systems. Secondly, it is more comprehensive, with a wider range of data available for analysis. Finally, it is more efficient, with faster reporting and analysis times.
Despite its advantages, the SurvNet system also has some limitations. Firstly, it requires significant resources and infrastructure to operate effectively. Secondly, it may not be suitable for all types of outbreaks, particularly those that are not well-defined or have limited data available.
In conclusion, the SurvNet electronic surveillance system for infectious disease outbreaks, Germany, is a comprehensive approach to surveillance and control. It has proven to be a valuable tool for outbreak surveillance, enabling the timely and comprehensive reporting of outbreaks, and facilitating the identification of emerging infectious diseases. While it has some limitations, the SurvNet system is a significant improvement over traditional outbreak surveillance systems and is likely to be an important tool for public health officials in the future.
The system's ability to capture outbreaks even when the causative pathogens have not yet been identified is a significant advantage. This is particularly important for emerging infectious diseases, where the incubation period may be long and the disease may not be well-defined. The system's ability to link single case records to create outbreak reports also enables the identification of multicounty and multistate outbreaks, which is critical for controlling the spread of infectious diseases.
The SurvNet system's use of standardized case definitions and exposure categories also enables the identification of emerging infectious diseases. This is particularly important for diseases that are not well-defined or have limited data available. The system's use of molecular analysis and other diagnostic tools also enables the identification of pathogens and the development of targeted interventions.
Overall, the SurvNet electronic surveillance system for infectious disease outbreaks, Germany, is a valuable tool for public health officials. Its ability to capture outbreaks, link single case records, and identify emerging infectious diseases makes it an important tool for controlling the spread of infectious diseases. While it has some limitations, the SurvNet system is a significant improvement over traditional outbreak surveillance systems and is likely to be an important tool for public health officials in the future. |
<urn:uuid:04f7be76-157d-4e5b-abf8-32f10b5daaf7> | wiki | Approximately one in eight children experiences an episode of acute conjunctivitis annually, prompting numerous visits to primary care physicians and the use of topical antibiotics, which not only incurs significant expense but also contributes to the development of antibiotic resistance. Furthermore, the efficacy of antibiotic therapy in treating common childhood infections, such as otitis media and pharyngitis, has been questioned, raising concerns about its utility in managing conjunctivitis. A randomized, double-blind, placebo-controlled trial conducted by Rose and colleagues investigated the efficacy of chloramphenicol in treating acute conjunctivitis in children.
In this study, family physicians from twelve participating practices recruited children aged six months to twelve years who presented with clinical symptoms of acute infective conjunctivitis, with the sole exclusion criterion being an allergy to chloramphenicol. The severity of the infection was assessed at baseline using standardized photographs, and conjunctival swabs were collected from the affected eye. Parents were administered eye drops and instructed to administer one drop every two hours for the first 24 hours, followed by four times daily until 48 hours after the infection had resolved. The children were randomly assigned to receive either 0.5 percent chloramphenicol or a placebo containing boric acid and borax. Parents recorded symptoms and treatment outcomes until the condition resolved, and participants were reassessed at seven days and six weeks post-treatment.
The results of this study revealed that the efficacy of chloramphenicol in treating acute conjunctivitis was not significantly different from that of the placebo group. In fact, the antibiotic group exhibited a similar rate of clinical cure, with 86 percent of children achieving clinical cure at seven days, compared to 79 percent in the placebo group. The microbiologic cure rate was also comparable between the two groups, with 78 percent of the antibiotic group and 77 percent of the placebo group showing evidence of pathogen eradication. The study also found that the number needed to treat to achieve one additional clinical cure by day 7 was estimated to be 14 to 25 children.
Notably, the study reported a low rate of adverse events, with only one episode of conjunctivitis occurring in the six weeks following treatment. Furthermore, the rates of further episodes of conjunctivitis and consultations with family physicians for minor problems were similar between the two groups. The authors concluded that symptoms of acute infective conjunctivitis can be effectively managed without the use of topical antibiotic therapy, and that parents can play a crucial role in controlling symptoms through good hygiene and symptom management, thereby reducing the need for medical services and antibiotics. |
<urn:uuid:48586632-71aa-4ec1-96ff-d5cde8cc4ecd> | wiki | Despite the substantial amount of data garnered from laboratory and epidemiological studies, the investigation of verified short sleepers has been relatively limited. However, the findings from these domains reveal several patterns that warrant further exploration. Firstly, research has consistently demonstrated that short sleep is associated with an increased risk of mortality, a relationship that transcends geographical boundaries and persists across multiple decades and countries. This association cannot be fully explained by the presence of cancer or cardiovascular events, suggesting that short sleep may be independently linked to mortality, or, more likely, it may serve as a mediator or moderator of a complex relationship involving cardiovascular disease, obesity, metabolic dysregulation, stress, immune dysfunction, psychological health, cancer, or coping difficulties. Laboratory studies have shown that sleep deprivation is associated with impairments in these domains, while epidemiological research has confirmed that short sleepers report impaired overall health and a range of cardiovascular and metabolic risk factors, thereby supporting the notion that this pattern may be observed in habitual short sleepers. However, future studies are necessary to bridge the gap between laboratory findings and epidemiological results, thereby elucidating the extent to which these risks are present in verified short sleepers.
Secondly, short sleep has been linked to metabolic dysregulation and obesity. Sleep deprivation has been shown to induce short-term changes in various endocrine systems, including insulin, glucose, leptin, and ghrelin, which may persist over the long term, thereby explaining some of the epidemiological findings. Furthermore, short sleepers may be more prone to consuming higher-fat foods, which may contribute to the repeated demonstration of obesity in epidemiological studies, and may or may not be driven by endocrine changes.
Thirdly, short sleep has been associated with poorer cardiovascular health. While this relationship has primarily been driven by epidemiological studies, which are subject to inherent limitations in measuring sleep, the evidence suggests that those reporting less sleep are at a greater risk of hypertension, stroke, and myocardial infarction compared to those who sleep 7-8 hours. This relationship may be more pronounced in women than men, and may also be evident in individuals who sleep for extended periods. This is supported by laboratory studies that demonstrate sleep deprivation is associated with heightened blood pressure and sympathetic activity.
Fourthly, short sleep has been linked to impaired neurobehavioral performance and cognitive functioning. These findings have primarily been explored in the context of sleep deprivation studies, which have not been replicated in naturalistic settings. It is unclear whether performance deficits associated with short-term sleep deprivation accurately describe the experience of habitual short sleepers. Epidemiological findings, however, suggest that short sleepers report more sleep disturbance, including daytime sleepiness.
Lastly, short sleep has been associated with psychological/psychiatric disturbances and poor general health. Sleep deprivation studies have shown that short-term neurophysiological changes indicative of stress and depressive symptoms result from sleep deprivation. Studies of self-reported short sleepers have also mirrored these findings, demonstrating that short sleepers exhibit more risk factors for stress and depression, as well as characteristic coping styles. |
<urn:uuid:d43a61d3-e430-486f-866e-64a84fa95c13> | wiki | A recent mouse study conducted by researchers at Brigham and Women's Hospital has provided novel insights into the role of fat tissue in surgical recovery, challenging the long-held notion that it serves merely as a barrier to be removed. The study, led by vascular surgeon Dr. C. Keith Ozaki, demonstrates that a short-term switch to a low-fat diet can significantly alter the fat tissue's response to surgical trauma, potentially leading to reduced complications and accelerated recovery.
This research builds upon two emerging concepts in medicine: the profound health effects of drastic, long-term dietary alterations and the crucial role of fat tissue in maintaining bodily balance and immune function. By exploring the possibility of priming patients with a short-term restricted diet before surgery, the researchers aimed to harness the potential of fat tissue to mitigate surgical trauma.
Historically, surgeons have relied on minimizing trauma to vital organs during operations to accelerate recovery. However, the role of fat tissue in this process has remained largely unexplored. Dr. Ozaki noted, "We've learned that minimizing trauma to the liver, kidney, blood vessels, and heart accelerates people's recovery from surgery, but we've never really considered the fat tissue. We've simply burned and yanked it aside."
In the study, three groups of mice were subjected to varying dietary regimens: one on a low-fat diet, another on a high-fat diet, and a third group that transitioned from a high-fat diet to a low-fat diet three weeks prior to surgery. The researchers then simulated surgical procedures, including cutting into fat tissue, applying clamps, and burning fat tissue. The results revealed that the fat tissue responded differently to each group, with the high-fat group exhibiting increased inflammation and decreased hormone production.
Notably, the mice that had undergone a short-term low-fat diet exhibited fat tissue behavior similar to that of mice raised on a low-fat diet from birth, suggesting that even a brief period of dietary restriction can have a lasting impact. Dr. Ozaki plans to conduct pilot studies in humans, proposing that modifying a patient's diet for as little as one week before surgery could have a meaningful effect on reducing complications and accelerating recovery.
Valter Longo, a professor of gerontology at the University of Southern California, noted that evidence is accumulating to support the notion that short-term restricted diets can have beneficial health effects. His laboratory is currently investigating the role of fasting in chemotherapy, with promising results from animal studies and a phase one trial in cancer patients. Longo praised the study's findings, stating that the reduction in inflammation is a significant finding, but emphasized the need for further research to demonstrate the diet's impact on surgical outcomes and test its efficacy in patients. |
<urn:uuid:85c9fdce-f7b0-4c84-bd83-2e36abf60635> | wiki | A wandering atrial pacemaker, also referred to as multifocal atrial rhythm, is a type of atrial arrhythmia characterized by the shifting of the natural cardiac pacemaker site between the sinoatrial node, the atria, and/or the atrioventricular node. This phenomenon is typically identified on electrocardiogram (ECG) Lead II through morphological changes in the P-wave, with sinus beats exhibiting smooth, upright P-waves and atrial beats displaying flattened, notched, or diphasic P-waves. The condition is often observed in individuals of advanced age, athletes, or those with varying vagal tone, and typically does not manifest symptoms or require treatment.
The wandering pacemaker is primarily caused by fluctuations in vagal tone, which can lead to a slowing of the sinoatrial node, thereby allowing a pacemaker located in the atria or atrioventricular node to temporarily assume a faster pace. Upon a decrease in vagal tone, the sinoatrial node resumes its natural rhythm. In cases where there are three or more ectopic foci within the atrial myocardium, a wandering atrial pacemaker is present, characterized by a continuously shifting pacemaker location and a changing vector of atrial activation. This results in a changing P-wave morphology and PR interval duration, making it challenging to identify a dominant P-wave. The rate of this arrhythmia is typically less than 100 beats per minute, and the RR intervals exhibit variable cycle lengths due to differences in automaticity and impulse generation among the ectopic foci.
The irregularly irregular rhythm of the wandering pacemaker can be confused with atrial fibrillation, although distinct P-waves are present. In contrast to sinus arrhythmia, which also exhibits irregularly irregular rhythms, the wandering pacemaker is distinguished by the presence of distinct P-waves and a normal QRS complex. This arrhythmia may also be confused with sinus rhythm with multifocal premature atrial contractions, but the presence of a dominant sinus P-wave and periods of regular RR intervals can help differentiate it from this condition. |
<urn:uuid:e0f2869b-0bce-41ec-ae3d-3bf0417dd79d> | wiki | The fundamental principles underlying the Integrated Management of Childhood Illness (IMCI) guidelines comprise several key components. Firstly, all sick children must undergo a comprehensive examination to identify "general danger signs" indicative of the need for immediate hospital referral or admission. Furthermore, children aged 2 months to 5 years must be routinely assessed for symptoms such as cough, difficult breathing, diarrhoea, fever, and ear problems, whereas infants aged 1 week to 2 months must be evaluated for bacterial infections and diarrhoea. Additionally, children must be assessed for their nutritional and immunization status, as well as other potential health issues.
The IMCI guidelines also emphasize the importance of a limited number of carefully selected clinical signs, which have been validated for their sensitivity and specificity in detecting various diseases. These signs are tailored to the specific conditions and realities of first-level health facilities. The classification of a child's condition is based on a combination of individual signs, rather than a definitive diagnosis. The classification system categorizes the severity of the condition, necessitating specific actions, including urgent referral to a higher level of care, specific treatments, or safe management at home.
The IMCI guidelines address most, but not all, of the major reasons for which a sick child is brought to a clinic. However, children returning with chronic problems or less common illnesses may require specialized care. The guidelines do not provide management procedures for trauma or acute emergencies resulting from accidents or injuries. The IMCI management procedures rely on a limited number of essential drugs and encourage active participation of caregivers in the treatment process.
A crucial component of the IMCI guidelines is the counselling of caregivers about home care, including guidance on feeding, fluids, and when to return to a health facility. The underlying principles of the IMCI guidelines remain constant, but they must be adapted to each country's specific situation. This adaptation involves covering the most serious childhood illnesses typically seen at first-level health facilities, aligning with national treatment guidelines and policies, and making the guidelines feasible through the health system and family care.
The adaptation of the IMCI guidelines is typically coordinated by a national health regulating body, such as the Ministry of Health, and involves decisions made by national health experts. As a result, some clinical signs and procedures may differ from those used in a particular country. However, the principles used for managing sick children remain universally applicable.
The IMCI case management process involves several key elements, including classification and identification of treatment, referral, treatment, or counselling of the child's caregiver, emergency triage assessment and treatment, diagnosis, treatment, and monitoring of patient progress. The sensitivity and specificity of clinical signs are crucial in evaluating their diagnostic performance. Sensitivity measures the proportion of those with the disease who are correctly identified by the sign, while specificity measures the proportion of those without the disease who are correctly called free of the disease. |
<urn:uuid:ec22f99d-5561-47fb-9a2b-f5450162563d> | wiki | The cyanobacterium Synechocystis, a unicellular organism, has evolved a unique mechanism to produce toxins that ultimately lead to its own demise. This phenomenon was elucidated by biologists Stefan Kopfmann and Prof. Dr. Wolfgang Hess of the University of Freiburg, whose findings were published in the Journal of Biological Chemistry and PLoS ONE.
The bacterium Synechocystis produces multiple toxins, yet most of these toxins are inactive due to the simultaneous production of an antitoxin that neutralizes their toxic effects. This symbiotic relationship between the toxin and antitoxin is mediated by a plasmid, a self-replicating circular DNA fragment that exists independently of the bacterial chromosome. The plasmid pSYSA of Synechocystis harbors seven distinct toxin-antitoxin pairs, thereby conferring enhanced protection against cellular loss.
The inherent instability of the antitoxin, which is often lost during cell division, results in the selective survival of cells that retain the plasmid. This mechanism, known as natural selection, ensures that only cells possessing the plasmid are able to thrive. The plasmid pSYSA also contains the genetic information for a bacterial immune system, which, when lost, triggers the destruction of the bacterium through the coordinated action of multiple toxins.
The discovery of this complex system has significant implications for our understanding of the intricate relationships between toxins and their corresponding antitoxins in bacteria. The project was supported by funding from the German Research Foundation, and its findings have been published in reputable scientific journals. |
<urn:uuid:23359bc6-d0a2-4331-8023-16056fd45ea2> | wiki | The study of ichthyosis, a group of inherited skin disorders characterized by the presence of scales on most or all of the body, has provided valuable insights into the mechanisms underlying desquamation, the shedding of the outermost skin cells. The visible scales that are a hallmark of ichthyosis have led researchers to focus on the skin's ability to prevent water loss, a process known as permeability barrier function. This barrier, which resides in the outermost layer of skin, the stratum corneum, is crucial in maintaining the body's water balance, as the skin is approximately 80% water and is exposed to a dry environment.
Interestingly, the thickness of the stratum corneum, which is often increased in ichthyosis, does not necessarily correlate with the effectiveness of the skin's barrier. For instance, the skin on the palms and soles, which has a significantly thicker stratum corneum, is actually more leaky than skin on other parts of the body. This phenomenon has led researchers to reevaluate the traditional "bricks and mortar" model of the stratum corneum, which posits that a thicker stratum corneum should provide a better barrier.
In reality, the skin's barrier function is maintained by the interposition of multiple layers of water-repellent lipids between the body's water-saturated interior and the drier external environment. These lipids, which are produced by the skin cells and deposited in sheets or lamellar membranes, provide an "insurance policy" for the barrier by ensuring that the skin cells, or corneocytes, are not exposed to the external environment. However, genetic mutations that affect the production or delivery of these lipids can compromise the barrier function, leading to ichthyosis.
Studies have identified over 40 genes that cause ichthyosis, and research has shown that mutations in these genes can affect various cellular operations, including the metabolism of epidermal cells. The most critical function of the epidermis is to generate a competent barrier to water loss, and mutations that disrupt this function can lead to barrier abnormalities. In severe cases, barrier failure can be life-threatening, particularly in infants and newborns, who are vulnerable to dehydration and electrolyte imbalances.
Furthermore, barrier failure can also lead to growth failure, as water loss through the skin can result in the loss of calories, which are essential for growth and development. This is particularly concerning in infants, who require a high caloric intake to support rapid growth. In some cases, babies with ichthyosis may experience extreme failure to thrive due to an inability to compensate for caloric losses through heat of evaporation. Therefore, managing fluid and nutritional needs is crucial in caring for infants with ichthyosis. |
<urn:uuid:9e910397-c98f-44cc-b30b-7357e9f5436b> | wiki | In 2009, the Nobel Prize in Physiology or Medicine was awarded to Elizabeth Blackburn, Carol Greider, and Jack Szostak for their groundbreaking discovery that telomeres, the protective DNA caps at the chromosome ends, play a pivotal role in determining cellular lifespan. The length of telomeres is safeguarded and augmented by the enzyme telomerase, which functions as an inhibitor to telomere shortening by replacing lost DNA strands during cell division. This fundamental breakthrough has garnered significant attention in the scientific community and beyond, as researchers and patients alike are intrigued by the prospect of lengthening telomeres, a crucial aspect of understanding cellular aging.
Research has revealed that various compounds, including omega-3 fatty acids, folate, vitamin D, ginger, and N-acetyl cysteine, can slow down telomere shortening. However, a significant breakthrough was achieved when it was discovered that an astragaloside compound derived from Astragalus membranaceus, a root used in traditional Chinese medicine, promotes telomerase activity and thereby lengthens telomeres. The biotech company Geron developed a specialized extraction of the herb, now known as TA-65, which is marketed by TA Sciences. Currently, patients can only undergo treatment with TA-65 under the guidance of healthcare professionals.
Dr. Woynarowski, a former consultant for TA Sciences, emphasizes the importance of high-dose treatment for optimal results from TA-65. Dr. Andrews of Sierra Sciences concurs that longer telomeres are desirable, but notes that some researchers argue that more data is required to confirm the efficacy of TA-65 in lengthening telomeres without increasing the risk of diseases associated with immortal telomeres, such as cancer. The discovery of TA-65 represents a significant milestone in the field of longevity, opening up new avenues for understanding the aging process and potentially leading to cellular age-reversal therapies. |
<urn:uuid:1741dcdc-dc71-4d68-a9ac-733cada4adea> | wiki | A comprehensive analysis of 42 research projects conducted in various countries worldwide revealed that moderate alcohol consumption, defined as three and three-quarters grams of alcohol per day, significantly reduces the risk of coronary heart disease by approximately a quarter. This conclusion was drawn from a meta-analysis of sixty-one data records from studies on alcohol's effects on the human body, which measured the blood concentrations of lipoprotein cholesterol, fibrinogen, high-density lipoprotein cholesterol (HDL-C), and apolipoprotein A1 in subjects before and after consuming various amounts of alcohol per day. The researchers found that moderate drinking was associated with lower levels of fibrinogen, higher levels of HDL-C and apolipoprotein A1, and slightly elevated levels of triglycerides. Based on these findings, the likelihood of coronary heart disease was calculated to be reduced by 24.7% with an intake of three and three-quarters grams of alcohol per day.
This conclusion was reached by combining the results of separate studies, which showed that moderate drinking had a significant impact on the bloodstream. Specifically, moderate drinking was found to decrease the concentration of fibrinogen, an essential component in blood clotting, and increase the levels of HDL-C and apolipoprotein A1, both of which play a crucial role in maintaining cardiovascular health. Although the association between moderate drinking and triglyceride levels was found to be statistically weak, the overall evidence suggested that moderate drinking could be a part of a healthy lifestyle.
In contrast, the authors of the study rejected the idea that teetotalers should be advised to drink, as most abstainers do so for specific reasons, such as religious or family obligations, and previous health problems. However, the official guidelines in both the UK and the USA suggest that moderate use of alcohol can be a part of a healthy lifestyle. |
<urn:uuid:927eb84f-47bc-4c33-b8f7-5b2b85a5c23f> | wiki | The determination of a normal BUN:creatinine ratio (BCR) in children remains undefined, with no established reference values for this age group. This study aimed to investigate the hypothesis that the BCR is elevated in young children and to establish age-specific normal BCR ranges. A retrospective analysis of 482 patients evaluated in an outpatient setting revealed a significant decline in the BCR with increasing age, with a negative correlation observed between BCR and age, body mass index (BMI), and serum creatinine levels, and a positive correlation with blood urea nitrogen (BUN) and glomerular filtration rate (GFR). The findings suggest that BCR values derived from adult populations are not applicable to children under the age of 10. Consequently, BCR values exceeding 60 in children aged 10 and under, and 30 in children over 10, are considered abnormal. The application of age-specific pediatric criteria is recommended to ensure the accurate interpretation of the BCR in evaluating acutely ill children. |
<urn:uuid:fd11e217-542b-47c7-b520-67a7033b34c0> | wiki | A novel cancer-causing virus in sheep, Jaagsiekte sheep retrovirus (JSRV), has been found to shed light on a disease whose incidence is rising and accounts for approximately 25 percent of all lung cancer cases. This discovery, made by scientists in the Hutch Human Biology Division, pertains to human bronchiolo-alveolar carcinoma, a disease whose causes remain unknown.
A study conducted by Dr. Dusty Miller's laboratory, in collaboration with postdoctoral fellow Dr. Sharath Rai, graduate student Vladimir Vigdorovich, and researchers at the National Cancer Institute, has revealed that JSRV infects both sheep and human cells cultured outside the body, and does so by binding to a receptor on the surface of lung cells. This receptor, a cell-surface protein known as HYAL2, has been implicated in lung cancer.
The findings, published in the Proceedings of the National Academy of Sciences, may provide crucial insights into the initiation of certain forms of human lung cancer and also aid in the development of effective gene therapy tools for lung diseases such as cystic fibrosis. JSRV causes a contagious form of lung cancer in sheep, characterized by excessive production of virus-filled lung fluid, which can lead to the formation of tumors in as little as 10 days.
Unlike other cancer-causing viruses, JSRV is a relatively simple virus with few genes, none of which resemble previously discovered oncogenes. However, one of the viral genes, env, specifies a protein that forms the viral envelope, which interacts with the target receptor on the surface of lung cells. To identify the JSRV receptor in lung cells, Dr. Miller developed a system using cultured hamster cells that contain small pieces of human DNA, which enabled the team to pinpoint the gene responsible for viral infection.
The viral receptor gene, HYAL2, was found to be located on a region of human chromosome 3 that is frequently altered in lung cancers. In 100 percent of small-cell lung cancers, there is a deletion in this region of chromosome 3, often including the HYAL2 gene. HYAL2 codes for a protein that is anchored to the cell surface of lung cells, and other proteins anchored to the cell surface in a similar fashion have been shown to play roles in cell proliferation, suggesting a possible mechanism for how HYAL2 might be involved in tumor formation.
The binding of JSRV to sheep lung cells may interfere with the receptor's normal role in regulating cell proliferation, leading to unregulated growth. While no human virus analogous to JSRV is known, Dr. Miller speculates that there may be viruses that interact with the HYAL2 in human cells. His group is currently studying JSRV for its potential applications in gene therapy for lung diseases, including cystic fibrosis, provided the oncogenic potential of the virus can be controlled.
JSRV's ability to replicate well in the lung makes it a promising candidate for developing viral vectors for gene therapy. Viruses for gene transfer to the lung could be engineered to contain JSRV envelope proteins, allowing them to specifically target lung cells. |
<urn:uuid:a32ea2f2-5ffd-412e-a3a3-68a6158e0119> | wiki | Iron that is either stored in the intestinal mucosal cells or in the liver can be transported into the bloodstream for distribution to other tissues. For this to occur, the iron must first be reduced to its ferrous form, iron (II), which is capable of crossing the plasma membrane. In the bloodstream, iron (II) is reoxidized to its ferric form, iron (III), by the enzyme ferroxidase II. The ferric iron is then bound to the serum protein, transferrin, which has two binding sites that can accommodate iron (III) molecules. Approximately one-ninth of the transferrin molecules are saturated with iron at both sites, while approximately four-ninth of them are saturated with iron at one site, and an additional four-ninth have no iron bound. Consequently, transferrin is typically only about one-third saturated with iron, and there is a substantial capacity for unsaturated plasma iron binding. This capacity can effectively handle unexpected increases in iron levels. The iron binding capacity of serum is of clinical significance, and it is primarily accounted for by the presence of transferrin. Serum iron refers to the concentration of iron present in the blood, which is typically around 100 micrograms per 100 milliliters. The total iron binding capacity (TIBC) is the maximum amount of iron that can be bound by transferrin, and it is typically around 300 micrograms per 100 milliliters. The unsaturated iron binding capacity (UIBC) is the difference between the TIBC and the serum iron, and it is typically around 200 micrograms per 100 milliliters. The iron binding capacity is used in the differential diagnosis of various conditions, including iron deficiency and late pregnancy, in which TIBC is increased, but saturation is decreased. In contrast, hemochromatosis is characterized by a low TIBC and high saturation. Certain other clinical conditions also exhibit characteristic patterns of TIBC and percent saturation. |
<urn:uuid:ced6214e-342a-4411-ad9a-2be029ccbdae> | wiki | Phlebitis is a medical condition characterized by the inflammation of a vein, typically in the leg, often accompanied by the formation of blood clots that adhere to the vein's wall. This condition can manifest as superficial phlebitis, where the affected vein is close to the surface, or deep vein thrombosis (DVT), a more severe condition where the clot can dislodge and lodge in the lungs, posing a life-threatening risk.
Superficial phlebitis is usually accompanied by symptoms such as pain, swelling, redness, and warmth around the affected vein, which can be alleviated with analgesics, warm compresses, and compression bandages or stockings to enhance blood flow. In more severe cases, anticoagulants or minor surgery may be required.
In contrast, DVT is a more complex condition that often requires hospitalization, strong anticoagulants, and various surgical procedures for treatment. The risk factors for phlebitis include recent surgery or childbirth, varicose veins, inactivity, or prolonged periods of sitting, such as on long airplane rides, as well as the use of intravenous catheters.
While conventional treatments for phlebitis include analgesics, warm compresses, and compression bandages, there are no well-established natural treatments for the condition. However, certain natural substances, such as oligomeric proanthocyanidins (OPCs) from pine bark or grape seed, may help prevent DVTs, and studies have shown that these substances can significantly reduce the risk of blood clots.
Other natural substances that have been studied for their potential to prevent DVTs include nattokinase, a fermented soy extract with blood clot-dissolving properties, vitamin E, which has been shown to have a blood-thinning effect, and bromelain, an anti-inflammatory agent found in pineapple. Additionally, mesoglycan, a substance found in the tissues of the body, has been suggested as a potential treatment for phlebitis, although the evidence is not yet conclusive.
It is essential to consult a doctor before attempting any natural treatments, as phlebitis is a potentially life-threatening condition that requires prompt medical attention. Travelers at high risk of developing DVTs are often advised to take aspirin to "thin" their blood prior to flying, and some studies have shown that OPCs, nattokinase, and other natural substances can help reduce the risk of blood clots on long airplane flights. |
<urn:uuid:c3ab97d1-25e9-4938-afd9-8a7c535b396e> | wiki | Nurses play a pivotal role in ensuring patient safety, particularly in preventing falls and fall-related injuries, which are a significant concern for the aging Veteran population and the general population alike. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines a sentinel event as an unexpected occurrence involving death or serious injury, or the risk thereof. Falls are one of the top five sentinel events for hospitals, long-term care facilities, and home care agencies, resulting in significant morbidity and mortality.
The Centers for Disease Control and Prevention (CDC) reports that falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma among people aged 65 years and older. More than half of all falls occur at home, and fractures are the major category of injuries produced by falls, with 87% of all fractures in older adults resulting from falls. Long-term care facilities have a higher fall rate than homes, and more frequently result in fracture, laceration, or the need for acute hospital care.
Nurses are leading practice innovators in systematically assessing patients' risk for falls and implementing population-based prevention interventions. Data analysis of fall rates by type of fall and severity of fall-related injury can help facilities examine the effectiveness of their interventions and program outcomes. The American Nurses Association (ANA) has developed nursing quality indicators that link nursing care and patient outcomes, including patient injury rate, which is a nurse-sensitive indicator of quality.
To determine the effectiveness of programs, data can be analyzed using various statistical measures, such as the number of patient falls per 1000 bed days. The ANA recommends using the following formula to calculate fall rates: Number of Patient Falls ÷ Number of Patient Bed Days × 1000. This formula accounts for changes in patient census and allows for comparison of fall rates across clinical units.
Injury analysis by severity levels enables clinical and administrative staff to profile both vulnerability of their patients and effectiveness of patient safety programs. Repeat fall rates can be analyzed to determine the effectiveness of interventions to prevent repeat falls. For example, a facility may report that 90% of their falls were single falls, while a second facility with the same patient population reports 40% single falls and 60% repeat falls.
The National Database of Nursing Quality Indicators (NDNQI) enables comparison of fall rates and other nurse-sensitive indicators for enrolled acute care organizations. The Uniform Data System for Medical Rehabilitation (UDSMR) for acute rehabilitation has a quality improvement program to analyze and report inpatients by demographic profile (age, gender, diagnosis) who fall once or more than once during their length of stay.
Visual presentation of falls data is an effective method for summarizing and presenting outcomes and trends over time. Run charts and control charts are two tools that provide this visual display and allow for evaluation of a program's effectiveness as well as identification of influential factors on program outcomes.
The development and implementation of a fall prevention program can be evaluated using control charts, which provide visual cues that help the viewer understand how the data relate to the process and outcomes of patient care. The control chart provides a visual display that is easily understood by all staff members, and higher peaks reflect longer injury-free intervals, indicating success.
Effective communication is a critical element of successful patient safety programs. The Joint Commission International Center for Patient Safety reports that communication issues were the leading root cause of errors reported between 1995-2004, as well as the sentinel events reported in 2005. A facility can improve communication by designing a tracking system that monitors patients who fall, communication, changes in plans of care, and the fall reporting process.
The use of a G-chart, a specific type of control chart, can help track the number of days between serious injuries due to falls, providing a visual display that is easily understood by all staff members. The G-chart can be used to assess process measures, such as percent of staff trained in fall prevention, and to evaluate the effectiveness of interventions to prevent falls and fall-related injuries.
In conclusion, nurses play a vital role in ensuring patient safety, particularly in preventing falls and fall-related injuries. The development and implementation of a fall prevention program can be evaluated using control charts, which provide visual cues that help the viewer understand how the data relate to the process and outcomes of patient care. Effective communication is a critical element of successful patient safety programs, and the use of a G-chart can help track the number of days between serious injuries due to falls. |
<urn:uuid:37711905-4843-4b64-ac69-443144e62545> | wiki | The growing prevalence of HIV/AIDS among women in the United States has necessitated the development of new guidelines for obstetric and gynecologic care, as reported by the American College of Obstetricians and Gynecologists.
Between 1985 and 2007, the proportion of women with HIV/AIDS in the U.S. increased from 7% to 27%, with the majority, approximately 72%, contracting the virus through heterosexual contact, and 80% belonging to minority groups.
The majority of these women are diagnosed during their reproductive years, resulting in an anticipated rise in the number of HIV-positive patients that obstetricians and gynecologists will encounter.
The guidelines, published in the December issue of Obstetrics & Gynecology, provide recommendations on health screenings, counseling, and routine gynecologic care for women with HIV.
These recommendations include routine screening for women aged 19-64, with targeted screening for women with specific risk factors, such as injection drug users, those with a history of another sexually transmitted infection, and those with HIV-positive sexual partners.
The guidelines also emphasize the use of condoms to prevent the transmission of HIV and other sexually transmitted infections, as well as the aggressive treatment of HIV-positive women for other STIs.
In couples where both partners have HIV, condoms are recommended to reduce the risk of superinfection.
Additionally, the guidelines address the potential interactions between antiretroviral regimens and oral contraception, highlighting the need for careful medication selection.
In some cases, the copper and levonorgestrel-containing intrauterine devices may be used.
The guidelines also stress the importance of counseling women on the use of both condoms and additional contraception to reduce the transmission of HIV and STIs, as well as the risk of unintended pregnancy.
The guidelines note that highly active antiretroviral therapy (HAART) is the standard of care for people with HIV, but that some medications raise particular concerns for women, such as the potential for miscarriage or birth defects associated with efavirenz.
Women taking efavirenz should be made aware of the risks and counseled on the need for effective contraception.
Although women with HIV are at higher risk for human papillomavirus infection, regular screening and recommended follow-up treatment can reduce the risk of invasive cervical cancer.
The guidelines recommend cervical cytology screening twice in the first year after diagnosis and every year thereafter.
However, the optimal management of women with HIV and abnormal cytology results remains unclear.
The efficacy of the currently available human papillomavirus vaccines has not been established in women or girls with HIV, but HIV infection is not considered a contraindication to vaccination, and CDC recommendations for children and adolescents should be followed. |
<urn:uuid:fa3ef431-09be-49a6-b9fb-e013df56086d> | wiki | A Novel Universal Platform for Personalized Cancer Immunotherapy was unveiled by a multidisciplinary team of researchers at the Perelman School of Medicine at the University of Pennsylvania, marking a significant breakthrough in the realm of cancer immunotherapy.
Published in the prestigious journal Cancer Research, this groundbreaking study presents a universal approach to personalized cancer therapy based on T cells, which has the potential to revolutionize the treatment of various types of cancer. The innovative platform, spearheaded by senior author Daniel J. Powell Jr., Ph.D., utilizes a novel chimeric antigen receptor (CAR) system to engineer adaptable T cells capable of targeting specific tumor types.
The CAR system, comprising a universal immune receptor, enables the recognition and binding of tumor antigens on the surface of cancer cells, triggering an inflammatory response and ultimately leading to the demise of the tumor cells. This novel approach has been demonstrated to be highly effective in targeting multiple tumor antigens simultaneously, thereby expanding the scope of conventional CAR approaches.
The researchers, led by Katarzyna Urbanska, Ph.D., have successfully engineered T cells to express the universal immune receptor, which can recognize and bind to a wide range of tumor antigens, including mesothelin, epCAM, alpha folate, and CD19. The universal immune receptor, which utilizes biotin-labeled molecules, has been shown to be highly versatile, allowing for the targeting of distinct antigens all at once or sequentially.
The implications of this breakthrough are profound, as it has the potential to significantly extend conventional CAR approaches, enabling the generation of T cells of unlimited antigen specificity. This, in turn, could lead to a highly personalized platform for cancer therapy, where patient tumors are analyzed for their expression of specific antigens, and T cells are engineered to express the universal immune receptor, which is then infused back into the patient to attack the tumor cells.
The study, supported by an R21 Exploratory/Developmental Bioengineering Research Grant from the National Institutes of Health, has been published in the esteemed journal Cancer Research, and its findings have the potential to revolutionize the treatment of various types of cancer. |
<urn:uuid:7c4a3469-85a5-4da7-a8a4-56b8da60f80b> | wiki | Congenital diaphragmatic hernia is a condition wherein the diaphragm fails to develop fully, resulting in the herniation of abdominal contents into the thoracic cavity. This condition often co-occurs with other birth defects, including chromosomal abnormalities, as documented in studies such as those by Forrester (1998), Robert (1997), and Cannon (1996). The majority of diaphragmatic hernias occur on the left side of the body, with most cases being associated with lung hypoplasia and pulmonary hypertension, as highlighted in Langham (1996).
Research has investigated the demographic and reproductive factors that contribute to the risk of diaphragmatic hernia, with some studies suggesting a lack of significant association with race/ethnicity, as reported by Forrester (1998) and Robert (1997). However, maternal weight has been found to be a potential risk factor, with very thin or underweight women being more likely to have infants with this defect, according to Waller (2003). Conversely, overweight or obese women have not been found to be at increased risk.
Secular trends in the incidence of diaphragmatic hernia have been reported, but these trends have been inconsistent and statistically insignificant, as noted by Forrester (1998) and Torfs (1992). Some studies have observed seasonal variation in the frequency of this defect, but this variation has been found to differ among types of diaphragmatic hernia, as reported by Torfs (1992). Additionally, prenatal diagnosis and elective termination have been found to affect birth prevalence rates for this defect, as documented in studies such as those by Forrester (1998) and Cannon (1996).
The prevalence of diaphragmatic hernia has been reported to vary by geographic location, with higher rates observed in rural areas compared to urban areas, as noted by Forrester (1998) and Torfs (1992). Maternal age and parity have not been found to be significant risk factors for diaphragmatic hernia, as reported by Forrester (1998) and Robert (1997). However, multiple births have been found to be associated with an increased risk of this defect, as noted by Robert (1997) and Torfs (1992).
Infant sex has been found to be a significant risk factor for diaphragmatic hernia, with males being more likely to have the defect than females, as reported by Robert (1997) and Torfs (1992). The recurrence risk of a woman having another infant with diaphragmatic hernia has been reported to be 0.9-2%, although the rate of recurrence is unknown for women with previous unaffected pregnancies.
Several studies have investigated the relationship between various maternal and environmental factors and the risk of diaphragmatic hernia, with no significant association found with maternal thyroid dysfunction or occupational and environmental chemicals, as reported by Bos (1994). However, an herbicide, Nitrofen, has been found to induce diaphragmatic hernia in rats, as documented in Thebaud (1999). The use of anticonvulsant drugs has been found to increase the risk of most birth defects, including diaphragmatic hernia, as reported by Holmes (2002).
No association has been found between diaphragmatic hernia and the use of marijuana, antihistamine drugs, fluoxetine, or corticosteroids, as reported by Fried (2002), Kallen (2002), and Park-Wyllie (2000). Additionally, no association has been found between diaphragmatic hernia and maternal diabetes, as reported by Wang (2002).
The prevalence of diaphragmatic hernia in the United States has been reported to range between 0.91 and 5.82 per 10,000 live births, as noted by National Birth Defects Prevention Network (2005). The rate in Texas for 1999-2002 deliveries was 2.68 cases per 10,000 live births. Differences in prevalence may be due to differences in case inclusion criteria and/or regional differences in diagnostic practices.
Several studies have investigated the relationship between various maternal and environmental factors and the risk of diaphragmatic hernia, with no significant association found with maternal thyroid dysfunction or occupational and environmental chemicals, as reported by Bos (1994). However, an herbicide, Nitrofen, has been found to induce diaphragmatic hernia in rats, as documented in Thebaud (1999). The use of anticonvulsant drugs has been found to increase the risk of most birth defects, including diaphragmatic hernia, as reported by Holmes (2002). |
<urn:uuid:d49df5a8-6f95-45d9-862f-92afb009cb2d> | wiki | {"error":{"status":"Bad Request","code":400,"type":"job","message":"job: job is not running, current state: FAILED, state info: Cluster error (0): DeadlineExceeded Pod was active on the node longer than the specified deadline"},"requestID":"7efc82d8db7db065907666c369dbded1"} |
<urn:uuid:39e442f0-cd50-47f3-b9a6-28612c771d44> | wiki | Physical activity among older adults is a multifaceted concept that encompasses a range of benefits, including the prevention of age-related loss of function, reduction of chronic disease risk, and enhancement of mental and physical well-being. Research has consistently demonstrated that regular physical activity can mitigate the risk of heart disease, certain cancers, hypertension, high cholesterol, and obesity, while also mediating hypertension, diabetes, and depression. Furthermore, physical activity has been shown to lower the risk of falls and injuries, improve sleep quality, and facilitate daily activities such as lifting groceries.
The American College of Sports Medicine recommends that older adults engage in at least 150 minutes of moderate-intensity cardiovascular exercise per week, with a focus on strength-training, neuromotor exercise, functional training to improve balance, and flexibility exercises. Strength training, in particular, is crucial for fall prevention, fat metabolism, and bone health, as well as facilitating the performance of daily activities. Cardiovascular conditioning, on the other hand, reduces the risk of heart disease, enhances endurance, and elevates mood, while improvements in flexibility aid in regular activities such as reaching and alleviate conditions such as arthritis.
Notably, walking is the primary recommended activity due to its simplicity and cost-effectiveness. Despite this, only 12% of adults aged 65-74 engage in strength training, highlighting the need for increased awareness and encouragement of this activity. It is essential to recognize that physical fitness and function levels can vary significantly among older adults, and a one-size-fits-all approach to physical activity prescription is not effective. Instead, a personalized approach that takes into account individual levels of function and the biological process of aging is necessary.
The value of physical activity for older adults is well-documented, yet the number of older adults who engage in regular physical activity remains alarmingly low. The prevalence of obesity among older adults is a pressing concern, with significant implications for future health. Furthermore, research has shown that physical activity is more prevalent among white Americans than among ethnic or minority groups, highlighting the need for targeted interventions to address these disparities.
Despite the challenges, there are promising strategies for increasing physical activity levels among older adults. The National Physical Activity Plan provides a solid foundation for research and recommendations, but its success depends on translating recognition of the importance of physical activity into tangible change. One potential approach is to shift the focus from medical prescriptions to emotional motivators, as suggested by Michelle L. Segar, a research investigator at the University of Michigan. By emphasizing the immediate rewards of physical activity, such as improved mood and reduced stress, rather than distant benefits like future health outcomes, experts can create a more compelling narrative that resonates with older adults.
This approach is supported by research that suggests that immediate rewards are more motivating than distant ones, and that portraying physical activity as a means to enhance current well-being and happiness is a more effective strategy than focusing on future health outcomes. By adopting this approach, organizations and individuals can create a more inclusive and engaging environment that encourages older adults to prioritize physical activity. Ultimately, the key to increasing physical activity levels among older adults lies in understanding the complex interplay between physical activity, emotional well-being, and social factors, and developing targeted interventions that address these needs. |
<urn:uuid:4b07e8d8-fbef-45bd-9a6e-04dd44e831da> | wiki | Superficial bladder cancer, also referred to as non-muscle invasive bladder cancer, is a type of cancer that predominantly affects the inner lining of the bladder. It is the most prevalent form of bladder cancer, accounting for approximately 75% of new cases, and is often diagnosed in patients presenting with symptoms such as blood in the urine, difficulties in urination, or irritation during urination. The presence of blood in the urine can be visually detected by the patient or identified through a routine urinalysis conducted by a healthcare professional. This type of cancer affects both males and females, with women occasionally misdiagnosing symptoms related to bladder cancer with urinary tract infections, thereby delaying diagnosis. The development of bladder cancer is often linked to a history of smoking, but other factors, including occupational and environmental exposures, can also contribute to its occurrence.
Fortunately, superficial bladder cancer is highly curable. The initial step in treatment involves identifying the cancer. When cancer is suspected, patients undergo a CT scan to assess potential issues in the kidney, ureter, and bladder. A cystoscopy, performed in the doctor's office, utilizes a small, flexible telescope to visually inspect the urethra and bladder. The bladder is then meticulously examined, and in some cases, very small bladder cancers can be removed and treated in the office using this flexible telescope. Most bladder cancers, however, require surgical removal in an operating room with the patient under anesthesia. Following tumor removal, a single dose of chemotherapy is administered inside the bladder to prevent recurrence. The pathologist examines the tumor under the microscope, and based on the results, further treatment may be necessary.
The treatment approach for superficial bladder cancer is determined by the pathologic analysis. The primary factor in determining the need for further treatment is the depth of cancer invasion into the bladder wall, which defines the stage of the cancer. The most common superficial bladder cancer is stage Ta, characterized by a cauliflower-like appearance and limited to the innermost layer of the bladder. In stage Ta tumors, further treatment is usually not required, although regular cystoscopy is necessary to monitor for potential recurrence. Patients with recurrent or multiple stage Ta tumors may be administered medication inside the bladder to prevent cancer recurrence. While stage Ta cancers can recur, they rarely progress to invasive bladder cancer or metastasize to other parts of the body.
In contrast, stage T1 bladder cancer has grown into the top layer of the bladder, known as the lamina propria, but has not invaded the muscle. These cancers possess a higher risk of recurrence and progression. The initial step in treating stage T1 bladder cancer is to perform a repeat cystoscopy approximately four weeks after the initial diagnosis to assess for further tissue invasion. If no muscle invasion is detected, most patients undergo treatment with BCG (Bacillus Calmette-Guérin), a medication administered weekly into the bladder for approximately six weeks, starting one month after tumor removal. This therapy helps prevent tumor recurrence and muscle invasive disease. Following BCG treatment, a repeat cystoscopy is performed approximately six weeks later to ensure complete cancer clearance. While most patients respond to BCG therapy, some may require bladder removal or additional chemotherapy. Maintenance BCG therapy, administered at three-month intervals, has been shown to be more effective than a single course of BCG. Additionally, more aggressive forms of T1 bladder cancer, including small cell cancer, micropapillary cancer, and cancers with lymphovascular invasion, may require chemotherapy or bladder removal.
Carcinoma in situ (CIS) is often visualized as a red, velvety patch in the bladder, and is characterized by its growth on the bladder's surface. CIS carries a high risk of progressing to invasive bladder cancer. Following diagnosis, treatment commences approximately four weeks later with BCG, administered once per week for six weeks. The bladder is then re-examined through cystoscopy and a urine test called cytology approximately six weeks after the final BCG dose. If the tumor has cleared, patients are initiated on maintenance BCG to prevent recurrence. If the CIS persists, a second six-week course of BCG is administered. If CIS is not treated with the second course of BCG, patients may require consideration of bladder removal due to the high risk of cancer progression. Fortunately, most patients exhibit a favorable response to BCG therapy, with a significant proportion achieving complete tumor clearance. |
<urn:uuid:c7cc799b-53c2-4dbb-9d45-6541ce446b50> | wiki | The administration of medications is a crucial component of maintaining overall health and preventing cardiovascular events such as heart attacks and strokes. To derive the full benefits of medication, it is essential to adhere to the prescribed regimen, refrain from reducing the dosage, and only discontinue treatment upon explicit instructions from the prescribing physician.
For individuals with cardiovascular disease, medication is typically a long-term commitment, often necessitating lifelong adherence. Understanding the medications prescribed and their mechanisms of action is a vital step in managing cardiovascular disease and preventing future events. Conversely, non-adherence to medication regimens can have severe, even fatal, consequences.
The importance of medication cannot be overstated, particularly for individuals at significant risk of cardiovascular disease or those who have experienced a heart attack, stroke, or other cardiovascular event. Medications may be prescribed for primary and secondary prevention, with primary prevention aimed at preventing heart disease and secondary prevention focused on limiting disease progression or alleviating symptoms.
To ensure optimal medication management, it is crucial to maintain open communication with the prescribing physician and to address any questions or concerns regarding medications. Furthermore, being aware of the purpose and potential benefits of each medication can facilitate adherence and enhance overall well-being.
Medications can be categorized into several types, including antiplatelet agents, beta blockers, and statins. It is essential to be aware of the potential side effects and interactions associated with each medication, as well as the importance of monitoring medication regimens to minimize adverse effects.
In addition to the benefits of medication, it is also essential to address the challenges associated with medication management, such as cost and inconvenience. By adopting a proactive approach to medication management, individuals can optimize their treatment regimens, minimize adverse effects, and improve overall health outcomes.
For individuals with cardiovascular disease, it is essential to maintain a comprehensive understanding of their medications, including their purpose, potential benefits, and potential side effects. By doing so, individuals can optimize their treatment regimens, minimize adverse effects, and improve overall health outcomes.
Medication adherence is a critical component of cardiovascular disease management, and it is essential to address any questions or concerns regarding medications. By adopting a proactive approach to medication management, individuals can optimize their treatment regimens, minimize adverse effects, and improve overall health outcomes.
The administration of medications is a complex process, and it is essential to address the challenges associated with medication management, such as cost and inconvenience. By adopting a proactive approach to medication management, individuals can optimize their treatment regimens, minimize adverse effects, and improve overall health outcomes.
Ultimately, the key to successful medication management is open communication with the prescribing physician and a comprehensive understanding of the medications prescribed. By adopting a proactive approach to medication management, individuals can optimize their treatment regimens, minimize adverse effects, and improve overall health outcomes. |
<urn:uuid:c7834fa8-18ef-4044-9fdb-aa8446d0f62c> | wiki | The Basic Knowledge Assessment Tool, BKAT-8SR, is a standardized instrument designed to evaluate the knowledge and skills of Telemetry/Progressive Care nurses. This tool is a critical component of in-service education in critical care nursing, as it assesses the fundamental knowledge required for safe and effective practice. The BKAT-8SR is based on the most recent version of the adult Telemetry/Progressive Care BKAT, which comprises 80 items that measure the nurse's understanding of critical care nursing practice in various areas, including cardiovascular, neurology, endocrinology, renal, pulmonary, gastrointestinal/parenteral, and other specialties.
The BKAT-8SR is a paper-and-pencil test that takes approximately 40 minutes to complete and has a total possible score of 80 points. The test consists of multiple-choice and fill-in-the-blank questions that assess both the recall of basic information and the application of basic knowledge in practice situations. Psychosocial aspects of critical care nursing practice are also integrated into the test.
The BKAT-8SR has undergone extensive validation and reliability testing, including a panel of experts and known group differences. The test has been used in various settings, including nursing education, orientation classes, and in-service education programs for critically ill patients. The results of the test have been used to identify areas of knowledge that require improvement and to develop targeted educational programs.
The BKAT-8SR is a widely accepted standard for measuring basic knowledge in critical care nursing, and its use has been supported by numerous studies and research findings. The test has been translated into multiple languages and has been used in over 24 countries worldwide. The BKAT-8SR is a valuable tool for nurses, educators, and healthcare administrators who seek to evaluate and improve the knowledge and skills of critical care nurses.
The test is administered by trained data collectors, including registered nurses with expertise in critical care nursing. The test results are used to identify areas of strength and weakness in the nurse's knowledge and skills, and to inform educational and professional development programs. The BKAT-8SR is a critical component of quality improvement initiatives in critical care nursing, and its use has been shown to improve patient outcomes and reduce medical errors.
The BKAT-8SR is copyrighted and is available for purchase at a cost of $15.00 per copy. The test is used by nurses, educators, and healthcare administrators to evaluate and improve the knowledge and skills of critical care nurses. The test is also used in research studies to evaluate the effectiveness of educational programs and interventions in critical care nursing.
The BKAT-8SR has undergone extensive testing and validation, including a panel of experts and known group differences. The test has been used in various settings, including nursing education, orientation classes, and in-service education programs for critically ill patients. The results of the test have been used to identify areas of knowledge that require improvement and to develop targeted educational programs.
The BKAT-8SR is a widely accepted standard for measuring basic knowledge in critical care nursing, and its use has been supported by numerous studies and research findings. The test has been translated into multiple languages and has been used in over 24 countries worldwide. The BKAT-8SR is a valuable tool for nurses, educators, and healthcare administrators who seek to evaluate and improve the knowledge and skills of critical care nurses.
The test is administered by trained data collectors, including registered nurses with expertise in critical care nursing. The test results are used to identify areas of strength and weakness in the nurse's knowledge and skills, and to inform educational and professional development programs. The BKAT-8SR is a critical component of quality improvement initiatives in critical care nursing, and its use has been shown to improve patient outcomes and reduce medical errors.
The BKAT-8SR is copyrighted and is available for purchase at a cost of $15.00 per copy. The test is used by nurses, educators, and healthcare administrators to evaluate and improve the knowledge and skills of critical care nurses. The test is also used in research studies to evaluate the effectiveness of educational programs and interventions in critical care nursing.
The initial version of the BKAT was co-authored by Jean C. Toth, RN, MSN, PhD, and Kathleen Ritchey, RN, CNS, MSN. The test has undergone numerous revisions and updates, with the most recent version being the BKAT-8SR. The test has been widely accepted and used in various settings, including nursing education, orientation classes, and in-service education programs for critically ill patients.
The BKAT-8SR is a valuable tool for nurses, educators, and healthcare administrators who seek to evaluate and improve the knowledge and skills of critical care nurses. The test is a critical component of quality improvement initiatives in critical care nursing, and its use has been shown to improve patient outcomes and reduce medical errors. |
<urn:uuid:14e9c28f-1269-4b89-91ea-76ae24940cc9> | wiki | The southern region of Africa, particularly Southern Sudan, is one of the most affected areas by visceral leishmaniasis, also known as kala-azar, a potentially fatal disease caused by the Leishmania protozoan parasite, which is transmitted through the bite of sandflies. The disease has been a significant public health concern in the region, resulting in substantial morbidity and mortality, with an estimated 95% of untreated patients succumbing to the disease, accounting for at least 50,000 deaths annually worldwide.
The return of stability to Southern Sudan, following the Comprehensive Peace Agreement in 2005, has opened up new opportunities for expanding existing interventions and introducing new ones to combat the disease. However, the lack of security and financial resources has hindered control efforts in the past. The disease was first reported in Southern Sudan in 1904, with the first epidemic documented in 1940, resulting in a mortality rate of 80%.
Visceral leishmaniasis is characterized by a cyclical pattern of cases, with considerable variation in the caseload from year to year, as indicated by passive case-detection data collected by the World Health Organization (WHO) since 1989. The data suggest that Southern Sudan is currently between epidemics, and there is a warning that cases may rise dramatically in the coming years. In 2006, a total of 1,117 cases were reported, with 65.4% of these being primary cases.
The disease is primarily transmitted through the bite of sandflies, with Phlebotomus orientalis and P. martini being the vectors in the northern and southern foci, respectively. Domestic animals have also been found to be infected with the parasite, but the role of these animals as disease reservoirs has not been proven. The disease is thought to be anthroponotic, meaning it is primarily transmitted between humans.
The case-fatality rate recorded at healthcare facilities has been 4-6% since 2002, with an estimated 91% of kala-azar deaths being undetected due to incomplete reporting. The healthcare system in Southern Sudan is weak, and patients often have to travel long distances to access basic healthcare services.
To address the disease, the Ministry of Health, with support from WHO and non-governmental organizations, has implemented various activities to strengthen case management, including training laboratory technicians on the direct agglutination test, updating case-management guidelines, and expanding the essential drugs list to include alternatives for second-line treatment.
The use of rapid diagnostic tests, such as the rK39 dipstick, has been a subject of debate, with concerns about their sensitivity and specificity in East Africa. However, recent studies suggest that these concerns are well-founded, and the use of direct agglutination tests is recommended to confirm suspected cases.
The treatment of kala-azar typically involves the use of sodium stibogluconate, with a dose of 20 mg/kg/day for 30 days. A recent study has shown that a combination of sodium stibogluconate and paromomycin can reduce treatment duration from 30 to 17 days, with improved patient survival and initial cure rates.
Despite the progress made, much remains unknown about the epidemiology of kala-azar in Southern Sudan, and the use of long-lasting insecticide-treated nets as a method of prevention is being explored. The return of stability to the region has also opened up new challenges and opportunities for kala-azar control, including the need for coordinated efforts to ensure consistency in diagnosis, treatment, and prevention.
The Ministry of Health, with support from international donors, has embarked on a number of activities to strengthen healthcare delivery, including the distribution of long-lasting insecticide-treated nets to areas in Jonglei and Eastern Equatoria, where malaria and kala-azar are co-endemic. However, the goal of reducing the incidence of kala-azar can only be achieved with the necessary resources. |
<urn:uuid:d22bce06-57bf-461b-ae19-fa5f7ed2c863> | wiki | Primary Amebic Meningoencephalitis (PAM) is a rare and potentially fatal disease caused by the protozoan parasite Naegleria fowleri. This species of Naegleria is the only known to infect humans and is typically found in warm freshwater environments such as rivers, lakes, and ponds. The risk of infection is extremely low, with only 30 reported cases in the United States over the past decade, despite millions of recreational water exposures annually.
Naegleria fowleri is an ameba that can be introduced to the brain through the nasal cavity, typically during freshwater recreational activities such as swimming, diving, or wading in warm waters. The organism can also be present in tap water, but it is not transmitted through drinking contaminated water. However, contaminated water from other sources, such as inadequately chlorinated swimming pool water or heated and contaminated tap water, can enter the nose and cause infection.
The primary mode of transmission is through the forced entry of water up the nose during freshwater recreational activities, allowing the free-living form of the ameba, a trophozoite, to penetrate the nasal tissue and migrate to the brain via the olfactory nerves, resulting in primary amebic meningoencephalitis.
Infection can occur in young, healthy individuals, and the initial signs and symptoms may include sudden onset of headache, fever, nausea and vomiting, stiff neck, and meningeal signs. As the disease progresses, new symptoms may develop, such as photophobia, mental-state abnormalities, lethargy, dizziness, loss of balance, visual disturbances, hallucinations, delirium, seizures, and coma.
The disease progresses rapidly, typically resulting in death within 3 to 7 days. Prevention is crucial, and the risk can be significantly reduced by refraining from water-related activities in warm freshwater environments during periods of high water temperature and low water levels. Additionally, measures such as holding the nose shut or using nose clips, avoiding digging in or stirring up sediment, and using sterile or distilled water for nasal irrigation or sinus flushes can help minimize the risk.
Several drugs have been shown to be effective against Naegleria fowleri in laboratory settings, and healthcare professionals should be aware of the disease and its treatment options. The Centers for Disease Control and Prevention (CDC) provides up-to-date information on treatment and prevention on their website.
In Texas, there have been sporadic cases of PAM reported over the past few decades, with most cases occurring in young males with a history of recent exposure to freshwater lakes, ponds, and rivers during the warm summer months. However, no cases have been linked to nasal irrigation or sinus flushes. |
<urn:uuid:abaef8f3-deb2-4fdf-a0d3-59992a5d4420> | wiki | Researchers at Beth Israel Deaconess Medical Center (BIDMC) and their international collaborators have made a groundbreaking discovery that may pave the way for the development of a novel therapeutic agent for the treatment of kidney disease. Through a decade-long study, the team identified a key molecular player and demonstrated the efficacy of a targeted experimental drug in reversing kidney damage in mouse models of diabetes, hypertension, genetic kidney disease, and other kidney injuries.
This breakthrough builds upon a previous discovery that a specific protein can repair and reverse renal fibrosis, a critical damage mechanism underlying various kidney diseases in humans. The new study, published in the March 2012 issue of Nature Medicine, reports the identification of a novel targeted drug specifically designed to reverse fibrosis and regenerate the kidney.
According to senior author Raghu Kalluri, MD, PhD, Chief of the Division of Matrix Biology at BIDMC and Professor of Medicine at Harvard Medical School (HMS), the discovery of this targeted drug is a significant milestone in the field. "We're optimistic about the benefits, but the real proof will come from clinical testing," he noted. Chronic kidney disease has become a major public health concern, with one in every 10 individuals over the age of 20 affected, and is most prevalent among those over 60. The disease can progress to end-stage renal disease, which often requires dialysis or transplantation.
The study's findings suggest that fibrosis, a condition characterized by the accumulation of scar tissue, can be countered by a specific protein, BMP-7, which was previously identified as a potential therapeutic agent. However, the large protein is not suitable for long-term treatment due to its size and the need for injection or surgical implantation. Kalluri's team sought to develop a smaller molecule that could be taken orally, which led to the identification of the protein Alk3, a key receptor involved in the molecular interaction between BMP-7 and the kidney.
In collaboration with a Canadian biotechnology company, Thrasos Therapeutics, the researchers developed a class of small functional peptides, including THR-123, which underwent further testing. The experimental compound was found to suppress inflammation, cell death, and fibrosis formation, as well as reverse established fibrosis and promote kidney regeneration. Notably, the test drug worked even better in combination with ACE inhibitors, a standard therapy for chronic kidney disease.
The study's results have significant implications for the treatment of kidney disease, and the researchers are optimistic about the potential of this targeted drug. "Targeting the receptor not only stops fibrosis, it removes established fibrosis, and it works in combination with an existing drug used in patients," Kalluri noted. The next step is to test this molecule in the clinic. While the mouse studies are a promising first step, further research is needed to understand the role of the BMP-7 pathway in kidney fibrosis in humans.
Going forward, Kalluri's group plans to continue studying the molecular players involved in fibrosis in other organs, including the liver, lung, intestine, and heart, with the aim of expanding the experimental-drug pipeline. As Kalluri emphasized, "If you don't have a pipeline of experimental drugs, how will you succeed in coming up with new drugs?" |
<urn:uuid:a9e667e7-e18a-452d-a526-fa07b9b42e6b> | wiki | Body Mass Index: A Comprehensive Framework for Assessing Weight Status
Body Mass Index (BMI) is a widely accepted method for determining an individual's weight status, serving as an estimate of body fat by comparing their weight to their height. Healthcare providers often utilize BMI in conjunction with additional risk factors to assess a person's likelihood of developing weight-related diseases. The higher an individual's BMI, the greater their risk of disease.
BMI Calculation for Adults
Adults can determine their BMI using a BMI calculator, with healthcare providers employing BMI ranges to categorize weight status. For adults, BMI ranges are as follows: a normal weight is indicated by a BMI of 18.5 to 24.9, whereas a BMI of 25.0 to 29.9 is classified as overweight, 30.0 to 39.9 as obese, and a BMI of 40.0 or higher as extremely obese. However, it is essential to note that BMI is not a direct measure of body fat and may not accurately reflect an individual's weight status in all cases. For instance, athletes with a high muscle mass may exhibit a higher weight without excess body fat.
BMI Calculation for Children and Adolescents
For children aged 2 and older, and adolescents, BMI incorporates sex and age into the calculation, resulting in a percentage value that reflects a child's BMI relative to their peers of the same sex and age. This percentage is obtained using a child and teen BMI calculator, which provides a more nuanced assessment of weight status. Children are categorized as follows: those with a BMI between the 5th and 85th percentiles are considered at a healthy weight, those with a BMI between the 85th and 95th percentiles are classified as overweight, and those with a BMI at or above the 95th percentile are deemed obese.
Alternative Methods for Measuring Body Fat
In addition to BMI, body fat can be assessed through various methods, including waist circumference, waist-to-hip circumference ratios, skinfold measurements, and ultrasound techniques. These alternative methods offer more precise estimates of body fat than BMI and may be necessary in certain cases. Healthcare providers can assist in determining the need for these additional assessments.
References:
1. National Heart, Lung, and Blood Institute. (2012). How are overweight and obesity diagnosed? Retrieved August 8, 2012, from http://www.nhlbi.nih.gov/health/health-topics/topics/obe/diagnosis.html.
2. Barlow, S. E., & the Expert Committee. (2007). Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics, 120, S164–S192. |
<urn:uuid:2d1758cb-ce87-48c6-b9dc-dcd24a1711c4> | wiki | Ebola hemorrhagic fever (EHF) and Marburg hemorrhagic fever (MHF) are rare viral diseases endemic to central Africa, characterized by high mortality rates and devastating local and regional consequences. Despite their rarity, EHF and MHF outbreaks typically occur in resource-limited settings, where impoverished conditions facilitate the spread of these diseases. The overall burden of EHF and MHF is small in comparison to other neglected tropical diseases (NTDs), but their outbreaks can have significant economic and social impacts.
EHF and MHF are caused by viruses of the genera Ebolavirus (EBOV) and Marburgvirus (MARV), respectively, both of the family Filoviridae. These viruses are highly pathogenic and have traditionally been associated with devastating outbreaks, with case fatality rates ranging from 25% to 90%. EBOV and MARV are considered potential bioweapons agents and are classified as class A select agents.
The epidemiology of EHF and MHF is primarily person-to-person transmission, which occurs through direct contact with the body, bodily fluids, or contaminated clothes or linens of an infected person. The level of viremia and thus the risk of transmission corresponds with disease severity, with highest concentrations of the virus during later stages of disease. Three distinct contact modalities account for virus transmission during outbreaks: transmission between family members, close contacts, and caregivers of sick individuals; contact with dead bodies during preparation and funeral proceedings; and transmission in healthcare settings from sick patients to medical staff or to other hospitalized patients through breaches in barrier nursing and reusing medical equipment.
Improved surveillance and healthcare safety are crucial in controlling EHF and MHF outbreaks. Public health approaches for NTDs have traditionally focused on vertical drug-based treatment strategies, but integration of EHF and MHF surveillance and response into public health systems for common NTDs may help in the control of both sets of diseases. Laboratory diagnostics are a crucial component of public health surveillance, and efforts need to be made to ensure capacity for rapid diagnostic testing for EHF and MHF across sub-Saharan Africa.
Vaccines and anti-viral therapies for EHF and MHF are currently in development, and there may be an optimistic picture for future licensing of efficacious biologic-based measures. However, these measures are contingent on identification of the outbreak, and classical public health surveillance and outbreak control guidelines will likely remain the cornerstone of disease control. Modern therapies have the potential to minimize the number of EHF and MHF deaths in outbreak settings.
EHF and MHF are often associated with limited public health surveillance and inadequate medical preventive measures, both partially the result of impoverished conditions. Effective methods to prevent and control EHF and MHF are well understood, but the bottom billion, who are residents of rural central Africa, are at high risk of endemic exposure to EBOV and MARV. Prophylactic vaccination may be a valuable preventive measure for individuals with potential exposure in the laboratory or through ecological work, as well as medical and public health personnel involved in hands-on outbreak response activities.
However, the potential value of prophylactic vaccination for those at risk of endemic exposure becomes murky, given the total burden of filovirus disease and the challenge of establishing high levels of coverage of routine immunizations in many endemic areas. A second prophylactic vaccination strategy would be to apply a targeted or mass vaccination campaign to an entire region in the event of an outbreak, but this would not be an efficient or cost-effective control mechanism and would likely draw resources and public personnel away from outbreak control activities.
A final strategy would be to apply these measures to high-risk contacts of suspected or confirmed EHF or MHF cases, as well as to those who are already ill and in isolation. This activity, if measures can be administered early enough to be effective, would inevitably save lives and would be an incentive for suspected patients to enter isolation. However, from an outbreak control standpoint, a symptomatic individual tracked through contact tracing activities is in essence removed from the "transmitter pool," and shortly after onset of symptoms and infectiousness will be placed under safe isolation for proper medical care. |
<urn:uuid:a2713e3a-6e28-44c2-ac6a-2d116a2c438e> | wiki | The molecular mechanisms underlying neurodegenerative diseases, such as frontotemporal dementia, have been elucidated through the study of tau protein aggregation. Research conducted by scientists at the University of California, San Diego, has revealed that mutations in the microtubule-binding protein tau lead to the formation of neurofibrillary tangles, a hallmark of tauopathies. However, the presence of tau tangles in certain neurodegenerative diseases suggests that the relationship between tau and axonal transport is more complex, with transport deficiencies potentially contributing to the development of tauopathy.
Studies have shown that axonal transport defects can lead to the hyperphosphorylation of tau protein, a key event in the progression of neurodegenerative diseases. The researchers interfered with axonal transport in mice by deleting the kinesin light chain 1 (KLC1) gene, a subunit of a microtubule motor essential for the localization of proteins such as amyloid-β precursor protein (APP). The resulting mice exhibited axonal degeneration, increased neurofilament phosphorylation, and hyperphosphorylated tau in the hippocampus and spinal cord.
The findings suggest that impaired axonal transport may be a common mechanism underlying the development of tauopathies, a group of neurodegenerative diseases characterized by the presence of hyperphosphorylated, aggregated tau protein. The researchers propose that the disruption of axonal transport can lead to a chronic axonal JNK-stress pathway, resulting in the hyperphosphorylation of tau protein and further impairing axonal transport.
The study's results have implications for our understanding of neurodegenerative diseases, including Alzheimer's disease and amyotrophic lateral sclerosis with frontotemporal dementia. The discovery of a link between axonal transport and tauopathy highlights the importance of investigating the molecular mechanisms underlying these complex diseases. Further research is needed to confirm the relationship between axonal transport and tauopathy and to explore the potential therapeutic strategies that may be developed from this knowledge.
The study's findings have been supported by the discovery of phosphorylated tau aggregates in the brains of mice models for Sanfilippo syndrome type B, a lysosomal storage disease that causes mental retardation and dementia. The researchers suggest that the link between axonal transport and tauopathy may be a common mechanism underlying these diseases, with implications for the development of novel therapeutic strategies. |
<urn:uuid:da16081a-acdf-4d79-94a4-1e1cc1d7bc80> | wiki | Pain, a complex physiological phenomenon, is characterized by an unpleasant sensory and emotional experience associated with actual or potential tissue damage, as defined by the International Association for the Study of Pain. This sensation is triggered by the activation of bare nerve endings, widely distributed throughout the body in the skin and mucous membranes, in response to mechanical, chemical, or thermal stimuli. The pain signal is then transmitted through the nerves to the spinal cord and ultimately to the brain, where it is perceived and processed.
The manifestation of cancer pain is influenced by a multitude of factors, including the type and stage of the disease, as well as the patient's individual tolerance. Cancer pain can arise from various sources, including blocked blood vessels leading to poor circulation, bone fractures resulting from metastasis, psychological or emotional problems, and side effects from cancer treatments, such as chemotherapy and radiation. Additionally, the tumor's pressure on a nerve can also contribute to the development of pain.
Initially, cancer pain may manifest with physiological signs, including grimacing, rapid heart rate, sweating, and rapid breathing. However, patients experiencing chronic pain, which persists for more than three months, often do not display these signs, leading to undertreatment and inadequate pain management. Effective communication between the patient and physician is crucial in ensuring adequate pain relief.
When possible, cancer pain is treated by removing or reducing the tumor that is causing it. In cases where the tumor cannot be removed, various treatment options are available, including medication, radiation therapy, and other interventions. Studies have shown that a significant proportion of patients with advanced cancer experience severe pain, with up to 90% of patients experiencing severe pain in the final stages of the disease.
The incidence and prevalence of cancer pain vary widely, with studies indicating that up to 50% of patients may be undertreated for cancer pain. However, not all cancer patients experience pain, and pain is rarely a sign of early cancer. Pain typically increases as cancer progresses, and the most common types of cancer pain are caused by tumors that metastasize to the bone, followed by tumors that infiltrate the nerve and hollow viscus.
The most severe forms of cancer pain are often caused by tumors near neural structures, which can lead to significant distress and impairment. In addition to bone metastasis, cancer pain can also occur in other parts of the body, with some patients experiencing multiple distinct pains. Chronic cancer pain, which persists for more than three months, poses a significant challenge for physicians, affecting a person's life in numerous ways, including their personality, ability to function, and quality of life.
Chronic cancer pain can manifest as persistent pain, which is continuous and may last throughout the day, as well as breakthrough pain, which is a brief flare-up of severe pain that occurs even while the patient is taking pain medication. Breakthrough pain can result from the cancer or cancer treatment, or it may occur during specific activities, such as walking or coughing. Effective treatment of chronic cancer pain requires the use of strong, short-acting pain medications that work faster than persistent pain medications. |
<urn:uuid:8bb3dae4-2441-48de-8075-2d3682831e9a> | wiki | Http request failed |
<urn:uuid:4a2d41ea-a124-4d65-a8bf-eb0344a0d508> | wiki | Human Colonization by Microorganisms: A Complex Interplay
At birth, the human body is colonized by a diverse array of microorganisms, marking the beginning of a lifelong interaction between the host and the microbial inhabitants. This colonization process involves the establishment of microorganisms on the body surface, which subsequently extends internally to various organs and cavities, including the oral cavity, gastrointestinal tract, ear canals, and others. The skin and mucous membranes, exposed to the external environment, harbor a variety of indigenous bacteria, collectively known as the normal flora.
Within hours of birth, the normal flora begins to establish itself on the body surfaces, with organisms acquired during passage through the birth canal being replaced by those obtained from caregivers and ingested foods. The process of colonization continues throughout life, with many microorganisms finding their niche within the first day, while others take months or years to reach the populations found in healthy adults. The sheer diversity of microorganisms living on the human body is vast, encompassing numerous species that remain uncharacterized and classified.
The principal resident bacteria, which are commonly found on the skin, in the mouth, and within the gastrointestinal tract, include species such as Staphylococcus, Micrococcus, Propionibacterium, Lactobacillus, Streptococcus, Neisseria, Corynebacterium, and Bacteroides. These microorganisms generally coexist with their host without causing disturbances in health, often benefiting the individual by outcompeting pathogenic bacteria, yeasts, and protozoa. However, when microorganisms invade areas within the body that are normally sterile, such as the lungs, heart, brain, spleen, and muscles, the immune system responds, leading to a diseased state.
The human body possesses a range of defenses to prevent the entry of microorganisms into internal regions, which are described in the context of animal defenses against microbes. In the diagnosis of bacterial diseases, a thorough understanding of the normal flora is essential, as exogenous pathogens must be distinguished from indigenous species. Furthermore, the increasing prevalence of clinically-diagnosed bacterial diseases involves bacteria that are indigenous yet potentially pathogenic, particularly when the host's resistance is compromised. Factors that lower the host's resistance include radiation damage, prolonged use of antibiotics or steroids, and the debilitating effects of diseases such as AIDS.
As treatment methods improve and more infections caused by virulent exogenous bacteria are controlled, endogenous bacterial diseases have become more common. These diseases occur when certain normal flora, opportunistic pathogens, take advantage of a weakened host, such as an individual with compromised immunity or a rare site of colonization, such as the eye or urinary tract. Examples of factors that lower the host's resistance include radiation damage, prolonged use of antibiotics or steroids, and the debilitating effects of diseases such as AIDS. |
<urn:uuid:9624870d-90f3-4b66-869b-83495f051d62> | wiki | Anorexia and bulimia are two distinct eating disorders characterized by a complex interplay of psychological and physical factors. While they share certain underlying causes, the symptoms, treatment options, and health consequences of these disorders exhibit marked differences.
The primary distinction between anorexia and bulimia lies in their respective manifestations. Anorexia nervosa is typically marked by a deliberate avoidance of food, resulting in severe caloric restriction and, consequently, a significant loss of body weight. In contrast, bulimia nervosa is often characterized by a cycle of binge eating followed by purging, which may involve the use of laxatives or self-induced vomiting. This dichotomy in symptomatology underscores the distinct pathophysiological mechanisms underlying these disorders.
The physical manifestations of anorexia and bulimia also diverge significantly. Individuals suffering from anorexia are often noticeably underweight, despite their insistence that they are overweight or fat. Conversely, bulimics may appear to be at a healthy weight, despite their struggles with a severe eating disorder, due to their relatively consistent caloric intake. Notable physical signs of bulimia include halitosis, stained teeth, and a puffy appearance to the face, which are often indicative of regular vomiting.
The manner in which anorexia and bulimia harm the body also differs. Anorexia is associated with a suppressed immune system, bone density loss, chronic fatigue, low blood pressure, and the potential for organ failure, primarily due to the lack of consistent nutrition. In contrast, bulimics are more likely to experience damage to their digestive system and esophageal lining through constant purging, which may lead to acid reflux, irregularity, severe stomach cramping, and possible tears in the esophagus.
Treatment recommendations for anorexia and bulimia also exhibit distinct differences. While both disorders require a comprehensive treatment approach that incorporates psychological care and practical measures, the specific treatment protocols vary depending on the individual's needs. Individuals with severe anorexia may require medically supervised weight gaining programs to restore their body weight to a healthy level, as well as medical treatment for any associated physical complications. In contrast, treatment for bulimia is often focused on altering lifestyle habits and instilling healthy eating principles to reduce the perceived need for binge/purge episodes.
The psychological underpinnings of anorexia and bulimia also exhibit distinct differences. Anorexia is often associated with distorted body image problems, whereas bulimia is more frequently linked to issues of control. Both disorders are predominantly found in women, particularly in their teens and twenties. However, it is essential to note that there is no absolute rule regarding when and in whom either disorder may manifest, and many individuals who develop an eating disorder in young adulthood may struggle with the problem for the remainder of their lives. |
<urn:uuid:fcbfb99f-29be-4d26-8e51-67285f320a12> | wiki | Pets exhibit head shaking due to a multitude of reasons, with the most prevalent being the aftermath of a swim or bath, resulting in a characteristic head and coat shake. However, regular or persistent head shaking in cats or dogs without an apparent cause is not a normal phenomenon and may be indicative of an underlying ear issue.
Cats and dogs can shake their heads for various reasons, with most of these reasons being related to the ears. These include the presence of a foreign body, such as grass seeds, within the ear canal, ear infections caused by bacteria, yeast, or ear mites, excessive ear wax, fly bites to the ear tips, immune-mediated diseases, polyps or masses within the ear canal, and other factors.
Given the potential for permanent ear damage, including a ruptured eardrum or hearing loss, if left untreated, it is essential to be concerned about head shaking in pets. Persistent or aggressive head shaking can lead to the development of aural haematomas, a painful and potentially debilitating condition. Chronic inflammatory processes, such as untreated infections, can also cause significant discomfort and pain.
Hearing is a vital sense for dogs, ranking second only to the sense of smell, and investigating the cause of head shaking is crucial to ensure the pet's quality of life. However, as a pet owner, it can be challenging to determine the underlying cause of head shaking, as the ear canal is L-shaped and problems can be hidden deep within.
The presence of certain signs, such as foul odour or discharge, ear scratching, unusual head positions, tenderness or irritability, redness or swelling, and hearing loss, can also indicate ear problems. It is essential to avoid using cotton buds or attempting to poke into the ears without a veterinarian's guidance.
In cases of suspected ear problems, consulting a veterinarian is the first step. A thorough examination with an otoscope can help detect infections, and cytology can be conducted to assess the presence and numbers of organisms in the ear canal. This information is crucial for selecting an accurate treatment plan.
Treatment options for ear problems may include antibiotics, anti-inflammatory tablets, topical ear drops, ear washes, ear mite treatments, dietary changes, and, in some cases, surgery. It is essential to follow a veterinarian's treatment plan and schedule follow-up appointments to monitor the pet's progress and adjust the treatment as necessary.
For cat owners, it is essential to be aware that head shaking-related problems can occur in cats as well, and veterinary assessment is necessary to determine the underlying cause and select an appropriate treatment. |
<urn:uuid:fed9ddb5-7d7d-4476-a7bd-fb0cafa52127> | wiki | The Body Mass Index (BMI) is a widely accepted measure of body fat based on an individual's height and weight, providing an accurate assessment of their health risks. Developed by Johns Hopkins Medicine, BMI is a simple calculation that involves dividing an individual's weight in kilograms by the square of their height in meters. A BMI greater than 40 is considered morbid obesity, while a BMI between 18.5 and 24.9 is generally regarded as a healthy range.
However, BMI has its limitations, as it does not distinguish between body fat and lean body mass, nor does it account for the location of body fat. Consequently, it is not an accurate measure of health for certain populations, such as individuals with high muscle mass or those whose body composition may be skewed due to various factors. As a result, BMI should not be used as the sole indicator of health for athletes, children, pregnant women, or the elderly.
Despite its limitations, BMI has been extensively studied and has been found to be a reliable predictor of health risks, including high blood pressure, heart disease, high cholesterol, Type 2 Diabetes, sleep apnea, female infertility, gastroesophageal reflux disease (GERD), and urinary stress incontinence. According to the National Institutes of Health (NIH), a BMI between 25 and 29.9 is associated with an increased risk of these diseases, while a BMI greater than 30 is considered obese.
In addition to its clinical applications, BMI has also been used as a tool for risk assessment in the general population. By categorizing individuals into different weight ranges, BMI provides a simple and accessible way to evaluate one's health risks. However, it is essential to note that BMI is not a perfect measure, and its accuracy may be compromised by various factors, including muscle mass and body composition.
To accurately assess one's health risks, it is recommended to consider BMI in conjunction with other factors, such as age, overall weight, and lifestyle habits. As Dr. Howard Sichel, a physical therapist, noted, "BMI is not a perfect measure, but it can be a useful tool in assessing one's health risks." Ultimately, a comprehensive approach to health assessment should involve a combination of BMI, lifestyle habits, and regular health check-ups.
In conclusion, BMI is a widely accepted measure of body fat that provides valuable insights into an individual's health risks. While it has its limitations, BMI remains a useful tool for assessing health risks and guiding individuals towards a healthier lifestyle. By understanding the importance of BMI and its limitations, individuals can make informed decisions about their health and well-being. |
<urn:uuid:f1483243-a543-4ae0-bd10-92dd515c494e> | wiki | Metatarsus adductus, also known as metatarsus varus, is a congenital foot deformity characterized by the inward deviation of the forefoot, resulting in a curved foot resembling a kidney bean. This condition can be classified into two categories: flexible and non-flexible, with the former being a milder form where the foot can be straightened to a degree by hand, whereas the latter is a more severe form where the foot cannot be straightened by hand.
The etiology of metatarsus adductus remains unknown, and it affects approximately one out of every 1,000 live births, with equal incidence in girls and boys. One or both feet may be affected, and other associated factors include a family history of metatarsus adductus, breech presentation during pregnancy, and an increased risk of developmental dysplasia of the hip (DDH).
DDH is a condition of the hip joint where the top of the thigh (femur) slips in and out of its socket due to a shallow socket, leading to joint instability. Babies born with metatarsus adductus are at a higher risk of developing DDH, which can be diagnosed with a physical examination, including a complete birth history and assessment of family members with metatarsus adductus.
Diagnostic procedures are not usually necessary, but x-rays of the feet may be performed in cases of non-flexible metatarsus adductus. The diagnosis of metatarsus adductus is typically made by a healthcare provider, who will assess the alignment of the heel and forefoot using passive manipulation techniques.
Treatment for metatarsus adductus is tailored to the individual child's needs, taking into account their age, overall health, and medical history. The primary goal of treatment is to straighten the position of the forefoot and heel. Treatment options vary, including observation for infants with a supple forefoot, stretching or passive manipulation exercises, and the application of long leg casts to help stretch the soft tissues of the forefoot.
Long leg casts are applied from the upper thigh to the foot and are used to treat various leg conditions, including fractures, dislocations, and post-surgical care. Proper cast care is essential to prevent complications, including skin irritation, cracks, and breaks. The cast should be kept clean and dry, and the skin under the cast should be protected from scratches and irritation.
In cases where the foot does not respond to stretching programs or casting, straight last shoes may be prescribed to help maintain the forefoot in a straight position. These shoes are made without a curve in the bottom and are connected with a bar that holds the feet pointed outward.
In some cases, metatarsus adductus may resolve spontaneously without treatment, but in others, it may require ongoing management and monitoring. Parents are advised to follow their child's healthcare provider's instructions for cast care and to seek medical attention if they notice any signs of complications, such as fever, increased pain, or swelling. |
<urn:uuid:73bcbef7-a9ad-4afe-a79a-8474100a0c22> | wiki | The Optimal Management of Blood Sugar Levels in Type 2 Diabetes: A Comprehensive Review
The recent publication of the United Kingdom Prospective Diabetes Study (UKPDS) has shed light on the crucial aspects of type 2 diabetes management, highlighting the importance of achieving optimal blood sugar levels and blood pressure control in preventing complications associated with the disease. Notably, the study revealed that only 3% of the study group achieved target glycemic goals using lifestyle modifications alone, emphasizing the need for a multi-faceted approach to diabetes management.
Insulin, a hormone that plays a pivotal role in glucose regulation, has multiple actions, including the suppression of glucose production by the liver and the facilitation of glucose uptake by cells. However, the development of insulin resistance, a condition characterized by impaired insulin action, is a critical factor in the pathogenesis of type 2 diabetes. Insulin resistance is often associated with obesity, particularly abdominal obesity, and is also linked to a lack of physical fitness. The compensatory response to insulin resistance, known as hyperinsulinemia, can lead to elevated blood sugar levels and the development of diabetes.
The mechanisms underlying insulin resistance and deficiency are not fully understood, but research suggests that genetic factors play a significant role. The relationship between insulin resistance and obesity is well-established, with obese individuals exhibiting a greater degree of insulin resistance. In contrast, leaner patients tend to exhibit a greater degree of insulin deficiency. Diabetes in the elderly is characterized by a greater degree of insulin deficiency, which may be attributed to the natural decline in insulin sensitivity that occurs with age.
Normal blood sugar levels in non-diabetic individuals range from 4.0 to 6.0 mmol/L before meals and bed, and less than 7.5 mmol/L two hours after meals. For individuals with diabetes, these levels are considered "ideal" and are slightly higher than those of non-diabetic individuals, ranging from 4.0 to 7.0 mmol/L before meals and bed, and less than 10.0 mmol/L two hours after meals.
The HbA1c test, a laboratory measurement, provides an index of blood sugar levels over the past 12 weeks, with normal values ranging from 0.048 to 0.062%. For individuals with diabetes, optimal HbA1c values are less than 0.070%. The relationship between blood sugar levels before meals and HbA1c values is strong, and monitoring HbA1c levels can provide valuable insights into the effectiveness of diabetes management.
Empowering individuals with diabetes to manage their own blood sugar levels is crucial for optimal outcomes. This can be achieved through diabetes education and home blood glucose monitoring (HBGM). By tracking their blood sugar levels, individuals can gain instant feedback and make informed decisions about their care.
Lifestyle modification therapy is a cornerstone of diabetes management, and should be continued throughout a person's life. Weight loss, particularly in overweight individuals, is desirable, but challenging to achieve and sustain. Diets that focus on reducing fat intake, particularly from dairy products, fried foods, and non-lean meats, can help minimize the rise in blood sugar levels after meals. Redistribution of calories throughout the day, through frequent small meals, can also help regulate blood sugar levels.
A graded exercise program, tailored to an individual's past exercise history and co-morbid illnesses, is essential for optimal diabetes management. Exercise not only burns calories but also promotes a greater sense of well-being and encourages smaller meal portions.
Medications, such as metformin and sulfonylureas, can be used to treat hyperglycemia in type 2 diabetes. Metformin, the oral hypoglycemic agent of choice, works by reducing insulin resistance, primarily by reducing liver glucose production. Sulfonylureas, on the other hand, stimulate insulin secretion. The use of sulfonylureas is often considered as a second-line treatment, particularly in patients who are thin, elderly, or have significant kidney or liver disease.
In patients who are unable to achieve optimal blood sugar levels with metformin and sulfonylureas, insulin therapy may be indicated. Acarbose, an inhibitor of the starch-splitting enzyme alpha-1,6-glucosidase, can also be used to reduce post-prandial hyperglycemia. Troglitazone, an insulin-sensitizing agent, has been shown to be moderately effective in reducing insulin resistance, but is associated with a higher risk of liver dysfunction.
In conclusion, the optimal management of blood sugar levels in type 2 diabetes requires a comprehensive approach that incorporates lifestyle modification, medication, and insulin therapy. By empowering individuals with diabetes to manage their own blood sugar levels, and by providing them with the necessary tools and support, we can improve outcomes and reduce the risk of complications associated with this disease. |
<urn:uuid:eeecd349-30dd-42ea-98da-ff326989c9ce> | wiki | Http request failed |
<urn:uuid:d21080c4-2fef-47b4-8c51-d97cf7c752de> | wiki | Detection of G12 Human Rotaviruses in Nepal, Volume 13, Number 3—March 2007.
A total of 731 stool specimens collected from children with diarrhea in Kathmandu, Nepal, from August 2004 through July 2005, were tested for the presence of rotavirus. The results revealed that 170 (23.3%) of the specimens were positive for rotavirus, with 56 (32.9%) identified as G2P and 39 (23.0%) identified as G12 with P, P, or P.
Rotavirus is a significant cause of severe childhood diarrhea globally, particularly in developing countries, where it is estimated that approximately 700,000 children die each year from this disease. In Nepal, a small, landlocked, and subtropical country in Asia, severe diarrhea is a common occurrence. Prior to Nepal's formal integration into the Asian Rotavirus Surveillance Network, a surveillance study was initiated in 2003-2004, which revealed the emergence of G12 strains against a backdrop of predominant G1P strains. The high prevalence of G12 strains in this population necessitated continued surveillance and characterization of rotavirus strains.
The stool specimens were collected from children with acute diarrhea attending the rehydration clinic at Kanti Children's Hospital, Kathmandu, Nepal, from August 2004 through July 2005. The rotavirus-positive specimens were identified using a commercially available ELISA test, and the genomic RNA was extracted using a QIAamp Viral RNA Mini kit. The purified RNA preparations were then used to determine the G and P types of the rotavirus using reverse transcription-polymerase chain reaction (RT-PCR).
A new primer pair was designed to detect G12 strains, which successfully amplified established G12 strains, L26 and Se585. The primer pair was also found to be specific for G12 strains, with no cross-reactions observed with prototype rotavirus strains carrying genotypes G1-G11 and G13-14.
The detection of G12 strains in Nepal is consistent with previous studies, which have reported the emergence of G12 strains in other parts of the world, including the United States, Japan, Brazil, South Korea, and Thailand. The increasing trend of G12 strains in Nepal may reflect the overall trend in the Ganges region at large, which justifies further surveillance in Nepal.
The detection of G12 strains also requires the development of a rapid detection method by PCR using specific primers that specifically target G12 strains. The primer pair developed in this study is expected to become a valuable asset for the identification of G12 strains found among nontypeable specimens in many epidemiologic studies.
Rotavirus vaccines have been licensed in over 60 countries and are being introduced into areas where they are most needed. However, the emergence and increase in G12 strains may become a challenge to the current rotavirus vaccination strategy, the efficacy of which may depend on the shared G and P serotype specificity of the vaccine strains and wild-type rotavirus strains circulating among children.
In conclusion, the detection of G12 human rotaviruses in Nepal highlights the need for continued surveillance and characterization of rotavirus strains. The development of a rapid detection method by PCR using specific primers that specifically target G12 strains is also essential for the identification of G12 strains found among nontypeable specimens in many epidemiologic studies. |
<urn:uuid:d01015da-429a-46e3-957d-88dc4dfab458> | wiki | Recent findings of a significant surge in drug-resistant tuberculosis cases in the UK and globally have prompted a call for increased focus on the development of new vaccines, a long-term, cost-effective solution to address the growing threat of this infectious disease.
A briefing held at the Science Media Centre in London, attended by top TB researchers, underscores the alarming rise in drug-resistant TB cases, with the World Health Organization estimating that 9 percent of multidrug-resistant TB cases are actually extensively drug-resistant, rendering even fewer treatment options available.
According to a study published in The Lancet, the rates of extensively drug-resistant tuberculosis (XDR-TB) range from 0.8 to 15.2 percent of multidrug-resistant TB cases worldwide. The alarming trend has prompted prominent TB researchers, including Helen McShane, MD, PhD, professor of vaccinology at the University of Oxford, and developer of the most clinically-advanced TB vaccine candidate, MVA85A, to emphasize the need for sustained investment in vaccine research.
McShane, joined by Ann Ginsberg, MD, PhD, vice president of scientific affairs at Aeras, and Tim McHugh, PhD, professor of medical microbiology at the University College London, stressed the importance of developing effective vaccines to prevent the spread of TB, rather than relying solely on the development of new treatments and diagnostics.
In the last decade, TB vaccine research has made significant strides, with over a dozen vaccine candidates in clinical trials, including MVA85A, which is poised to deliver its first efficacy results early next year following a clinical trial in South Africa. Ginsberg highlighted the potential of vaccines to prevent infectious tuberculosis in adolescents and adults, stating that such a breakthrough would be the single greatest advance in the global fight against TB.
The majority of reported TB cases, over half, are concentrated in Asia, with India, Pakistan, China, and Indonesia being the most affected countries. South Africa, however, has the highest rate of TB in Africa, accounting for 26 percent of the global burden of disease. The UK has also seen a significant rise in drug-resistant TB cases, with over 50 percent increase in the last decade, underscoring the need for sustained investment in vaccine research.
According to McHugh, treatment for multidrug-resistant TB is more expensive and protracted, lasting up to two years, with significant side effects, and clinicians often struggle to diagnose MDR-TB rapidly, increasing the risk of transmission. The development of new treatments and diagnostics is crucial, but McHugh emphasized that investments in vaccines are essential to protect the wider community from the spread of TB.
TB, once known as "consumption," has been one of history's greatest global killers, with one out of every three people globally thought to be infected by the airborne TB organism, although a much smaller number will go on to develop the disease. |
<urn:uuid:b26f71e3-39a4-46ba-a679-8c8e2d31964c> | wiki | A 2013 study published in the Journal of the American College of Cardiology has established a significant correlation between abdominal fat and increased risks of cardiovascular disease and cancer, contradicting previous findings that solely relied on body mass index (BMI) for predictive purposes. Researchers conducted a longitudinal study involving over 3,000 Americans, aged 50, who underwent CT scans to assess abdominal fat accumulation around the heart tissue and aortic artery. The participants were subsequently followed for up to seven years, during which time 90 cardiovascular events, 141 cancer cases, and 71 deaths were recorded.
The study's findings suggest that abdominal fat, which typically indicates fat accumulation around internal organs, is a more reliable predictor of cardiovascular disease and cancer than BMI alone. This discovery may provide insight into the varying obesity-related health problems experienced by individuals with similar BMI but disparate body types.
The researchers' hypothesis is that abdominal fat may play a partial role in the association between body fat and heart disease and cancer, thereby supporting the notion that this type of fat accumulation is a more nuanced indicator of health risk. According to Dr. Caroline Fox, the study's senior author, the presence of abdominal fat improved the ability to predict cardiovascular disease, thereby lending credence to the hypothesis.
Dr. Kathryn Britton, another study author, emphasized the significance of identifying high-risk individuals, as this enables targeted preventive and therapeutic measures to be implemented. Although the study established an association between abdominal fat and increased risks of cardiovascular disease and cancer, it did not provide conclusive evidence of a cause-and-effect relationship. |
<urn:uuid:2a8ec60e-0eb4-4829-b667-2d73618ea5cd> | wiki | Marin County, California, boasts one of the world's highest rates of breast cancer, a phenomenon that has been attributed to factors beyond geographical location, rather than the land itself. A recent study conducted at the University of California, San Francisco (UCSF), has identified a potential underlying cause: a genetic trait prevalent among women within the predominantly white population of the county.
Published in the Journal of the American College of Surgeons, a retrospective pilot study led by surgeon scientist Kathie Dalessandri, MD, FACS, and colleagues at UCSF and InterGenetics Inc. in Oklahoma City, analyzed mouth buccal cell samples from 338 women residing in Marin County. The study revealed a correlation between slight variations in the DNA of the human gene for vitamin D receptor and breast cancer risk.
While caution is exercised, as the findings must be validated in a larger, prospective study, the research indicates that women at high risk for breast cancer were 1.9 times more likely to possess a specific vitamin D receptor variation compared to the general population.
A larger, collaborative prospective study in Marin County, spearheaded by the Marin County Department of Health and Human Services, is currently underway, involving the examination of breast cancer risk on a scale involving thousands of women.
For the time being, Dr. Dalessandri notes that there is no clear-cut advice on the optimal level of vitamin D required for breast cancer prevention, but variations in the vitamin D receptor may serve as an important modulator of risk.
The discovery does not preclude the possibility of other factors contributing to the elevated breast cancer risk in Marin County, but it provides a crucial clue for future investigations.
A landmark study, led by UCSF cancer epidemiologist Margaret Wrensch, MPH, PhD, and Georgianna Farren, and colleagues from Marin Breast Cancer Watch, was the first to investigate the question of why women in Marin County are at a higher risk for breast cancer. Published in 2003, the study compared 285 women with breast cancer in Marin with 286 local women without the disease, examining traditional risk factors and environmental, lifestyle, and nutritional factors that may have accounted for the disparity. |
<urn:uuid:dcd5d70b-e421-49cb-b27f-707ee9ccaafd> | wiki | Researchers at the earliest stages of fate determination among white blood cells known as T lymphocytes have unveiled novel insights that could potentially aid in the development of more efficacious and prolonged vaccines against microbial pathogens or cancer.
Naive T lymphocytes, which patrol the periphery of the human body's defense mechanisms against infection, circulate through the bloodstream and tissues, searching for invasive microbes and other foreign antigens. These cells are termed "naive" due to their lack of prior exposure to pathogens.
Upon encountering an invader, these T cells undergo activation and proliferation, resulting in the emergence of two distinct daughter cells: "effector lymphocytes" responsible for immediate host defense, and "memory lymphocytes" that provide long-term protection against similar infections.
John T. Chang, MD, assistant professor in the Department of Medicine, and Gene W. Yeo, PhD, assistant professor in the Department of Cellular and Molecular Medicine and Institute for Genomic Medicine, co-principal investigators of the study, have been endeavouring to elucidate the timing and mechanisms underlying T lymphocyte differentiation into effector and memory cells during an infection.
Janilyn Arsenio, a postdoctoral fellow in the Chang lab, and Boyko Kakaradov, a graduate student in the Yeo lab and UCSD Bioinformatics graduate program, leveraged recent technological advancements in single-cell gene expression profiling and cutting-edge machine-learning algorithms to address this query with unprecedented precision.
The research team discovered that the decision by an individual T cell to produce effector and memory cells is precipitated almost instantaneously upon infection. "The'mother' lymphocyte appears to divide into two daughter cells that exhibit inherent differences from birth," stated Chang, "with one becoming an effector cell while its sister becomes a memory cell."
These findings have been published online in the journal Nature Immunology. |