Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026: 03/21/16

Δευτέρα 21 Μαρτίου 2016

Contributors to Patients’ Ratings of Quality of Care Among Ethnically Diverse Patients with Type 2 Diabetes

Abstract

We examined racial/ethnic differences in patients' ratings of components of interpersonal quality [participatory decision making (PDM) style, being treated as an equal partner, and feelings of trust], and evaluated the association between each of these components and patients' ratings of overall healthcare quality among non-Hispanic white (NHW), Vietnamese American, and Mexican American patients with type 2 diabetes. The findings indicated that although all three components were significantly associated with ratings of overall healthcare quality, the significant interactions between race/ethnicity and both PDM style (β = −0.09, p < 0.01) and equal partner (β = −0.06, p < 0.05) for the Vietnamese American patients suggested that the relationship between these components and patients' ratings of healthcare quality were less strong among Vietnamese American patients than among the NHW patients. Understanding racial/ethnic differences in the components of interpersonal quality that are associated with patients' ratings of overall healthcare quality is an important step for improving patients' experiences of their own care.

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A Case of Leprosy in Italy: A Multifaceted Disease Which Continues to Challenge Medical Doctors

Abstract

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, characterized by a very long incubation period, confounding signs and symptoms and difficulty to establish the onset time. Considering the stigma associated with the diagnosis and the difficulties in detecting asymptomatic leprosy, the incidence and prevalence of this disease are underestimated. In Italy, leprosy is currently included among the rare diseases and can occur as an imported pathology in native individuals or extra-EU immigrants. Currently, given its exceptional appearance in Italy, leprosy is extremely difficult to recognize. In fact, the incomplete knowledge by the medical class of geographical epidemiology and aetiology of tropical diseases including leprosy, often delays the definitive diagnosis. Due to the increasing rate of the migration flows, in Italy and in Europe, leprosy should be considered among the differential diagnosis in patients with cutaneous and neurological signs, especially when originating from endemic countries.

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Frequency and Perceptions of Herbal Medicine use Among Hmong Americans: a Cross Sectional Survey

Abstract

To determine the frequency and perceptions of herbal medicine use among Hmong Americans. Cross-sectional telephone survey. Sacramento, California Hmong community. Out of 118 subjects reached, 77 (65.3 %) reported lifetime use of herbal medicines. A majority of respondents agreed that herbal medicines were able to treat the body as a whole. Respondents felt that a leaflet of information indicating uses/side effects would be important to include for herbal medicines. Herbal medicine use was commonly reported among Hmong Americans. Thus, health care providers should be encouraged to discuss these alternative medicines with their Hmong American patients.

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Mortality by Cause of Death Among Immigrants and Natives in a South European Country: The Case of Greece, 2011

Abstract

The aim of the paper is to examine for the first time in Greece mortality by cause of death among immigrants. The analysis makes use of vital registration statistics for 2010–2012 and census data for 2011; standardised mortality ratios are estimated for four distinct groups: natives, migrants from EU-27 (excluding Greece), other Europeans (mainly Albanians) and those from all other countries (mainly Asia/Africa). All immigrants seem to experience favourable mortality from neoplasms but higher mortality from external causes in comparison to Greeks. The results regarding cardiovascular diseases are mixed. Persons originating in Asian/African regions exhibit higher mortality from infectious diseases and TB. The findings highlight the specificities of immigrant mortality which stem from pre-existing conditions in the country of origin as well as from the adverse socio-economic environment in the country of destination. As immigrants experience some excessive 'avoidable' mortality implementation of appropriate measures should be a social policy priority.

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A Qualitative Exploration of Less Acculturated Mexican Mothers’ Safety Perceptions of Herbs, Medicines, and Cleaners in the Home

Abstract

Childhood poisoning is a leading public health concern in our society. The death rate from unintentional poisonings among children has increased by 80 % from 2000 to 2009. Immigrant children are also at-risk. A qualitative study, consisting of a pile sort, was conducted among immigrant Mexican mothers to determine their safety perceptions of commonly used medicines, herbs, and cleaners. Participants (N = 35) were selected for semi-structured interviews from a pediatric primary care clinic in the Dallas/Fort Worth Metroplex. Some mothers over-estimated their children's ability to discern the dangers of substances, relied heavily on sensory skills of children, and perceived a medicine as safe after successful use in the past. Other mothers were more cognizant of allergic reactions, ingestion, and the need to store substances carefully. Brief interventions that incorporate culturally-appropriate safety messages are needed to assist Mexican mothers in creating a safe home environment.

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Tuberculosis Treatment Completion Rates in Southern New Mexico Colonias

Abstract

TB medication completion treatment rates for active TB patients living in impoverished US-Mexico border communities called colonias in southern New Mexico counties are unknown. It might be suspected that residents of colonias have lower completion rates than those living in incorporated and medically more accessible areas. A retrospective record review of closed TB case records from 1993 to 2010 of southern New Mexico border counties, was conducted using a modified version of the New Mexico Department of Health Tuberculosis Targeted Health Assessment/History form (Appendix 1). Study findings reveal that despite their unincorporated status, poorer living conditions and questionable legal status, colonia TB patients had a higher medication completion rate than their non-colonia counterparts. A robust New Mexico TB treatment program contributed to high completion rates with death being the number-one reason for treatment non-completion in both colonia and non-colonias.

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Self-Efficacy as a Mediator of the Relationship Between the Perceived Food Environment and Healthy Eating in a Low Income Population in Los Angeles County

Abstract

While previous studies have described psychosocial and environmental factors that contribute to healthy eating, much remains unknown about the interactions between them. We assessed the relationship between the perceived food environment, self-efficacy and fruit and vegetable consumption, using data from a sample of racially diverse, low-income adult clientele of five public health centers in Los Angeles County (n = 1503). We constructed a negative binomial regression model to examine the association between perceived food environment and the number of fruits and vegetables consumed. For every one point increase on the perceived food environment scale, individuals ate about 5 % more fruits and vegetables (95 % CI 1.007, 1.089), controlling for other covariates. Self-efficacy was shown to be a significant mediator (mediated effect = 0.010; 95 % CI 0.002, 0.020), accounting for 22.9 % of the effect. Efforts to increase access to healthy options may not only improve eating behaviors, but also influence individuals' beliefs that they can eat healthfully.

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Civil Surgeon Tuberculosis Evaluations for Foreign-Born Persons Seeking Permanent U.S. Residence

Abstract

Foreign-born persons in the United States seeking to adjust their status to permanent resident must undergo screening for tuberculosis (TB) disease. Screening is performed by civil surgeons (CS) following technical instructions by the Centers for Disease Control and Prevention. From 2011 to 2012, 1,369 practicing CS in California, Texas, and New England were surveyed to investigate adherence to the instructions. A descriptive analysis was conducted on 907 (66 %) respondents. Of 907 respondents, 739 (83 %) had read the instructions and 565 (63 %) understood that a chest radiograph is required for status adjustors with TB symptoms; however, only 326 (36 %) knew that a chest radiograph is required for immunosuppressed status adjustors. When suspecting TB disease, 105 (12 %) would neither report nor refer status adjustors to the health department; 91 (10 %) would neither start treatment nor refer for TB infection. Most CS followed aspects of the technical instructions; however, educational opportunities are warranted to ensure positive patient outcomes.

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Misidentification of English Language Proficiency in Triage: Impact on Satisfaction and Door-to-Room Time

Abstract

We examined triage nurses' assessment of patients' language proficiency compared to patients' self-reported proficiency and the impact of language discordance on door-to-room time and patient satisfaction. This was a prospective study of emergency department walk-in patients. Patients completed a survey in which they identified their language proficiency. On a Likert scale, patients ranked how well they felt they were understood and how satisfied they were with the triage process. Nurses completed surveys identifying the patient's primary language and how well they felt they understood the patient. Door-to-room times were obtained from medical records. 163 patients were enrolled. 66 % of patients identified themselves as having good English proficiency, while 34 % of patients had limited English proficiency. Nurses misclassified 27 % of self-identified Spanish-speaking patients as being English proficient. Spanish-speakers felt less satisfied with triage than English-speakers (p < 0.01). There were no differences in door-to-room time. Triage nurses overestimate patient language skills. Spanish-speaking patients feel less satisfied with triage than English-speakers.

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Erratum to: Acculturation and Depressive Symptoms in Hispanic Older Adults: Does Perceived Ethnic Density Moderate their Relationship?

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Domestic Violence: Intersection of Culture, Gender and Context

Abstract

This study examines South Asian women's experience of domestic violence in Hong Kong. Despite the proliferation of literature on domestic violence, this issue remain unexplored in the discourse of domestic violence in Hong Kong. A qualitative research approach through face to face interview with 14 women was employed. Participants were recruited through purposive and snowball sampling. Findings from this study highlight the importance of considering the social and cultural influence on how women perceived and construct their experiences of abuse.Implications for practice and policies are highlighted.

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Impact of Routine Quantiferon Testing on Latent Tuberculosis Diagnosis and Treatment in Refugees in Multnomah County, Oregon, November 2009–October 2012

Abstract

Interferon-gamma release assays have potentially been transformative to screening programs focused on latent tuberculosis infection (LTBI) in foreign-born persons. We sought to add to this assessment by presenting the impact of a well-established refugee screening and treatment program switching from skin testing to Quantiferon^®-TB Gold (QFT). We completed a retrospective cohort of refugees screened for tuberculosis between November 1, 2009–April 30, 2011 (pre-QFT) and May 1, 2011–October 31, 2012 (post-QFT). Among 2244 refugees screened that met the inclusion criteria, there was a significant difference in the proportion of refugees diagnosed with LTBI between the two time periods (p = <0.0001). In multivariate analysis, refugees tested with QFT had a greater odds of treatment initiation (adjusted odds ratio 1.53; 95 % CI 1.02–2.29, p = 0.040). However, test type had no impact on treatment completion (odds ratio 0.88; 95 % CI 0.57–1.36, p = 0.560). Although we demonstrated increased efficiency in LTBI diagnosis in this group, treatment completion rates indicate other barriers to treatment that must be addressed.

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Stress and Personality Development Among US-Immigrating Youth

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Immunization Status of Young People Attending a Youth Clinic in Geneva, Switzerland

Abstract

Adolescent vaccination coverage is very variable in European countries and data are scarce. The aim of this study was to assess immunization status and analyze potential variations according to sociodemographic variables in a youth clinic in Geneva, Switzerland. Immunization status was assessed retrospectively: Tetanus (number of doses or in absence of data tetanus antibodies) and measles as indicators of childhood coverage as well as hepatitis B and human papillomavirus. All new patients (N = 390) of Geneva University Hospital's youth clinic were included between January 2010 and June 2011. Vaccine coverage was low for all vaccines regardless of sex or origin. 89 % of young people tested (mostly recent immigrants with no available data) had tetanus antibodies indicating adequate childhood immunization but hepatitis B and HPV coverage was low especially in recent immigrants. Systematic assessment allows better adolescent vaccine coverage and can improve safety by avoiding unnecessary dosis.

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Needs, Risks, and Context in Sexual Health Among Temporary Foreign Migrant Farmworkers in Canada: A Pilot Study with Mexican and Caribbean Workers

Abstract

Every year Canada hosts approximately 40,000 temporary foreign migrant farmworkers (MFWs). They are predominantly Mexican and Caribbean married men or single mothers who leave their families for months at a time over a span of many years. This pilot study investigated their knowledge about HIV/AIDS, attitudes towards condoms and their use, and perceived barriers to accessing sexual health services. A survey (n = 103) and four focus groups (n = 21) were conducted in Ontario's Niagara Region. The results suggest that MFWs commonly face vulnerabilities to HIV/AIDS, STIs and other sexual health issues due to personal, social–cultural, environmental and structural factors. The findings highlight the need for increasing culturally and gender sensitive sexual health education and harm reduction outreach and providing information about local health care systems and resources for MFWs. The study also calls for further community-based research and actions to reduce MFWs' perceived access barriers to health care services.

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A Review of Barriers to Minorities’ Participation in Cancer Clinical Trials: Implications for Future Cancer Research

Abstract

To enhance nurses' awareness and competencies in practice and research by reporting the common barriers to participation of minorities in cancer clinical trials and discussing facilitators and useful strategies for recruitment. Several databases were searched for articles published in peer reviewed journals. Some of the barriers to minorities' participation in clinical trials were identified within the cultural social-context of cancer patients. The involvement of community networking was suggested as the most effective strategy for the recruitment of minorities in cancer clinical trials. Using culturally sensitive approaches to enhance ethnic minorities' participation is important for advancing cancer care and eliminating health disparities. Awareness of barriers and potential facilitators to the enrollment of ethnic minority cancer patients may contribute to enhancing nurses' competencies of recruiting ethnic minorities in nursing research, playing efficient roles in cancer clinical trials team, and providing culturally competent quality care.

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“Can I Ask That?”: Perspectives on Perinatal Care After Resettlement Among Karen Refugee Women, Medical Providers, and Community-Based Doulas

Abstract

This study characterized the perspectives of Karen refugee women in Buffalo, NY, their medical providers, and Karen interpreters/doulas on perinatal care for Karen women in resettlement. In-depth qualitative interviews with Karen women (14), Karen doulas/interpreters and key informants (8), and medical providers (6) were informed by the social contextual model and focused on women's questions about and opinions of perinatal care in Buffalo and on providers' experiences caring for Karen patients. Karen women expressed gratitude for and understanding of perinatal care in Buffalo, and providers described Karen patients as agreeable but shy. Karen doulas offered an alternative view that exposed women's many questions and concerns, and described how doula training empowered them as patients' advocates. Low self-efficacy, trauma histories, and cultural expectations may contribute to Karen women's seeming agreeability. Doulas/interpreters possess insider knowledge of women's concerns and facilitate communication between patients and the care team.

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Determinants of Subjective Social Status and Health Among Latin American Women Immigrants in Spain: A Qualitative Approach

Abstract

This qualitative study was carried out to better understand factors that determine the subjective social status of Latin Americans in Spain. The study was conducted following a theoretical framework and forms part of broader study on subjective social status and health. Ten immigrant participants engaged in semi-structured interviews, from which data were collected. The study results show that socioeconomic aspects of the crisis and of policies adopted have shaped immigrant living conditions in Spain. Four major themes that emerged from the analysis were related to non-recognition of educational credentials, precarious working conditions, unemployment and loneliness. These results illustrate the outcomes of current policies on health and suggest a need for health professionals to orient practices toward social determinants, thus utilizing evaluations of subjective social status to reduce inequalities in health.

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Migrant Selectivity or Cultural Buffering? Investigating the Black Immigrant Health Advantage in Low Birth Weight

Abstract

Prior studies on population health have reported an "immigrant health advantage" in which immigrants tend to show better health outcomes compared to their native-born racial/ethnic counterparts. Migrant selectivity and cultural buffering have been proposed as explanations for this relative advantage, predominantly in studies that focus on Latino immigrants' health in the US. This study adds to the relatively scant literature on black immigrant health advantage by comparing the two hypotheses (migrant selectivity and cultural buffering) as related to black immigrant health. The effect of nativity on infant low birth weight is tested using data from the US Fragile Families and Child Wellbeing Study. Results indicate that immigrant black mothers do have relatively better health outcomes that may result from cultural buffering, which reduces their risky health behaviors.

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The Relationship Between Self-Rated Health and Acculturation in Hispanic and Asian Adult Immigrants: A Systematic Review

Abstract

We systematically reviewed studies to identify the association between acculturation and self-rated health (SRH) and the impact of nativity and language use in Asian and Hispanic adult immigrants. Six electronic databases were searched. Data on nativity and limited English proficiency (LEP) was extracted and analyzed. Nine studies met review criteria. A positive association between acculturation and fair/poor SRH among Asians and Hispanics was found. For both Asians and Hispanics, six out of eight studies showed nativity and all three studies reporting LEP were associated with worse SRH compared to whites. Nativity and LEP were found to be risk factors for reporting worse SRH in Hispanics compared to Asians. The degree of association between nativity and LEP and worse SRH was found to vary by Asian and Hispanic subgroup. Further studies are needed to accurately assess the health status of these populations, which will be essential to eliminating disparities.

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Enteroscopy and radiology for the management of celiac disease complications: Time for a pragmatic roadmap

Celiac disease is the most common autoimmune enteropathy in Western countries, and is usually associated with a good response to the gluten free diet and an excellent prognosis. However, a minority of patients develop complications of the disease, such as refractory celiac disease, ulcerative jejunoileitis and neoplastic complications such as adenocarcinoma of the small bowel and enteropathy associated T cell lymphoma. Neoplastic complications described in association with celiac disease have a high mortality rate, due to their aggressive behavior and to the usual advanced stage at the time of diagnosis.

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Protective effects of P2X7 receptor deletion on aging-related memory alterations

Abstract

Neuroinflammation is one of the factors implicated in cognitive aging. Recent studies have shown that the P2X7 receptor (P2X7R) is a major inflammatory regulator in microglia. The present study examined the effects of deletion of P2X7R on cognitive aging. Cognitive status was examined in 5-month-old (young) and 11- to 14-month-old (middle-aged) mice with P2X7R deletion (P2X7R knockout (KO)), and in age-matched control wild type mice, using the Morris water maze task. No differences were observed between the performances of young control mice and young P2X7R KO mice in the Morris water maze task. However, middle-aged P2X7R KO mice demonstrated better performance than middle-aged control mice. No differences were observed in hippocampal interleukin-1β levels and the number of microglial cells in the cornus ammonis (CA1) region of the hippocampus during microglial activation in young and middle-aged P2X7R KO mice, and control mice. Hippocampal levels of the inhibitory form of glycogen synthase kinase-3β were lower in young control mice than in mice in the other groups. These results suggest that the inhibition of P2X7R might have beneficial effects on aging-related cognitive impairments.

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Treatment satisfaction, preferences and perception gaps between patients and physicians in the ulcerative colitis CARES study: A real world-based study

Ulcerative colitis (UC) is a life time disease and issues with therapy may impact on patient satisfaction and treatment preferences.

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Improved outcome of acute severe ulcerative colitis while using early predictors of corticosteroid failure and rescue therapies

Intravenous corticosteroids remain the first line therapy for severe attacks of ulcerative colitis although up to 30–40% of patients do not respond to treatment. The availability of alternative therapies to colectomy and the knowledge of early predictors of response to corticosteroids should have improved the clinical outcomes of patients with severe refractory ulcerative colitis. The aim of the study is to describe the current need, way of use, and efficacy of rescue therapies, as well as colectomy rates in patients with severe ulcerative colitis flares.

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Identification of microRNA and target gene associated with marbling score in Korean cattle (Hanwoo)

Abstract

Marbling is a crucial characteristic in meat quality assessment. In the search for a genetic basis of meat quality, a large number of gene analyses seeking to find loci for a marbling trait have already been reported. However, the influence of microRNA (miRNA) on expression patterns and their ultimate influence on marbling is poorly understood. To better understand post-transcriptional influences on marbling, we applied a microarray analysis to measure the relationship between marbling scores and miRNA and messenger RNA expression in Hanwoo longissimus muscle tissue. Our results build correlations between miRNAs and differentially expressed genes and pathways. Our microarray analysis identified 763 genes and 11 miRNAs that are differentially expressed relative to marbling score. Overall, upregulated miRNAs were associated with downregulated genes. Fifteen genes targeted by miRNAs including insulin-like growth factor 1 (IGF-1) and kruppel-like factor 11 (KLF11), which regulate fatty acid synthase and lipid metabolism. And the expression levels of KLF11 and bta-miR-494 were validated. The results show that downregulated bta-miR-494 was associated with the upregulation of KLF11 gene. Among the differentially expressed genes found to be associated with the marbling score, we identified 15 genes targeted by miRNAs. Furthermore, the expression patterns of the genes KLF11, and bta-miR-494, may influence marbling in Hanwoo.

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Successful eradication of Helicobacter pylori infection with vonoprazan-based triple therapy after failure of PPI-based triple therapy

In Japan, first- and second-line regimens for Helicobacter pylori (H. pylori) eradication consist of twice daily dosing (b.d.) with a proton pump inhibitor (PPI), such as amoxicillin (750mg), and clarithromycin (200/400mg) or metronidazole (250mg) for 7 days [1]. However, the rate of eradication has been gradually decreasing due to increased prevalence of clarithromycin-resistant H. pylori strains [1,2], thus third-line treatment with sitafloxacin is increasingly used with moderate success [3]. Recently, vonoprazan fumarate, a first-in-class potassium-competitive acid blocker (PCAB) with rapid, potent, and prolonged gastric acid suppression, became available for clinical use in Japan [4].

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Dual therapy with peg-interferon and ribavirin in thalassemia major patients with chronic HCV infection: Is there still an indication?

Iron overload and hepatitis C virus (HCV) infection together can lead to chronic liver damage in thalassemia major (TM) patients.

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Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Patients with cirrhosis present with hemostatic alterations secondary to reduced availability of pro-coagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014.

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Fecal hemoglobin concentration is useful for risk stratification of advanced colorectal neoplasia

Although a fecal immunochemical test (FIT) allows quantitation of fecal hemoglobin (f-Hb), it is typically used as a binary result to identify subjects above a predetermined cut-off concentration.

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Enteroscopy and radiology for the management of celiac disease complications: Time for a pragmatic roadmap

The internal mammary artery as a shunt in a noncyanotic infant with hemitruncus: surgical and anesthetic management

The internal mammary artery (IMA) has been used as a systemic-to-pulmonary artery shunt in selected patients with congenital heart disease. Growth and development of hypoplastic pulmonary arteries have been described. We discuss the surgical and anesthetic management of an infant with an atretic-thrombosed right pulmonary artery originating from the ascending aorta in whom the IMA was used to create a systemic-to-pulmonary artery shunt after failure of a previous shunt and later successful pulmonary artery reconstruction.

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Treatment satisfaction, preferences and perception gaps between patients and physicians in the ulcerative colitis CARES study: A real world-based study

A first look at the Accreditation Council for Graduate Medical Education anesthesiology milestones: implementation of self-evaluation in a large residency program

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The objective was to determine if there is a correlation between resident postgraduate year (PGY) of training and self-evaluation of performance using the Accreditation Council for Graduate Medical Education milestones.

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Improved outcome of acute severe ulcerative colitis while using early predictors of corticosteroid failure and rescue therapies

Inspection of the nasopharynx prior to fiberoptic-guided nasotracheal intubation reduces the risk epistaxis

Various complications may occur during nasotracheal intubation. This may include epistaxis and damage to the nasopharyngeal airway. We tested the hypothesis that the use of fiberoptic bronchoscopy (FOB)–guided intubation is superior to endotracheal tube (ETT) obturated with an inflated esophageal stethoscope.

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Successful eradication of Helicobacter pylori infection with vonoprazan-based triple therapy after failure of PPI-based triple therapy

Significance of basic airway management simulation training for medical students

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The American Heart Association cardiopulmonary guidelines recommend not only tracheal intubation (TI), but also bag-valve-mask (BVM) ventilation and supraglottic device (SGD) ventilation in emergent situations. However, given their lack of experience, novice doctors and medical students may find it difficult to implement these recommendations. Here, we used simulation training to have medical students experience the practical difficulties associated with basic airway management.

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Dual therapy with peg-interferon and ribavirin in thalassemia major patients with chronic HCV infection: Is there still an indication?

No laughing matter: nitrous oxide triggers serotonin syndrome in an anxious adolescent

A 16-year-old girl with generalized anxiety disorder and chronic abdominal pain presented for elective upper endoscopy and colonoscopy. Her medication list included fluoxetine and buspirone. Because of severe preoperative anxiety, 50% nitrous oxide was administered to facilitate intravenous catheter placement. Despite this, the patient was extremely tearful, so general anesthesia was induced with the addition of 8% sevoflurane.

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Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

A proposal for modification of nontechnical skill assessment for perioperative crisis management simulation training

Effectiveness of simulation-based training for improving operating room patient safety is established [1]. Simulation-based education and training are not only effective for acquiring technical skills but also for developing nontechnical skills, such as situation awareness, cooperation, decision making, leadership, and communication in emergency situations. In the operating room, the importance of establishing "perioperative team" training is essential from the viewpoints of crisis management and resuscitation; examples include intraoperative massive bleeding and cardiac arrest [2].

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Fecal hemoglobin concentration is useful for risk stratification of advanced colorectal neoplasia

Facilitators and Barriers of Implementing a Measurement Feedback System in Public Youth Mental Health

Abstract

This study examines implementation facilitators and barriers of a statewide roll-out of a measurement feedback system (MFS) in a youth public mental health system. 76 % of all state care coordinators (N = 47) completed interviews, which were coded via content analysis until saturation. Facilitators (e.g., recognition of the MFS's clinical utility) and barriers (e.g., MFS's reliability and validity) emerged paralleling the Exploration, Adoption/Preparation, Implementation, and Sustainment framework outlined by Aarons et al. (Adm Policy Mental Health Mental Health Serv Res, 38:4–23, 2011). Sustainment efforts may leverage innovation fit, individual adopter, and system related facilitators.

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Response to correspondence to Hale et al. atypical phenotypes associated with pathogenic CHD7 variants and a proposal for broadening CHARGE syndrome clinical diagnostic criteria

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The management of pregnancy and delivery in 3-hydroxy-3-methylglutaryl-CoA lyase deficiency

3-hydroxy-3-methylglutaric (HMG)-CoA lyase is required for ketogenesis and leucine degradation. Patients with HMG-CoA lyase deficiency typically present with hypoketotic hypoglycemia and metabolic acidosis, which can be fatal if untreated. The patient is a 28-year-old female with HMG-CoA lyase deficiency who presented at 4 weeks gestation for prenatal care. Protein intake as well as carnitine supplementation were gradually increased to support maternal and fetal demands up to 65 g per day for protein and 80 mg/kg/day for carnitine. Fetal growth was appropriate. At 36 5/7 weeks, she presented with spontaneous rupture of membranes. Twice maintenance 10% glucose-containing intravenous fluids were initiated. During labor, vomiting and metabolic acidosis developed. Delivery was by cesarean. Preeclampsia developed postpartum. The patient recovered well and was discharged home on postpartum day 5. Stress of pregnancy and labor and delivery can lead to metabolic decompensation in HMG-CoA lyase deficiency. Patients should be monitored closely by a biochemical geneticist, dietitian, and high-risk obstetrician at a tertiary care center during their pregnancy. Fasting should be avoided. Intravenous 10% glucose-containing fluids should be provided to prevent catabolism and metabolic decompensation during labor and delivery. © 2016 Wiley Periodicals, Inc.

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THE CAUSALITY RELATIONSHIP BETWEEN INFLATION, INCOME AND HEALTH EXPENDITURE

2016-03-21T09-27-11Z
Source: TAF Preventive Medicine Bulletin
Serap Taşkaya, Mustafa Demirkıran.
BACKGROUND: Health expenditures per capita has been increased substantially over the worldwide. As a result of the increase in health spending, conducting researches to understand the determinants of this change has gained great importance with increases in health spending. However, when the studies on this subject were analyzed, it was observed that researches were generally focused on the gross domestic product per capita and health spending per and the other economic variables were ignored. Therefore, the aim of this study was to determine the causality relationship between health expenditure as a part of the gross domestic product, gross domestic product per capita and the inflation rate in Turkey. METHODS: The empirical modeling of this research was based on how gross domestic product per capita and inflation rates had an impact on health expenditure per capita. Data were gathered from the World Bank Databases and OECD Health Data, 2015 and were included the period from 1975 to 2013. Granger method was used to investigate the causal relationship between variables. Analyses were performed with Eviews 9 software program. RESULTS: At the end of the analysis, it was found out that there is no relationship between gross domestic product per capita, infilation rate, and health expenditure as a part of the gross domestic product. Inflation rate had only an effect on gross domestic product. CONCLUSION: These results are expected to provide evidence base information for understanding the differences occurred in health system and explaining determinants that have an impact on dynamics of health expenditures.

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Genetic testing: Whole-exome sequencing for clinical diagnostics

Nature Reviews Genetics. doi:10.1038/nrg.2016.38

Author: Linda Koch

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A NeuroAnatomoPhysiological approach to the "Formation and Expression" of Personality and Psychopatology:

2016-03-21T07-39-06Z
Source: The Journal of Neurobehavioral Sciences
Levon Antikacioglu.
Despite the advancements in neurosciences, there are still, only a few Personality Theories, making use of neuropsychology. In the present paper, we tried to propose a NeuroAnatomoPhysiological approach to the Formation and Expression of Personality and Pschopatology and discussed the possibility of formation of a new study area.

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Brain-Derived Neurotrophic Factor and Exercise, Can It Be a New Factor for Athletic Performance?

2016-03-21T07-39-06Z
Source: The Journal of Neurobehavioral Sciences
Korkut Ulucan.

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Complex disease: A global view of regulatory networks

Nature Reviews Genetics. doi:10.1038/nrg.2016.36

Author: Linda Koch

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Clinicians’ hesitation in using clozapine

2016-03-21T07-39-06Z
Source: The Journal of Neurobehavioral Sciences
Gökben Hızlı Sayar.

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Translating RNA sequencing into clinical diagnostics: opportunities and challenges

Nature Reviews Genetics. doi:10.1038/nrg.2016.10

Authors: Sara A. Byron, Kendall R. Van Keuren-Jensen, David M. Engelthaler, John D. Carpten & David W. Craig

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Gene Therapy and Gene Delivery to the Brain Using Viral Vectors

2016-03-21T07-39-06Z
Source: The Journal of Neurobehavioral Sciences
Can Akpınaroğlu, Gökben Hızlı Sayar.
Treating monogenic disorders via gene therapy although still considered experimental by some, has becoming a more accepted method lately especially in these last 10 years with a number of recent clinical successes. Genetic modifications are becoming easier to perform with the progressing technology and discovery of new techniques such as the Clustered regularly interspaced short palindromic repeats (CRISPR)-CRISPR associated protein 9 (Cas9) methods which can modify DNA with great ease and accuracy. Gene therapy is a powerful technique with huge potential to treat psychiatric and neurodegenerative disorders including Alzheimers and Parkinsons disease. Gene therapy is simple in principle, which is corrective genetic material is sent into cells and the disease is cured by ending the problem at its source. Viral and non-viral vectors which are used for the delivery of the desired genes to the targeted cells are briefly listed and explained. Unlike viral vectors non-viral vectors dont cause an immune response but their pretty low transfer rate makes them rather less interesting for research. Viral vectors of adenoviruses, adeno-associated viruses, retroviruses with its subclass of lentiviruses and herpes viruses are compared with their advantages and disadvantages related to usage in brain and CNS treatment of our topic. Neurotrophic factors (NTFs) have important roles in brain and nervous tissue. Delivering NTFs via viral vectors for treating neurodegenerative diseases is a promising approach. Providing information about principles, methods, hurdles and clinical applications of gene therapy with its historic background to present it with its all basic details and therapeutic effects it can provide to problems related to brain are aimed in this writing.

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Technique: Unwanted sequences DASH off

Nature Reviews Genetics. doi:10.1038/nrg.2016.37

Author: Linda Koch

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Neuroprotective Benefits of Atorvastatin in Dementia and Stroke

2016-03-21T07-39-06Z
Source: The Journal of Neurobehavioral Sciences
Pushpa Natarajan, Sampath Kumar, Sinu Sahl, Vijaya Anand.
Dementia and stroke are the major health problem often occurs in older individuals aged 65 or more. There are many studies confirm that cholesterol might be involved in the pathogenesis of dementia and stroke. Atorvastatin, broadly used to lower cholesterol in coronary heart disease, are viable medications in decreasing the danger of dementia and stroke. Use of atorvastatin for prolonged period seems to be effective for the prevention of dementia and stroke. The objective of this review is to focuses the pharmacological benefit of atorvastatin in dementia and stroke.

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Reprogramming: Your contacts reveal your past

Nature Reviews Genetics. doi:10.1038/nrg.2016.35

Author: Darren J. Burgess

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Comparative study of tramadol and piroxicam as analgesic for postoperative pain in patients operated for inguinal hernia and hydrocele

2016-03-21T08-00-44Z
Source: International Journal of Basic & Clinical Pharmacology
Ajay Kumar Shukla, Mustafa Raja, Arun Kumar Srivastav.
Background: Pain is usually protective, it warns of tissue damage and prompts treatment but postoperatively, it can delay recovery. Postoperative pain is both distressing and detrimental for the patient. Postoperative pain may be a significant reason for delayed discharge from hospital, increased morbidity and reduced patient satisfaction. Methods: This was a hospital based prospective, randomized, comparative, observational study conducted over a period of one year. Patients operated for hydrocele and inguinal hernia were included in the study after applying the inclusion and exclusion criteria. For the purpose of study, equal numbers of subjects were randomly allocated one of the two analgesic protocols. Pain assessment was done by using visual analog scale (VAS) for the first 72 hours of the postoperative period. Results: When the drugs were compared individually, piroxicam was superior to tramadol in first 24, 48 and 72 hours of postoperative period in case of pain after surgery for hernia. Piroxicam was found to be superior to tramadol in first postoperative 24 hours after surgery for hydrocele with no significant difference first 48 & 72 hours of postoperative period. Piroxicam has the advantage of requiring lesser frequency of administration than tramadol due to prolonged duration of action. Conclusions: Piroxicam provides better and effective analgesia in acute post-operative pain along with the advantage of requiring lesser frequency of administration than tramadol.

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Comparison of effects of rocuronium bromide vs. vecuronium bromide on hemodynamic parameters during anaesthesia for elective surgical procedures

2016-03-21T08-00-44Z
Source: International Journal of Basic & Clinical Pharmacology
Anjali P. Savargaonkar, Dipakkumar H. Ruparel, Ranjit S. Patil.
Background: Understanding haemodynamic effects of muscle relaxants may help us in selection of most appropriate muscle relaxant in a given case after considering preoperative cardiac status, preoperative medications, anaesthetic drugs to be used, nature of surgery and desirable intraoperative hemodynamics. Hemodynamic effects of rocuronium are not as clear as vecuronium. Present study was conducted to compare haemodynamic parameters during general anaesthesia for elective surgical procedures with vecuronium vs. rocuronium as muscle relaxant. Methods: Haemodynamic effects of vecuronium 0.15 mg/kg and 0.9 mg/kg of rocuronium was evaluated in patients (25 patients in each group) undergoing elective surgical procedures not lasting more than two hours. During this study period patients were evaluated for heart rate (HR), systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP). Results: When both groups were compared, degree of fall in heart rate was more in vecuronium group (V group) compared to rocuronium group at all-time intervals after administration of drug. The fall in mean heart rate in V group was significant at two minutes after administration of muscle relaxant when compared to R group i.e.77.12±9.96 vs. 85.04±12.82 (p

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A study to assess and increase awareness regarding fixed dose combinations among medical undergraduates at Indore and Sagar, India

2016-03-21T08-00-44Z
Source: International Journal of Basic & Clinical Pharmacology
Shubham Atal, Pradeep Phadnis, Gopal Gudsurkar.
Background: Fixed dose combination (FDC) is a formulation containing two or more active ingredients in a fixed ratio of doses. Presently, there is lot of debate over rationality- irrationality, advantages-disadvantages of FDCs. Their judicious use or misuse is primarily up to the physician. FDCs should be focused upon in detail in undergraduate teaching as these students would be the future practitioners. Hence, the present study was undertaken to address these issue regarding FDCs in medical undergraduates in 2 government medical colleges in central India. Methods: Questionnaire addressing various aspects of FDCs was prepared. Survey was conducted at medical colleges at Indore and Sagar among MBBS students belonging to 2nd and 3rd professional years. After pre-test questionnaires were filled, an educational intervention was given to students in the form of an interactive presentation on FDCs addressing all the major aspects. After a week, the post-test questionnaire containing same 20 questions was administered to the students. Data from pre and post-test responses was compiled in tabular form and analysed using simple percentage method. Results: Pre-test responses showed that students already have a high level of awareness regarding basic concepts of FDCs; however they were found lacking in knowledge about the scientific aspects of FDCs. The educational interventional led to a substantial improvement in awareness regarding all aspects of FDCs and cleared students confusions. Conclusions: Students awareness and knowledge about an important topic like FDCs should be strengthened through focused training which can prove critical in promoting rational use of drugs in the future.

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Observational study to assess prescription cost and its relation to the socioeconomic status of the patients in psychiatry outpatient department in a tertiary care hospital

2016-03-21T08-00-44Z
Source: International Journal of Basic & Clinical Pharmacology
Sumit G. Goyal, Dnyaneshwar G. Kurle, Balwant D. Samant.
Background: To analyse the cost of prescriptions and to determine the relationship between socioeconomic status of the patients and the cost of prescriptions. Methods: A prospective, observational study was conducted in psychiatry OPD of a tertiary care hospital from August 2007 to January 2008. 300 patients of either sex and irrespective of age suffering from mental disorders were included. Information about the socioeconomic status of the patient was analysed on the basis of Kuppuswamis socioeconomic status scale (updated for 2007). Cost analysis (calculated for 30 days) was done by calculating (a) average cost of the prescription borne by the hospital (b) average cost of the prescription borne by the patient and (c) average total cost of the prescription. The correlation between the socioeconomic score of the patients with the above three cost parameters was carried out using the Spearman rank correlation. Results: In a cohort of 300 patients, 61.3% patients belong to upper lower class. Cost analysis showed that the average total cost of the prescription was 121.97 INR of which average cost of the prescription borne by the hospital and the patients was 18.43 INR and 103.54 INR respectively. The total cost of the prescription and cost of prescription borne by the patient had a positive correlation with the socioeconomic score of the patient, while the cost of prescription borne by the hospital was inversely correlated with the socioeconomic score of the patient. Conclusions: It seems that the prescribing decision was influenced by the socioeconomic status of the patients.

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Parameters affecting to select of contraceptive methods

2016-03-21T08-47-28Z
Source: Medicine Science | International Medical Journal
Mehmet Cinar, Hakan Timur, Rifat Taner Aksoy, Demet Kokanali, Aytekin Tokmak, Yasemin Tasci.
Aim of this study is to evaluate the relationship between choose a contraceptive method and demographic values in patients who examined in our family planning clinic. This study included 252 patients who want to choose a contraceptive method to prevent pregnancy in Zekai Tahir Burak Women Health and Resource Hospital family planning clinic. Risk factors recorded were age, gravidity, parity, duration of marriage, education status, systemic disease and selected contraceptive method. The mean age of the study group was 30.4±8.6 and the mean of the duration of marriage, gravidity, parity were 9.4±6.2(0-12) years, 3.1±1.6 (0-7), 2.6±1.4 (0-5); respectively. The most commonly used method were coitus interruptus (% 30.6). The frequency of other methods were; intrauterine device (IUD) (%29.7),oral contraceptives (%15.1), condom (%11.5), tubal ligation (% 3.1), depot progesterone (%9.12), subcutaneous implants (%0.8); respectively. Women's level of education increases, subcutaneous implants , oral contraceptives and IUD use was increasing (p

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Effect of slow breathing training on heart rate, spontaneous respiratory rate and pattern of breathing

2016-03-21T08-36-40Z
Source: International Journal of Research in Medical Sciences
Ritu Adhana, Moneet Agarwal, Rani Gupta, Jyoti Dvivedi.
Background: The study was performed to see the effect of slow breathing (6 breaths/minute) training on spontaneous respiratory rate, heart rate and pattern of breathing. Methods: Sixty subjects between the ages 20-50 years were included in the study. After the rest of 10-15 minutes in a comfortable sitting posture their baseline heart rate (HR), respiratory rate (RR) and pattern of breathing were recorded on digital polygraph. Then they were guided to do slow breathing maintaining rate of around 6 per minute. Subjects were then instructed to do slow breathing exercise for 8-10 minutes twice daily for next three months. Subjects reported back after three months of practicing slow breathing and their HR, RR, and pattern of breathing were again assessed by digital polygraph. Results: After three months of practicing slow breathing there was statistically significant reduction in heart rate and spontaneous respiratory rate. Shifting of pattern of breathing from thoracic pattern to abdominal pattern of breathing was also very highly significant. Conclusions: The study showed that slow breathing technique causes comprehensive change in body physiology by controlling autonomic nervous system. It regularizes rate and pattern of breathing.

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The diagnostic value of CRP and ADA biomarkers for differentiation of exudative pleural effusion

2016-03-21T08-36-40Z
Source: International Journal of Research in Medical Sciences
Lira Hakani, Anila Mitre.
Background: The aim of the present study was to investigate the roles biomarkers C-reactive protein (CRP) and adenosine deaminase (ADA) in the differentiation of exudative pleural effusion and tuberculosis from non-tuberculosis pleural effusion. Methods: The present study enrolled 150 patients with pleural effusion that were admitted to hospital between 2012-2015. From the patients were obtained pleural fluid and serum which were administrated to test analyses within 24 hours. ADA and CRP levels were compared between the groups of exudative pleural effusion. Based on Light's criteria, biochemical, cytological etc. analyses were established the pleural effusion as exudative and the etiology of the effusion, 60 malign, 48 tuberculosis, 42 parapneumonic. Results: ADA and CRP levels differ significantly between the different groups of exudative pleural effusion but ADA ratio, pleural fluid/serum, didnt contribute in this difference. As a better test for the difference of tuberculosis from non-tuberculosis was evaluated, ADA level in pleural fluid. Conclusions: ADA and CRP are considerable biomarker for the differences in exudative pleural effusion groups and for the difference of tuberculosis from non-tuberculosis pleural effusion. It is recommended that that other markers need to be taken into consideration to assist the results.

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A study of awareness and knowledge about cataract among students

2016-03-21T08-36-40Z
Source: International Journal of Research in Medical Sciences
Sanjeev Kumar Puri, Suma Elangovan.
Background: To study the awareness about cataract among students (non-medical). Methods: A questionnaire based study was conducted among 430 students (non-medical). The questions tested their awareness about cataract and also about the potential ocular complications of the disease and the treatments available currently. Results: 65.81% (283/430) have heard about cataract. 50 students out of 283 students were aware about the basic facts about cataract. The rest 233 students have just heard of the term cataract. Overall only 11.62% (50/430) were aware about the basic facts about cataract. 34.10% (147/430) was not aware about cataract. Conclusions: The awareness of one of the leading cause of treatable blindness like cataract is low among students. Steps should be taken to increase the awareness about cataract and also about the various treatment options available for cataract. More focus should be on cataract in health education programmes.

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New Insights into Enhancing Maximal Exercise Performance Through the Use of a Bitter Tastant

Abstract

It is generally acknowledged that for an orally administered ergogenic aid to enhance exercise performance it must first be absorbed by the gastrointestinal tract before exerting its effects. Recently, however, it has been reported that some ergogenic aids can affect exercise performance without prior absorption by the gastrointestinal tract. This is best illustrated by studies that have shown that rinsing the mouth with a carbohydrate (CHO) solution, without swallowing it, significantly improves exercise performance. The ergogenic effects of CHO mouth rinsing in these studies have been attributed to the activation of the brain by afferent taste signals, but the specific mechanisms by which this brain activation translates to enhanced exercise performance have not yet been elucidated. Given the benefits of CHO mouth rinsing for exercise performance, this raises the issue of whether other types of tastants, such as bitter-tasting solutions, may also improve exercise performance. Recently, we performed a series of studies investigating whether the bitter tastant quinine can improve maximal sprint performance in competitive male cyclists, and, if so, to examine some of the possible mechanisms whereby this effect may occur. These studies have shown that mouth rinsing and ingesting a bitter-tasting quinine solution can significantly improve the performance of a maximal cycling sprint. There is also evidence that the ergogenic effect of quinine is mediated, at least in part, by an increase in autonomic nervous system activation and/or corticomotor excitability. The purpose of this article is to discuss the results and implications of these recent studies and to suggest avenues for further research, which may add to the understanding of the way the brain integrates signals from the oral cavity with motor behaviour, as well as uncover novel strategies to improve exercise performance.

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A study of awareness of ocular complications of diabetes among students

2016-03-21T08-36-40Z
Source: International Journal of Research in Medical Sciences
Sanjeev Kumar Puri, Suma Elangovan.
Background: To study the awareness of ocular complications due to diabetes mellitus among students. Methods: A questionnaire based study was conducted among 430 students (non-medical). The questions tested their awareness about diabetes mellitus and also about the potential ocular complications of the disease. Results: Out of 430 students 73.02% (314/430) have heard about diabetes mellitus but they did not know that it can affect the eye and can lead to blindness. They were unaware that regular eye check-up is important in diabetes mellitus. 18.83% (81/430) were aware about the disease and its potential to cause vision threatening complications. 8.13% (35/430) were not aware about diabetes mellitus. Overall only 18.83% had some basic knowledge about diabetes and its complications. Conclusions: The level of awareness about ocular complications due to diabetes mellitus is low among students. Therefore steps should be taken to increase the awareness about diabetes and inculcate some basic knowledge about its potential complications especially vision threatening diabetic retinopathy. It should be strongly emphasized that periodic eye check-up is important to prevent needless blindness and visual dysfunction.

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The impact of obesity on semen parameters and hormone levels in infertile men

2016-03-21T02-34-19Z
Source: Medicine Science | International Medical Journal
Erkan Ozdemir, Aytekin Tokmak, Ahmet Deniz Tuzluoglu, Sezen Bozkurt Koseoglu, Mehmet Cinar, Ayse Sahin, Nafiye Yilmaz.
Previous studies in overweight men have shown an increased likelihood of abnormal semen parameters. Obesity has been found to be associated with male subfertility. In this study we aimed to investigate the effect of obesity on semen parameters and hormone levels in infertile males. This was a prospective cross-sectional study designed to assess the influence of obesity on semen parameters and hormone levels in infertile men. 88 obese [Body mass index (BMI) ≥30 kg/m2] men and 169 non-obese (BMI

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Baseline features and differences in 48 week clinical outcomes in patients with gastroparesis and type 1 vs type 2 diabetes

Neurogastroenterology & Motility

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Clinical characteristics and molecular analysis of hepatitis B virus reactivation in hepatitis B surface antigen-negative patients during or after immunosuppressive or cytotoxic chemotherapy

Journal of Gastroenterology

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The role of postoperative adjuvant chemotherapy for lymph node-positive esophageal squamous cell carcinoma: a propensity score matching analysis

Medical Oncology

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Outcome of long-term maintenance steroid therapy cessation in patients with autoimmune pancreatitis: a prospective study

Journal of Clinical Gastroenterology

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Medullary carcinoma in the colorectum: a systematic review and meta-analysis

Human Pathology

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Risk of headache-related healthcare visits in patients with celiac disease: a population-based observational study

Headache: The Journal of Head and Face Pain

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Serum models accurately predict liver related clinical outcomes in chronic hepatitis C

Journal of Gastroenterology and Hepatology

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Sequential therapy is superior to triple therapy for Helicobacter pylori infection in children: a meta-analysis

The Indian Journal of Pediatrics

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A validated prognostic multigene expression assay for overall survival in resected colorectal cancer liver metastases

Clinical Cancer Research

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Risk of hepatocellular carcinoma after sustained virologic response in veterans with HCV-infection

Hepatology

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Comparative study of tumor markers in patients with colorectal carcinoma before and after chemotherapy

Annals of Translational Medicine

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Usefulness of housekeeping genes for the diagnosis of Helicobacter pylori infection, strain discrimination and detection of multiple infection

Helicobacter

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Conditional survival in anal carcinoma using the national population-based survey of epidemiology and end results database (1988–2012)

Diseases of the Colon and Rectum

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Δευτέρα 21 Μαρτίου 2016

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