Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026: 08/22/16

Δευτέρα 22 Αυγούστου 2016

Correlates of well-being among caregivers of long-term community-dwelling stroke survivors.

Although caregiving for stroke survivors is usually long-term, most studies on caregivers have generally involved only the first year following the event. We assessed and compared the long-term level of well-being measures among stroke survivors and their caregivers at more than 1 year following the stroke event and examined the associations between well-being, survivors' characteristics, and caregiver burden. We interviewed a convenience sample of 51 community-dwelling stroke survivors, at least 1 year after the last stroke event, and their primary caregivers. Disability of survivors was assessed using the Barthel index and the modified Rankin Scale; health-related quality of life by the SF-36 questionnaire; and depression and anxiety using the Hospital Anxiety Depression Scale. Caregivers filled the SF-36 questionnaire, Hospital Anxiety Depression Scale questionnaire, and the Zarit Burden Interview, which assesses caregiver burden. Caregivers reported low levels of health-related quality of life and high levels of burden, anxiety, and depression. Caregivers' anxiety level was higher than that of the survivors (7.7+/-5.1 vs. 5.8+/-4.5, respectively; P=0.02). Anxiety was the only characteristic of caregivers that was associated with overall caregiver burden. Our study suggests that there is a spillover effect of the disease on stroke patients' primary caregivers. Intervention programs for caregivers should focus on their mental state and address their specific needs. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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A Comparison of the Nutritional Value of Cow's Milk and Non-dairy Beverages.

Background and Objectives: Non-dairy beverages are advertised as a healthy alternative to cow's milk. There is an increased availability and consumption of non-dairy beverages and a decrease in consumption of cow's milk. The aim of this study is to review and compare the contents and nutritional value of non-dairy beverages to cow's milk. Methods: Information about the non-dairy beverages on the shelves at stores in Buffalo, New York was collected. The web pages of several manufacturers were assessed for product contents. The nutrient contents including the protein quality of the non-dairy beverages and cow's milk were compared. The nutrient contents of non-dairy beverages and cow's milk were also compared to recommended dietary allowance (RDA) or adequate intake (AI) for toddlers and young children. Results: Commonly available non-dairy beverages are derived from almond, cashew, coconut, hazelnut, hemp, oat, rice, and soy. Cow's milk has higher protein content and quality compared to most of these products. It was noted that most of these beverages are fortified with calcium and vitamin D. However, the the bioavailability of these substances after fortification is not available. Discussion: Non-dairy milk beverages vary in their nutritional profiles. These should not be considered a nutritional substitute for cow's milk until nutrient quality and bioavailability is established. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Clinical importance of cine-MRI assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction: a retrospective study of 33 patients

Abstract

Background

Although chronic intestinal pseudo-obstruction (CIPO) is a rare and extremely severe functional digestive disorder, its clinical course and severity show various patterns. We assessed small bowel peristalsis in CIPO patients using cine-MRI (video-motion MRI) and their clinical characteristics to evaluate the clinical importance of performing cine-MRI in patients with this intractable disease.

Methods

The medical records of 131 patients referred to our institution with a suspected diagnosis of CIPO between 2010 and 2015 were retrospectively evaluated. Thirty-three patients (22 female/11 male; age range 16–79 years) who met the criteria for CIPO and underwent cine-MRI were enrolled. Mean luminal diameter (MLD), contraction ratio (CR), and contraction cycle (CC) were determined and compared with these parameters in healthy volunteers. Clinical outcomes in patients with CIPO were also evaluated.

Results

The median follow-up time was 25.2 months (range, 1–65 months). Of the 33 patients with CIPO, 23 (70 %) showed apparently disturbed small intestinal peristalsis, whereas 10 (30 %) did not. The percentage of patients requiring intravenous alimentation was significantly higher (p = 0.03), and the mean serum albumin level was significantly lower (p = 0.04), in patients with than without impaired small intestinal peristalsis. Although both cine-MRI and CT findings in the latter ten cases were within the normal range, MLD and CR differed significantly from healthy volunteers.

Conclusions

Cine-MRI is useful in predicting severe clinical features in patients with CIPO, and in detecting slightly impaired small contractility that cannot be detected on CT.

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Ramucirumab as second-line treatment in patients with advanced hepatocellular carcinoma: Japanese subgroup analysis of the REACH trial

Abstract

Background

REACH evaluated ramucirumab in the second-line treatment of patients with advanced hepatocellular carcinoma. In the intent-to-treat population (n = 565), a significant improvement in overall survival (OS) was not observed. In patients with an elevated baseline α-fetoprotein (AFP) level (400 ng/mL or greater), an improvement in OS was demonstrated. An analysis of the Japanese patients in REACH was performed.

Methods

An analysis was performed with the subset of the intent-to-treat population enrolled in Japan (n = 93).

Results

The median OS was 12.9 months for the ramucirumab arm (n = 45) and 8.0 months for the placebo arm (n = 48) [hazard ratio (HR) 0.621 (95 % confidence interval (CI) 0.391–0.986); P = 0.0416]. The median progression-free survival was 4.1 months for the ramucirumab arm and 1.7 months for the placebo arm [HR 0.449 (95 % CI 0.285–0.706); P = 0.0004]. The objective response rates were 11 % for the ramucirumab arm and 2 % for the placebo arm (P = 0.0817). The grade 3 or higher treatment-emergent adverse events occurring in more than 5 % of patients with a higher incidence for the ramucirumab arm (n = 44) than for the placebo arm (n = 47) were ascites (7% vs 2 %), hypertension (7 % vs 2 %), and cholangitis (7 % vs 0 %). In patients with a baseline AFP level of 400 ng/mL or greater, the median OS was 12.9 months for the ramucirumab arm (n = 20) and 4.3 months for the placebo arm (n = 22) [HR 0.464 (95 % CI 0.232–0.926); P = 0.0263].

Conclusions

In the Japanese patients in REACH, ramucirumab treatment improved OS, including in patients with a baseline AFP level of 400 ng/mL or greater; improvements in progression-free survival and objective response rate were also demonstrated. The safety profile of ramucirumab was acceptable and well tolerated in Japanese patients.

ClinicalTrials.gov identifier NCT01140347.

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A Suspected Case of Suppurative Frontal Sinusitis in a Friesian Heifer: Clinical Management

2016-08-22T22-48-55Z
Source: International Journal of Livestock Research
Faez Firdaus Abdullah Jesse, Yusuf Abba, Muhammed Abubakar Sadiq, Mohammed Umer, Eric Lim Teik Chung, Asinamai Athliamai Bitrus, Nadhirah Siti Latif, Idris Umar Hambali, Abd Wahid Haron, Mohd Azmi Mohd Lila.
A Friesian heifer weighing about 100 kg was presented to the Large Animal Veterinary unit of the Universiti Veterinary Hospital, Faculty of Veterinary Medicine, Universiti Putra Malaysia with a complaint of an open wound at the base of the horn after dehorning. Upon physical examination, the infected wound had a purulent discharge. The wound was debrided with Hydrogen peroxide and cleansed with diluted Chlorhexidine gluconate and Tincture iodine solutions. Gentamicin injection (2mg/kg), was administered intramuscularly for 3 days and Ilium Dermapred was topically applied on the wound. Flunixin meglumine (1.1mg/kg) was given intramuscularly as an analgesic agent for 3 days. The improper dehorning procedure resulted in the complications observed in this case. Farmers are advised to always seek the professional services from veterinarians in order to prevent deterioration of such conditions.

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Severe case of a bilateral gangrenous mastitis in a doe: A case report on clinical management.

2016-08-22T22-48-55Z
Source: International Journal of Livestock Research
Faez Firdaus Abdullah Jesse,Asinamai Athliamai Bitrus, Yusuf Abba, Muhammad Abubakar Sadiq, Eric Lim Teik Chung, Idris Umar Hambali, Mohd Azmi Mohd Lila, Abdul Wahid Haron.
This case report describes the clinical management of a severe gangrenous mastitis in a 35 kg adult doe . The doe was presented to the Universiti Putra Malaysia Veterinary hospital with a complaint of lack of milk production four days after kidding. Clinical examination revealed anorexia, increased body temperature, pulse rate and response to pain upon palpation of the udder. There was exudation of blood-tinged foul smelling exudates when the mammary gland was expressed. Clinical laboratory findings revealed the presence of anemia, neutrophilia with a left shift and monocytosis. Serum biochemistry showed hypophosphatemia, hypocalcemia, hypocreatinemia, hyperuricemia and hyperproteinemia. The doe was administered with Benacillin (1 mL/25 kg) intramuscularly 3/7, flunixin meglumine (2.2 mg/kg) intravenously 7/7, 23% calcium borogluconate (15 mL) subcutaneously and oxytetracycline (20 mg/kg) once intramuscularly. Medical management of this case was not successful and bilateral mastectomy was opted and performed. The doe w recovered and was discharged. To prevent mastectomy due to gangrenous masitis, early intervention is critical and paramount.

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Va. EMS hires 13th female paramedic, dept. record high

VIRGINIA BEACH, Va. — The Virginia Beach Department of Emergency Medical Services reached a department record high after hiring its thirteenth female paramedic this summer.

The department has hired six paramedics since July and currently employs 32 paramedics, 13 of whom are women. There are also 60 volunteer paramedics, 19 of whom are women, reported the Southside Daily. Last year, the department employed 12 female medics.

"Since we implemented career medics, this is the highest number of women we've had on staff," Retention Officer Susan Palmer said.

Palmer said that the increase in female paramedics taking paid positions in the city is due to an increase in volunteering.

"I think more women are trying to do it (become paramedics)," Palmer said. "I think it opens doors for women to be able to come in."

Of the 220,000 EMTs and paramedics employed in 2015, the Bureau of Labor Statistics reported 33 percent were women.

"I think it shows there is a definite change in the culture of what used to be a predominantly male field, like firefighting and being a paramedic," Virginia Beach paramedic Brett Johnson said.

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What can CDC data tell us about first responder suicide?

The Centers for Disease Control and Prevention released a review of suicide rates by occupational group on July 1, 2016 [1]. The report is based on data obtained from the National Violent Death Reporting System, one of the databases the CDC uses to track suicides.

The CDC researchers used the Standard Occupational Classification system to categorize people into occupations. The Standard Occupational Classification system uses primary and secondary classification groups to classify occupations. EMTs and paramedics are members of group 29, Healthcare Practitioners and Technical Occupations. Firefighters and police officers are members of group 33, Protective Service Occupations.

While initially hopeful that this review would improve the information available about the suicide rate in first responders, it has some limitations that prevent any conclusions from being made about first responder suicide.

SOC group limitations
Standard Occupational Classification groups are broad designations with multiple sub-classifications in each category. First responders do not have their own category, and are split into two categories with multiple other professions.

For example, group 29 also includes physicians, pharmacy technicians and traditional Chinese herbalists. While group 33 also includes animal control workers, crossing guards and playground monitors. This means that the suicide rate for Standard Occupational Classification groups 29 and 33 include people from a number of other professions and do not accurately represent the suicide rates of first responders.

A person's Standard Occupational Classification grouping was also based on their listed profession on their death certificate or other official record. Since people can only be assigned to one group it is likely that a large percentage of volunteer first responders were not classified as members of groups 29 and 33, further skewing the numbers.

The 17 states included in the review reported 12,312 total suicides or about one-third of the total number of suicides in 2012 [1]. Of the 12,312 individuals, a total of 450 were classified into group 29 and 295 into group 33. Given how broad these groups we have no way of knowing what percentage of each group were first responders or if the percentage of first responders included had a statistically significant impact on the suicide rate for the overall group.

What we can learn
Unfortunately for first responder suicide prevention, not much can be ascertained from the report. Some groups, such as the legal professions group, are more homogenous, and thus the information provides an accurate idea of the suicide rate within that field. The CDC plans on releasing another review using the 2014 data from 32 states.

The importance of numbers
An accurate idea of the suicide rate among first responders is an important step towards understanding the problem and lowering the rate. The data can also help us track suicide clusters or identify other patterns that might exist. Having an accurate idea of the suicide rate is also vital to knowing if interventions and education aimed at reducing the suicide rate are successful in subsequent years.

While the CDC does collect suicide data via the National Violent Death Reporting System, first responder suicides are not tracked by the government in the same way line of duty deaths are. If you know of a first responder suicide you can make a confidential report to either the Firefighter Behavioral Health Alliance or The Code Green Campaign.

Reference

1. Suicide Rates by Occupational Group — 17 States, 2012. Weekly / July 1, 2016 / 65(25);641–645.

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Continuous spinal labor analgesia for two deliveries in a parturient with severe subvalvular aortic stenosis

Abstract

Various degrees of left ventricular outflow tract (LVOT) obstruction have been seen in patients with subvalvular aortic stenosis (SAS). Regional analgesia during labor for parturients with SAS is relatively contraindicated because it has a potential risk for hemodynamic instability due to sympathetic blockade as a result of vasodilation by local anesthetics. We thought continuous spinal analgesia (CSA) using an opioid and minimal doses of local anesthetic could provide more stable hemodynamic status. We demonstrate the management of a 28-year-old pregnant patient with SAS who received CSA for her two deliveries. For her first delivery (peak pressure gradient (∆P) between LV and aorta was approximately 55 mmHg), intrathecal fentanyl was used as a basal infusion, but we needed a small amount of bupivacaine to provide supplemental intrathecal analgesia as labor progressed. Although there were mild fluctuations in hemodynamics, she was asymptomatic. For her second delivery (∆P between LV and aorta was approximately 90 mmHg), minimal doses of continuous bupivacaine were used as a basal infusion. For her additional analgesic requests, bolus co-administration of fentanyl was effective. There were no fluctuations in her hemodynamics. Although her SAS in her second pregnancy was more severe than in the first, her hemodynamics exhibited less fluctuation during the second delivery with this method. In conclusion, CSA using fentanyl combined with minimal doses of bupivacaine provided satisfactory analgesia and stable hemodynamics in parturient with severe SAS.

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The effects of intensive care environment on postoperative nightmare

Abstract

Purpose

We retrospectively investigated the incidence of postoperative nightmares and evaluated the impact of postoperative intensive care on the incidence of during subsequent hospital stay. To reduce the effect of selection bias, we compared the incidence of nightmares in propensity-matched pairs with postoperative management in ICUs or in surgical wards.

Methods

This is a retrospective review of an institutional registry containing 21,606 anesthesia cases and was conducted with ethics board approval. Outcomes of surgical patients treated in ICUs and in postsurgical wards (ICU admission vs non ICU admission) were compared first for nightmares using the initial 12,508 patients. To avoid channeling bias, propensity score analysis was used to generate a set of matched cases (ICU admission) and controls (non ICU admission), yielding 642 matched patient pairs. The incidence rate of nightmares was compared as the primary outcome.

Results

Before adjusting patients' characteristics, ICU environment exposure increased the incidence of nightmares compared with non-ICU environment during subsequent hospital stay [ICU vs non-ICU: 101/718 (12.3 %) vs 1147/10,542 (9.81 %)]. The odds ratio (95 % CIs) for ICU was 1.29 (1.03–1.61) for nightmares (p = 0.022). After propensity score matching, however, an equal rate of nightmares occurred in the ICU environment exposure compared to the non-ICU environment [ICU vs non-ICU: 81/561 (12.6 %) vs 73/569 (11.4 %)]. The odds ratio and 95 % CIs for ICU were 1.13 (0.80–1.58) for nightmares (p = 0.54).

Conclusions

The incidence of nightmares did not become more evident during subsequent hospital stay after ICU environment exposure.

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Remember 2 Things: Improve communication during cardiac arrest patient care

Listen to two tips for managing a patient in cardiac arrest from Steve Whitehead, host of Remember 2 Things. Calm and clear communication is critical for a smooth, efficient incident. Whitehead also describes the importance of communicating what is coming next to the patient care team.

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Remember 2 Things: How to improve cardiac arrest response

Do you remember your first cardiac arrest call? Remember 2 Things host Steve Whitehead shares two tips for responding to a patient in cardiac arrest and to increase the likelihood of ROSC.

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Remember 2 Things: Improve communication during cardiac arrest patient care

Remember 2 Things: How to improve cardiac arrest response

The Heart of the Pressor Effect: Acute Caffeine Ingestion and Resting Heart Rate Variability

Journal of Caffeine Research , Vol. 0, No. 0.

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Rocky Elements of Service collection now available

NELSONVILLE, Ohio — Rocky is adding to its line of duty footwear with the launch of Rocky Elements of Service, a new collection designed to deliver a versatile set of high-performance footwear options to those who serve our communities every day. "Duty and military footwear is a part of Rocky's DNA, and we're proud of our latest launch, Rocky Elements of Service," said Kate Robey ...

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Community paramedicine: How EMS can work smarter, not harder

Progressive programs like community paramedicine and MIH are important steps towards fixing a broken health care system.

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Remember 2 Things: Improve communication during cardiac arrest patient care

Remember 2 Things: How to improve cardiac arrest response

Paramedic responds on Facebook after man tries to shame her in parking lot

PERU, Ill. — Paramedic Meagan Ryan was returning to her ambulance from a coffee run when she was ridiculed by a man in the parking lot — but she's not letting it get her down.

"Looks like you guys are working really hard tonight, right?" the man sneered before driving away.

Instead of snapping at the man, Ryan addressed the incident on social media.

"You didn't insult or humiliate me," she wrote. "What you did do was teach your young children and your giggling wife that you hold disdain for public servants."

"I do understand that people are so fed up and angry with increasing taxes, I'm a taxpayer, too," Ryan told CBS 2 News, noting that her salary was paid through donation money and billing revenue.

She channeled her anger into a donation for the Code Green campaign, which benefits EMS personnel suffering from PTSD.

Ryan feels that because of the intense nature of their profession, first responders shouldn't be shamed for taking time in between calls to grab coffee, run errands and care for themselves as human beings.

"When we do work, I assure you, we are 'working hard,'" she writes. "Working hard to care for and fix the sick, the dying, the mentally ill, the abused and assaulted, the mangled bodies and the dead."

"May you and your family never need us."

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Remember 2 Things: Improve communication during cardiac arrest patient care

Remember 2 Things: How to improve cardiac arrest response

Beery-Buktenica Developmental Test of Visual-Motor Integration

Link to instrument: Link to Instrument

Acronym:

Beery VMI

Purpose:

Designed to 1) assist in identifying significant difficulties in visual-motor integration, 2) assist with individuals with deficits to obtain needed services, 3) assess the effectiveness of educational and other intervention programs and serve as a research tool.

The purpose of the VMI is to determine whether a child demonstrates age-appropriate visual-motor integration skills.

Description:

30-items for the full form and 21-items for the short form
Ceiling score is established after 3 consecutive forms have not been passed.
Standardized score has a mean of 100 and a standard deviation of 15.
1 point is awarded for each correct imitated or copied item.
Administration instructions: see scoring manual
Primarily used with children, it can be administered to adolescents and adults.

Area of Assessment: Cognition, Coordination, Developmental, Dexterity, Infant & Child Development, Vision & Perception

Body Part: Not Applicable

ICF Domain: Body Structure, Body Function

Domain: Cognition, Motor, Sensory

Assessment Type: Performance Measure

Length of Test: 06 to 30 Minutes

Time to Administer:

5-15 Minutes for the 30-item Full Form Beery VMI

Number of Items: 30-Items for the full form and 21-Items for the short form

Equipment Required:

Score booklet
Pencil or Pen; No erasers allowed
Administration, Scoring, and Teaching Manual
Stopwatch or timepiece for the supplemental Visual Perceptional and Motor Coordination tests

Training Required:

No specialized training is required; training provided by reading manual.

Type of training required: Reading an Article/Manual

Cost: Not Free

Actual Cost:

$145.00 for the starter kit, additional test booklets will need to be purchased for an additional cost (http://ift.tt/2bcccr7)

Age Range: Preschool Child: 2-5 years, Child: 6-12 years, Adolescent: 13-17 years, Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Acquired Brain Injury, Traumatic Brain Injury

Populations Tested:

Children without disability
Traumatic Brain Injury
ADHD

Standard Error of Measurement (SEM):

Handwriting for Kindergarten, First-Grade and Second Grade Students: (Pfeiffer, 2015; n = 105; all were between 5-8 years old)

Calculated from Pfeiffer, 2015 using SEM = standard deviation of Test-Retest difference / √ 2

SEM for kindergarteners in control group (n= 29): .919
SEM for kindergarteners in the experimental group (n= 27): -1.060
SEM for First-Graders in the control group (n= 35): 1.272
SEM for Frist-Graders in the experimental group (n= 39): -57.558
SEM for Second-Graders in the control group (n= 40): .777
SEM for Second-Graders in the experimental group (n= 37): 1.484
SEM for entire group in the control group (n=105): .989
SEM for entire group in the experimental group (n=1-4): 0

Handwriting Elementary Aged Children: (Howe, 2013; n= 72; mean age intensive practice group 6.69 and mean age visual-perceptual-motor group 6.57 years old)

Calculated from Howe, 2013 using SEM = standard deviation of Test-Retest difference / √ 2

SEM for the intensive practice group (n= 34): .353
SEM for the visual-perceptual-motor group (n= 38): .084

Minimal Detectable Change (MDC):

Handwriting for Kindergarten, First-Grade and Second Grade Students: (Pfeiffer, 2015)

Calculated from Pfeiffer, 2015 using MDC= SEM x 1.96 x √2

MDC for kindergarteners in control group (n= 29): 2.547
MDC for kindergarteners in the experimental group (n= 27): -2.960
MDC for First-Graders in the control group (n= 35): 3.525
MDC for Frist-Graders in the experimental group (n= 39): -159.542
MDC for Second-Graders in the control group (n= 40): 2.153
MDC for Second-Graders in the experimental group (n= 37): 4.113
MDC for entire group in the control group (n=105): 2.741
MDC for entire group in the experimental group (n=104): 0

Handwriting Elementary Aged Children: (Howe, 2013)

Calculated from Howe, 2013 using MDC= SEM x 1.96 x √2

MDC for the intensive practice group (n= 34): .978

MDC for the visual-perceptual-motor group (n= 38): .232

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Traumatic Brain Injury (TBI): (Sutton et al, 2011; n= 123 children; mean age 11.6 years old; SD = 3.1 years; assessments occurred from 3 to 60 months post injury; M = 7.4, SD =6.4)

VMI score of 83 accurately identified most TBI cases (sensitivity =.08, specificity =.42)

Attention-Deficit/Hyperactivity Disorder (ADHD ): (Sutton et al , 2011; n= 65 children; mean age 8.8 years; SD = 2.0 years)

VMI score of 95 most accurately identified ADHD group (sensitivity =.72, specificity =.40)

Normative Data:

No statistically significant differences were found among rural, urban and suburban children's performances.

Test-retest Reliability:

Handwriting: elementary aged children: (Howe, 2013)

Excellent (ICC = .89)

Preschool Children: (Simons, 2009, n = 68, aged between 53 and 81 months, mean age 64.08 months, SD = 7.49 months)

Adequate: (ICC= .65)
Adequate: (ICC= .70)
Adequate: (ICC= .51)

Interrater/Intrarater Reliability:

Handwriting: (Howe, 2013)

Excellent: (ICC = .92)

Handwriting for Kindergarten, First-Grade and Second Grade Students: (Pfeifer, 2015)

Excellent: (ICC= .93)

Visual-Motor Integration: (Preda, 1997, n= 103 children, mean age 9.1 years old)

Excellent: (ICC= .97)

Internal Consistency:

Not Established

Criterion Validity (Predictive/Concurrent):

Predictive Validity:

Visual-Motor Integration (Preda, 1997)

Adequate correlation with age (r= .42, p< .001).

Construct Validity (Convergent/Discriminant):

Not Established

Content Validity:

Not Established

Face Validity:

Not Statistically Assessed

Floor/Ceiling Effects:

Not Established

Responsiveness:

Not Established

Considerations:

VMI was not developed or intended to be used to assess handwriting ability or used as screening for handwriting dysfunction (Pfeiffer, 2015).
Due to the VMI being a poor indicator for handwriting the VMI should be used with caution as a screening tool for children with poor handwriting and may have limitations when used as a measurement for measuring the effectiveness of intervention (Howe, 2013).
VMI measures a related but different construct from handwriting (Pfeiffer, 2015).
The purpose of the VMI is to determine whether a child demonstrates age-appropriate visual-motor integration skills (rather than to measure motor learning or handwriting skills) (Pfeiffer, 2015).
Visual-motor integration difficulties can have an effect on a child's ability to perform their full potential on occupational performance activities, the Beery VMI should be used in a broader perspective in the evaluation process (Coallier, 2014).

Bibliography:

Beery, K. E., & Beery, N. A. (2006). The Beery-Buktenica Developmental Test of Visual-Motor Integration: Administration, scoring and teaching manual (5th ed). Minneapolis, MN: Pearson.

Coallier, M. & Rouliau, N. (20140. Visual-Motor skills performance on the beery-VMI: A study of Canadian kindergarten children. The Open Journal of Occupational Therapy 2 (4), 1-10.

Goyen, T. A. & Duff, S. (2005). Discriminant validity of the developmental test of visual-motor integration in relation to children with handwriting dysfunction. Australian Occupational Therapy Journal, 52, 109-115.

Howe, T. H., Roston, K. L., Shue, C. F., & Hinojosa, J. (2013). Assessing handwriting intervention effectiveness in elementary school students: A two-group controlled study. American Journal of Occupational Therapy, 67 (1) 19-26.

Pfeiffer, B., Moskowitz, B., Paoletti, A., Brusilovskiy, E., Eckberg Zylstra, S., & Murray, T. (2015). Developmental test of visual-motor integration (VMI): An effective outcome measure for handwriting interventions for kindergarten, first-grade, and second- grade students? The American Journal of Occupational Therapy 69 (4), 1-7.

Preda, C. (1997). Test of visual-motor integration: Construct validity in a comparison with the beery-buktenica developmental test of visual-motor integration. Perceptual and Motor Skills, 84, 1439-1443.

Simmon, J. & Probst, C. (2009). Validity and reliability of the developmental test of visual-motor integration and its supplemental tests of visual perception and motor coordination in preschool children in Luxemburg. European Psychomotricity Journal, 2 (1) 8-18.

Sortor, J. M. & Kulp, M. T. (2003). Are the results of the beery-buktenica developmental test of visual-motor integration and its subtests related to achievement test scores? Optometry and Vision Science, 80 (11)758-763

Sutton, G. P., Barchard, K. A., Bello, D. T., Thaler, N. S., Ringdahl, E., Mayfield, J., & Allen, D. N. (2011). Beery-Buktenica developmental test of visual-motor integration performance in children with traumatic brain injury and attention-deficit/hyperactivity disorder. Psychological Assessment, 23 (2) 805-809.

Instrument in PDF Format: No

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Behavior Rating Inventory of Executive Function - Parent Questionnaire

Link to instrument: Link to Instrument

Acronym:

BRIEF

Purpose:

The BRIEF is an 86 item measure designed to assesses executive function skills in children 5-18 years completed by a parent.

Description:

Child's parent or guardian completes form.
Parent must have had recent and extensive contact with the child over the past 6 months to complete form
Eight clinical scales: Inhibit, Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, Organization of Materials, Monitor
Item level scores rated on a three point Likert scale from 1-3(1=never, 2=sometimes, 3= often)
Combined subscales also provide three index scores: (1) Global Executive Composite(GEC) is the total score of all 8 clinical subscales; (2) Behavioral Regulation Index (BRI) is a score that includes Inhibit, Shift, Emotional Control); and (3) Metacognition Index (MCI)includes Initiate, Working Memory, Plan/Organize, Organization of Materials, and Monitor
Item scores are summed for each clinical scale and index
Using the appropriate gender and age range table, the raw scores are converted to T-scores, percentile and 90% confidence intervals
Versions of the BRIEF include the following: BRIEF (Parent and Teacher questionnaires for children aged 5-18); BRIEF Preschool (BRIEF-P completed by either teacher, parent, or day care provider for children aged 2.0 to 5.11 years); BRIEF-Self-Report (BRIEF-SR, for children aged 11-18 years).

Area of Assessment: Attention and Working Memory, Cognition, Executive Function

Body Part: Not Applicable

ICF Domain: Body Function

Domain: Cognition

Assessment Type: Proxy

Length of Test: 06 to 30 Minutes

Time to Administer:

Approximately 10 - 15 Minutes

Number of Items: 86

Equipment Required:

Pen or pencil, and parent form.

Training Required:

Training would be provided by reading the manual; Interpretation of scores and profiles requires graduate training in psychology, school counseling, occupational therapy, speech–language pathology, social work, education, special education, or closely related field; as well as relevant training or coursework in the interpretation of psychological tests.

Type of training required: Reading an Article/Manual, Training Course

Cost: Not Free

Actual Cost:

BRIEF Parent Questionnaire (Pack of 25), $62; BRIEF Parent Questionnaire Scoring Summary/Profile (Pack of 50), $50.00; BRIEF Manual, $75.00

Age Range: Preschool Child: 2-5 years, Child: 6-12 years, Adolescent: 13-17 years

Administration Mode: Paper/Pencil

Diagnosis: Acquired Brain Injury, Multiple Sclerosis, Traumatic Brain Injury

Populations Tested:

Attention Deficit Hyperactivity Disorder (ADHD)
Traumatic Brain Injury (TBI)
Tourette's Disorder
Reading Disorder
Low Birth Weight
Autism spectrum disorders
Phenylketonuria (PKU)
Bipolar disorder vs. ADH
Childhood onset Multiple Sclerosis
Galactosemia
Obstructive sleep apnea
Sickle cell disease
22q11 deletion

Standard Error of Measurement (SEM):

Children with Unilateral Cerebral Palsy (Piovesana et al, 2015; n=42; mean age = 11.96 years; 20 weeks ±2 between testing Time 1 and Time 2)

BRIEF Measures
Scale	SEM
Inhibit	7.68
Shift	6.89
Emotional Control	6.77
Initiate	6.63
Working Memory	5.08
Plan/Organize	4.4
Organization of Materials	3.68
Monitor	4.31
Behavioral Regulation Index(BRI)	6.14
Metacognition Index(MCI)	5.13
Global Executive Composite (GEC)	4.15

Minimal Detectable Change (MDC):

Children with Unilateral Cerebral Palsy (calculated from statistics in Piovesana et al, 2015)

BRIEF Measures
Scale	MDC
Inhibit	17.92
Shift	16.08
Emotional Control	15.08
Initiate	15.47
Working Memory	11.85
Plan/Organize	10.27
Organization of Materials	8.59
Monitor	10.06
Behavioral Regulation Index(BRI)	14.33
Metacognition Index(MCI)	11.97
Global Executive Composite (GEC)	9.68

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Children aged 5-18 Years (Gioia et al, 2000; n=1419; mean age = 10.70(3.35) years; boys and girls)

A T-score of 65 or higher is interpreted as an abnormally elevated score for each of the scales and the three index measures.

Normative Data:

Not Established

Test-retest Reliability:

Children aged 5-18 years (Huizinga and Smidts 2011, n=847; Dutch version)

Scale or Index	ICC
Inhibit	Excellent	.94
Shift	Excellent	.89
Emotional Control	Excellent	.90
Initiate	Excellent	.81
Working Memory	Adequate	.73
Plan/Organize	Excellent	.82
Organization of Materials	Excellent	.91
Monitor	Adequate	.75
Behavioral Regulation Index(BRI)	Excellent	.95
Metacognition Index(MCI)	Excellent	.84
Global Executive Composite (GEC)	Excellent	.86

Interrater/Intrarater Reliability:

Not Established

Internal Consistency:

Children Aged 5-18:

Excellent (Cronbach's alphas = .80-.98)(Gioia, et al, 2000)
Adequate to Excellent (Cronbach's alphas = .76-.96) (Huizinga and Smidts)

Criterion Validity (Predictive/Concurrent):

Concurrent Validity:

ADHD and/or Tourette Syndrome (Mahone et al, 2002; n=76 (ADHD=18, mean age 11.20(2.5) years; Tourette Syndrome=21, mean age =10.00(1.80) years; Tourette Syndrome and ADHD=17, mean age 10.80(2.7)years, controls (n=20, mean age=10.60(3.60) years)

Excellent concurrent validity between BRIEF WM with Child Behavior Checklist, Diagnostic Interview for Children and Adolescents (DICA) & ADHD rating scale (r=.82, .75 & .87 respectively) and BRIEF MCI on same measures with correlations at .81, .74 and .85 respectively/

Predictive validity:

ADHD: (McCandless & O'Laughlin, 2007; n=70, mean age=8.24(1.85) years referred for ADHD assessment)

Excellent: Behavior Regulation differentiates ADHD-Combined Type from non ADHD r=.8

ADHD: (Reddy et al, 2011; n=58, mean age= 12.02(2.32months) years

Excellent correlation with BRI r=.77 classified 79% of children with ADHD versus control group

Construct Validity (Convergent/Discriminant):

Convergent Validity:

ADHD: (Gioia et al, 2000, n=100, mean age=8.73(3.54)years)

Excellent correlations of the BRIEF BRI with the ADHD Rating Scale IV Inattention Index and Hyperactivity Index (r=.67, .70 respectively).
Excellent correlations of the BRIEF GEC with the ADHD Rating Scale's Inattention and Hyperactivity Indexes at 0.63 & 0.60 respectively
Adequate correlations of the BRIEF Initiate scale to Child Behavior Checklist Scales (CBCL) with Withdrawn, Anxious/Depressed and Attention Problems(r=.50,r=.52 , r=0.5 respectively)

ADHD: (McCandless & O'Laughlin, 2007; n=70, mean age=8.24(1.85) years referred for ADHD assessment)

Excellent correlations of the BRIEF BRI with the ADHD Rating Scale IV Inattention Index and Hyperactivity Index (r=.67, .70 respectively).

Content Validity:

Items were selected from clinical interviews of parents, teachers, and agreement from an expert panel of 12 pediatric neuropsychologists was also used.
Items refined via item-total correlations and interrater agreement (Gioia et al, 2000)

Face Validity:

Items were selected from clinical interviews of parents, teachers, and agreement from an expert panel of 12 pediatric neuropsychologists was also used.
Items refined via item-total correlations and interrater agreement (Gioia et al, 2000)

Floor/Ceiling Effects:

Not Established

Responsiveness:

Not Established

Considerations:

Further studies on the ecological validity of BRIEF in relation to behaviors within the home, classroom and community
Further refinement to increase parent teacher inter rater reliability
Change scores available to evaluate cognitive function of children with unilateral cerebral palsy with mild to moderate cerebral palsy should not be applied to children with more severe diagnosis of cerebral palsy or bilateral cerebral palsy
Further studies with children with ADHD in the presence of other comorbidities may influence generalization

Bibliography:

Gioia, G., Isquith, P., Guy, S., & Kenworthy, L. Behaviour Rating Inventory of Executive Function. Odessa, FL: Psychological Assessment Resources; 2000.

Gioia G, Isquith P, Retzlaff P, Espy K. Confirmatory factor analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a clinical sample. Child Neuropsychology [serial online]. December 2002;8(4):249-257

Huizinga M, Smidts D. Age-Related Changes in Executive Function: A Normative Study with the Dutch Version of the Behavior Rating Inventory of Executive Function (BRIEF). Child Neuropsychology [serial online]. January 2011;17(1):51-66

Mahone EM, Cirino PT, Cutting LE, Cerrone PM, Hagelthorn KM, Hiemenz, J.R., et al. Validity of the behavior rating inventory of executive function in children with ADHD and/or Tourette syndrome. Arch Clin Neuropsychol. 2002; 17 (7):643–62.

McCandless S, O' Laughlin L. The Clinical Utility of the Behavior Rating Inventory of Executive Function (BRIEF) in the Diagnosis of ADHD. Journal of Attention Disorders. 2007; 10(4):381-389. doi: 10.1177/1087054706292115.

Piovesana, A. M., Ross, S., Whittingham, K., Ware, R. S., & Boyd, R. N. (2015). Stability of Executive Functioning Measures in 8–17-Year-Old Children With Unilateral Cerebral Palsy. The Clinical Neuropsychologist, 29(1), 133-149.

Rasmussen, Carmen, Rosalyn McAuley, and Gail Andrew. "Parental ratings of children with fetal alcohol spectrum disorder on the behavior rating inventory of executive function (BRIEF)." J FAS Int 5.e2 (2007): 1-8.

Reddy LA, Hale JB, Brodzinsky LK. Discriminant validity of the Behavior Rating Inventory of Executive Function Parent Form for children with attention-deficit/hyperactivity disorder. School Psychology Quarterly. 2011; 26(1):45-55. doi: 10.1037/a0022585.

Year published: 2000

Instrument in PDF Format: No

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A new modality in treatment of obesity: which is more effective in reduction of visceral adiposity index in Obese Patients Orlistat alone or in combination with Garcinia Cambogia?

2016-08-22T05-12-51Z
Source: Journal of Intercultural Ethnopharmacology
hayder M. al-kuraishy, Ali I. Al-Gareeb.
Abstract Aim: The objective of the present study was estimation the effect of orlistat alone and in combination with Garcinia Cambogia on visceral adiposity index in obese patients. Subjects and Methods: Ninety nine obese male patients were recruited with aged range between 37-46 years. They were randomized into three equal groups, first group treated with orlistat, second group treated with Garcinia Cambogia and third group treated with both orlistat plus Garcinia Cambogia. The duration of treatments was three consecutive months. Body mass index (BMI), visceral adiposity index (VAI), blood pressure, blood glucose, total lipid profile, atherogenic index and cardiac risk ratio were recorded at baseline and after three months. Results: Treatment with Garcinia Cambogia leads to reduction in visceral adiposity index p 0.05. Combined therapy of Garcinia Cambogia plus orlistat showed additive effects through significant reduction in visceral adiposity index (VAI) p

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Inhibitory effect of leaves extracts of Ocimum basilicum and Ocimum gratissimum on two key enzymes involved in obesity and hypertension in vitro

2016-08-22T05-12-51Z
Source: Journal of Intercultural Ethnopharmacology
Emmanuel Anyachukwu Irondi, Samson Olalekan Agboola, Ganiyu Oboh, Aline Augusti Boligon.
Aim: To evaluate the phenolics composition and inhibitory effect of the leaves extracts of Ocimum basilicum (O. basilicum) and Ocimum gratissimum (O. gratissimum) on two key enzymes [pancreatic lipase (PL) and angiotensin 1-converting enzyme (ACE)] involved in obesity and hypertension in vitro. Methods: The phenolics (flavonoids and phenolic acids) were quantified using high performance liquid chromatrography coupled with diode array detection (HPLC-DAD). PL and ACE inhibitory effects; and DPPH* and ABTS*+ scavenging activities of the extracts were tested using Spectrophotometric methods. Results: O. basilicum had the following major phenolics: rutin, quercetin and quercitrin (flavonoids); caffeic, chlorogenic and gallic acids (phenolic acids); while O. gratissimum had the following major phenolics: rutin, quercitrin and luteolin (flavonoids); ellagic and chlorogenic acids (phenolic acids). Extracts of both plants inhibited PL and ACE; and scavenged DPPH* in a dose-dependent manner. O. gratissimum extract was more potent in inhibiting PL (IC50: 20.69 μg/mL) and ACE (IC50: 29.44 μg/mL) than O. basilicum (IC50: 52.14 μg/mL and IC50: 64.99 μg/mL, against PL and ACE, respectively). O. gratissimum also scavenged DPPH* and ABTS*+ more than O. basilicum. Conclusion: O. basilicum and O. gratissimum leaves could be used as functional foods for the management of obesity and obesity-related hypertension. However, O. gratissimum may be more effective than O. basilicum.

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Medicinal plants used by traditional healers from South-west Algeria: an ethnobotanical study

2016-08-22T05-12-51Z
Source: Journal of Intercultural Ethnopharmacology
Bachir Benarba.
The present study aimed to document and analyze the local knowledge of medicinal plants use by traditional healers in South-west Algeria. The ethnobotanical survey was conducted in two Saharian regions of South-west of Algeria: Adrar and Bechar. In total, twenty-two local traditional healers were interviewed using semi-structured questionnaire and open questions. Use value (UV), fidelity level (FL) and Informant Consensus Factor (FIC) were used to analyze the obtained data. Our results showed that 83 medicinal plants species belonging to 38 families are used by traditional healers from South-west of Algeria to treat several ailments. Lamiaceae, Asteraceae, Apiaceae and Fabaceae were the most dominant families with 13, 8, 6 and 4 species respectively. Leaves were the plant parts mostly used (36%), followed by seeds (18%), aerial parts (17%) and roots (12%). Furthermore, decoction was the major mode of preparation (49%) and oral administration was the most preferred (80%). Thymus vulgaris L. (UV=1.045), Zingiber officinale (UV=0.863), Trigonella foenum-graecum L. (UV=0.590), Rosmarinus officinalis L. (UV=0.545) and Ruta chalepensis L. (UV=0.5) were the most frequently species used by local healers. A great informant consensus has been demonstrated for kidney (0.727), cancer (0.687), digestive (0.603) and respiratory diseases. The present study revealed rich ethnomedicinal knowledge in South-west Algeria. The reported species with high use-value, fidelity level and informant consensus factor could be of great interest for further pharmacological studies.

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Clinical-Radiologic-Pathologic Correlation of Smoking-Related Diffuse Parenchymal Lung Disease

Publication date: Available online 22 August 2016
Source:Radiologic Clinics of North America
Author(s): Seth Kligerman, Teri J. Franks, Jeffrey R. Galvin

Teaser

The direct toxicity of cigarette smoke and the body's subsequent response to this lung injury leads to a wide array of pathologic manifestations and disease states that lead to both reversible and irreversible injury to the large airways, small airways, alveolar walls, and alveolar spaces. These include emphysema, bronchitis, bronchiolitis, acute eosinophilic pneumonia, pulmonary Langerhans cell histiocytosis, respiratory bronchiolitis, desquamative interstitial pneumonia, and pulmonary fibrosis. Although these various forms of injury have different pathologic and imaging manifestations, they are all part of the spectrum of smoking-related diffuse parenchymal lung disease.

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Alcohol words elicit reactive cognitive control in low-sensitivity drinkers

Abstract

Previous ERP studies shown support for the idea that alcohol-related stimuli are particularly salient to individuals who report low sensitivity (LS) to alcohol's effects (a known risk factor for alcohol-related problems), leading such stimuli to spontaneously capture their attention and interfere with self-regulatory goal pursuit. The current study investigated LS individuals' use of reactive and proactive cognitive control in response to alcohol-related stimuli. Participants performed an alcohol Stroop task in which they indicated the font color of alcohol- and nonalcohol-related words while ERPs were recorded. The probability of alcohol and nonalcohol words was manipulated to test predictions derived from Dual Mechanisms of Control theory. Among LS individuals, infrequent alcohol-related words elicited slower responses and larger N2 amplitude, consistent with these stimuli eliciting enhanced reactive control responses. Amplitude of the frontal slow wave (FSW) component, associated with proactive control, was marginally larger among LS individuals when alcohol words were more frequent, but response accuracy was lower. These findings demonstrate that LS individuals experience conflict when presented with task-irrelevant alcohol-related stimuli, even in a context where conflict arguably should not be present. Findings further suggest that LS individuals can effectively implement reactive control to deal with this conflict when it is infrequent but have difficulty implementing proactive control in the context of more frequent conflict.

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Primary outcome of babies with hypoxic ischemic encephalopathy

2016-08-22T02-42-25Z
Source: International Journal of Contemporary Pediatrics
Anil Kumar Rawat*, Rupali Praveen Shirke, Vipan Chandar.
Background: Intrapartum fetal hypoxia followed by hypoxic ischemic encephalopathy (HIE) is a common cause of potentially avoidable brain injury in term infants. This study was conducted in a tertiary care centre and included 119 babies of hypoxic ischemic encephalopathy born in hospital as well as referred from neighbouring areas. Methods: Babies with history of intrapartum hypoxia, delayed cry who required resuscitation at birth and in stage II or III of modified sarnat encephalopathy grade (MSEG) and those who had abnormal intrapartum course were included. After performing clinical neurological assessment further data collection included perinatal maternal characteristics- ante partum and intrapartum complications; morbidity pattern in baby including type of resuscitation, onset of seizure, antiepileptic drug, other co morbidity and short term outcome. Results: Out of 119 babies 19% were born low birth and 6% were IUGR. 47% mother were primi gravida whereas 53% were multigravida, 32% pregnancy were unbooked. Ante partum risk factor was found in 3 cases and Intrapartum risk factor was found in 45 (38%) cases. According to MSEG stage II and III babies were enrolled overall 92% babies had seizure and 60% had on day one only. Single antiepileptic drug controlled seizure in 60% of babies who had seizure additional two and more antiepileptic drug were required in fewer no of cases. During stay most common complication was sepsis, observed in 26% cases followed by DIC in 11% cases and AKI in 7% cases. Majority 59% of babies were discharged, mortality was observed in 12.6% cases and 27% left against medical advice. Conclusions: Maternal perinatal risk factors and effective neonatal intervention may improve outcome in babies with hypoxic ischemic encephalopathy.

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Clinical spectrum of premature sexual developments in a tertiary care center of South India

2016-08-22T02-42-25Z
Source: International Journal of Contemporary Pediatrics
Durai Arasan G., Hemachitra J..
Background: The clinical spectrum of precocious sexual development and its etiology are varied and we need to know our own data regarding this. The objective of the study was to study the clinical spectrum of premature sexual developments and the usefulness of imaging modalities in understanding the ongoing insult. Methods: Female child of less than 8 years of age and male child of less than 9 years of age with development of secondary sexual characteristics were registered and analyzed. After through clinical examination the children were subjected to investigations, which included radiological and hormonal. Results: Majority of cases 54% (14 cases) had symptoms before 2 years of age. Premature thelarche was seen in 58% and the majority 71% was less than 2 years of age. 17% of the female children with sexual precocity had true precocious puberty. Hypothyroidism as a cause of true precocious puberty is 8%. Heterosexual precocious puberty was seen in 16%. Among male children peripheral cause of isosexual precocious puberty was seen in two cases. Congenital adrenal hyperplasia as a cause of sexual precocity among both sexes was seen in 15%. All four children (100%) with true precocious puberty showed uterine length of > 3.5 cm and 93% of the children with isolated premature thelarche showed a uterine length of

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Therapeutic plasma exchange in Gullian Barre Syndrome: an experience of our centre

2016-08-22T02-34-28Z
Source: International Journal of Advances in Medicine
Mahima Mittal, Jawahar Agrawal, Ambrish Singh.
Background: Therapeutic plasma exchange (TPE) has been used for the treatment of neurological diseases in which autoimmunity plays a major role. Although, there are several modes of plasmapheresis applicable to Gullian Barre Syndrome (GBS) but no definite guidelines for selecting an optimum mode have been established so far. The aim of the study was to analyze the clinical benefits of plasma exchange (PE) on the patients of GBS and compare the cost effectiveness of TPE over other modalities. Methods: Records of 36 patients who received TPE between March 2015 to September 2015 were analysed using continuous flow cell separator CS-3000. All the patients had undergone minimum 2 cycles of PE. One plasma volume was exchanged for each cycle. Results: Out of 36 patients, there were 28 (77.78%) male and 8 (22.22%) females. The mean age of patient was 28.23±1.23 years which range from 12 to 36 years. After TEP on 36 patients, 28 (77.78%) patients clinically improved after first cycle of PE and 5 (13.89%) patients improved after second cycle. Patients who received 4 and 3 cycle of PE experience no complications and >75% and 55-60% patients showed improvement respectively. Conclusions: The treatment is cost effective in comparison to the available IV immunoglobulins. TPE is an easy and effective treatment in GBS.

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Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: Experience with 250 cases

Journal of Pediatric Surgery

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Outcome of acute severe ulcerative colitis in patients previously exposed to immunosuppressive therapy

Digestive and Liver Diseases

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Efficacy and safety of elbasvir/grazoprevir and sofosbuvir/pegylated interferon/ribavirin: A phase III randomized controlled trial

Journal of Hepatology

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Intragastric balloon device: weight loss and satisfaction degree

Obesity Surgery

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Metformin, diabetes, and survival among US veterans with colorectal cancer

Cancer Epidemiology, Biomarkers & Prevention

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Increased EHEC survival and virulence gene expression indicate an enhanced pathogenicity upon simulated pediatric gastrointestinal conditions

Pediatric Research

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FOLFOX4 or sorafenib as the first-line treatments for advanced hepatocellular carcinoma: A cost-effectiveness analysis

Digestive and Liver Diseases

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Readout-segmented echo-planar imaging improves the image quality of diffusion-weighted MR imaging in rectal cancer: Comparison with single-shot echo-planar diffusion-weighted sequences

European Journal of Radiology

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Exploring the risk factors for differences in the cumulative incidence of coeliac disease in two neighboring countries: The prospective DIABIMMUNE study

Digestive and Liver Diseases

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Myocardial infarction and ischemic hepatitis complicated by postpartum hemorrhage

Taiwanese Journal of Obstetrics and Gynecology

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Type 2 diabetes mellitus and risk of colorectal adenoma: A meta-analysis of observational studies

BMC Cancer

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Comparison of transumbilical laparoscopic-assisted appendectomy versus single incision laparoscopic appendectomy in children: Which is the better surgical option?

Journal of Pediatric Surgery

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Impact of diabetes on outcomes of sorafenib therapy for hepatocellular carcinoma

Targeted Oncology

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Reliable complex abdominal wall hernia repairs with a narrow, well-fixed retrorectus polypropylene mesh: A review of over 100 consecutive cases

Surgery

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Πληροφορίες

Δευτέρα 22 Αυγούστου 2016

Abstract

Background

Methods

Results

Conclusions

Abstract

Background

Methods

Results

Conclusions

Abstract

Abstract

Purpose

Methods

Results

Conclusions

Teaser

Abstract