Δευτέρα, 13 Ιουνίου 2016

Fabry's disease: Case series and review of literature

Muzaffar Maqsood Wani, Imran Khan, Riyaz Ahmad Bhat, Muzaffar Ahmad

Annals of Medical and Health Sciences Research 2016 6(3):193-197

Fabry's disease is an X-linked lysosomal storage disorder caused by a deficiency of alpha-galactosidase A enzyme with the progressive accumulation of globotriaosylceramide in vascular endothelial cells leading to cardiovascular, renal, gastrointestinal, neuropathic, lenticular, and dermatological manifestations. It is a rare cause of end-stage renal disease. It classically affects males whereas 10–15% of female heterozygote carriers are affected depending on localization. Both the FD and its association with ESRD is rare. With this background, this case series of five patient's along with the review of literature is presented here.

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Ghrelin and its association with nutritional and inflammatory status of patients on maintenance hemodialysis in a South Indian tertiary care hospital

RN Vanitha, S Kavimani, P Soundararajan, D Chamundeeswari, G Kannan, S Rengarajan

Annals of Medical and Health Sciences Research 2016 6(3):146-155

Background: Malnutrition and inflammation are associated with morbidity and mortality in patients on maintenance hemodialysis (MHD). Ghrelin, an orexigenic peptide hormone, is speculated to be associated with nutritional and inflammatory status in MHD. Aim: To assess the serum total ghrelin levels and its possible relationship with inflammation and nutritional status in patients on MHD. Subjects and Methods: The study was conducted on 90 patients on MHD for 6 months and above (56 males, 34 females, mean age 52.6 [11.7] years; mean dialysis vintage 20.9 [12.1] months) and 70 healthy volunteers as control (5 males, 25 females, mean age 50.6 [9.7] years). Demographics were obtained for the study population, and dialysis-related data were collected for cases. Anthropometry, biochemical parameters, serum total ghrelin and inflammatory markers tumor necrosis factor-alpha (TNF-α), and high-sensitivityC-reactive protein (hsCRP) were assessed for cases and control. Self-reported appetite (five questions of appetite and diet assessment tool) and nutritional status (subjective global assessment-dialysis malnutrition score) were assessed for cases. Results: Ghrelin (242.5 [62.3] pg/mL vs. 80.2 [19.6] pg/mL; P< 0.001), TNF-α (39.8 [15.2] pg/mL vs. 6.5 [1.2] pg/mL; P< 0.001), hsCRP (10.2 [2.8] mg/L vs. 2.7 [0.54] mg/L; P< 0.001) were significantly elevated in cases versus control, anthropometry, and biochemical parameters were significantly decreased in hemodialysis patient. Of 90 cases, (13/90 [14.4%]) were well-nourished, (28/90 [31%]) mild to moderately malnourished, and (49/90 [54.4%]) were moderate to severely malnourished. Appetite was very good for14.4%, good and fair for 47.8%, poor and very poor for 37.8% patients. There was a significant difference in appetite with respect to nutritional status (P < 0.001). Ghrelin had positive correlation with inflammatory markers and negative correlation with nutritional status (P < 0.001). Conclusion: The study identified the association of ghrelin with appetite, nutritional, and inflammatory status of the patients on MHD.

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Refining the journal club presentations of postgraduate students in seven clinical departments for better evidence-based practice

A Herur, S Kolagi, U Ramadurg, CS Hiremath, CP Hadimani, SS Goudar

Annals of Medical and Health Sciences Research 2016 6(3):185-189

Background: A gap between best practice and actual clinical care exists and this can be overcome by evidence-based practice (EBP), which is essential to improve the clinical decision making. A strategy to reduce deficits in care provision is to train the postgraduate students in the practice of EBP in the journal clubs as evidence from medical colleges in India reveals that current format of journal club presentations is unsatisfactory. Aim: The aim of the present study was to refine the journal club presentations of postgraduate students of clinical departments and to study the effectiveness of EBP training in them for better EBP. Subjects and Methods: This study was conducted in S. Nijalingappa Medical College, Bagalkot, Karnataka, India, and it was a pre- and post-trial. This study was a pre- and post-trial done during the journal club presentations of postgraduate students from clinical departments. Postgraduate students' understanding of concepts about EBP was assessed using Fresno test questionnaire in traditional journal club presentation. A hands-on session incorporating steps of EBP was imparted to them. Soon after the session, each student was assessed. In the next journal club presentation, 1 week later, the students were assessed again with the same questionnaire by the same faculty. Scores of the postgraduate students, before and after intervention (immediate and 1 week later), were compared. Data were analyzed by paired t-test using SPSS. Results: An increase in mean posttest scores was seen immediately and also 1 week later as compared to the pretest scores. The scores also increased significantly, when each step of EBP was considered. Conclusions: Incorporating teaching of EBP in journal club presentations improved the competencies of postgraduate students in clinical decision making.

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Seroprevalence and correlates of hepatitis c virus infection in secondary school children in Enugu, Nigeria

CB Eke, SO Ogbodo, OM Ukoha, VU Muoneke, RC Ibekwe, AN Ikefuna

Annals of Medical and Health Sciences Research 2016 6(3):156-161

Background: Although children comprise a small fraction of the burden of hepatitis C virus (HCV) infections, which is a major global health challenge, a significant number of them develop chronic HCV infection and are at risk of its complications. Aim: The aim of the current study was to determine the prevalence and associated factors of HCV infection in school children in Enugu urban. Subjects and Methods: This was a cross-sectional seroepidemiological study involving children aged 10–18 years selected using multistage systematic sampling in Enugu metropolis, Southeast Nigeria. The anti-HCV was tested using a 3rd generation enzyme-linked immunosorbent assay. Data were analyzed using SPSS Version 16.0 with the level of significance set atP< 0.05. Results: Four hundred and twenty children were selected and screened comprising 210 (50.0%) males and females. The seroprevalence of anti-HCV was 4 (1.0%). Three (75%) out of the four positive cases for the anti-HCV were females while one was a male giving a male to female ratio of 0.3–1. Traditional scarifications/tattoos were the putative risk factors observed to be significantly associated with anti-HCV seropositivity. Conclusion: This study has demonstrated an anti-HCV seroprevalence of 1.0% among children aged 10–18 years in Enugu with traditional scarification as the predominant associated risk factor. Proper health education including school health education and promotion of behavioral change among the public on the practice of safe scarifications/tattoos should be encouraged in our setting.

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The wonders of phosphodiesterase-5 inhibitors: A majestic history

AS Elhwuegi

Annals of Medical and Health Sciences Research 2016 6(3):139-145

The Nobel Prize winning discovery of nitric oxide (NO) in 1986 was the starting point for a new innovation in drug discovery. NO acting as a mediator at different physiological systems is believed to be involved in many physiological and pathological conditions through the formation of the second messenger cyclic guanosine monophosphate (cGMP). cGMP-dependent vasodilation effect of NO is important in regulating pulmonary and systemic pressures, maintaining penis erection, preventing atherosclerosis, preventing platelet aggregation, and protecting and controlling cardiac functions. The main enzyme involved in the termination of cGMP effects is phosphodiesterase enzyme 5 (PDE-5), which is overexpressed in ventricular hypertrophy and heart failure. A milestone in drug discovery was the selective inhibitors of PDE-5 that developed to be a multibillion dollar blockbuster in drug market. PDE-5 inhibitors are approved for the treatment of erectile dysfunctions (EDs), pulmonary hypertension, and benign prostatic hypertrophy. They are also under clinical trials for their cardiac protection against damage induced by ischemia or heart failure. This review article is an update about the pharmacotherapeutics of PDE-5 inhibitors and the majestic history that led to their discovery. The information reported in this review was obtained from the electronic sources of different databases such as PubMed Central, Google Scholar, and Scopus. Keywords used for search included cGMP (mechanisms and functions), EDs (drugs used), nitric oxide, and PDE-5 inhibitors (clinical applications). A total of 165 articles were studied, of which 45 articles were referred to in this review.

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Emergence of multidrug resistance and metallo-beta-lactamase producing Acinetobacter baumannii isolated from patients in Shiraz, Iran

MN Moghadam, M Motamedifar, J Sarvari, Ebrahim-Saraie H Sedigh, Same M Mousavi, FN Moghadam

Annals of Medical and Health Sciences Research 2016 6(3):162-167

Background: Metallo-beta-lactamase (MβL) enzymes production is one of the most important resistance mechanisms against carbapenems in some bacteria including Acinetobacter baumannii. Aims: This study was aimed to determine the antimicrobial susceptibility and the prevalence of MβL among carbapenem-resistant isolates of A. baumannii. Materials and Methods: In this cross-sectional study from October 2012 to April 2013, 98 isolates were identified as A. baumannii using Microgen™ kits and confirmed by molecular method. These isolates were tested for antimicrobial susceptibilities by disk diffusion method according to the Clinical and Laboratory Standards Institute guidelines. Carbapenem-resistant isolates were further detected phenotypically by MβL minimal inhibitory concentration (MIC)-test strips, and subsequently positive MβL isolates were confirmed by polymerase chain reaction (PCR). Results: Overall, 98% (96/98) of A. baumannii isolates were detected as carbapenem-resistant by MIC test. Highest sensitivity to the tested antibiotic with 42.9% (42/98) was observed to colistin. Of 96 carbapenem-resistant isolates, 43 were phenotypically positive for MβL; out of 43 isolates, 37 were confirmed for the presence of MβL genes by PCR. Conclusion: The frequency of drug resistance among the clinical samples of A. baumannii isolated in our study against most of the antibiotics was very high. Moreover, all MβL producing isolates were multidrug resistance. Therefore, systematic surveillance to detect MβL producing bacteria and rational prescription and use of carbapenems could be helpful to prevent the spread of carbapenem resistance.

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Utility of bacillary index in slit skin smears in correlation with clinical and histopathological alterations in hansen's disease: An attempt to revive a simple useful procedure

P Premalatha, IV Renuka, A Meghana, SI Devi, PAVK Charyulu, G Sampoorna

Annals of Medical and Health Sciences Research 2016 6(3):181-184

Leprosy, a relatively common chronic contagious disease having diverse modes of clinical presentation, can mimic a variety of unrelated diseases. For proper and adequate treatment, the diagnosis must be made accurately with subtyping which should be done with the help of bacillary index, histopathological features, and clinical correlation. This is extremely important in patient care as paucibacillary and multibacillary types have different modes of treatment. Our aim is to categorize leprosy into various types based on bacillary index, morphological findings both in slit skin smears, and biopsy along with clinical correlation.

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Accidental childhood poisoning in Enugu, South-East, Nigeria

BO Edelu, OI Odetunde, CB Eke, NA Uwaezuoke, T Oguonu

Annals of Medical and Health Sciences Research 2016 6(3):168-171

Background: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time. Aim: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu. Subjects and Methods: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted. Results: Sixty-five cases of childhood poisoning were recorded during the 10-year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65). Conclusion: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications.

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Bi-lobed perirectal epidermoid cyst: An unusual cause of hematochezia in a middle-aged woman

AO Atolagbe, O Ogunleye, CT Apakama

Annals of Medical and Health Sciences Research 2016 6(3):190-192

Perirectal epidermoid cysts are congenital cysts originating from the ectodermal germ cell layer of the hind gut. Their presenting symptoms are most often nonspecific and distinguishing them from other presacral developmental cysts often present a diagnostic and therapeutic dilemma. We present a 58-year-old woman who presented with chronic dyschezia and hematochezia of a few days duration and no prior colonoscopies. Initial blood work and tumor markers were unremarkable. Pelvic magnetic resonance imaging (MRI) showed a 7.5 cm × 5 cm × 6 cm homogenous bi-lobed cystic mass in the pelvis adherent to the left lateral wall of the rectum and posteriorly to the sacrum with a displacement of the rectum anteriorly and to the right. There was no pelvic sidewall adenopathy or free fluid in the pelvis. Preoperative colonoscopy showed rectal compression with no rectal involvement of the mass. The cyst was successfully resected posteriorly via the trans-sacrococcygeal approach. An intraoperative proctosigmoidoscopy confirmed an intact rectum. The patient remains recurrence-free 1 year postsurgical resection.

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Endoscopic versus surgical management of biliary complications – Outcome analysis after 1188 orthotopic liver transplantations

After liver transplantation, the endoscopic approach has become the standard treatment modality for biliary complications. Aim of this study was to compare primary endoscopic with primary surgical management.

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Firefighter EMT/Paramedic - Washington Township Fire Department

WASHINGTON TOWNSHIP FIRE DEPARTMENT 8320 MCEWEN RD. DAYTON, OHIO 45458 Updated: June 13, 2016 Job Classification: FIREFIGHTER/EMT-PARAMEDIC – FULL-TIME Washington Township Fire Department is currently hiring for Full-time Firefighter/EMT-Paramedic. All testing through National Testing Network (NTN) must be completed by June 24, 2016. Salary Information: Starting base salary is $52,959, with the ...

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Full-Time Paramedic - Winona Area Ambulance Service, Inc.

Winona Area Ambulance Service, Winona, MN. is currently accepting applications for full-time paramedic positions. Crews are station based and work 24 hour shifts on a "California" schedule (24 on, 24 off, 24 on, 24 off, 24 on, 4 days off) Winona Area Ambulance Service Inc. serves as the sole 911 advanced life support provider for the greater Winona Area, covering nearly 100 square miles ...

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The burden of pulmonary hypertension in patients with degenerative mitral valve disease in Enugu South-East Nigeria: An echocardiographic based study

EC Ejim, NI Oguanobi

Annals of Medical and Health Sciences Research 2016 6(3):172-175

Background: Pulmonary hypertension is a common complication of degenerative mitral valve disease, and contributes significantly to both morbidity and mortality. The use of medications for reduction of pulmonary pressure in patients is not a common practice by most physicians in this part of the world because of the absence of data on pulmonary hypertension. Aim: The authors set out to find the prevalence of pulmonary hypertension in patients with degenerative mitral valve disease and to determine if there are gender differences in affectation. This will form a basis for future research on the management of pulmonary hypertension in sub-Saharan Africa. Subjects and Methods: The echocardiographic records of 1390 patients carried out over a period of 4 years were retrospectively reviewed. The examinations were done with a Logic 500 MD echocardiographic machine. Tricuspid valve regurgitation velocity above 250 cm/s defined pulmonary hypertension. Data obtained included presence of degenerative mitral valve disease, pulmonary hypertension, age, and gender. Results: A total of 1390 echocardiogram reports done at Conquest Medical Imaging, Enugu, from July 2009 to August 2013 were retrospectively reviewed. Degenerative mitral valve disease was noted in 18.7% of the patients, (259/1390) made up of 149 males and 110 females with a mean age of 68.3 (14.4) years. Pulmonary hypertension was present in 30% of the patients (78/259) and affected males more than females. Conclusion: Pulmonary hypertension is common in patients with degenerative mitral valve disease in Enugu, and affects males more than females.

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The use of succinylcholine after sugammadex reversal



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An alternative instrument for making entry point for elastic intramedullary nail

GS Dharmshaktu, I Khan

Annals of Medical and Health Sciences Research 2016 6(3):198-198



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Brachytherapy Using Elastin-Like Polypeptides with 131 I Inhibit Tumor Growth in Rabbits with VX2 Liver Tumor

Abstract

Background

Brachytherapy is a targeted type of radiotherapy utilized in the treatment of cancers. Elastin-like polypeptides are a unique class of genetically engineered peptide polymers that have several attractive properties for brachytherapy.

Aims

To explore the feasibility and application of brachytherapy for VX2 liver tumor using elastin-like polypeptides with 131I so as to provide reliable experimental evidence for a new promising treatment of liver cancer.

Methods

Elastin-like polypeptide as carrier was labeled with 131I using the iodogen method. Ten eligible rabbits with VX2 liver tumor were randomly divided into the treatment group (n = 5) and control group (n = 5). The treatment group received brachytherapy using elastin-like polypeptide with 131I, and in the control group, elastin-like polypeptide was injected into the VX2 liver tumor as a control. Periodic biochemical and imaging surveillances were required to assess treatment efficacy.

Results

The stability of elastin-like polypeptide with 131I in vitro was maintained at over 96.8 % for 96 h. Biochemistry and imaging indicated brachytherapy using elastin-like polypeptide with 131I for liver tumor can improve liver function and inhibit tumor growth (P < 0.05).

Conclusions

Elastin-like polypeptide can be an ideal carrier of 131I and have high labeling efficiency, radiochemical purity and stability. Brachytherapy using elastin-like polypeptide with 131I for liver tumor is a useful therapy that possesses high antitumor efficacy advantages.



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Turned versus anodised dental implants: a meta-analysis

Summary

The aim of this meta-analysis was to test the null hypothesis of no difference in the implant failure rates, marginal bone loss (MBL)and post-operative infection for patients being rehabilitated by turned versus anodised-surface implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in November 2015. Eligibility criteria included clinical human studies, either randomised or not. Thirty-eight publications were included. The results suggest a risk ratio of 2·82 (95% CI 1·95–4·06, < 0·00001) for failure of turned implants, when compared to anodised-surface implants. Sensitivity analyses showed similar results when only the studies inserting implants in maxillae or mandibles were pooled. There were no statistically significant effects of turned implants on the MBL (mean difference-MD 0·02, 95%CI −0·16–0·20; = 0·82) in comparison to anodised implants. The results of a meta-regression considering the follow-up period as a covariate suggested an increase of the MD with the increase in the follow-up time (MD increase 0·012 mm year−1), however, without a statistical significance (= 0·813). Due to lack of satisfactory information, meta-analysis for the outcome 'post-operative infection' was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.



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Orlando Shooting: EMS, police response to mass shooting

Video of bystanders, police and EMS providers treating and transporting victims of the deadliest mass shooting in U.S. history.

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5 ways paramedics can use a 3-way stopcock

Dr. Peter Antevy demonstrates five uses for a 3-way stop, a valuable device which has many uses for providing care to critical pediatric patients.

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Orlando shooting victim planned to become an EMT

By Annie Martin
The Orlando Sentinel

ORLANDO, Fla. — An attraction operator at Universal Orlando, Luis Vielma always went above and beyond for the park's guests — and his friends.

"He was always a friend you could call," said Josh Boesch, who worked with Vielma at Universal. "He was always open and available."

Vielma, 22, posted on social media about going to Pulse the night he died, Boesch said.

Vielma's family couldn't be reached for comment Sunday, but dozens of friends mourned his death on social media. The last publicly posted photo on his Facebook profile shows a group of young people posing in front of Cinderella's Castle at Magic Kingdom with the caption "True friends who become family."

Vielma held several roles at Universal, said Boesch, including running the former Disaster! attraction and, most recently, the Harry Potter and the Forbidden Journey ride.

Luis Vielma worked on the Harry Potter ride at Universal. He was 22 years old. I can't stop crying. #Orlando http://pic.twitter.com/Nz2ZCWxNsS

— J.K. Rowling (@jk_rowling) June 13, 2016

Olga Glomba, who also said she worked with Vielma at Universal, wrote in an email that he was "always there, without fail."

"He was a true friend," Glomba wrote. "A funny, sweet, nerdy guy without a mean side. He just wanted to make people smile."

Beyond Universal, Vielma also talked about his plans to become an EMT, Boesch said. Vielma's Facebook page said he attended Seminole State College.

From the President and COO of Universal Orlando Resort http://pic.twitter.com/OmuNmUORpQ

— Universal Orlando (@UniversalORL) June 13, 2016

"He was always caring and he always wanted to learn more," Boesch said.

Copyright 2016 The Orlando Sentinel



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Orlando Shooting: EMS, police response to mass shooting

Video of bystanders, police and EMS providers treating and transporting victims of the deadliest mass shooting in U.S. history.

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5 ways paramedics can use a 3-way stopcock

Dr. Peter Antevy demonstrates five uses for a 3-way stop, a valuable device which has many uses for providing care to critical pediatric patients.

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Paramedic - TCESD#2, Pflugerville Fire Department

Go to http://ift.tt/1DITfDT and click on careers for more information. Direct link is below: http://ift.tt/1OlMbIW

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Orlando Shooting: EMS, police response to mass shooting

Video of bystanders, police and EMS providers treating and transporting victims of the deadliest mass shooting in U.S. history.

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5 ways paramedics can use a 3-way stopcock

Dr. Peter Antevy demonstrates five uses for a 3-way stop, a valuable device which has many uses for providing care to critical pediatric patients.

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Orlando Shooting: EMS, police response to mass shooting

Video of bystanders, police and EMS providers treating and transporting victims of the deadliest mass shooting in U.S. history.

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5 ways paramedics can use a 3-way stopcock

Dr. Peter Antevy demonstrates five uses for a 3-way stop, a valuable device which has many uses for providing care to critical pediatric patients.

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Genetic variation and exercise-induced muscle damage: implications for athletic performance, injury and ageing

Abstract

Prolonged unaccustomed exercise involving muscle lengthening (eccentric) actions can result in ultrastructural muscle disruption, impaired excitation–contraction coupling, inflammation and muscle protein degradation. This process is associated with delayed onset muscle soreness and is referred to as exercise-induced muscle damage. Although a certain amount of muscle damage may be necessary for adaptation to occur, excessive damage or inadequate recovery from exercise-induced muscle damage can increase injury risk, particularly in older individuals, who experience more damage and require longer to recover from muscle damaging exercise than younger adults. Furthermore, it is apparent that inter-individual variation exists in the response to exercise-induced muscle damage, and there is evidence that genetic variability may play a key role. Although this area of research is in its infancy, certain gene variations, or polymorphisms have been associated with exercise-induced muscle damage (i.e. individuals with certain genotypes experience greater muscle damage, and require longer recovery, following strenuous exercise). These polymorphisms include ACTN3 (R577X, rs1815739), TNF (−308 G>A, rs1800629), IL6 (−174 G>C, rs1800795), and IGF2 (ApaI, 17200 G>A, rs680). Knowing how someone is likely to respond to a particular type of exercise could help coaches/practitioners individualise the exercise training of their athletes/patients, thus maximising recovery and adaptation, while reducing overload-associated injury risk. The purpose of this review is to provide a critical analysis of the literature concerning gene polymorphisms associated with exercise-induced muscle damage, both in young and older individuals, and to highlight the potential mechanisms underpinning these associations, thus providing a better understanding of exercise-induced muscle damage.



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NY city auctions off ambulances despite union grievance over elimination of service

By Thomas J. Prohaska
The Buffalo News

LOCKPORT, N.Y. — Almost two years after the city stopped its ambulance service, Lockport's two ambulances were auctioned off last week – even though a grievance over the elimination of the service has yet to be resolved.

The ambulances were among a long list of surplus city equipment offered for sale in an online sale through Auctions International. The city also sold a paving machine, a pavement crack-sealing machine, and an assortment of mowers, snowplow blades and vehicles, some dating back from the 1980s or '90s.

The ambulances both were 2008 models with about 65,000 miles on them. One sold for $11,301 and the other for $11,601 in bidding that began May 20 and ended last Monday.

Mayor Anne E. McCaffrey said that both ambulances were purchased by the same bidder. The mayor said Highways and Parks Director Michael E. Hoffman told her that the buyer was from downstate, but she wasn't sure whether it was a municipality, a fire company or an ambulance company. Bids on Auctions International are under anonymous names.

The sale of the ambulances came before the resolution of a grievance filed by the firefighters' union over the September 2014 elimination of ambulance service and a connected reduction in minimum staffing levels on each Fire Department shift.

Firefighter Kevin W. Pratt, president of the Lockport Professional Fire Fighters Association, said the matter was argued months ago before an arbitrator from the state Public Employment Relations Board, but no ruling has been issued; nor is it known when one will be made. The PERB arbitrator conceivably could order the city to return to offering its own ambulance service, instead of through its contract with Twin City Ambulance Service.

"I'm surprised only because they were advised by legal counsel not to sell them until the results of the PERB hearing were in," Pratt said.

McCaffrey said, "They've been sitting for a couple of years. They're depreciating."

She added that Corporation Counsel John J. Ottaviano "is aware of the sale and confirms there is no municipal purpose for them."

Of the ambulances, Pratt said, "They were on their last legs, anyway. They weren't roadworthy. So if we get back into the ambulance business, we'd have to get new ambulances, anyway. It doesn't break my heart one way or the other."

McCaffrey said Hoffman compiled a sale list last fall, but decided to delay the auction until spring in hopes of getting better prices, especially for the paving equipment. The paver, purchased in 2004, sold for $13,101, even though it hasn't been used for several years. The sale listing said that it has no batteries and "an undiagnosed electrical problem."

The crack sealer, which dates from 1999 and hasn't been used in two years although it works, sold for $9,101.

In all, the auction of 26 items brought in bids totaling $57,991, according to the Auctions International website.

Copyright 2016 The Buffalo News



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Homegrown talent may be key to hiring more Ill. minority police and firefighters

By Steve Tarter
The Journal Star

PEORIA, Ill. — Plans to grow the number of minority police officers and firefighters in this community could resemble setting up a farm system similar to baseball's minor leagues.

The Peoria Fire and Police Departments are both in the final stages of announcing "cadet" programs which would "home-grow" talent by allowing teens to be hired onto the force before they complete their formal training.

The city's idea is to develop new and diverse talent. Think of it as a plan to extend the existing explorer programs which offer opportunities for those between 14 and 21 to get a sense of what it is like to be a police officer or firefighter.

If it works, City Hall hopes the departments will be more reflective of the communities they serve.

Setting up such a farm system for the city departments would have multiple benefits, said Police Chief Jerry Mitchell, himself an African American.

"When you grow your own, there's no guessing on the people you're hiring," he said.

Having officers visit schools talking about law enforcement can also serve as a deterrent to crime, said Mitchell who's been with the Peoria force for 26 years. He was named captain in 2014.

"It's all about the interruption. We know what 14 and 15 looks like. If we can get to kids at 13. If we can engage them, we think it will continue to trend in the right direction."

That direction, he hopes, will provide a boost in diversifying police and fire numbers. Minority representation on the Peoria Police Department is presently at 18.6 percent while the number of minority firefighters on the Peoria Fire Department is at 14 percent.

That's drawn fire from groups like the NAACP who want to see municipal hiring reflect the fact that minorities make up 40 percent of Peoria's population.

"There's a real sense of despair and hopelessness when it comes to the potential of finding meaningful employment with governmental units in this area," said Don Jackson, president of the local NAACP branch, when addressing the Peoria City Council last year.

Added City Manager Patrick Urich: "From the city's perspective, we don't have a workforce that's reflective of our community. When it comes to hiring police officers and firefighters, there are rules we have to follow but the importance of these jobs in the community is that there's no better opportunity for young men and women to move into the middle class."

The present salary range for Peoria policemen and women is from $39,944 to $56,595 (not including bonuses or benefits) while the range for a Peoria firefighter is between $37,000 and $55,784.

A report filed last year noted there was only one African-American hired out of 74 firefighters employed in the past 10 years. Out of that report, a 10-person committee was found to address the lack of representation. The committee presented its report to the City Council last October with 10 recommendations.

"We studied the data and saw some very serious problems," said Rita Ali, vice president of diversity, international and adult education at Illinois Central College and one of the committee's cochairs.

Along with citing the need for more minority positions with the city's police and fire departments, there were also significant gaps in the hiring of female candidates, she said. Some of the subcommittee's recommendations have already been implemented, said Ali, adding City Hall is working on an ordinance addressing minority hiring.

One recommendation from the committee, a pass-fail system for testing potential police officers, likely wouldn't take hold until next summer. Pass-fail isn't possible for firefighters as current state law requires fire exam finalists be ranked in order, meaning the department must pick the candidate with the highest grade.

One of the recommendations already acted upon is the city's decision to move to semi-annual testing of candidates rather than just once a year. Preference points will also be added for those living in the city of Peoria, another recommendation made by the subcommittee.

Mitchell and Peoria fire chief Charles Lauss agree the key to increasing minorities in the ranks is more applicants.

"We need to bring more people to the table. That means talking to younger kids to prepare them for a career in the future," Lauss said.

Of the seven police recruits hired on March 28, two were black women, one white woman and one black man. Out of 13 firefighters hired on April 8, there were two blacks and one Hispanic, all three men.

Gone, it seems, are the days when hundreds would test for the coveted jobs of a firefighter or a police officer. Now it's just one of many opportunities.

"Typically, law enforcement hasn't had to recruit in the past. But now we're competing with Caterpillar, Sears and Chuck E. Cheese. We have to be better at what we do — not just go to job fairs," Mitchell said. "When you've got five large agencies recruiting the same kid, the question is how do we convince that individual to come with us?

Lauss noted his department is collaborating with Peoria Public Schools and Illinois Central College on a dual-credit program. "Students can earn an EMT license while taking two fire science classes. They can earn up to 12 credit hours at ICC," he said.

With the Peoria City Council set to take up consideration of a minority hiring ordinance on Tuesday, Ali said she was excited about the progress that's been made with the city since the report was issued last year.

"We're very pleased that many of the recommendations have already been put in place. There's still a lot of work to do with (the hiring of) women and minorities in the fire department but the doors have opened," she said.

Copyright 2016 the Journal Star



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A study on practices regarding menstrual hygiene among adolescent girls of urban areas of Jabalpur District

2016-06-13T09-45-44Z
Source: International Journal of Medical Science and Public Health
Shubhangi Nayak, Neelam Anupama Toppo, Shashi Prabha Tomar, Pradeep Kumar Kasar, Rajesh Tiwari.
Background: Adolescence in girls is a phase of transition toward womanhood and its beginning is marked by menstruation. But unfortunately most of the adolescent girls do not maintain proper hygiene during menstruation because of ignorance, which in turn increase their risk of developing genital infections in future. Objective: To assess practices regarding menstrual hygiene among adolescent girls of urban areas of Jabalpur district, Madhya Pradesh, India. Materials and Methods: We conducted a cross-sectional study and 200 adolescent girls were randomly selected from the area under study. Result: A total of 70.2% of the girls used sanitary pads but the rest used cloth and the practice of reusing without washing properly was seen commonly among girls. A total of 74.4% of the girls reported pain in abdomen, 57.7% reported lower back pain, and 29% experienced pain in breast and tiredness during menstruation. Conclusion: This study showed that some adolescent girls had poor information about the hygienic practices during menstruation.


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Perceptions about pill use among former users of oral contraceptives in a Tertiary Care Centre of Gujarat state

2016-06-13T09-45-44Z
Source: International Journal of Medical Science and Public Health
Priyanka D Jogia, Kaushik K Lodhiya, Mehul M Solanki.
Background: Oral contraceptive pills (OCPs) continue to be an underutilized spacing method with a high non-compliance rate, the reasons for which still needs to be explored. Objective: To assess the awareness, attitudes, and beliefs about the pills and to study the occurrence of side effects among former users of the pills. Materials and Methods: The study was conducted in a tertiary care centre of Gujarat state during August 2015 to December 2015. Postnatal mothers admitted in the hospital during the study period and who had previously used one or more cycles of OCPs for the purpose of family planning were interviewed for study purpose. Result: Of the 84 mothers interviewed, over one-fifth (22%) of them were not provided any counseling before prescribing OCP. Although over 80% of the mothers reported to be satisfied with OCP use, only 61% of the mothers agreed to use it again if needed and even less than half of the mothers were ready to take it for prolonged period of time. Over one thirds of the mothers (36.90%) believed that OCPs were stored in the body and there was a need to take a break after continuous use of 6 months or more. Over half of the former users of OCPs did not know what to do if they missed one or two consecutive pills in a cycle. Residence, education standards, past history of abortion, and duration of use of OCPs significantly affected the knowledge scores of the mothers. Conclusion: The study participants had poor knowledge, several myths, and an unfavorable attitude toward pill use. Periodic counseling of the users of OCPs is needed to address their beliefs and concerns about pill use which will improve their compliance.


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A five year prevalence of HIV among attendees of Integrated Counselling and Testing Centre (ICTC) of a Government Medical College of Central India

2016-06-13T09-45-44Z
Source: International Journal of Medical Science and Public Health
Anjana Niranjan, Sanjeev Kumar, Paharam Adhikari, Deepankar Patnayak, Manoj Saxena.
Background: Acquired immune deficiency syndrome (AIDS) has been one of the most devastating diseases to have affected mankind. In the past 30 years, AIDS has emerged as a devastatingly fatal disease, assuming pandemic proportions sparing no region of the world, so its early diagnosis and prompt treatment can provide the healthy life for the human immunodeficiency virus (HIV) infected persons. Objective: The purpose of this study was to estimate the prevalence of HIV infection and their gender variance among the clients attending ICTC, situated in microbiology department of S.S.M.C. Rewa, India, for a period of 5 years from 2010 to 2015. Materials and Methods: A total of 44,460 clients attended ICTC, situated in Microbiology Department of Shyam Shah Medical College Rewa, India, from 2011 to 2015. Serum samples were collected after taking informed consent and pretest counseling. In India for all ICTCs, NACO (National AIDS Control Organization), a national guideline has been followed for HIV testing, reporting and release of results with posttest counseling. Result: Of the total 44,460 clients tested for HIV infection, 572 (1.28%) were found to be HIV-1 seropositive. Seropositivity was higher in male clients (i.e., 331 (57.86%)) than female (i.e., 241 (42.13%)). In all these cases pediatric age group (014 years) prevalence was 4.19%. Conclusion: HIV prevalence of 3.78% among the clients attending ICTC, situated in S.S.M.C. Rewa, M.P., Central India. Puts light on the burden on HIV in this part of the country and suggests the need for the scaling up of focused prevention efforts in high-risk groups by various modes of IEC activities.


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Spectrum of congenital heart diseases at tertiary-care hospital in north western Rajasthan in India

2016-06-13T09-45-44Z
Source: International Journal of Medical Science and Public Health
Ashok Kumar Meena, Devendra Kumar Agrawal, Renu Agrawal.
Background: Heart diseases constitute an important group of pediatric illness and major cause of childhood mortality and morbidity. According to a status report on congenital heart disease (CHD) in India, 10% of the present infant mortality may be accounted for by CHD. Objective: (i) To study the spectrum of CHD in children under 5 years of age and (ii) to study the correlates of different CHDs through demographic and socioeconomic variables. Materials and Methods: This study was conducted on 390 patients under 5 years of age in the Department of Pediatrics, SP Medical College attached to PBM Associated Group of Hospitals, Bikaner, Rajasthan, India, from September 2014 to August 2015. The criteria to suspect heart disease was followed as formulated by Alexander Nadas as NADAS criteria. The diagnosis was confirmed by echocardiography. Result: Pattern of CHD in this study was 88.9% cases of acyanotic CHD and 11.1% cases of cyanotic CHD. Ventricular septal defect (VSD) was the most common CHD present in 38.5%, followed by atrial septal defect (ASD) in 12.8%, patent ductus arteriosus (PDA) in 8.5%, ASD + VSD in 7.4%, tetralogy of fallot (TOF) in 5.1% of total cases. A total of 131 (33.6%) patients had 85%95%, and 55 cases (14.1%) with SpO2 > 95%. Conclusion: Acyanotic CHD was the most common. VSD was the most common CHD. TOF was the most common cyanotic CHD. According to the WHO Z-score, 52.6% patients showed moderate to severe malnutrition. About 72.1% of cases showed SpO2 between 85% and 95%, which shows that a pulse oximetry SpO2


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Medicosocial profile of rural elderly and its covariates in Northern India – A community-based study

2016-06-13T09-45-44Z
Source: International Journal of Medical Science and Public Health
Neelam Kumar, Gaurav Kamboj, Nilika, Meenakshi Kalhan, Manju Pilania.
Background: India has 8.6% of its population more than 60 years with old dependency ratio of 142. Providing health services to this ever-increasing segment of society is an unenviable task. Objective: To analyze the medicosocial profile of elderly population and its sociodemographic covariates. Materials and Methods: A cross-sectional study on 280 subjects was conducted in a rural area of 5 villages. Every fifth elderly person was selected from all the villages after taking their consent. A predesigned, pretested, semistructured schedule was used for the purpose. Result: About half (47.1%) of the subjects presented 1 episodes of an acute disease in the last 1 month. Maximum subjects gave history of fever (23.2%), followed by diarrhea (14.6%), backache (13.2%), and upper respiratory tract infection (12.5%). About 83.9% of geriatric population presented 1 chronic diseases (self-reported). Maximum subjects reported eye problems (53.2%) closely followed by locomotor problems (47.9%), oro-dental problems (38.6%), and respiratory problems (27.9%). The sociodemographic covariates of acute disease found to be statistically significant were increasing age, decreasing education level, illiteracy, >10 members in the family, involvement in outdoor activities, and having no decision-making power in the family whereas of chronic diseases were decreasing education levels, illiteracy, and no involvement in outdoor activities. Conclusion: This study has identified an increasing need of nationwide efforts for facilitating the access to medical care of the elderly people in India.


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Spirometric studies in normal healthy Punjabi male subjects of rural and urban areas between 20 and 50 years of age group

2016-06-13T09-45-44Z
Source: International Journal of Medical Science and Public Health
Iqbal Singh, Avnish Kumar.
Background: Inhalation of polluted air over a long period of time leads to proliferation and fibrotic changes in lungs. Early recognition of this damage provides an important clue to insure good health. Spirometery is an invaluable screening test to identify patients with air flow obstruction. Objective: To study spirometric parameters in normal healthy Punjabi males of rural and urban areas between 20 and 50 years of age group Materials and Methods: This study was conducted among 200 urban and 200 rural Punjabi males between 20 and 50 years of age in and around Patiala, Punjab. Pulmonary function tests were carried out in standing position, height was measured in centimeters, weight was measured in kilograms, and body surface area was read from Nomogram Dobous and Dobous. Result: The ventilatory tests such as peak expiratory flow rate (PEFR), forced expiratory flow (FEF)0.2%1.2% and FEF25% measured by computerized spirometer (Med-spiror) showed a highly significant decline in urban subjects. While in rest of the parameters, there is statistically nonsignificant decrease in urban subjects. The cause of decline in flow volume in urban subjects is owing to industrial pollution (SO2, SO42-, NO2), suspended particulate matter and cumulative dust exposure, and exhaust emission of vehicles. The cause of better preserved lung function, especially the flow volumes in rural subjects is owing to excessive physical activity and because of nonexposure to pollution. Conclusion: The strategies such as use of air purifiers, use of mask, better fuel for vehicles, proper and timely servicing of vehicles, regular health checkups, and awareness of effects of pollution on health need to be adopted for protection from air pollution.


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Assessment of dietary trends and its impact on academic performance among young adult medical students of a tertiary care teaching hospital

2016-06-13T09-45-44Z
Source: International Journal of Medical Science and Public Health
Rajeshwari Arasegowda, N. Asha Rani, Pramit Mukherjee, Aliya Nusrath.
Background: Nutrition is one of the most important and modifiable environmental factor that may affect the neurocognitive development, which in turn has an impact on academic performance. Medical students generally tend to indulge in erratic lifestyle behaviors such as unhealthy eating habits, skipping meals, inadequate intake of nutrients, irregular sleep, and physical inactivity. Objective: To examine the dietary habits among undergraduate medical students and to assess its impact on their academic performance Materials and Methods: A cross-sectional medical collegebased study was carried out among 289 young medical college students of both sexes in the age group of 17 to 25 years. Following ethical clearance and consent, information regarding demographic profile, dietary habits, and academic performance was collected using self-administered questionnaire. Result: Of the 289 medical students, 42.9% were male students and 57.1% were female students and majority of them were on mixed diet. The study participants were grouped into two category as high (≥60%) and low (


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3 things paramedics need to know about seizures and respiratory compromise

Seizures are one of the most common conditions encountered by EMS providers and one where critical interventions can significantly affect patient outcomes [1]. Timely seizure management is a benchmark proposed by a group of metropolitan medical directors and is currently being studied as a performance measure by the EMS Compass initiative [2].

Oxygenation and ventilation can be compromised during prolonged the seizures, as well as during the postictal phase after seizures. Here are three things you should know about seizures and respiratory compromise.

1. Seizures can cause upper airway obstruction and respiratory depression
A seizure is an episode of abnormal electrical discharges from neurons in the brain that causes a change in behavior, sensory perception or motor activity [3]. Seizures can be generalized or partial, depending on how much of the brain is affected [4].

Generalized tonic-clonic seizure is the most common type of seizure EMS providers encountered. Generalized tonic-clonic seizures occur when both hemispheres of the brain are affected by abnormal neuronal discharges. They present with a loss of consciousness, body-wide muscle rigidity (tonic phase), and are followed by rhythmic convulsions (clonic phase) [4]. A deviated gaze and incontinence are also common signs of a tonic-clonic seizure.

Seizures can affect both respiration and upper airway protection. Patients may stop breathing at the beginning of a convulsive seizure as muscles contract [4]. Generalized seizures then cause a catecholamine surge and increased metabolic rate, which increases cerebral oxygen demand and strains the cardiovascular system [3,4].

The gag reflex is also suppressed during a seizure and the patient may aspirate if they vomit. The patient's upper airway may also be obstructed by their relaxed tongue.

Generalized tonic-clonic seizures usually last a few seconds to a few minutes. Afterward, there is often a postictal phase, during which patients have an altered mental status before returning to a full alertness.

Since seizures are usually of short duration, patients are most often in the postictal phase when EMS arrives [4]. Patients may be unconscious or only respond to painful stimuli during the postictal phase. The patient is likely to have respiratory depression and diminished airway reflexes [4].

Postictal patients may also be confused or combative, especially as they transition from somnolent to awake. The postictal phase may last a few minutes to several hours, but patients usually fully recover after 20 minutes. If a patient remains confused for longer than 20 minutes after a seizure, consider another cause of altered mental status [4].

A seizure that lasts more than 20 minutes, or recurs before a patient regains consciousness, is a life-threatening condition known as status epilepticus [1]. This may lead to brain damage, hypoxia, hypercapnia, pulmonary edema, hypoglycemia, and metabolic acidosis [4].

It is important to determine the duration of seizures, how many seizures the patient had, what the patient was doing before the seizure and whether or not the patient regained consciousness after each seizure to identify status epilepticus.

Epilepsy is the most common cause of seizures, particularly when patients are not compliant with prescribed anticonvulsants. Seizures can also be caused by hypoxia, head injury, stroke, hypoglycemia, brain tumor, poisoning, meningitis and fever [4].

It is important to identify and treat the underlying cause of seizures and to never assume that one was caused by epilepsy. Ask bystanders and look for a medical identification bracelet to determine if the patient has a history of seizures.

Ask if the patient was complaining of anything before the seizure began, if they struck their head or if they may have overdosed. Check blood glucose on any suspected seizure patient to assess for hypoglycemia.

Two other types of seizures are absence and partial seizures. An absence seizure is a type of generalized seizure that usually occurs in children, which causes a temporary loss of awareness that may only last for a few seconds. Patients are unable to communicate during the episode and there is no postictal phase afterwards [4].

Partial seizures affect only part of the brain and patients usually remain conscious during the episode. They may report an odd feeling or you might see a shaking of one limb. Partial seizures can progress to a generalized tonic-clonic seizure, which are known as complex partial seizures [4].

2. Waveform capnography can help guide airway management during and after seizures
Airway management for a patient having a seizure involves protecting the upper airway, administering high-flow oxygen and assisting ventilation if needed [4]. Waveform capnography provides continuous feedback on upper airway patency and ventilation, which can help determine what treatment is needed to achieve those goals.

Capnography measures the amount of carbon dioxide exhaled (end-tidal CO2, or ETCO2) after each breath. Normal ETCO2 is 35 to 45 mm HG. Capnography also displays a waveform for each breath and continuously measures the patient's respiratory rate. ETCO2 can be measured with nasal prongs or a circuit connected to a bag-valve mask.

Elevated ETCO2 with a normal respiratory rate may be caused by an increase in basal metabolic rate. Elevated ETCO2 with a slow respiratory rate indicates hypoventilation, as excess CO2 accumulates in the lungs and is not excreted effectively. Hypoventilation may also cause low ETCO2 if respirations are shallow and little exhaled air reaches the sensor or if the patient exhales excess CO2.

Pulse oximetry measures oxygenation through a probe attached to a finger, toe or earlobe. Pulse oximetry may be difficult to obtain during a tonic-clonic seizure, so look for cyanotic skin as another sign of hypoxia. Remember that patients may be adequately oxygenated and have a normal pulse oximetry reading, but still be hypoventilating and have an abnormal ETCO2.

Administer oxygen via non-rebreather mask at 12-15 liters per minute to any patient who is actively seizing or is postictal, regardless of their pulse-ox reading, to help with the increased metabolic demands of the brain for oxygen [4]. Patients who are hypoventilating during a seizure, remain hypoxic despite high-flow oxygen or have poor respiratory effort require assisted ventilation with a bag-valve mask connected to oxygen.

Waveform capnography is also useful to assess upper airway patency. A waveform will be absent if the airway is obstructed by the tongue or oral secretions. A waveform will reappear if interventions work at achieving patency.

Start by positioning the patient on their side, suction the oropharynx and insert a nasal airway to clear a path for oxygenation and ventilation. Do not place anything in a seizure patient's mouth.

3. Definitive airway management for seizures is stopping the seizure
As important as oxygenation and ventilation are during a seizure, it is equally important to stop the seizure. Depending on resources available, airway management may have to be temporarily deferred in order to administer anti-seizure medication.

Assume that any patient who is actively seizing on EMS arrival is in status epilepticus, which can cause permanent brain damage even with adequate oxygenation and ventilation [3]. Seizures that last longer than 5 minutes are unlikely to stop without intervention and should be promptly treated with a benzodiazepine [3].

Benzodiazepines, such as Valium (diazepam), Ativan (lorazepam) or Versed (midazolam), are the first line treatment for seizures. The earlier a seizure is treated with a benzodiazepine, the more likely it is to terminate [3].

While intravenous administration of a benzodiazepine is ideal, obtaining intravenous access can be difficult in a seizing patient, as well as time consuming. Diazepam, lorazepam, and midazolam can all be administered intramuscularly.

A large trial showed that intramuscular midazolam terminated seizures faster than intravenous lorazepam [5]. Midazolam can also be administered intranasally, and diazepam can be administered rectally.

Depending on local protocols, it may be best to administer a benzodiazepine by intramuscular, intranasal or rectal route before attempting to obtain intravenous access. Whichever medication or route is used, use a reference or cross-check process to ensure that the correct dose is administered. The few extra seconds to perform a medication cross check is well worth the added layer of patient safety.

Repeated doses of benzodiazepines may be needed to terminate seizures, and they should be administered until all seizure activity has ceased. Seizure activity may still be taking place in the brain, even if generalized convulsions have stopped. A deviated gaze, irregular respiratory pattern and occasional muscle contractions are all signs that the patient is still seizing and requires more medication.

Respiratory depression is a side effect of benzodiazepines, which can be detected immediately when monitoring waveform capnography. Assist ventilation with a bag-valve mask if respiratory depression occurs, and titrate respiratory rate and tidal volume to maintain ETCO2 between 35 and 45 mm Hg.

Generalized seizures can cause many forms of respiratory compromise, including respiratory arrest, respiratory depression and loss of upper airway reflexes. Waveform capnography is a reliable tool to help detect respiratory compromise, make airway management decisions and provide feedback on how well airway interventions are working.

References:

1. Michael G, O'Connor R. The diagnosis and management of seizures and status epilepticus in the prehospital setting. Emerg Med Clin N Am (2011) 29; 29-39.

2. Myers JB, Slovis CM, Eckstein M, et al. Evidence based performance measures for emergency medical services systems: a model for expanded EMS benchmarking. Prehosp Emerg Care, 2008; 12: 141–51.

3. Pillow M, Howes, D, O'connor, R et al. Seizure assessment in the emergency department. Medscape 2015, Jan 8. Retrieved from: http://ift.tt/1VVdGum

4. EMS Training: Epilepsy and Seizure Management. Epilepsy Foundation, 2011.

5. Silbegleit R, Durkalski V, Lowenstein D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012; 366(7):591-600



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3 things paramedics need to know about seizures and respiratory compromise

Understand how respiratory monitoring devices can be used to guide treatment during and after seizures

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Characteristics of Low-income Racial/Ethnic Minority Pregnant Women Screening Positive for Alcohol Risk

Abstract

The current study examined the prevalence and characteristics associated with alcohol risk among low-income, predominantly racial/ethnic minority pregnant women in an urban area. We surveyed 225 pregnant women receiving nutritional care. Twenty-six percent screened positive for alcohol risk. Current smoking status (AOR 2.9, p = 0.018, 95 % CI [1.2, 7.0]) and a history of marijuana use (AOR 3.1, p = 0.001, 95 % CI [1.6, 6.2]) were the strongest predictors of alcohol risk status. This study underscores the need for screening for alcohol risk, smoking, and illicit drug use among low-income, racial/ethnic minority pregnant women and highlights the usefulness of the TWEAK in identifying alcohol risk in WIC settings.



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Coping Styles and Depression Among Undocumented Hispanic Immigrants

Abstract

This cross-sectional study examined coping strategies and their relationship with depression among undocumented Hispanic immigrants. A community sample of 122 self-identified undocumented Hispanics filled out questionnaires measuring coping and depression. The authors categorized coping strategies as problem-focused, active-emotional, or avoidant-emotional. Findings indicated that coping through "prayer and meditation" (problem-focused), "get comfort from someone" (active-emotional), and "see bad things positively" (active-emotional) were more frequently used by undocumented Hispanics. Contrary to past research and predictions, problem-focused and active-emotional coping were both positively related to depression. What is more, problem-focused coping accounted for additional variance of depression above and beyond active-emotional coping. The insoluble nature of many of the problems faced by undocumented immigrants may explain the counterintuitive finding that as problem-focused and active-emotional coping increased, so too did depression.



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Effect of Laser Acupuncture on Hemodialysis Male Patient

2016-06-13T09-21-39Z
Source: International Journal of Therapies and Rehabilitation Research
mona mohamed abdel khalek, hany ezzat obaya.
Background: Kidney disease is a heterogeneous group of disorders affecting kidney structure and function. Pain and increases serum urea are usually associated with sever renal damage or failure. Dialysis may be used for those with an acute disturbance in kidney function or for those with progressive but chemically worsening kidney function a state know as chronic renal failure. The purpose was to investigate the impact of laser puncture on management of pain symptoms and urea reduction ratio (URR) in patients with chronic kidney disease (CKD). Material and methods: thirty male patients ranged age 35- 45 years who had chronic kidney diseases (CKD), were divided into two equal groups in number. Group (A) received laser puncture sessions plus their traditional medical treatment (medications and dialysis). Group (B) received their traditional medical treatment only (medications and dialysis). Results: there was a significant decrease in group (A) in pain intensity, but there was a non- significant difference in the urea reduction ratio (URR) in response to the designed laser puncture program. Conclusion: laser puncture had a significant effect to alleviate pain in patient with CKD.


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Drinking and Driving Among Undocumented Latino Immigrants in Miami-Dade County, Florida

Abstract

There is concern that by failing to understand fully the risks associated with driving under the influence (DUI), some Latino immigrants—undocumented in particular—may be overrepresented in alcohol-related crashes. Until now, data on undocumented immigrants has been absent. Data came from an ongoing longitudinal sample of Latino immigrants to Miami-Dade County, FL. Descriptive analyses and regression techniques were applied. Compared with permanent residents, undocumented drivers are more likely to binge drink, less likely to understand DUI laws, and less likely to perceive the risks associated with DUI—three factors largely associated with high DUI rates. Despite facing these risk factors, undocumented immigrants showed low DUI rates, partly due to their limited amount of driving. Differences in risk perceptions and actual DUI events between Latino immigrants of different residency statuses suggest the possibility of early interventions aimed at reducing DUI among Latino immigrants.



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Family Violence and Child Sexual Abuse Among South Asians in the US

Abstract

Family violence, including child sexual abuse (CSA), is a significant public health problem in the United States. It is particularly difficult to assess family violence and CSA among South Asians because it is often hidden due to cultural and familial stigma. A web-based survey was administered to a convenience sample (n = 368) of South Asian adults in the US. One-fourth (25.2 %) of the sample reported CSA; 13.8 % reported abuse involving exposure; 21.5 % reported abuse involving touching; 4.5 % reported attempted sexual intercourse; and 3.5 % reported forced sexual intercourse. Adjusted odds ratios found that participants who reported any relationship violence were significantly more likely to have experienced CSA (OR 2.28; 95 % CI 1.26–4.13); and suicide attempt was significantly associated with CSA (OR 3.96; 95 % CI 1.27–12.3). The findings presented in this formative study will assist in guiding future studies and interventions for South Asians in the United States.



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Health-Seeking Behaviors of Filipino Migrants in Australia: The Influence of Persisting Acculturative Stress and Depression

Abstract

This study examined the relationships among the constructs of acculturative stress, depression, English language use, health literacy, and social support and the influence of these factors on health-seeking behaviors of Filipino Australians. Using a self-administered questionnaire, 552 respondents were recruited from November 2010 to June 2011. Structural equation modelling was used to examine relationships. A direct and negative relationship between health-seeking behaviors and depression, and an indirect relationship with acculturative stress, was observed mediated through depression. Social support had an important moderating influence on these effects. Although there was an inverse relationship between age and English language usage and depression, age was positively related to health-seeking behavior. Despite their long duration of stay, Filipino Australian migrants continue to experience acculturative stress and depression leading to lower health-seeking behaviors. This study highlights the importance of screening for acculturative stress and depression in migrants and fostering social support.



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Latino Mother/Daughter Dyadic Attachment as a Mediator for Substance Use Disorder and Emotional Abuse

Abstract

To date, no studies have investigated emotional abuse of adult Latina women by their mothers despite evidence that emotional maternal abuse may significantly contribute to the emotional abuse experienced by Latina women in their lifetime. Cross-sectional data including 316 women was analyzed using mediation and logistic regression. Overall, 7.1 % of mothers and 24.1 % of daughters abused drugs; and, 19.5 % of daughters were emotionally abused by their mothers. Mother's attachment to her daughter mediated the association between mother's drug abuse and emotionally abusing her adult daughter (indirect effect: 0.863). Latina women can serve as perpetrators of emotional abuse of their adult children. Since drug-abusing daughters are more likely to be victims of emotional abuse by their mothers and drug-abusing mothers are more likely to abuse their daughters, drug-rehabilitation practitioners should incorporate a family abuse component into rehabilitation programs.



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Beyond Trauma: Post-resettlement Factors and Mental Health Outcomes Among Latino and Asian Refugees in the United States

Abstract

War-related traumas impact refugees' mental health. Recent literature suggests that structural and sociocultural factors related to the resettlement also become critical in shaping refugees' mental health. So far, there is limited empirical evidence to support this claim among resettled refugees. Resettlement contextual factors that influence mental health outcomes were examined using Latino and Asian refugees (n = 656) from a nationally representative survey. Linear and logistic regressions predicted factors associated with the study's outcomes (self-reported mental health, mood disorders, and anxiety disorders). Post-resettlement traumas were significantly associated with mental health outcomes, but pre-resettlement traumas were not. Unemployment, everyday discrimination, and limited English were significantly associated with mental health outcomes among both Latino and Asian refugees. The outcomes indicate that resettlement contextual factors have a significant association with refugees' mental health. Therefore, future studies with refugees must pay closer attention to structural and sociocultural factors after resettlement.



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Foreign-Born Latinos Living in Rural Areas are more likely to Experience Health Care Discrimination: Results from Proyecto de Salud para Latinos

Abstract

Health care discrimination is increasingly considered a significant barrier to accessing health services among minority populations, including Latinos. However, little is known about the role of immigration status. The purpose of this study was to examine the association between immigration status and perceived health care discrimination among Latinos living in rural areas. Interviews were conducted among 349 young-adult Latinos (ages 18 to 25) living in rural Oregon, as part of Proyecto de Salud para Latinos. Over a third of participants experienced health care discrimination (39.5 %). Discrimination was higher among foreign-born (44.9 %) rather than US-born Latinos (31.9 %). Multivariate results showed that foreign-born Latinos were significantly more likely to experience health care discrimination, even after controlling for other relevant factors (OR = 2.10, 95 % CI 1.16–3.82). This study provides evidence that health care discrimination is prevalent among young-adult Latinos living in rural areas, particularly the foreign-born. Effective approaches towards reducing discrimination in health care settings should take into consideration the need to reform our broken immigration system.



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Effects of long-term infusion of sedatives on the cognitive function and expression level of RAGE in hippocampus of rats

Abstract

Purpose

This study aims to investigate the effects of long-term infusion of midazolam, propofol, and lytic cocktail on the rat cognitive ability and expression of receptor for advanced glycation end products (RAGE) in the hippocampus. The correlation between cognitive function and RAGE protein expression level could provide basis for clinical application.

Methods

Adult male Wistar rats were first treated with midazolam, propofol, lytic cocktail, and saline solution for 5 consecutive days, respectively, and then their behavioral performance in a Morris water maze was monitored to determine the effects of these sedatives on the cognition of spatial learning and memory. After the behavioral tests, the expression level of RAGE protein in the hippocampus of each rat was determined by ELISA and immunohistochemistry.

Results

Compared with the control rats, the sedative-treated rats showed impaired performance in the Morris water maze. These three sedatives rendered similar extents of impairment of learning and memory at the first day after the treatment (p < 0.05, vs. control). However, the impairment by propofol and lytic cocktail gradually reduced in the following days (p < 0.05), while the impairment by midazolam did not show a significant reduction (p > 0.05). In addition, midazolam and propofol, but not lytic cocktail, caused significant upregulation of RAGE expression in the hippocampus. The upregulation of RAGE protein was further corroborated by the increment of RAGE-positive cells in the CA1 region of hippocampus from midazolam- and propofol-treated rats.

Conclusions

The long-term treatment of propofol, midazolam, and lytic cocktail could impair cognition. The upregulation of RAGE protein in hippocampus might play a role in the midazolam- and propofol-caused cognitive dysfunction.



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Pre-migration Trauma Exposure and Psychological Distress for Asian American Immigrants: Linking the Pre- and Post-migration Contexts

Abstract

Drawing on the life course perspective and the assumptive world theory, this paper examines whether pre-migration trauma exposure is associated with psychological distress through post-migration perceived discrimination for Asian American immigrants. The study is based on cross-sectional data from the National Latino and Asian American Study (N = 1639). Structural equation model is used to estimate the relationship between pre-migration trauma, post-migration perceived discrimination, and psychological distress. Additional models are estimated to explore possible variations across ethnic groups as well as across different types of pre-migration trauma experience. Pre-migration trauma exposure is associated with higher levels of psychological distress, both directly and indirectly through higher level of perceived discrimination, even after controlling for demographic/acculturative factors and post-migration trauma exposure. This pattern holds for the following sub-types of pre-migration trauma: political trauma, crime victimization, physical violence, accidental trauma, and relational trauma. Multi-group analyses show that this pattern holds for all Asian immigrant subgroups except the Vietnamese. Studies of immigrant mental health primarily focus on post-migration stressors. Few studies have considered the link between pre- and post-migration contexts in assessing mental health outcomes. The study illustrates the usefulness of bridging the pre- and post-migration context in identifying the mental health risks along the immigrant life course.



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Association of bone age with overweight and obesity in children in the age group of 8 to 11 years

2016-06-13T08-24-56Z
Source: International Journal of Contemporary Pediatrics
Godfrey D. A., Umapathy P, Latha Ravichandran, Elayaraja S, Shilpa Senthil Murugan, Srinivasan V.
Background: Obesity is one of the most common nutritional problems in developed countries. The prevalence of obesity is rapidly progressing in children. It is associated with serious health hazards in adolescence and especially in adulthood, like hypertension, coronary artery disease, diabetes mellitus, etc. Methods: A cross sectional study was conducted on 60 children fulfilling the inclusion criteria aged 8 to 11 years, of which 30 children were obese and 30 children were overweight. The body mass index (BMI) values of the children were plotted against the corresponding WHO charts. Children were segregated as overweight and Obese based on the BMI. Based on a radiological examination of skeletal development of the left-hand wrist, bone age is assessed and then compared with the chronological age. Results: Among the study population the mean bone age index of obese children was 1.08615 and the mean bone age index of overweight children was 0.98097 which was statistically significant. Bone age index=0.016 (BMI)+0.6742. By using this formula we derived that a BMI of 19 or above triggered significant acceleration of bone age. Conclusions: In our study by deriving at the bone age index of both obese and overweight children and comparing them, we found that the trends of obesity affecting the bone age is significantly more than overweight children. Hence the lifestyle modifications in overweight children are vital so as not to get into obese category. This will prevent the bone age changes which in turn will avoid serious health hazards in adolescence and especially in adulthood.


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FDNY celebrates LGBTQ members, community leaders

NEW YORK — The FDNY is hosting the first ever FDNY Pride Month celebration on Monday evening at the New York City Fire Museum.

"I'm excited to announce this new tradition of honoring members of the LGBTQ community — including individuals who proudly serve within our department as well as community leaders and groups that have made a tremendous impact in our city," Daniel Nigro, Fire Commissioner said. "Every day, we are becoming a stronger organization through our improved diversity which includes the growing number of LGBTQ firefighters, EMT's, paramedics and civilians in the FDNY."

FDNY will honor Deputy Assistant Chief Lillian Bonsignore, Chief of EMS Training; the Marble Collegiate Church, a diverse, inclusive church in Manhattan; and Tanya Koifman, the clinical social worker at Harvey Milk High School in Manhattan.

In October, 2015, FDNY debuted its first "It Gets Better" video, in support of the It Gets Better Project. The Project's mission is to communicate to lesbian, gay, bisexual, transgender, queer and questioning youth around the world that life gets better, and to create and inspire the changes needed to improve quality of life for them.

In the FDNY-produced video, twelve active FDNY firefighters, paramedics, and EMTs discuss the challenges they faced throughout their lives and the success they have found both as adults, and as FDNY members. Several participants in the video will be attending the Pride Celebration. 



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Herbal drugs: knowledge, attitude and practice of its concurrent use with allopathic drugs, scientific testing and effectiveness in common diseases among educated class

2016-06-13T07-52-15Z
Source: International Journal of Basic & Clinical Pharmacology
Md. Faiz Akram, Mohd Tariq Salman, Divya G. Krishnan, Nihal Ahmad, Afzal Khan.
Background: Craving for a holistic approach for healthcare and concern about side effect of the chemically produced drug is increasing interest in herbal medicine. There is a favourable perception about its effectiveness in complete cure of certain diseases. Its regulation, concurrent use with allopathic medicine and scientific testing has always been of concern. Methods: Cross sectional descriptive study was done using predesigned questionnaire among the educated class. Socio-demographic data, attitude and practice about simultaneous use, effectiveness in common disease, scientific testing and regulation of herbal medicine were asked. Also a rating of different system of medicine i.e allopathy, unani, ayurveda, homeopathy was asked. Results: Total completed participants were 120. Across level of education use of herbal medicine was 55% in the last 1 year, 56.7% have used or intend to use herbal along with allopathic and only 18.9 % tell it to treating physician. 50% consider concurrent use as safe, 43% believe it cures completely, 31.7% consider equally effective than allopathic and 95% have not encountered any side effect or allergic reaction with it. A majority did not know about any scientific testing and clinical study of herbal drugs. Conclusions: Herbal medicines have very positive perception. The regulatory authorities are also patronising it in many countries. They are also being used along with allopathic medicine and many times even without knowledge of treating doctor. The perception about herbal medicine is historical based on personal or clinical experiences, mostly lacking with good grade of strength of evidence. There is need to have Level Ia or Ib evidence for their effectiveness and safety.


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Quantifying lip-read-induced suppression and facilitation of the auditory N1 and P2 reveals peak enhancements and delays

Abstract

Lip-read speech suppresses and speeds up the auditory N1 and P2 peaks, but these effects are not always observed or reported. Here, the robustness of lip-read-induced N1/P2 suppression and facilitation in phonetically congruent audiovisual speech was assessed by analyzing peak values that were taken from published plots and individual data. To determine whether adhering to the additive model of AV integration (i.e., A+V ≠ AV, or AV−V ≠ A) is critical for correct characterization of lip-read-induced effects on the N1 and P2, auditory data was compared to AV and to AV−V. On average, the N1 and P2 were consistently suppressed and sped up by lip-read information, with no indication that AV integration effects were significantly modulated by whether or not V was subtracted from AV. To assess the possibility that variability in observed N1/P2 amplitudes and latencies may explain why N1/P2 suppression and facilitation are not always found, additional correlations between peak values and size of the AV integration effects were computed. These analyses showed that N1/P2 peak values correlated with the size of AV integration effects. However, it also became apparent that a portion of the AV integration effects was characterized by lip-read-induced peak enhancements and delays rather than suppressions and facilitations, which, for the individual data, seemed related to particularly small/early A-only peaks and large/late AV(−V) peaks.



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The evolutionary relationships and age of Homo naledi: An assessment using dated Bayesian phylogenetic methods

Publication date: August 2016
Source:Journal of Human Evolution, Volume 97
Author(s): Mana Dembo, Davorka Radovčić, Heather M. Garvin, Myra F. Laird, Lauren Schroeder, Jill E. Scott, Juliet Brophy, Rebecca R. Ackermann, Chares M. Musiba, Darryl J. de Ruiter, Arne Ø. Mooers, Mark Collard
Homo naledi is a recently discovered species of fossil hominin from South Africa. A considerable amount is already known about H. naledi but some important questions remain unanswered. Here we report a study that addressed two of them: "Where does H. naledi fit in the hominin evolutionary tree?" and "How old is it?" We used a large supermatrix of craniodental characters for both early and late hominin species and Bayesian phylogenetic techniques to carry out three analyses. First, we performed a dated Bayesian analysis to generate estimates of the evolutionary relationships of fossil hominins including H. naledi. Then we employed Bayes factor tests to compare the strength of support for hypotheses about the relationships of H. naledi suggested by the best-estimate trees. Lastly, we carried out a resampling analysis to assess the accuracy of the age estimate for H. naledi yielded by the dated Bayesian analysis. The analyses strongly supported the hypothesis that H. naledi forms a clade with the other Homo species and Australopithecus sediba. The analyses were more ambiguous regarding the position of H. naledi within the (Homo, Au. sediba) clade. A number of hypotheses were rejected, but several others were not. Based on the available craniodental data, Homo antecessor, Asian Homo erectus, Homo habilis, Homo floresiensis, Homo sapiens, and Au. sediba could all be the sister taxon of H. naledi. According to the dated Bayesian analysis, the most likely age for H. naledi is 912 ka. This age estimate was supported by the resampling analysis. Our findings have a number of implications. Most notably, they support the assignment of the new specimens to Homo, cast doubt on the claim that H. naledi is simply a variant of H. erectus, and suggest H. naledi is younger than has been previously proposed.



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The altitudinal mobility of wild sheep at the Epigravettian site of Kalavan 1 (Lesser Caucasus, Armenia): Evidence from a sequential isotopic analysis in tooth enamel

Publication date: August 2016
Source:Journal of Human Evolution, Volume 97
Author(s): Carlos Tornero, Marie Balasse, Adrian Bălăşescu, Christine Chataigner, Boris Gasparyan, Cyril Montoya
Kalavan 1 is an Epigravettian hunting campsite in the Aregunyats mountain chain in northeastern Armenia (Lesser Caucasus). The site lies at an elevation of 1640 m in a bottleneck that controls the descent into the Barepat Valley from the alpine meadows above. The lithic and faunal assemblages show evidence of the production of hunting weapons, the hunting and targeting of wild sheep (Ovis orientalis), and the constitution of animal product reserves. A seasonal occupation of the site was proposed within a model of occupation by Epigravettian hunter-gatherers that involved a search for obsidian resources in high altitude sources from the spring to the summer and settling at Kalavan 1 at the end of summer or during autumn to coincide with the migration of wild herds from the alpine meadows to the valley. A key parameter of this model is wild sheep ethology, with a specifically seasonal vertical mobility, based on observations from contemporary mouflon populations from the surrounding areas. In this study, the vertical mobility of Paleolithic wild sheep was directly investigated through sequential isotope analysis (δ18O, δ13C) in teeth. A marked seasonality of birth is suggested that reflects a physiological adaptation to the strong environmental constraints of this mountainous region. Most importantly, a recurrent altitudinal mobility was demonstrated on a seasonal basis, which confirms that wild sheep migrated from lowland areas that they occupied in the winter and then moved to higher altitude meadows during the summer. Last, low inter-individual variability in the stable isotope sequences favors a hypothesis of accumulation for these faunal remains over a short time period. Overall, this new dataset strengthens the previous interpretations for Kalavan 1 and contributes to an understanding of the pattern of occupation of mountain territories by Epigravettian communities.



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Laparoscopic ventral mesh rectopexy versus Delormes operation in management of complete rectal prolapse: a prospective randomized study

Colorectal Disease

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Association between level of fibrosis, rather than antiviral regimen, and outcomes of patients with chronic hepatitis B

Clinical Gastroenterology and Hepatology

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A pre-operative clinical model to predict microvascular invasion and long-term outcome after resection of hepatocellular cancer: the australian experience

European Journal of Surgical Oncology

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Biomarker analyses of clinical outcomes in patients with advanced hepatocellular carcinoma treated with sorafenib with or without erlotinib in the search trial

Clinical Cancer Research

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A pooled analysis of robotic versus laparoscopic surgery for total mesorectal excision for rectal cancer

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

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Diabetes and cirrhosis are risk factors for hepatocellular carcinoma after successful treatment of chronic hepatitis C

Clinical Infectious Diseases

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Case-matched comparison of robotic versus laparoscopic proctectomy for inflammatory bowel disease

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

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Comparison of ciprofloxacin-based triple therapy with conventional triple regimen for Helicobacter pylori eradication in children

Acta Medica Iranica

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Organization of flexor-extensor interactions in the mammalian spinal cord: insights from computational modelling

Abstract

Alternating flexor and extensor activity represents the fundamental property underlying many motor behaviours including locomotion. During locomotion this alternation appears to arise in rhythm-generating circuits and transpires at all levels of the spinal cord including motoneurons. Recent studies in vitro and in vivo have shown that flexor-extensor alternation during locomotion involves two classes of genetically identified, inhibitory interneurons: V1 and V2b. Particularly, in the isolated mouse spinal cord, abrogation of neurotransmission derived by both V1 and V2b interneurons resulted in flexor-extensor synchronization, whereas selective inactivation of only one of these neuron types did not abolish flexor-extensor alternation. After hemisection, inactivation of only V2b interneurons led to the flexor-extensor synchronization, while inactivation of V1 interneurons did not affect flexor-extensor alternation. Moreover, optogenetic activation of V2b interneurons suppressed extensor-related activity, while similar activation of V1 interneurons suppressed both flexor and extensor oscillations. Here, we address these issues using the previously published computational model of spinal circuitry simulating bilateral interactions between left and right rhythm-generating circuits. In the present study, we incorporate V1 and V2b neuron populations on both sides of the cord to make them critically involved in flexor-extensor interactions. The model reproduces multiple experimental data on the effects of hemisection and selective silencing or activation of V1 and V2b neurons and suggests connectivity profiles of these neurons and their specific roles in left-right (V1) and flexor-extensor (both V2b and V1) interactions in the spinal cord that can be tested experimentally.

This article is protected by copyright. All rights reserved



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Gremlin1 expression associates with serrated pathway and favorable prognosis in colorectal cancer

Histopathology

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A physiological increase in maternal cortisol alters uteroplacental metabolism in the pregnant ewe

Abstract

Fetal nutrition is determined by maternal availability, placental transport and uteroplacental metabolism of carbohydrates. Cortisol affects maternal and fetal metabolism but whether maternal cortisol concentrations within the physiological range regulate uteroplacental carbohydrate metabolism remains unknown. This study determined the effect of maternal cortisol infusion (1.2 mg kg−1 day−1 iv. for 5 days, n = 20) on fetal glucose, lactate and oxygen supplies in pregnant ewes on day ∼130 of pregnancy (term = 145 days). Compared to saline-infusion (n = 21), cortisol infusion increased maternal, but not fetal, plasma cortisol (P < 0.05). Cortisol infusion also raised maternal insulin, glucose and lactate concentrations, blood pH, PCO2 and HCO3 concentration. Although total uterine glucose uptake determined by Fick principle was unaffected, a greater proportion was consumed by the uteroplacental tissues so net fetal glucose uptake was 29% lower in cortisol-infused than control ewes (P < 0.05). Concomitantly, uteroplacental lactate production was > 2-fold greater in cortisol- than saline-treated ewes (P < 0.05), although uteroplacental O2 consumption was unaffected by maternal treatment. Materno-fetal clearance of non-metabolisable 3H-methyl-D-glucose and placental SLC2A8 (glucose transporter 8) gene expression were also greater with cortisol treatment. Fetal plasma glucose, lactate or α-amino nitrogen concentrations were unaffected by treatment although fetal plasma fructose and hepatic lactate dehydrogenase activity were greater in cortisol- than saline-treated ewes (P < 0.05). Fetal plasma insulin levels and body weight were also unaffected by maternal treatment. During stress, cortisol-dependent regulation of uteroplacental glycolysis may allow increased maternal control over fetal nutrition and metabolism. However, when maternal cortisol concentrations are raised chronically, prolonged elevation of uteroplacental lactate production may compromise fetal wellbeing.

This article is protected by copyright. All rights reserved



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Helicobacter pylori detection and clinical symptomatology of gastroesophageal reflux disease in pediatric patients with otitis media with effusion

International Journal of Pediatric Otorhinolaryngology

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The oncocytic subtype is genetically distinct from other pancreatic intraductal papillary mucinous neoplasm subtypes

Modern Pathology

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Functional adaptations of the coronary microcirculation to anemia in fetal sheep

Abstract

Fetal anemia causes cardiac adaptations that have immediate and life-long repercussions on heart function and health. It is known that resting and maximal coronary conductance both increase during chronic fetal anemia, but the coronary microvascular changes responsible for the adaptive response are unknown. Until recently, technical limitations have prevented quantifying functional capillary-level adaptations in the in vivo fetal heart. Our objective was to characterize functional microvascular adaptations in chronically anemic fetal sheep. Chronically instrumented fetuses were randomized to a control group (n = 11) or were made anemic by isovolumetric hemorrhage (n = 12) for one week prior to myocardial contrast echocardiography at 85 % of gestation. Anemia augmented cardiac mass by 23 % without changing body weight. In anemic fetuses, microvascular blood flow per volume of myocardium was twice that of control fetuses at rest, during vasodilatory hyperemia, and during hyperemia plus increased aortic pressure. The elevated blood flow was attributable almost entirely to an increase in microvascular blood flux rate whereas microvascular blood volumes were not different between groups at baseline, during hyperemia, or with hyperemia plus increased aortic pressure. Increased coronary microvascular flux rate in response to chronic fetal anemia is consistent with expected reductions in capillary resistance from capillary diameter widening detected in earlier histological studies.

This article is protected by copyright. All rights reserved



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Toll-like receptor expression and signalling in peripheral blood mononuclear cells correlate with clinical outcomes in acute hepatitis C infection

The Journal of Infectious Diseases

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Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review

Journal of Psychosomatic Research

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Revisiting Frank-Starling: regulatory light chain phosphorylation alters the rate of force redevelopment (ktr) in a length-dependent fashion

Abstract

Force and power in cardiac muscle have a known dependence on phosphorylation of the myosin-associated regulatory light chain (RLC). We explore the effect of RLC phosphorylation on the ability of cardiac preparations to redevelop force (ktr), in maximally activating [Ca2+]. Activation was achieved by rapidly increasing the temperature (T-jump 0.5 - 20ºC) of permeabilised trabeculae over a physiological range of sarcomere lengths (1.85 - 1.94 μm). The trabeculae were subjected to shortening ramps over a range of velocities, and the extent of RLC phosphorylation was varied. The latter was achieved using an RLC-exchange technique, which avoids changes in the phosphorylation level of other proteins. Results show that increasing RLC phosphorylation by 50 % accelerates ktr by ∼50 %, irrespective of the sarcomere length, whereas decreasing phosphorylation by 30 % slows ktr by ∼50 %, relative to the ktr obtained for in vivo phosphorylation. Clearly phosphorylation affects the magnitude of ktr following step shortening or ramp shortening. Using a two-state model we explore the effect of RLC phosphorylation on the kinetics of force development, which proposes that phosphorylation affects the kinetics of both attachment and detachment of cross-bridges. In summary RLC phosphorylation affects the rate and extent of force redevelopment. These findings were obtained in maximally activated muscle at saturating [Ca2+] so are not explained by changes in the Ca2+-sensitivity of acto-myosin interactions. The length-dependence of the rate of force redevelopment, and the modulation by the state of RLC phosphorylation suggest that these effects play a role in the Frank-Starling law of the heart.

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Recurrence patterns and disease-free survival after resection of intrahepatic cholangiocarcinoma: Preoperative and postoperative prognostic models

Journal of the American College of Surgeons

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No difference in sexual dysfunction after transabdominal preperitoneal (TAPP) approach for inguinal hernia with fibrin sealant or tacks for mesh fixation

Surgical Endoscopy

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Robotic-assisted apical lateral suspension for advanced pelvic organ prolapse: Surgical technique and perioperative outcomes

Surgical Endoscopy

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Maternal and perinatal conditions and the risk of developing celiac disease during childhood

BMC Pediatrics

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Electromagnetic-guided bedside placement of nasoenteral feeding tubes by nurses is non-inferior to endoscopic placement by gastroenterologists: A multicenter randomized controlled trial

The American Journal of Gastroenterology

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