Σάββατο, 13 Αυγούστου 2016

Let-7b inhibits the malignant behavior of glioma cells and glioma stem-like cells via downregulation of E2F2

Abstract

Glioblastoma multiforme (GBM), the most common and lethal primary brain tumor in adults characterized by high proliferative ability and mortality rate, contains a small subpopulation of cancer stem-like cells (CSCs), which is responsible for GBM progression and therapeutic resistance. Numerous microRNAs are strongly implicated in the malignancy of glioma. However, their specific functions and roles have yet to be fully demonstrated. In the present study, we revealed that the upregulation of Let-7b, a member of the Let-7 microRNA family, inhibited proliferation, migration, and invasion in glioma cell lines. Using bioinformatics, expression analysis, and luciferase assay, E2F2 was confirmed as a candidate target of Let-7b. Moreover, we also observed that elevated levels of Let-7b resulted in a reduction of tumor sphere growth and stemness of glioma stem-like cells. Furthermore, we found that knockdown of E2F2 expression could reduce the proliferation of glioma and GSCs, while overexpression of E2F2 partially abrogated the inhibitory effect of Let-7b on the proliferation of glioma and GSCs. In conclusion, we suggest that Let-7b could be developed into a promising anticancer target in glioma.



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Depression predicts functional outcome in geriatric inpatient rehabilitation

Publication date: Available online 13 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Saba Shahab, Diana-Felicia Nicolici, Alva Tang, Paul Katz, Linda Mah
ObjectiveTo evaluate the effect of depression on functional recovery in geriatric patients who have completed an inpatient rehabilitation program.DesignProspective cohort study.SettingUniversity-affiliated multidisciplinary, high-tolerance, short-duration geriatric rehabilitation.ParticipantsConvenience sample of 65 patients [mean age 81.6, 25 males] admitted to rehabilitation over a 10-month period. Patients over the age of 60 who were proficient in English and capable of providing informed consent were eligible to participate in the study.InterventionsDepression was assessed using both the Geriatric Depression Scale-Short Form (GDS-15) and the Patient Health Questionnaire (PHQ-9). Measures of well-established predictors of rehabilitation outcome, which may interact with depression, were also obtained and multiple regression linear modeling was used to evaluate the relationship between depression and functional outcome over and above the contribution of these other factors.Main Outcome MeasureFunctional Independence Measure at discharge from the rehabilitation programResultsDepression, as assessed by the GDS-15, but not the PHQ-9, was predictive of functional outcome (standardized β=-.165, p=.021) after controlling for other significant predictors, which included baseline disability, pain, cognition, and educational level. Participation in recreational, but not physio- or occupational, therapy additionally contributed to a small amount of variance in the functional outcome.ConclusionsOur findings suggest that self-report of depression is an independent predictor of functional outcome in high-tolerance, short duration geriatric rehabilitation. Routine assessment of depressive symptoms in older adults using an instrument, such as the GDS-15 may help identify those at risk for poorer outcomes in rehabilitation.



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Sarcopenia and Physical Function in Middle-Aged and Older Stroke Survivors

Publication date: Available online 13 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Alice S. Ryan, Frederick M. Ivey, Monica C. Serra, Joseph Hartstein, Charlene E. Hafer-Macko
ObjectiveTo determine the prevalence of sarcopenia in stroke survivors using different methodologies and compared a subset of the stroke group to age, sex, and BMI-matched non-stroke control counterparts.DesignCohort StudySettingVeterans Affairs Medical Center and University HospitalParticipantsMild to moderately disabled chronic participants with stroke aged 40-84 yrs (n=190, 61% male, 57% African American, BMI: 29±1 kg/m2, X±SEM)InterventionsNot applicableMain Outcome MeasuresDXA scans to assess appendicular lean mass (ALM). Rates of sarcopenia were determined using four established methods: 1) ALM/ht2; 2) European Working Group on Sarcopenia in Older Persons; 3) International Working Group on Sarcopenia; and 4) ALM/BMI.ResultsSarcopenia prevalence in our stroke cohort ranged between 14% and 18%. The stroke survivor subset (n=38) matched one-for-one with control counterparts for race, sex, age±4 years and BMI±2.5 units had higher prevalence rates compared to their non-stroke counterparts (13.2% vs. 5.3%, P<0.0001). ALM/ht2 was related to six-minute walking speed (r=0.28, P<0.01) and VO2peak (l/min r=0.58, P<0.0001) for the stroke group.ConclusionsStroke survivors show an elevated prevalence of sarcopenia when considering age, sex, and race to non-stroke individuals.



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A Clinical Prediction Rule for Declines in Activities of Daily Living at 6 Months after Surgery for Hip Fracture Repair

Publication date: Available online 13 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ryo Tanaka, Takuya Umehara, Takafumi Fujimura, Junya Ozawa
ObjectiveTo develop and assess a clinical prediction rule (CPR) to predict declines in activities of daily living (ADL) at 6 months after surgery for hip fracture repair.DesignA prospective, cohort study.SettingFrom hospital to home.ParticipantsOne hundred and four patients with hip fractures after surgery.InterventionsNo special intervention was employed in this study.Main Outcome MeasureADL was assessed using the Barthel Index at 6 months after surgery.ResultsAt 6 months after surgery, 86 patients (82.6%) were known to be alive, one patient died, and 17 (16.3%) were lost to follow-up. Thirty-two patients (37.2%) did not recover their ADL at 6 months after surgery to levels before fracture. The Classification and Regression Trees (CART) methodology was used to develop two models to predict a decline in ADL: model-1, which included age, type of fracture, care-level before fracture (sensitivity = 0.750, specificity = 0.815, positive predictive value = 70.6%, and positive likelihood ratio = 4.050), and model-2, which included the independence of post-surgery 2 weeks ADL chair transfer and ambulation and age (sensitivity = 0.656, specificity = 0.870, positive predictive value = 75.0%, and positive likelihood ratio = 5.063). The areas under receiver-operator characteristic curves of both CPR models were 0.825 [95% confidential interval (CI) = 0.728–0.923) and 0.790 (95% CI = 0.683–0.897), respectively.ConclusionCPRs with moderate accuracy were developed to predict declines in ADL at 6 months after surgery for hip fracture repair.



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Ultrasonographic assessment of superficial fibular nerve branches

Peripheral nerve injury is a possible complication of orthopaedic surgery and the correct diagnosis of patient's condition, after the intervention, is crucial for the specific rehabilitation program (Bade et al., 2010). The use of ultrasound (US) to assess nerves is well known and extensively shown in literature by many studies (Padua et al., 2013). High-frequency US is routinely applied for the evaluation of the main and largest nerve structures in limbs, like fibular nerve (Coraci et al., 2015).

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Added diagnostic value of magnetoencephalography (MEG) in patients suspected for epilepsy, where previous, extensive EEG workup was unrevealing

Although epilepsy can be diagnosed solely on clinical data, additional investigations are often needed after the first seizure to assess the probability of recurring seizures (Fisher et al. 2014). EEG is one of the most important investigations, which besides supporting diagnosis of epilepsy, also contributes to its classification (Berg et al. 2010). It is well established that in about 10-20% of patients with epilepsy, multiple EEG studies including sleep deprived EEG, fail to show abnormalities (Alving and Beniczky.

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Repetitive facial nerve stimulation in myasthenia gravis 1 minute after muscle activation is inferior to testing a second muscle at rest

To explore the increased diagnostic yield of repetitive nerve stimulation (RNS) following activation for myasthenia gravis (MG) diagnosis, and compare with testing an additional muscle at rest only.

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Malnutrition in Pre-school Children across Different Geographic Areas and Socio-Demographic Groups in Ghana

Abstract

Objective Malnutrition in children pervades all aspects of their health, growth, cognitive and social development and can lead to irreversible and lifelong effects. We examine the prevalence and determinants of malnutrition in children under 5 in the Ghanaian population. Methods Using data from the latest available Ghana Demographic and Health Survey (GDHS), we estimated and compared prevalence of malnutrition in children among the different subgroups of the population. We used multivariable logistic regression to identify potential factors associated with childhood malnutrition in Ghana. Results Overall, 35.6 % (95 % CI: 33.6, 37.6) of Ghanaian children under 5 years of age suffer from some form of malnutrition. Specifically, 27.5 % (95 % CI: 25.1, 28.7), 13.8 % (95 % CI: 12.5, 15.3), 8.9 % (95 % CI: 7.8, 10.2) were stunted, underweight and wasted, respectively. Results from the logistic regression indicate that gender and age of the child, educational and nutritional status of the mother, and financial status of the household are risk factors associated with childhood malnutrition in Ghana. Conclusions for Practice In view of the observed high rate of malnutrition among Ghanaian children despite the interventions that have been in place since the 1990s, there is a need for increased awareness and improved targeted interventions as well as knowledge translation tools including extensive education on infant and young child feeding practices.



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Creating Supportive Breastfeeding Policies in Early Childhood Education Programs: A Qualitative Study from a Multi-Site Intervention

Abstract

Objectives To understand the process by which early childhood education (ECE) providers effectively used an existing intervention to facilitate the creation or strengthening of a written breastfeeding policy, understand the factors important to this process, and present a logic model to guide future intervention design and evaluation. Methods A purposive sample of interviewees who recently completed an ECE nutrition and physical activity intervention and reported positive pre-post scores for breastfeeding support were recruited to complete semi-structured interviews. Interviews were recorded, transcribed, and coded, following a Grounded Theory approach. Results The ECE programs (n = 23) had a written breastfeeding policy and were located across six states in the United States. The most common aspects of breastfeeding support covered in the policies were handling and storing of breastmilk, pieces of equipment to be provided (e.g., breast pump), and the creation of a space or room designated for breastfeeding and pumping. Many factors important to the policy creation process were identified such as motivation, education, technical assistance, perceptions of parental indifference, staff buy-in, and time and administrative constraints. Once motivated to create a policy, ECE providers described actions, such as gathering background information and model policies, discussing policy needs with stakeholders, utilizing technical assistance, and overcoming barriers. Conclusions for Practice From these findings, a logic model was created to guide future intervention design and evaluation, and several recommendations were made to help guide subsequent interventions in promoting the development and implementation of written breastfeeding policies at ECE programs.



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Firefighter/Paramedic Trainee - Villages Public Safety Department

VILLAGES PUBLIC SAFETY DEPARTMENT 3035 MORSE BOULEVARD THE VILLAGES, FLORIDA 32163 Updated: August 11, 2016 Classification: Firefighter/Paramedic Trainee Villages Public Safety Department is currently hiring for Firefighter/Paramedic Trainee. National Testing Network (NTN) FireTEAM and a valid CPAT are required for this position. All NTN testing must be completed by September 2, 2016. Salary Information: ...

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Follow up in posterior urethral valve after primary valve fulguration or diversion with fulguration with special references to urodynamic studies

2016-08-13T13-00-44Z
Source: International Journal of Medical Science and Public Health
Lalit Kumar, Rahul Tiwari, Amit Sandhu, Sakshi Agarwal, Bajrang Tak.
Background: Follow up of posterior urethral valve patients is very crucial as it is commonest congenital obstruction of the lower urinary tract. Objective: To evaluate outcome after surgery with special reference to urodynamic studies. Materials and Methods: Study has been carried out retrospectively. Fifty cases of PUV of age ≥3 years were included in the study between the time period of July 2010 to June 2012. Long term outcome had been evaluated by renal profile, MCU, and UDS regarding bladder dysfunction. In most of the cases the initial presentation data were collected retrospectively at the time of follow up. At that time UDS was performed if there was no contraindication. 50 cases were divided into 2 groups. Group 1 included 18 patients which were managed only by primary valve fulguration while group 2 included 32 patients which required urinary diversion procedure. Result: The mean value of serum creatinine in group 1 was 1.486±0.7646 mg/dl at the time of initial presentation and 0.8511±0.22721 mg/dl at the time of follow up while for group 2 it was 1.737±0.9734 mg/dl and 1.0913±0.41396 mg/dl, respectively. The mean value of PdetMax was 79.20±33.842 cm H2O in group1 and it was 51.14±28.141 cm H2O in group 2. Mean value of bladder compliance was 15.86±17.902 mL/cm H2O in group 1 and 6.26±3.605 mL/cm H2O in group 2. PdetMax and bladder compliance showed significantly better results in group 1 as p


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A Community based cross sectional study of dog bites in children in a rural district of Tamil Nadu

2016-08-13T13-00-44Z
Source: International Journal of Medical Science and Public Health
Murugan Venkatesan, Amol Dongre, Kalaiselvan Ganapathy.
Background: Worldwide dog bites are becoming a significant public health problem and the annual frequency of dog bite injuries in children is estimated to be 22 per 1000 children of which less than half of them are reported in medical facilities. Objective: To study the period prevalence of dog bites in children, its risk factors and treatment seeking behavior. Materials and Methods: The present cross sectional study was conducted in field practicing areas of rural health centre covering 4150 households in 34 villages involving 5841 children. Data was collected by trained medical interns and social workers. Collected data was entered and analyzed using EPI_INFO software (3.5.3). Result: The period prevalence of dog bites episodes in last one year is 17.9 per 1000 children. Most of bites happened in male children (51.5%), less than 10 years of age (56%), and children below poverty line (80%). Almost 78% of bites are unprovoked and the most common place of bites is in and around the house (70%). The most common site of bite is lower limb (53.6%) followed by upper limb (27.6%). The most common treatment source for bites is primary health centre followed by traditional faith healers. Almost 67% of wounds belonging to class 3 wounds but only 4% of dog bite victims received immunoglobulins. Conclusion: Period prevalence of dog bites is high and it is common in children belonging to poor socioeconomic conditions. In a country with very high population of unvaccinated dogs, health education program focusing on prevention of dog bites, correct methods of local wound treatment, vaccine, and rabies immunoglobulins are needed.


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Drug utilization pattern of antiepileptic drugs in a tertiary care teaching rural hospital

2016-08-13T12-17-30Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Pragna M Patel, Amit M Shah, Bharat M Gajjar.
Background: Antiepileptic drugs (AEDs) are also commonly used therapy for other conditions like prophylaxis for a manicdepressive disorder, to relieve neuralgic pain and for many more conditions apart from epilepsy. Data suggest that 45% of AEDs prescriptions were for conditions other than epilepsy. All of these uses are off-label except for some AEDs approved for limited indications. Aims and Objective: To study the AEDs utilization pattern in a tertiary care teaching rural hospital in India. Materials and Methods: Patients who prescribed AEDs by treating physician from the various outpatient departments of a tertiary care hospital were enrolled in the study irrespective of their diagnosis. Their demographic data, clinical profile and drug use related details were obtained from the case files and history and analyzed. Results: Out of total 160 patients enrolled, the majority were male 103 (64.4%), in the age group of 18-65 years (123, 76.9%), and from neuromedicine 149 (93.1%) department. 81 (50.63%), 45 (28.12%), and 10 (6.25%) were diagnosed as epilepsy, pain, and psychomotor disorders, respectively, and remaining patients having a dual indication for AEDs prescription. Partial epilepsy (45, 47.87%) was the most common type and cryptogenic (44, 46.80%) was most common aetiological factor among epileptic patients. Average number of AEDs prescribed per patient was 1.331. 113 (70.6%) patients were managed by monotherapy. Most frequently prescribed AEDs were pregabalin (20.19%) followed by phenytoin (16.90%). Conventional AEDs (78.95%) were prescribed more frequently than newer AEDs (21.05%) for epilepsy; while newer AEDs (68.10%) were frequently prescribed in patients suffering from non-epileptic condition. 52% of drugs were prescribed by generic name. No fixed dose combinations of AEDs were prescribed throughout this study period. Conclusions: The use of AEDs not limited to epilepsy only. AEDs were prescribed more frequently in neuropathic pain and psychiatric disorders other than epilepsy. AEDs are usually prescribed as monotherapy and by generic name and not as fixed dose combination. Awareness about off-label use of ADEs is essential for its appropriate use.


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The pattern of adverse drug events to antiepileptic drugs: A cross-sectional study at a tertiary care teaching hospital

2016-08-13T12-17-30Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Bharat M Gajjar, Amit M Shah, Pragna M Patel.
Background: The goal of antiepileptic therapy is to achieve complete seizure control with minimum adverse effects impacting negatively on the quality of life. The drugs available in the market for the treatment of epilepsy have their own new and unique adverse drug reaction profile. Aims and Objective: To study the pattern of adverse drug events (ADEs) to antiepileptic drugs (AEDs) in a tertiary care teaching rural hospital in India. Materials and Methods: Data of all the patients visited the Outpatient Department of Neuromedicine, Neurosurgery, and Paediatric Department of the Shree Krishna Hospital in the study duration and who received AEDs as treatment, irrespective of diagnosis, age or sex were collected after obtaining written informed consent from the patients. All the adverse events reported spontaneously as well as founded by researcher during the interview at each visit were recorded in the case record form with all necessary information. Results: Total 112 ADEs were reported from 58 (36.25%) patients in 6-month follow-up. Central nervous system was most frequently affected with 68 (60.71%) ADEs followed by the gastrointestinal system (68, 60.71%). Phenytoin was most commonly suspected AEDs (with 39 cases) followed by carbamazepine (in 23 cases). Causality assessment by the WHO-UMC criteria most common association was possible in 75 (66.96%) cases, probable 21 (18.75%), certain 6 (5.36%), and conditional/unclassified 10 (8.93%). Similar result was obtained by Naranjos criteria as possible 84 (75.00%), probable 22 (19.64%), and definite 6 (5.36%). 91 (80.36%) ADEs were not preventable by modified Schumock and Thornton scale. Severity assessment by Hartwigs criteria showed 79 (70.53%) ADEs as mild. Number of AEDs given per patient had a statistical correlation with ADEs. Conclusions: There are higher chances of development of ADEs in patients taking AEDs. However, at individualized regimens, the burden of ADEs is likely to be related more to individual responsiveness, type of AEDs/AED combinations chosen, and physician treatment skills, intensive therapeutic surveillance, education about epilepsy and the importance of drug compliance, and psychosocial interventions.


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Evaluation of perceived stress in bus drivers of Pune city

2016-08-13T12-17-30Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Anuradha Rajiv Joshi, Savita Madhukar Vaidya.
Background: Occupational stress has an aversive affect on individuals and organizations. Stress leads to physical and mental ill-health. Bus driving is a classic example of high-strain occupation. In a metropolitan city like Pune, drivers have responsibility to overcome traffic congestion and to get passengers safely and comfortably in scheduled time to the desired destination. Stress in bus drivers leads to absenteeism, substance abuse, decreased productivity, and increased accident rates. Stress detection will help in taking measures for stress reduction. Thus, this study was planned to assess perceived stress in Pune Mahanagar Parivahan Mahamandal Ltd (PMPML) bus drivers of Pune city. Aims and Objectives: To study and compare perceived stress score using Perceived Stress Scale (PSS) in PMPML bus drivers and office staff. Materials and Methods: This was a cross-sectional observational study. Study group (n = 130) included PMPML bus drivers and control group (n = 130) included volunteers from office staff of general population. In both the groups, PSS score was estimated with the help of PSS questionnaire. Data were analyzed by Students t-test. Results: Statistically significant increase in PSS score was observed in the study group. Conclusions: It is evident from the study that PSS score was very high in bus drivers as compared to office staff. This indicates that bus driving is a tremendously stressful job, and effective measures should be taken to reduce stress in bus drivers.


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Full-Time/Supplemental Paramedic - Trinity County Life Support

LOCATION: Trinity County SHIFT: 24 hours (three consecutive 24s per week is the full-time schedule) ANNUAL PAY: $49,920 to $70,520 (based on experience) Trinity County Life Support is a non-profit ambulance service that allows for the unique opportunity to provide critical care in a rural situation, with extended transport times. Trinity County is a beautiful area, with miles of scenic river, surrounded ...

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Genetics and pathophysiology of mammalian sulfate biology

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Publication date: Available online 13 August 2016
Source:Journal of Genetics and Genomics
Author(s): Rachel Langford, Elizabeth Hurrion, Paul A. Dawson
Nutrient sulfate is essential for numerous physiological functions in mammalian growth and development. Accordingly, disruptions to any of the molecular processes that maintain the required biological ratio of sulfonated and unconjugated substrates are likely to have detrimental consequences for mammalian physiology. Molecular processes of sulfate biology can be broadly grouped into four categories: firstly, intracellular sulfate levels are maintained by intermediary metabolism and sulfate transporters that mediate the transfer of sulfate across the plasma membrane; secondly, sulfate is converted to 3'-phosphoadenosine 5'-phosphosulfate (PAPS), which is the universal sulfonate donor for all sulfonation reactions; thirdly, sulfotransferases mediate the intracellular sulfonation of endogenous and exogenous substrates; fourthly, sulfate is removed from substrates via sulfatases. From the literature, we curated 91 human genes that encode all known sulfate transporters, enzymes in pathways of sulfate generation, PAPS synthetases and transporters, sulfotransferases and sulfatases, with a focus on genes that are linked to human and animal pathophysiology. The predominant clinical features linked to these genes include neurological dysfunction, skeletal dysplasias, reduced fecundity and reproduction, and cardiovascular pathologies. Collectively, this review provides reference information for genetic investigations of perturbed mammalian sulfate biology.



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A randomized prospective comparative study of efficacy of asenapine, iloperidone and zotepine in patients with psychosis

2016-08-13T06-53-28Z
Source: International Journal of Basic & Clinical Pharmacology
Nagesh H. N., Anil Kumar Nagaraj.
Background: Antipsychotic drugs constitute the mainstay in the treatment of schizophrenia and other psychotic disorders. For these medications to be maximally beneficial, they must be efficacious, with an acceptable side effect profile and be taken as prescribed. The objective of the study was to compare the efficacy of iloperidone, asenapine and zotepinein subjects with psychotic disorders. Methods: Randomized prospective study was conducted in the Department of Psychiatry of a tertiary care hospital, at Mysore, India. Sixty Patients who met the criteria for acute psychosis and schizophrenia according to ICD 10 were recruited. Atypical antipsychotics-asenapine, iloperidone and zotepine were administered and their efficacy was monitored by brief psychiatric rating scale (BPRS), which was administered on day one, week 1, week 3 and week 6. Results: Out of 60 recruited subjects 31 (51.7%) completed all four visits of the study. Iloperidone and asenapine showed significant improvement in efficacy than zotepine at week 6. Among the total dropouts 55.2% subjects didnt come for follow-up and 44.8% were dropped due to development of side effects. Conclusions: In patients with acute psychosis and schizophrenia, iloperidone appears more effective and tolerated than the other two. Asenapine was effective but less tolerated and zotepine was less efficacious and produced poor response. Asenapine and zotepine have more dropouts and showed few uncommon extrapyramidal side effects.


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Comparative study of problem based learning versus structured group discussion in teaching pharmacology

2016-08-13T06-53-28Z
Source: International Journal of Basic & Clinical Pharmacology
Laveesh M. R., Vishwaprakash M. K., Somashekara S. C..
Background: Pharmacology for undergraduate students is taught primarily with a drug centric approach using didactic lectures. Hence the students cant correlate the drug with the disease and loses interest in the subject. Problem based learning (PBL) on the other hand involves effort from the students themselves which gives them a sense of ownership and helps to enhance their analytical skills. Structured group discussion (SGD) is used to enable students directed learning where they are given structured objectives on the topic followed by a discussion. Methods: This was a quasi-experimental study done on 100 second year MBBS students. They were divided into 2 groups (group A and B) of 50 each. Group A was allotted a therapeutic problem (PBL) and the group B was assigned structured objectives on the same topic (SGD). Later the groups were switched for PBL and SGD and given another topic. A pre and post-test was conducted using MCQs for each session. Finally a feedback was taken from all the students. Results: There was a statistically significant gain in knowledge following both the methods of learning. However there was no statistically significant difference in the mean marks between PBL and SGD. Nonetheless the mean for PBL (5.42) in group A and B was greater than that of SGD (5.17) in the same. Students feedback was also better for PBL under all the heads. Conclusions: PBL and SGD are effective small group methods for teaching undergraduate medical students. However learning outcome with PBL is better than SGD.


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A prospective randomised double-blinded study of intranasal midazolam atomizer spray for procedural sedation in paediatric patients

2016-08-13T05-35-38Z
Source: International Journal of Research in Medical Sciences
Vijaykumara, Shalaka S. Nellore*, Bharati Tendolkar.
Background: Premedication prior to anaesthesia in children provides anxiolysis, facilitates parenteral separation and lessens adverse psychological effects on young minds. The present study was designed to study the safety, acceptability and degree of sedation by intranasal midazolam spray in children undergoing short procedures like endoscopy and CT scan. Methods: Sixty children scheduled for CT scan or endoscopy were randomly divided in to two groups. Thirty patients received intranasal midazolam spray 0.2 mg/kg, 20 minutes prior to procedure (group M) while other thirty patients received intra-nasal 0.9% normal saline spray (group C). Vital parameters such as heart rate (HR), systolic and diastolic blood pressure, respiratory rate (RR), SpO2, ramsay sedation score (RSS) and anxiety score level was observed and recorded prior to the premedication and then every 5 minutes till the end of the procedure. Parenteral separation and behaviour of the patient while entering the procedure room was also evaluated in both groups. Results: The mean heart rate, systolic blood pressure, respiratory rate, oxygen saturation were comparable between groups M and C. The mean diastolic blood pressure was significantly lower in group M as compared to group C. RSS and anxiety level score achieved were significantly higher in group M thereby facilitating easy parenteral separation. Conclusions: We can thereby say that administration of preservative free intranasal midazolam atomizer spray in dose of 0.2mg/kg as premedication in paediatric patients produces satisfactory level of sedation and anxiolysis with minimal adverse effects.


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Analysis of cerebrospinal fluid adenosine deaminase levels in meningitis

2016-08-13T05-35-38Z
Source: International Journal of Research in Medical Sciences
Vyankatesh T. Anchinmane, Shilpa V. Sankhe.
Background: A precise etiological diagnosis of meningitis is required so that appropriate therapy can be started at the earliest. Due to inconsistent clinical presentations and the lack of a rapid, sensitive and specific test, tuberculous meningitis (TBM) is particularly difficult to diagnose. The present study was done to analyze the utility of adenosine deaminase (ADA) activity in CSF for differentiating TBM from other forms of meningitis. Methods: In our study, ADA activity measured in 26 TBM, 15 pyogenic meningitis (PM) and 10 aseptic/viral meningitis (AM) cases. A cut-off ADA level of 10 IU/L was used for differentiation of TBM cases from other meningitis cases. Results: The mean ADA levels in CSF were highest in TBM patients as compared to PM and AM. The sensitivity, specificity and accuracy of ADA were 96.15%, 92% and 94.11% respectively for detection TBM cases from non-tuberculous meningitis cases. Conclusions: Since ADA test is simple, rapid and inexpensive, it can be used as rapid diagnostic test for differential diagnosis of CSF and confirmation of TBM cases.


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Comparison of haemodynamic responses in normotensive and hypertensive patients among three intubation devices: macintosh laryngoscope, intubating laryngeal mask airway and lightwand

2016-08-13T05-35-38Z
Source: International Journal of Research in Medical Sciences
S. K. Gvalani, Sushant Mane.
Background: The pressor response to endotracheal intubation is of special concern, especially in the presence of comorbidities like diabetes, hypertension, obesity and ischemic heart disease (IHD). It is commonly assumed that insertion of laryngeal mask airway (LMA) is associated with lesser hemodynamic fluctuations than conventional laryngoscopy. Also, the lightwand (LW) is believed to provoke a milder pressor response as it does not involve elevation of epiglottis. We decided to evaluate the pressor response to all three devices in normotensive and hypertensive patients. Methods: We conducted a randomized prospective study consisting of 126 patients posted for surgical procedures under general anesthesia. 63 hypertensive and 63 normotensive patients were randomly assigned to each intubation device: the macintosh laryngoscope (LS), the lightwand (LW), and the intubating laryngeal mask airway (ILMA).The peri-intubation hemodynamic parameters were recorded. Statistical analysis was done with SPSS version 17.0 Inter- and intra-group differences among the hemodynamic variables recorded over time were analyzed by using one-way analysis of variance for repeated measures with bonferroni post-test analysis as appropriate. All quantitative data were expressed as mean±standard deviation (SD). A p-value less than 0.05 was considered statistically significant. Results: All 3 devices (LS, ILMA and LW) are comparable with respect to hemodynamic fluctuations in normotensive patients. However, in hypertensive patients conventional laryngoscopy was associated with greater hemodynamic fluctuations than ILMA or LW. However there was no significant difference in the hemodynamic fluctuations between ILMA and LW. Conclusions: The ILMA and LW may be preferable to LS in hypertensive patients where attenuation of hemodynamic stress response is desired.


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A sequential anesthesia technique for surgical repair of unilateral vocal fold paralysis

Abstract

Thyroplasty with arytenoid adduction, a combined procedure for treatment of unilateral vocal fold paralysis, is typically performed under local anesthesia with sedation to allow for intraoperative voice assessment. However, the need for patient immobility and suppression of laryngeal responses to surgical manipulation can make sedation-analgesia challenging. We describe our first 26 consecutive cases undergoing thyroplasty and arytenoid adduction with a standardized technique consisting of a combination of general anesthesia with tracheal intubation followed by sedation-analgesia. Most patients (69 %) were women, with age of 53 ± 15 years (mean ± SD). Neck surgery was the cause of vocal fold paralysis in 50 % of patients. Initially, general anesthesia was maintained with desflurane and remifentanil with dexmedetomidine added just before tracheal extubation. During the sedation-analgesia phase, patients received infusions of remifentanil and dexmedetomidine. Duration of general anesthesia and sedation-analgesia phases was 162 ± 68.2 and 79 ± 18.3 min, respectively. Mean (SD) wake-up time was 8.0 ± 4.0 min after desflurane discontinuation. Extubation occurred without coughing, bucking, or agitation in 96 % of patients. All the patients were able to phonate appropriately and remained comfortable after emergence. This technique allowed improved surgical conditions with reduced patient discomfort and may be advantageous for other laryngeal and neck surgeries in which intraoperative patient feedback is required.



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CIT , a gene involved in neurogenic cytokinesis, is mutated in human primary microcephaly

Abstract

Autosomal recessive primary microcephaly (MCPH) is a static neurodevelopmental disorder characterized by congenital small head circumference and non-progressive intellectual disability without additional severe brain malformations. MCPH is a genetically heterogeneous disorder. Sixteen genes (MCPH1–MCPH16) have been discovered so far, mutations thereof lead to autosomal recessive primary microcephaly. In a family, segregating MCPH in an autosomal recessive manner, genome-wide homozygosity mapping mapped a disease locus to 16.9-Mb region on chromosome 12q24.11-q24.32. Following this, exome sequencing in three affected individuals of the family discovered a splice site variant (c.753+3A>T) in citron kinase (CIT) gene, segregating with the disorder in the family. CIT co-localizes to the midbody ring during cytokinesis, and its loss of expression results in defects in neurogenic cytokinesis in both humans and mice. Splice site variant in CIT, identified in this study, is predicted to abolish splice donor site. cDNA sequence of an affected individual showed retention of an intron next to the splice donor site. The study, presented here, revealed the first variant in the CIT causing MCPH in the family.



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