The majority of disease-associated genetic variants identified by genome-wide association studies (GWAS) are in non-coding regions of the genome. This indicates a pathological regulatory role for these variants, but identifying mechanisms of action and their corresponding target genes is often challenging. As part of the
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Δευτέρα, 12 Δεκεμβρίου 2016
The majority of disease-associated genetic variants identified by genome-wide association studies (GWAS) are in non-coding regions of the genome. This indicates a pathological regulatory role for these variants, but identifying mechanisms of action and their corresponding target genes is often challenging. As part of the
Publication date: Available online 12 December 2016
Source:International Journal of Psychophysiology
Author(s): Vsevolod Peysakhovich, François Vachon, Frédéric Dehais
Pupillary reactions independent of light conditions have been linked to cognition for a long time. However, the light conditions can impact the cognitive pupillary reaction. Previous studies underlined the impact of luminance on pupillary reaction, but it is still unclear how luminance modulates the sustained and transient components of pupillary reaction – tonic pupil diameter and phasic pupil response. In the present study, we investigated the impact of the luminance on these two components under sustained cognitive load. Fourteen participants performed a novel working memory task combining mathematical computations with a classic n-back task. We studied both tonic pupil diameter and phasic pupil response under low (1-back) and high (2-back) working memory load and two luminance levels (gray and white). We found that the impact of working memory load on the tonic pupil diameter was modulated by the level of luminance, the increase in tonic pupil diameter with the load being larger under lower luminance. In contrast, the smaller phasic pupil response found under high load remained unaffected by luminance. These results showed that luminance impacts the cognitive pupillary reaction – tonic pupil diameter (phasic pupil response) being modulated under sustained (respectively, transient) cognitive load. These findings also support the relationship between the locus-coeruleus system, presumably functioning in two firing modes – tonic and phasic – and the pupil diameter. We suggest that the tonic pupil diameter tracks the tonic activity of the locus-coeruleus while phasic pupil response reflects its phasic activity. Besides, the designed novel cognitive paradigm allows the simultaneous manipulation of sustained and transient components of the cognitive load and is useful for dissociating the effects on the tonic pupil diameter and phasic pupil response.
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Investigations on the impact of chemicals on the environment and human health have led to the development of an exposome concept. The exposome refers to the totality of exposures received by a person during life, including exposures to life-style factors, from the prenatal period to death. The exposure to genotoxic chemicals and their reactive metabolites can induce chemical modifications of DNA, such as, for example, DNA adducts, which have been extensively studied and which play a key role in chemically induced carcinogenesis. Development of different methods for the identification of DNA adducts has led to adopting DNA adductomic approaches. The ability to simultaneously detect multiple PAH-derived DNA adducts may allow for the improved assessment of exposure, and offer a mechanistic insight into the carcinogenic process following exposure to PAH mixtures. The major advantage of measuring chemical-specific DNA adducts is the assessment of a biologically effective dose. This review provides information about the occurrence of the polycyclic aromatic hydrocarbons (PAHs) and their influence on human exposure and biological effects, including PAH-derived DNA adduct formation and repair processes. Selected methods used for determination of DNA adducts have been presented.
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In this video, the worsening problem of bed bugs and how to avoid and terminate them are explained.
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- How satisfied or dissatisfied are you with an activity?
- Would like this to change?
- How important would this change be to you?
Acute TBI: (Johnston et al, 2005; n = 162; moderate to severe TBI; 90% assessed 1 month after discharge from rehab; mean age = 44.8 (17.6) years)
- Functional/instrumental activities (24 items; mean across items)
- 1 Month: Satisfaction = 2.0, Desire to change = 18.6%
- 12 Month Satisfaction 2.5, Desire to change = 9.9%
- Social/recreational items (24 items; mean outcome measurements)
- 1 Month: Satisfaction = 2.1, Desire to change = 20.9%
- 12 Month Satisfaction 2.5, Desire to change = 12.9%
- Functional/instrumental activities
- 1 month median correlation = 0.17 (Correlations are Kendall's tau)
- 12 month median correlation = 0.21 (Correlations are Kendall's tau)
- Social/recreational items
- 1 month median correlation = 0.18 (Correlations are Kendall's tau)
- 12 month median correlation = 0.21 (Correlations are Kendall's tau)
- Some CIQ-2 activities have low or little relation to satisfaction of individuals with TBI
- Excellent relationship between the PART-O and CIQ-2 total score (r = 0.83)
- Excellent relationship between the PART-O and the CIQ-2 Social Integration subscale r = 0.79
- Excellent relationship between the PART-O and the CIQ-2 Productivity subscale r = 0.62
- Adequate relationship between the PART-O and the CIQ-2 Home Integration r = 0.52
Johnston, M. V., Goverover, Y., et al. (2005). "Community activities and individuals' satisfaction with them: quality of life in the first year after traumatic brain injury." Archives of physical medicine and rehabilitation 86(4): 735-745. Find it on PubMed
Whiteneck, G. G., Dijkers, M. P., et al. (2011). "Development of the Participation Assessment With Recombined Tools-Objective for Use After Traumatic Brain Injury." Arch Phys Med Rehabil. Find it on PubMed
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By Julie Buntjer
The Daily Globe
LUVERNE, Minn. — For more than 33 years, Terri Ebert's voice was the one people in Rock County heard when they called 911 in a panic. She was the voice of calm in their storm, sending out help for everything from fires and crashes to domestic situations and life or death circumstances.
"If I'd kept better journals, I could have written a book — people would not believe some of the things that go on," Ebert says now as she nears the end of her career with the Rock County Sheriff's Office. Her last day on the job is Dec. 30.
Ebert spent much of her career working as a dispatch supervisor and handling records as an administrative assistant. Her role, like that of fellow dispatchers, is to protect the public and answer 911 calls.
"The dispatcher's job can be hours of boredom and moments of terror," Ebert said. "You can sit there all night and then, all of a sudden, you can get calls at the end of the night that are life-and-death types of calls. You don't sleep when you get home because you're thinking about them."
During her tenure in Rock County, Ebert worked with five sheriffs, including Ole Hommen, Ed Elbers, Ron McClure, Mike Winkels and current sheriff Evan Verbrugge.
Just as the role of sheriff changed over the years, so too did the face of criminals and victims.
"Things were easier and harder back when I started," Ebert shared. "You didn't have as many reported domestics. Back in the day, you didn't get a DWI if you drove home from the bar unless you did some flagrant violation. These days, you get charged with a lot more. It's a lot more paperwork.
"It's not fun — it never was real fun. It was always a very interesting job," she added. "It's just gotten harder. The older I get (the harder it is) to take some of those 911 calls and to deal with some of the people that we deal with, because it's a lot of the same people."
While she may not have written down many of the experiences she has had on the job, there are a few memorable stories Ebert shared about working in dispatch.
The first, a call that came in long before the advent of 911, was when someone called in and said, "My house is on fire!" before hanging up the call. She and another dispatcher got up from their stations and looked out the window for any signs of smoke.
When the caller realized he didn't give the address, he called again.
"You get so you recognize people's voices," Ebert said. "We got one call from a mother who was so panicked because her son had been blowing up a balloon and when it sucked back in his throat it got caught.
"She was so rattled she didn't know her address. We recognized her voice and I believe she told us her name. We just happened to have two officers within a couple blocks. They went and one did the Heimlich maneuver and the other pulled the balloon out," Ebert recalled. The 4-year-old boy survived, and it taught Ebert a valuable lesson with her own children — balloons are not to be played with.
Ebert and her husband, Chuck, had three young daughters when she applied for the job in dispatch and began her career in 1983. Chuck, along with her in-laws, Vance and Doris Ebert, helped with the girls when she worked overnight shifts or received a late-night call to come in.
For the first 23 years of her career, Ebert worked inside the old law enforcement center, which was later renovated and now serves as home to the Brandenburg Gallery, Herreid Military Museum and Luverne Area Chamber of Commerce office.
The move to their new facility on Blue Mound Avenue in January 2007 brought with it new technology and enhanced security.
"I was the first person to work in this building during the changeover," Ebert said, noting her fellow dispatcher, Gordy Bremer, was the last dispatcher to work a shift in the old setting. Incidentally, Bremer retired with the longest tenure as a Rock County dispatcher after 36 years. Ebert said her 33-plus years in Rock County dispatch is likely the second longest.
"When we were in the old jail, we were like a family," she said, noting that at the time, Luverne also had a police department and they all worked together. "When we came here, we had more room and got better equipment, but things are different. Now they have different shifts … they have a regular night shift and day shift."
At one point during her career, Ebert said the department had gone 22 years without a change in dispatch staff.
"We just had real good dispatchers and everyone wanted to stick around," she said. "In recent years, we've had a lot of changeover — young people who have gotten married and moved on or have gone on to other things.
"We have a real good batch right now of dispatchers," she added. "They're wonderful — I know that they're going to make a career of it. It takes a special person to be able to handle all this — the hours and the stress."
For all the hours that were stressful, Ebert said there were moments where she felt like she was making an impact.
"I think one of the most satisfying things that ever happened to me was we had a young girl who was about 13 that was a habitual runaway and in trouble all the time," Ebert shared. "She had her hair about four different colors and shaved on one side. She came into our office several times, and I had to sit with her a few times. I told her if she lived at my house, she would not be allowed to do that. She would have a curfew, she would have to be home for meals. She said, 'I wish I had something like that.'
"Several years later, she came back and she asked to see me and I did not recognize this person. She was beautiful," Ebert added. She learned the girl had been taken away from her mother, raised by relatives and went through college with a B-plus average.
"She said, 'I made something of myself … I have never forgotten that conversation we had,' and I thought, 'Wow.'"
Said Ebert, "Most of the time you try and help people — if they want to be helped."
Throughout her career, Ebert found a way to deal with the stresses at work by being involved in her community. She serves on the Green Earth Players community theater board and has played numerous roles in GEP productions since 1985. She also rings bells in church and helps plan the live nativity, is a member of a pinochle group, joined Bookin' Buddies — a program with second-graders at Luverne Elementary — and also enjoys reading and is "on the go all the time."
"I've got to learn how to say no — I haven't learned to do that yet," she said. "I intend to stay busy in retirement."
Staying busy includes spending more time with her family, which includes her three daughters, their husbands and four grandchildren. Her husband died in 2002. She also has a list of things she wants to get done, and plans to be more involved with Green Earth Players. Perhaps there will be time to take some shorter trips along the way.
On Ebert's last day of work, coffee and cake will be served from 2 to 4 p.m. at the Rock County Law Enforcement Center. The public is invited to attend.
Copyright 2016 The Daily Globe
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By Lindsay Boyle
New London, Conn. — Robin Schwarze fell into her career of more than 25 years by chance.
A clerk at Electric Boat back in 1990, she learned she was the next in line to get laid off.
Worried, Schwarze applied to a flurry of similar positions, including one at the New London Police Department. She became a records clerk there in January 1991.
She didn't know then that the move would lead her to dispatching.
"I hadn't really thought about it," said Schwarze, whose background in public safety was minimal, at best.
But when a dispatcher told the single mother of three about the position's higher pay and additional hours, she couldn't say no.
On a day in May 1992, she signed on for the first time.
On Nov. 29, at 55, she signed off for the last.
Speaking by phone Wednesday evening, Schwarze recalled some of the most striking moments in her nearly 26-year career.
The most memorable, she said, was working on 9/11, when one lieutenant was trying to track down his daughter while other supervisors were realizing New London could be a target.
"We had no idea what was going on," she said. "That was a really long day."
Then there was the devastating murder of Donna Millette-Fridge, a social worker with mental health care provider First Step who died at the hands of one of her clients in September 1998.
"The first call I took that day was her supervisor calling from the office upstairs," Schwarze said.
The man, 28-year-old Adrian Isom, had attacked Millette-Fridge as she was walking to her workplace.
"This poor woman is screaming, watching this guy stab her coworker to death, and I'm just constantly trying to talk to her," Schwarze said. "I need to know what he looks like, what his name is — if she knows. I need her to stay on the phone, so if he runs, she can tell me which way."
An officer eventually shot and killed Isom. Schwarze heard the gunfire on her end of the phone.
Toward the beginning of her career, she said, someone called to say a dog had been run over near the end of Ashcraft Road that butts up against Bates Woods.
"I didn't think anything of it," she said. "Then — I don't know how long it was — I hear (the officer) on the radio, saying, 'I need help. I need help.' You could just hear in his voice that something was desperately wrong."
There was no dog. Someone, hidden in the bushes, had jumped the officer when he arrived and was trying to take his gun.
"You just want to run out the building and go find him," Schwarze said. "But that's not your job. Your job is to stay there and rally resources and keep track of everything."
Delivery of babies and socks
Several people, including Chief Margaret Ackley, commended Schwarze for her ability to keep cool in such situations.
"Robin's professionalism and ability to take control in an emergency situation has made her second to none," Ackley wrote in an email. "Robin's well-deserved retirement is a huge loss to all of New London."
There were good calls, too.
Once, Schwarze talked a man through delivering his wife's baby in the backseat of their car.
Another time, an elderly, disabled man called with an odd request.
"He kept falling because he was walking around in socks," she recalled. "He wanted somebody to go to the hospital and get a pair of the socks with grippers."
She sent a cop over to get them.
"He was so grateful," Schwarze said.
Then there were the absurd calls, like when an officer trying to rescue a deer ended up impaled on the fence surrounding Cedar Grove Cemetery, and when a woman called 911 with a complaint for an officer: She'd given $20 to a man who said he would buy her crack, she said, but he never came back.
"It's not an easy job," said Battalion Chief Roger Tompkins, a 32-year employee of the city who spent some time dispatching many years ago.
"Everybody remembers the firemen at the fire or the police at the accident, but they forget about the dispatcher who's trying to coordinate everything," he said.
Moving on to Backus
Schwarze said she never stopped enjoying the work — she gave as much effort on her last day as she did on her first.
"You wouldn't want to look somebody in the face and think, something I did is part of the reason this ended badly," Schwarze said. "It's one of those jobs where you really have to want to do it. If your heart's not in it 100 percent, it's not a good idea to be there."
But when the harsh, rotating shifts started making her feel her age, she decided it was time to retire.
Soon, she'll sign on as a dispatcher for The William W. Backus Hospital's security unit.
While she's looking forward to the switch, she knows she'll miss the people she grew close to over the years.
"I feel like most people don't understand that in vocations like that — firefighters, police, dispatchers, EMTs — where you're working in an environment where really, seriously bad things happen," Schwarze said, "you see a lot of stuff normal people don't see. You become closer with your workmates than you would normally."
Dispatcher Kerry Hibbs, who was Schwarze's partner, agreed.
Hibbs came to the department as a secretary eight years ago. Schwarze inspired her to transition to a full-time dispatching gig.
"When I started to train as a part-time dispatcher, several of the guys said to me, 'Make sure you learn from Robin. She's the best,'" Hibbs said.
Soon, she became Schwarze's partner. Isolated in the dispatch center, Hibbs spent more time with Schwarze than with her own family, sometimes working 16-hour days and always working through paid lunch breaks. They developed an unspoken language. Hibbs kept learning.
"In our job, it's not always routine," Hibbs said. "Sometimes things happen that throw you for a loop. If I said, 'What do we here?' she always had the answer."
Hibbs said the woman with an "endless well of knowledge" became like a surrogate mother to her.
"She's only been gone a week and a half and I miss her already," Hibbs said.
Police Union President Todd Lynch said he knows the others — including his sister, Hibbs, and Schwarze's daughter Tiffany — will step up, but it will be different without Schwarze there.
"The funny thing about Robin is she would give you the address … and would tell you who lives there, what has happened there before on other calls, whether there are weapons in the home — not from looking at a computer, but from her experience," Lynch said.
"That's what you're going to miss," he continued. "You can't replace experience."
Copyright 2016 The Day
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By EMS1 Staff
From fixing roofs, mowing lawns and taking patients to baseball games, EMS providers went the extra mile to brighten their patient's day.
EMS providers often take care of people when they are in their most vulnerable state. This year, EMS crews across the country went above and beyond for their communities — no matter how big or small the deed.
1. Photo: Ambulance crew helps man fulfill dying wish
Ambulance crew members took it upon themselves to ensure that a terminally ill father could watch his daughter perform for her high school color guard one last time. Nikki Pittenger-Bankes thanked the hospice and EMS crew via Facebook for taking her husband, Mike, to watch their daughter perform.
2. Man fixing his roof dies, paramedics return to finish repair
After a man tragically died while fixing his roof, paramedics completed the job for him. After transporting the man to the hospital, where he was pronounced dead, paramedics were concerned impending rain would damage the roof. As a result, they returned to the man's home and finished the roof maintenance.
3. Ala. paramedic, EMT honored for act of kindness
Following a bloody call, a paramedic and EMT decided to clean the home of an elderly couple. The first responders returned the next day, with cleaning supplies and a rented carpet cleaner to erase all traces of violence. Although the two did not want recognition for their kind act, they stated, "it was just the right thing to do."
4. Photo of EMT mowing patient's lawn goes viral
After an elderly man passed out while mowing his lawn, an EMT returned to his home to take care of business. The man's son, Ken Densley, snapped a photo of the EMT finishing the job, which received over 10,000 Facebook likes and 2,000 shares.
5. EMTs give paralyzed Cubs fan lift to Wrigley Field
A lifelong Chicago Cubs fan got by with a little help from his friends — and EMS — to watch the team play ball. Norman Wilson, who was paralyzed from the waist-down in a car crash in 2007, was transported by EMS to Wrigley Field. Crews worked with the Cubs to reserve space for Wilson's reclining stretcher. "This is a dream come true," Wilson said.
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Source: International Journal of Medical Science and Public Health
Background: Xanthogranulomatous cholecystitis (XGC) is an uncommon inflammatory disease of the gallbladder characterized by the infiltration of plasma cells, lipid-laden histiocytes, and the proliferation of fibroblasts in the gallbladder wall. Its importance lies in the fact that imaging studies and intraoperative appearance may be confused with tumors of the gallbladder. It is the name generally used to describe the lesion which results when lipids from the bile in the lumen of the gallbladder enter the wall of the organ and induce a granulomatous inflammation. The present study was undertaken to analyze histological features of XGC along with clinical features and ultrasonographic findings. Objectives: Correlation of XGC with clinico-radiological findings and to look for various morphological changes microscopically. Material and Methods: A retrospective study of 1018 patients who had undergone cholecystectomy between July 2014 and June 2016 at our hospital. Totally, 33 cases of XGC were identified among these cholecystectomies. The clinical features and radiological findings of these patients have been analyzed and compared with histologic findings. Results: The clinical symptoms were abdominal pain, nausea, and jaundice in 81.8%, 60.6%, and 12.12% of the patients. Preoperative ultrasonography for 33 patients revealed gallstone (90.90%) bile sludge (9.09%) and thickened wall in 30.30% of patients. Conclusions: XGC is difficult to diagnose pre- or intra-operatively and remains a challenge in medical practice. The definitive diagnosis depends on the histopathologic examination.
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Prevalence of hepatitis B, hepatitis C and human immunodeficiency virus infection among hemodialysis patients in a tertiary health care center of Western Rajasthan
Source: International Journal of Medical Science and Public Health
Narendra Rawat, Navgeet Mathur, Kiran Rawat, Medha Mathur, Nitesh Chauhan, Rahul Kakkar, Rajat Tinna.
Background: Infections such as viral hepatitis (both B and C) and human immunodeficiency virus (HIV) have major role in morbidity and mortality in hemodialysis (HD) patients. It is important to know the prevalence of these infections in HD patients to encounter medical challenges. Not much work has been carried out in this regard in Western Rajasthan. Objectives: To find out the prevalence and age, sex, religion-wise distribution of hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infections in HD patients in a tertiary care institute of Western Rajasthan. Materials and Methods: This cross-sectional study was conducted for 3 months in HD unit at Dr. S. N. Medical College, Jodhpur. All patients (n = 1314) were screened for hepatitis B surface antigen (HBsAg), antibody to HCV (anti-HCV) and HIV antibody. Prevalence and age-, sex-, religion-wise distribution of these infections were observed. Results: A total of 1314 patients (967 males and 347 females) were screened for the presence of HBV, HCV and HIV infections. It was found that 92 (7.0%) patients were positive only for HBsAg, 483 (36.75%) only for anti-HCV, 12 (0.9%) for HIV antibody and 4 (0.3%) had dual HBV and HCV infection. Conclusion: There is a considerable burden of these infections in HD patient. Effort should be made to minimized infections to improve morbidly and mortality profile.
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Seminal plasma caspase 3, cytochrome c and total antioxidant capacity in oligospermic males and association with sperm indices
Source: Journal of Experimental and Integrative Medicine
Abiodun Mathias Emokpae, Happy Ngozi Chima, Muhammed Ahmed.
Objective: To determine the levels of cytochrome c, caspase 3 and total antioxidant capacity (TAC) in oligospermic male subjects in Zaria, northern Nigeria. Materials and methods:The study participants were 56 oligospermic male subjects attending fertility clinic and 30 control subjects who were males of proven fertility with normal semen parameters. Semen samples were collected by masturbation after a minimum of 3 days sexual abstinence into sterile containers, were allowed to liquefy at room temperature and manual semen analysis was performed according to WHO standard. Seminal plasma cytochrome c, caspase 3 and total antioxidant capacity were assayed by sandwiched ELISA technique using reagents supplied by Elabscience and Wkea Medical supplies corporation, China respectively. The differences in the mean levels of measured parameters were compared using Students t test and caspase 3 was correlated with sperm indices. Results: The mean values of cytochrome C and caspase 3 were significantly higher (p
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By David Fifer
We were relatively close to the tail end of a nine hour road trip, driving back to Richmond, Ky. from Baltimore, Md. in a university SUV. I was the chaperone for a group of Eastern Kentucky University Paramedic Science students and recent graduates attending the EMS Today Conference & Expo.
Our group was comprised of Ashley Brosmer, a senior in our Bachelor's degree program who was about halfway through the clinical portion of her paramedic education; Brad Harp, a recent graduate who works as a paramedic in Southern Kentucky; Leah Gaddis, a senior who had recently finished the clinical portion of our program and was working as a paramedic in Central Kentucky while finishing her academic degree; and her husband, Jon Gaddis, who had recently graduated and works as a trauma ICU technician at our regional Level 1 trauma center.
Just outside of Charleston, W.Va., I noticed that the traffic ahead of us was slowing rapidly to a crawl. It was the sort of chaotic pattern that experienced drivers recognize as being the initial result of a sudden accident: brake lights suddenly alighting, vehicles weaving slightly to avoid fender benders, and no obvious traffic control devices or emergency vehicles in sight.
Perhaps a minute or two later, we found ourselves alongside what appeared to be a recent single vehicle collision, "truck versus embankment." An older model pickup truck looked to have traveled off the right shoulder of the highway and into a small hillside, experiencing enough force that it seemed to have been lifted off the ground and nearly flipped.
Though the roof and windshield of the truck appeared intact, the front end was heavily damaged, the vehicle was facing the wrong way as it lay upright in a ditch, its frame was badly twisted and the contents of the bed and cab scattered about.
There were Good Samaritans milling around somewhat frantically, and some of them were wearing nitrile gloves. We'd learn a few minutes later that one of them was a nurse who had distributed the gloves to the others.
But there didn't appear to be any sort of organized effort or uniformed responders on the scene. Curiously, nobody appeared to be treating any patients despite their donning of basic personal protective equipment.
So, I stopped, and Jon rolled down his window in the rear passenger seat. "Hey," he said. "We're a car full of paramedics. Need some help?"
The reply from one of the Good Samaritans was immediate, from a face whose relief was evident: "Yes! He's hurt pretty bad!"
I angled the nose our Chevy Suburban out a bit in an attempt to provide some blocking just as a local sheriff's deputy pulled up behind us and began some more appropriate traffic control. Fortunately, the personal vehicles of the various Good Samaritans were still occupying the travel lane and shoulder behind us, providing additional protection.
Heightened sense of responsibility
As we all piled out of our vehicle, my first thought wasn't of the patient. Just as I stress to my students in the classroom and in simulations, it was of the safety factors. I was rapidly scanning the area for hazards and clues in a continuation of the "windshield survey" I had initiated as we rolled up on the scene.
As my students' chaperone, I felt a heightened sense of responsibility for that function beyond the normal imperative. Moreover, as likely the most experienced responder on the scene (aside, perhaps, from the sheriff's deputy), I felt that I needed to act in the role of the Incident Commander until additional professional responders arrived.
We all snagged some gloves from the nurse who had been handing them out (presumably she had a box in her car), and with great pride I watched as my students went to work as a team, operating on the common educational foundation they shared. Even Ashley, the least experienced among them, had already experienced hundreds of hours of simulation and clinical internship time, riding with EMS agencies throughout central, souther and eastern Kentucky.
As Jon and Brad headed to the truck to access the patient, Ashley and Leah began organizing the other Good Samaritans to collect a seemingly endless number of prescription pill bottles and personal papers that were strewn about the scene. I held back, initially, trying to maintain accountability of my students and keep an overall eye on all personnel on the scene.
Jon found the driver lying mostly in the passenger side floorboard, on his right side, with his head sticking partially out of the open passenger door and rotated upright. He was effectively wedged between the bench seat of the truck and dashboard, across the axle hump. Jon assumed c-spine stabilization and noted snoring respirations with a small amount of gurgling, so he applied a jaw-thrust maneuver to better position the patient's airway. The driver, our only patient, was unresponsive.
Brad began a blood sweep of the patient's upper body, fortunately coming up empty, but his exam was made challenging by the enormous amount of debris that was piled on top of the patient. It appeared that the gentleman had a bit of a tendency toward hoarding, and all manner of papers, toiletries, chewing tobacco cans, plastic bags filled with knick-knacks, books, maps, luggage and random personal effects were literally burying him.
That dynamic presented a scene safety consideration that I hadn't yet envisioned, but soon would.
The grip of a semi-automatic pistol
As Jon and Brad continued their care on the passenger side, I moved around to the driver's side, satisfied that Ashley and Leah were keeping the Good Samaritans out of the roadway and themselves out of danger. I let Jon and Brad know that I was entering the vehicle to assess the patient's lower extremities.
As I felt my way up his legs (somewhat blindly given the amount of stuff piled on top of him and his positioning), I felt a strangely familiar object: the grip of a semi-automatic pistol. Though I'm not a handgun owner or avid shooter myself, I'm familiar enough with firearms that the dimensions and texture in my palm immediately registered with me.
I further realized that it was unsecured. I carefully removed it from beneath him, and called for one of the more recently arriving sheriff's deputies to secure it.
After that discovery, we continued our physical exam with the utmost care. As we continued working in the cab, multiple knives and two additional firearms were discovered and secured: a revolver and a rifle pointing up from the backseat. There was nothing that seemed criminal or suspicious about all these weapons; just the possessions of a guy who appeared to keep most of what he owned in his truck.
Shortly after completing our initial assessment, local professional responders began arriving and we worked together to place airway adjuncts and package and extricate the driver. After helping to load him for transport, we piled back into our Suburban and continued our trip.
Real life EMS lessons
Our impromptu response was a great object lesson for my students on a number of core concepts:
- Importance of scene safety and a systematic approach to patient care
- Need to work within the care team while still being self-directed
- Wisdom of keeping some basic first aid supplies handy if you're going to accept the responsibility of responding as a Good Samaritan while off-duty
As their instructor, it was incredibly gratifying to see how well they responded to an unexpected situation, combining their various degrees of experience and skill sets and performing in exactly the manner we teach them.
Several days after the incident, we were pleased to hear from our patient. He had experienced a medical emergency while driving and suffered a broken neck. We believe that emergency to have been a seizure, and his diminished level of consciousness to have been a postictal state. To the best of our knowledge, he recovered fully.
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By Peter Amato
In the winter of 1989, I wanted to help out my community in some way. I had some high school friends that volunteered at the local ambulance company and thought it would be a great way to help out my friends and neighbors.
This was a short-lived period in my life. Because at 21 years old, life just gets in the way. Jobs were changing, girlfriends were changing, friends were changing and my life was changing.
One year later, I found the love of my life, married in the Spring of 1992, moved into an apartment a few towns over and 25 years later we are still one, plus three kids and a dog.
I mention this because ever since departing from the ambulance company, I had a feeling something was missing.
Longing to get back in EMS
Shortly after settling in on the "marriage thing" and before kids, my wife and I had a heart-to-heart talk one night and I realized I couldn't do my job for the rest of my life.
I worked sales and was not happy. It was not my passion. Later that night, while watching television, my favorite show came on — "Rescue 911." That episode highlighted the heroism of the Maryland State Trooper Aviation Division and I recall saying, "Now that's cool. I could see doing that for the rest of my life."
My bride turned to me and said, "Go for it," and I have had her full support for a quarter of a century and have never looked back.
It's been a long road to finally get to where I am today, but it has been a journey well-traveled.
Several volunteer agencies and fire departments later, I have finally landed my dream job, working as a flight paramedic for the county's only Level I Trauma Center.
I give you this backstory so you have an understanding to the events leading up to Jan. 23, 2016.
White blanket of snow
On that day, the country's northeast was being hammered by a blizzard and therefore shutting down the aviation bases. The night before, I received a phone call from one of my supervisors explaining such and that I was being relocated to work out of the hospital on an ambulance in the morning.
As I woke up and got ready, strapping on my boots, donning my jacket and gloves, I kissed my wife and kids "good day." I dislike goodbye, it feels like it is forever. I made the 15-mile trip to work through less than optimal road conditions and the peak of the storm was just beginning.
A few hours into my shift, the snow was coming down in what appeared to be a white blanket shifting side to side from the howling wind. Suddenly, there was a call from transplant services asking for an odd request.
There is a standing joke in our office — if someone in the hospital can't figure something out, then they call EMS.
We are a small office down the hall from the ER that is very resourceful and we will make things happen. The request was a kidney was on its way to us, but the recipient was not. The patient was snowed in.
Knowing there is a small window of opportunity in which to coordinate the successful outcome, we all sprang into overdrive. One person called the transplant floor, one person called the patient, two people went outside to clear off an ambulance and I ran down the hall to discuss the situation with my supervisor.
It was quickly determined that the hospital owned a 4x4 First Responder, a Ford Expedition, that would be the best vehicle to make the attempt to get the recipient to the hospital.
I stepped up asking to be the one to make such attempt. I had no doubt in my mind that I couldn't pull this off. That was until I started the 20-plus mile trip to the home of a woman that was trapped by piles of the fluffy white stuff.
Paramedic Pete Amato talks with patient Melanie Chirichella in her room at Stony Brook
University Hospital. (AP Photo/Julie Jacobson)
Failure is not an option
Shortly after leaving the base at the hospital, I was confronted by a tractor-trailer jackknifing in front of me — nearly forcing me off the road into a ditch.
Maybe it was goodbye this morning to my family.
After making it through that, I thought: what were the road conditions ahead of me like? How long would this take and would we be there in time? What conditions faced me when I arrived at the home? Would my vehicle get stuck and how bad would the conditions be for our return?
Then I remembered a saying a friend always says, "Failure is not an option."
This entire course of events struck a personal chord for me. In April 1998, my own brother received a similar phone call from transplant services at Cornell Hospital in New York City. He was on the list for a kidney and pancreas transplant, and, though I didn't need to track through snow on that day, I did need to drive him almost 100 miles in bumper-to-bumper traffic so he could receive his gift.
Once arriving at the home of my intended patient, I was confronted with yet another obstacle. There was two feet of snow in an unshoveled driveway.
Leaving the Responder vehicle running in the street, I made my way to the front door and rang the bell. I was greeted by a frail older woman asking, "Are you from Stony Brook?" I replied, "Yes I am and are you ready for the next chapter of your life to begin?"
We both teared up and then asked how I was going to get her out of the house that she can't even open the front door because of the snow. I explained I will get the door open and I could either carry her to the Responder or if she had a shovel I could shovel the driveway, get my truck as close to the door as possible and go from there. After finding a shovel in her garage, the latter was the option of choice.
Paramedic Pete Amato, left, answers questions during an interview while visiting with
Stony Brook University Hospital patient Melanie Chirichella. (AP Photo/Julie Jacobson)
A family affair
My patient was now buckled in and off we went. Our return trip was nearly cut short similarly to how it started. A vehicle slid out causing a Jeep to spin out of control — almost hitting us.
My frail companion asked, "Is this safe?"
I told her, "No, but I'm getting you to your long-awaited prize."
Continuing to maneuver around stuck cars, snowdrifts and other obstacles, I started a conversation to get to know her battle with kidney disease and other complications. I told her about my family's personal journey with transplant and that she will see first-hand the results of one.
Puzzled to what I was saying, I explained my brother's situation and that he also works for the hospital as an EMT. He was there awaiting our arrival, because he was my partner that day and also helped coordinate these events.
As I pulled into the ER bay, I told her she will be assisted into a wheelchair and brought up to the transplant floor by my brother.
It took her a few seconds to absorb what was happening and then fighting back more tears said, "This is really happening," she asked?
I explained, "Yes it is."
After parking the Responder back in its original spot, I made my way back to the EMS office to be asked proudly by my supervisor, "How'd it go?"
I joked, "Boss, I'm a paramedic. How do you think it went? The patient is upstairs being prepped for surgery."
We all chuckled and went about our day ready for the next challenge.
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By Sharon McDonough
Because we are the safety net that most rely upon, fire-based EMS departments nationwide are realizing an increased demand for non-emergent care. In an effort to meet this need, many are implementing programs like mobile integrated health and community paramedicine.
These programs permit crews to get to know their patients in a less-rushed setting than that of traditional, emergent EMS, allowing for home visits, personalized care plans and in-home post-hospital care.
So why are so many municipal departments opting out? The reason is simple — current program models can be costly.
And while they are conducive to the rural environment, they don't provide enough bang for the buck in the larger, busier urban setting. Big departments have different challenges and must find a more suitable solution.
In FY2016, the Tucson Fire Department responded to over 91,000 calls for service, more than 90 percent of them EMS in nature. Like many, our call load continues to increase while our budget remains stagnant.
With disparities like these, leaders are asking how we can incur the cost of staff hours and resources to provide community paramedicine? How can we allow crews to stay out of service longer while "real emergencies" stack up? How can we afford to provide this additional tier of service?
The better question is more likely, how can we afford not to?
Tucson Fire has responded to more than 82,000 EMS calls in the past 12 months. Of those, only 41 percent have resulted in emergent on-scene interventions and/or an advanced life support level transport to the hospital.
Statistical evidence tells us that in our city the percentage of non-emergent EMS calls is rising and at a precariously faster rate every year. Due in large part to a fragmented health care system that is increasingly difficult to navigate, the EMS system has become over-taxed and with limited transport destination options; local emergency rooms are sharing the heat.
As a result, the entire system suffers — response times to our time-dependent big four (cardiac arrests, heart attacks, strokes and trauma) are increasing and crews are suffering from burnout.
The reality for most large departments is that we are already providing this lower tier of service. But because we have not adapted to the shift in call type and volume, we aren't doing it very efficiently.
For most of us, a disproportionate part of this problem can be attributed to the frequent 911-user population within our communities. In 2014, 50 of Tucson's frequent users accounted for almost 1,400 calls, with most culminating in an ambulance ride to an emergency department.
They call 911 reporting an emergency, we send big red, we provide an ambulance ride to an emergency department, they receive the most expensive care of the medical system and are released home with some paperwork telling them to follow up with a primary-care doctor.
Only they don't, and the next day they call 911.
How many times can we afford to apply a code-three bandage fix in the name of rapidly returning to a response ready state?
The impact of the frequent-user population is not limited to fire and EMS agencies; it affects the whole community. At national average costs of $1,200 per transport, staffing and resource costs of $500 per response and $2,100 per emergency room visit, the financial burden alone is evident.
As this group ties up dispatch, fire, EMS and law enforcement resources, as well as emergency department staff and beds, the impact grows. Personnel suffer from compassion fatigue, sleep deprivation and decreased job satisfaction evidenced by increased sick leave use and decreased interest in overtime.
Effects on system reliability and community readiness are significant, with emergency resources responding from greater distances to transport to overcrowded hospitals with extreme wait times. Customer service suffers and tensions between agencies skyrocket as both public and private providers look for quicker ways to pass off non-emergent patients and return to a mission-ready status.
Individual reasons for repeated use of 911 resources are numerous and significant — mental health, substance abuse, chronic and unattended disease, non-compliance with care plans, inaccessibility to definitive care, nutritional limitations, lack of transportation, pharmaceutical misunderstanding, legal status, poor living conditions, homelessness and financial barriers are among the common factors.
Resource and need disconnect
Although our study focused on frequent users, the issues presented by this group are mirrored and compounded by low-frequency users as well. The problem is that although most communities have a wide variety of social and human service resources to help those in need, and a like abundance of at-risk persons needing those services, the two often are not easily connected.
Even when caseworker relationships are established, maintaining these connections remains difficult for many reasons. Our system suffers from severe fragmentation, entrenched interests, an absence of system-wide coordination and planning, and a lack of fiscal accountability.
While successful in the rural setting, the smaller-community mobile integrated health programs simply lack the quantitative means necessary to deliver services on a larger scale in much busier urban settings.
Models that include a nurse at the 911 communications center are bound by the what-if liabilities of triaging unreliable callers to a no-send status. Nurses and physician assistants on day trucks are helpful, but they are expensive and outreach is limited to a few visits per day.
After-care may be best suited to private entities capable of providing scheduled service for less money.
So what is a big department to do? How do we best capitalize on established resources and infrastructure to address this growing problem, and how do we do it in a cost-effective manner?
Cannot afford to do nothing
An often overlooked but key component of municipal fire departments is that they almost universally have the trust of both their community leaders and residents. Fire department first responder's ability to gain initial access to homes and the homeless allows them to obtain a comprehensive picture of the patient situation.
This includes living arrangements, home conditions, family support, transportation options, medication history, domestic or substance abuse indicators and many other barometers that are not available to traditional care providers.
We are in the best position to get these folks to competitive and specialized human service agencies that can best offer long-term resolution of chronic patient issues.
The frequent users have shown by word and action that handing them phone numbers and pamphlets doesn't work; the system is too complex, fragmented and siloed. We must instead take these people by the hand and navigate them through the intricacies of insurance and social service offerings to get them, and keep them, connected to the help they need.
A person who falls repeatedly must have the cause examined, the care provided, the step fixed. The trust that patients have with fire personnel that allows us into their homes must be extended to the trust of a caseworker-type relationship. Without this trust, an essential bond rarely exists and patients voluntarily opt out of assistance.
Earlier this year, Tucson Fire introduced Tucson Collaborative Community Care, or TC-3, a program designed to do just that. The direction given was simple: find the people where they are, find the resources available to help them and solve their problem — no matter what it is, don't say no.
With no revenue to launch this pilot program, we reallocated three uniformed staff and set about collecting a large, ever-growing group of diverse community partners. Initially we had four partner groups; that has grown to 40.
The results have been noteworthy.
911 responses to our TC-3 clients have dramatically declined with some completely removed from the 911 cycle, all showing improvement and the vast majority reporting that their quality of life has improved.
Our crews are feeling supported, our reliability for time-critical incidents has improved and our clients are finally able to get the right help for their often multi-faceted issues.
The work of the TC-3 team is two-fold, focusing on the care of the individual and coordination of resources within the community.
How it works
With the click of a button and a consent signature, responding crews use an electronic patient care reporting system to begin the enrollment process for an at-risk individual. A notification is immediately sent to the TC-3 operations manager, who runs a full query on all previous visits made to the individual, looking for patterns, needs and outcomes.
A file is created, and based on severity and urgency, the individual is entered into Tucson Fire's web-based Human Services Referral Program and/or placed into queue for a scheduled in-home visit with our TC-3 coordinator team.
The HSRP program immediately gets the wheels rolling via an auto-generated email to key staff at community agencies with which formal HIPAA-compliant business agreements have been made. There they can weigh in on pertinent offerings and communicate with us on any visits, care, services and follow-up provided to the client.
An un-hurried, in-home visit with the TC-3 team allows our personnel to better understand the individual's specific needs and limitations through conversation and examination of their environment. A thorough assessment is conducted and findings are matched to the services and qualifiers of local community partners.
Because real-time follow up is crucial, TC-3 clients are then identified to the 911 communications center to allow immediate notification to the TC-3 team each time a TC-3 client activates 911.
The help provided by TC-3 is active rather than passive; appointments are scheduled, contacts are made, paperwork is filled out and transportation is arranged.
Some individuals find solution immediately, coming out of the 911 system as they are connected to long-term disease management, palliative care, hospice, home repairs, housing, pet solutions and dietary care. Others require on-going assistance and contact to keep them engaged and their needs managed.
Catching insurer's eye
TC-3 personnel navigate clients through the maze of the health care system, providing customized, person-centered, inclusive attention, pertinent to their specific and multiple needs.
The TC-3 program also coordinates community-wide quarterly meetings to discuss, understand and add to our growing bank of resources.
Representatives of the Behavioral Health Court System, the Regional Behavioral Health Authority, Affordable Care Organizations, hospitals, Veterans Affairs, law enforcement, county health, pet welfare, palliative care and hospice programs, private subsidiaries, volunteer groups and many specialized agencies have collaborated with us in a joint effort toward resolving this wide-spread issue.
This referral model has attracted the attention and collaboration of some of the nation's largest insurance agencies looking for ways to meet the highly sought after triple aim of the Affordable Care Act: enhance the patient experience, reduce health care costs and improve the population's health.
The misalignment between the critical care priorities of yesterday's EMS system and the appeal from constituents for non-emergent, total-person care necessitates a change to our service delivery model. The demand of our communities must be met by the supply side of the equation.
Fire-based EMS must remain relevant to the needs of our constituents and meet those needs in a fiscally responsible manner by facilitating better care, better outcomes and lower costs. Each agency must find or create a program that realistically suits its ability and its community's needs.
TC-3's proactive, preventative, navigate – refer – follow-up model is well suited to the dense population of the urban setting.
Here in Tucson, it is saving stakeholder's money and frustration, augmenting a reliable and efficient emergency response system and most importantly, is helping our at-risk population get the care they so desperately need.
City and department leaders should indeed ask themselves: "Can we afford to start a mobile integrated health program in our area?" The truth is, you can't afford not to.
About the author
Deputy Chief Sharon McDonough was hired by TFD in 1990 and has moved through the ranks of firefighter/EMT, paramedic, captain, battalion chief and deputy chief. During her 11-year tenure as a chief officer, she has been tasked with the oversight of fire operations, safety and the 911 communications center. She currently oversees medical administration and is the privacy officer for the department. She is the lead officer on TC-3.
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RSI can be lifesaving when appropriately applied or deadly if not performed with a high-level of proficiency and accuracy
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Nature Reviews Genetics. doi:10.1038/nrg.2016.145
Authors: Lars A. Forsberg, David Gisselsson & Jan P. Dumanski
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Adverse drug reactions report among hospitalized patients with hypertension in a Nigerian Tertiary Healthcare Centre: a retrospective study
Source: Medicine Science | International Medical Journal
Abiola Muhammad Adeosun, Aduragbenro D.A. Adedapo, Waheed Adeola Adedeji.
Adverse drug reactions (ADRs) are serious clinical problem with growing global concern. This study focused on incidence and outcome of ADRs among in-patients with hypertension in Nigeria. This is a descriptive, cross-sectional study on incidence of adverse drug reactions among in-patients with hypertension conducted in the University College Hospital (UCH), Ibadan, Nigeria, within June 2012 to May 2013. Of 196 patients, 105 (53.6%) were male, and 91 (46.4%) were female. Prevalence of ADRs was 53 (27.04%), of these, 28 (52.8%) were male, and 25 (47.2%) were female patients. Adverse drug reaction was cause of admission in 2 (1.02%) patients. Prevalence of ADRs during hospitalized was 51 (26.02%) patients. Patients with adverse drug event spent approximately additional 5 days more in bed compared to those without adverse drug reactions (p = 0.028) . ADRs experienced by the patients were managed by withdrawing the suspected drug(s). ADR recorded among hospitalised patients with hypertension was 27.04%. ADR was cause of admission in 1% of in-patients with hypertension. Patients that experienced ADR spent additional five days in hospital compared to those without adverse drug effect during hospitalization.
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Secondary prophylaxis of hepatocellular carcinoma: The comparison of direct-acting antivirals with pegylated interferon and untreated cohort
Journal of Viral Hepatitis
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Five year efficacy and safety of tenofovir-based salvage therapy for patients with chronic hepatitis B who previously failed LAM/ADV therapy
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Chromoendoscopy for surveillance in ulcerative colitis and Crohns disease: A systematic review of randomized trials
Clinical Gastroenterology and Hepatology
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Alimentary Pharmacology and Therapeutics
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Alcoholism: Clinical and Experimental Research
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Phase I clinical and pharmacokinetic study of S-1 plus oral leucovorin in patients with metastatic colorectal cancer
Cancer Chemotherapy and Pharmacology
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Racial disparity in all-cause mortality among hepatitis C virus-infected individuals in a general US population, NHANES III
Journal of Viral Hepatitis
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Liver steatosis in pre-transplant liver biopsies can be quantified rapidly and accurately by nuclear magnetic resonance analysis
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Distinct hepatitis B virus integration patterns in hepatocellular carcinoma and adjacent normal liver tissue
International Journal of Cancer
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University of Bristol Research News
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The survival impact of delayed surgery and adjuvant chemotherapy on stage II/III rectal cancer with pathological complete response after neoadjuvant chemoradiation
International Journal of Cancer
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Endoscopic and pharmacological treatment for prophylaxis against postendoscopic retrograde cholangiopancreatography pancreatitis: A meta-analysis and systematic review
European Journal of Gastroenterology & Hepatology
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Journal of Psychosomatic Research
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Stable knockdown of CREB, HIF-1 and HIF-2 by replication-competent retroviruses abrogates the responses to hypoxia in hepatocellular carcinoma
Cancer Gene Therapy
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Postoperative pain management in colorectal surgical patients and the effects on length of stay in an Enhanced Recovery After Surgery (ERAS) setting
The Clinical Journal of Pain
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Pro-inflammatory cytokine IFNγ and microbiome-derived metabolites dictate epigenetic switch between FOXP3 isoforms in celiac disease
Clinical and Experimental Immunology
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Baseline hepatitis B core antibody predicts treatment response in chronic hepatitis B patients receiving long-term entecavir
Journal of Viral Hepatitis
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STAT3 signaling drives EZH2 transcriptional activation and mediates poor prognosis in gastric cancer
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Nucleolin targeting impairs the progression of pancreatic cancer and promotes the normalization of tumor vasculature
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A study on treatment outcome and adverse drug reactions among extra pulmonary tuberculosis patients treated under DOTS in a tertiary care hospital
Source: International Journal of Basic & Clinical Pharmacology
Priyadarshini Bai G., Ravikumar P..
Background: Pulmonary tuberculosis being the predominant manifestation of the disease Extra-Pulmonary sites can also involve as a result of dissemination from a chief focus. The present study aims to determine the presentation and outcome of patients with extra-pulmonary tuberculosis treated with category I DOTS and to identify the incidence and pattern of ADRs caused by anti-tubercular drugs and to assess the causality and severity of the reported ADRs. Methods: Data was collected from cases of Tuberculosis patients diagnosed and treated under category I DOTS at Sri Siddhartha Medical College for the period of one year (during 2015). These patients were monitored for ADRs during OPDs and hospital stay. Any Adverse effects observed were recorded in Adverse Drug Event Reporting Form prepared by the CDSCO, Govt. of India. The data were evaluated for patient demography, types of TB, incidence of ADRs, onset and outcome of the ADRs. ADRs were also assessed for their causality and severity by using WHO-UMC criteria and Hartwigs scale. Results: Extra-pulmonary cases accounted for 32.2% of total TB cases. Among 224 cases of extra-pulmonary TB studied, 136 (60.7%) were males and 88 (39.3%) were females. Among these patients 82.2% completed treatment, 7.5% were defaulted, 9.9% died and 0.4% treatment failure. The most common reason for default was irregular treatment (29.5%) followed by alcohol abuse (23.5%). Among 224 patients of EPTB who were started on ATT as per DOTS, we noted ADR in 52 patients and 73 ADRs. Gastritis was the most common ADR (25%) followed by anorexia (14%) and skin reactions (9.6%) and multiple drug therapy was the major predisposing factor for these ADRs. Conclusions: Extra-pulmonary Tuberculosis accounts for 32.2% of the total cases studied. Treatment irregularities and alcohol abuse are the two most common reasons for default. On evaluation of the causality of ADRs, majority of them were found to be possible by WHO-UMC and Naronjos causality assessment scale. The severity assessment of ADRs showed that 42% reactions were moderate and 58% were of the mild nature.
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