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

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

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

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

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

Abstract

Background

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

Methods

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

Results

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

Conclusions

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

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

Abstract

Background

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

Methods

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

Results

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

Conclusions

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

ClinicalTrials.gov identifier NCT01140347.

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

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


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

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


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

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

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

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

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

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

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

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

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