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Non-hormonal treatments for managing vulvovaginal atrophy/genitourinary syndrome of menopause. Climacteric 2023:1-6. [PMID: 37199295 DOI: 10.1080/13697137.2023.2210283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The demand for non-hormonal therapies for vulvovaginal atrophy (VVA) is increasing due to an increasing number of patients surviving long term post cancer diagnosis, as well as increased public knowledge of the symptoms of menopause and availability of non-hormonal therapies. Treatment options are wide-ranging and encompass different formulations and methods of application. This review summarizes the key characteristics of the main forms of these therapies, as well as considering the current evidence for each of them and where future clinical studies should be directed. Care for VVA may be in primary care, or under gynecology or oncology. Further research requirements include the need for long-term data as well larger randomized controlled trials into alternatives where vaginal estrogen cannot be used as first-line treatment. Widespread education of health-care providers and patients on VVA and the impact on quality of life is urgently needed, as well as increased use of non-hormonal methods in routine clinical practice.
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POS1131 THE INCIDENCE AND PREVALENCE OF CARDIOVASCULAR DISEASES IN GOUT: A SYSTEMATIC REVIEW AND META-ANALYSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Gout is an inflammatory crystal arthropathy characterised by hyperuricaemia and sodium urate crystal deposition. Both gout and subclinical hyperuricaemia are associated with adverse cardiovascular outcomes. Several studies have found gout to cause an increased risk of cardiovascular disease, but the evidence is not unanimous. The conflicting evidence has made it difficult to establish the extent of the cardiovascular risk to patients with gout.Objectives:To describe the incidence and prevalence of cardiovascular disease in gout, compare these results with non-gout controls.Methods:PubMed, Scopus and Web of Science were systematically searched in January 2021 for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded. Sample size, prevalence of the investigated cardiovascular disease, definition of gout and cardiovascular disease, demographic data, data source and any comparisons with non-gout controls were extracted from each study. Where prevalence data was reported in ≥3 cohorts meta-analysis was performed using random-effect models.Results:Of the 6164 titles identified, 105 full texts were assessed for eligibility with 30 included in the review, producing a gout population of 1,125,988. Pooled prevalence estimates were calculated for six cardiovascular diseases: heart failure (8.73%; 95% confidence interval (CI), 2.85 – 23.76), cerebrovascular accident (4.27%; 95% CI, 1.83 – 9.67), myocardial infarction (2.82%; 95% CI, 1.58 – 5.01), venous thromboembolism (2.05%; 95% CI, 1.22 – 3.43), hypertension (63.94%; 95% CI, 24.51 – 90.64) and cardiovascular mortality (4.75%; 95% CI, 3.56 – 6.31). Twenty studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases, particularly for myocardial infarction.Conclusion:Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. These results are in line with other studies which have shown an increased cardiovascular risk for sufferers of hyperuricaemia, highlighting the need for future research to explain this finding. There are limited studies in the literature investigating less common cardiovascular conditions, illustrating the need for future work if a more thorough picture of prevalence is to be established.Figure 1.Forest plots of pooled prevalence of: (A) 8.73% for heart failure, (B) 4.27% for cerebrovascular accident, (C) 2.82% for myocardial infarction, (D) 2.05% for venous thromboembolism, (E) 63.94% for hypertension and (F) 4.75% for cardiovascular mortality.Disclosure of Interests:None declared.
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CONGENITAL MUSCULAR DYSTROPHIES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cause of intrauterine and neonatal death in twin pregnancies (CoDiT): development of a novel classification system. BJOG 2020; 127:1507-1515. [PMID: 32359214 DOI: 10.1111/1471-0528.16291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Twin pregnancies have a significantly higher perinatal mortality than singleton pregnancies. Current classification systems for perinatal death lack twin-specific categories, potentially leading to loss of important information regarding cause of death. We introduce and test a classification system designed to assign a cause of death in twin pregnancies (CoDiT). DESIGN Retrospective cross-sectional study. SETTING Tertiary maternity unit in England with a perinatal pathology service. POPULATION Twin pregnancies in the West Midlands affected by fetal or neonatal demise of one or both twins between 1 January 2005 and 31 December 2016 in which postmortem examination was undertaken. METHODS A multidisciplinary panel designed CoDiT by adapting the most appropriate elements of singleton classification systems. The system was tested by assigning cause of death in 265 fetal and neonatal deaths from 144 twin pregnancies. Cause of death was validated by another obstetrician blinded to the original classification. MAIN OUTCOME MEASURES Inter-rater, intra-rater, inter-disciplinary agreement and cause of death. RESULTS Cohen's Kappa demonstrated 'strong' (>0.8) inter-rater, intra-rater and inter-disciplinary agreement (95% CI 0.70-0.91). The commonest cause of death irrespective of chorionicity was the placenta; twin-to-twin transfusion syndrome (TTTS) was the commonest placental cause in monochorionic twins and acute chorioamnionitis in dichorionic twins. CONCLUSIONS This novel classification system records causes of death in twin pregnancies from postmortem reports with high inter-user agreement. We highlight differences in aetiology of death between monochorionic and dichorionic twins. TWEETABLE ABSTRACT New classification system for #twin cause of death 'CoDiT' shows high rater agreement.
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What is the effect of increased standing time in non-ambulant children with cerebral palsy? a feasibility study. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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The first clonal spread of vanA-positive Enterococcus raffinosus in a nursing home. J Hosp Infect 2017; 96:72-74. [PMID: 28377181 DOI: 10.1016/j.jhin.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 11/29/2022]
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Re: Stillbirth collection by Man et al. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:281-282. [PMID: 28169497 DOI: 10.1002/uog.17380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
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Developing a multidisciplinary tongue-tie service: pitfalls of setting up. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Multi-disciplinary approach to neonatal ankyloglossia. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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COMBINED CO AND DUST SCALING RELATIONS OF DEPLETION TIME AND MOLECULAR GAS FRACTIONS WITH COSMIC TIME, SPECIFIC STAR-FORMATION RATE, AND STELLAR MASS. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/800/1/20] [Citation(s) in RCA: 418] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Deaths. Vet Rec 2015. [DOI: 10.1136/vr.h47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cardiac MRI demonstrates increased pericardial effusions and subclinical myocardial inflammation, as a potential cause for cardiac dysfunction in a contemporary cohort of patients with HIV. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Efficient development of highly polymorphic microsatellite markers based on polymorphic repeats in transcriptome sequences of multiple individuals. Mol Ecol Resour 2014; 15:17-27. [DOI: 10.1111/1755-0998.12289] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 11/26/2022]
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The immunological basis of villitis of unknown etiology - review. Placenta 2013; 34:846-55. [PMID: 23891153 DOI: 10.1016/j.placenta.2013.07.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/04/2013] [Accepted: 07/05/2013] [Indexed: 01/22/2023]
Abstract
Villitis of unknown etiology (VUE) represents a common placental inflammatory lesion, primarily, but not exclusively, identifiable T lymphocytes at term. Despite considerable evidence to contest that this simply represents a benign pathological finding, VUE remains a significantly undervalued diagnosis. Given its association with adverse pregnancy outcomes; including fetal growth restriction, preterm birth, and recurrent pregnancy loss, an increased awareness amongst clinician obstetricians is certainly warranted. The underlying immunopathogenesis of VUE remains uncertain. Despite initial theories that this represents an infectious placental lesion of undiagnosed pathogenic source, a more complex sequence of events involving the "breakdown" of maternal-fetal tolerance is emerging. Characterization of a unique inflammatory phenomenon in which both maternal and fetal T lymphocytes and Höfbauer cells interact has captivated particular research interest and has generated analogies to both the problems of allograft rejection and graft-versus-host disease (GvHD). Within the context of VUE, this review evaluates how disruption of the multidimensional immunological mechanisms underlying feto-maternal tolerance may permit abnormal lymphocyte infiltration into placental villi. We shall review the existing evidence for these events in VUE and outline areas of certain future interest.
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The role of ultrasound in fetal congenital myopathy detection: a novel case of fetal-onset cap myopathy. Prenat Diagn 2013; 33:1102-4. [DOI: 10.1002/pd.4184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/23/2013] [Accepted: 06/20/2013] [Indexed: 11/09/2022]
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Myocardial substrate metabolism in obesity. Int J Obes (Lond) 2013; 37:972-9. [PMID: 23069666 DOI: 10.1038/ijo.2012.170] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/29/2012] [Accepted: 09/02/2012] [Indexed: 12/28/2022]
Abstract
Obesity is linked to a wide variety of cardiac changes, from subclinical diastolic dysfunction to end-stage systolic heart failure. Obesity causes changes in cardiac metabolism, which make ATP production and utilization less efficient, producing functional consequences that are linked to the increased rate of heart failure in this population. As a result of the increases in circulating fatty acids and insulin resistance that accompanies excess fat storage, several of the proteins and genes that are responsible for fatty acid uptake and metabolism are upregulated, and the metabolic machinery responsible for glucose utilization and oxidation are inhibited. The resultant increase in fatty acid metabolism, and the inherent alterations in the proteins of the electron transport chain used to create the gradient needed to drive mitochondrial ATP production, results in a decrease in efficiency of cardiac work and a relative increase in oxygen usage. These changes in cardiac mitochondrial metabolism are potential therapeutic targets for the treatment and prevention of obesity-related heart failure.
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Efficacy of extended cefquinome treatment of clinical Staphylococcus aureus mastitis. J Dairy Sci 2013; 96:4983-92. [PMID: 23706485 DOI: 10.3168/jds.2012-6197] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/07/2013] [Indexed: 11/19/2022]
Abstract
Clinical Staphylococcus aureus mastitis is difficult to cure. Extended antimicrobial treatment is often advocated as a practical approach to improve cure rates; however, scientific evidence of this hypothesis is lacking. A multi-centered, nonblinded, randomized, positive-controlled clinical trial was conducted in 5 European countries-France, Hungary, Italy, the Netherlands, and the United Kingdom-to study the efficacy of an extended intramammary cefquinome treatment (5 d) compared with a standard intramammary cefquinome treatment (1.5 d) of Staph. aureus clinical mastitis. Least squares means estimates of bacteriological cure during lactation were 34% [standard error (SE)=9.9%] for the standard treatment group and 27% (SE=8.4%) for the extended treatment group. In the final model, extended therapy was not significantly better. The only factor predicting bacteriological cure was pretreatment cow somatic cell count (SCC). Cows with >250,000 cells/mL in milk before treatment were less likely to cure. Least squares means of clinical cure during lactation was 60% (SE=19%) for the standard treatment group and 82% (SE=12%) for the extended treatment group. In the final model, clinical cure after extended treatment was significantly better. Pretreatment cow udder firmness predicted clinical cure. Firm udders were less likely to cure clinically. Irrespective of treatment regimen, new infection rates with pathogens other than Staph. aureus were higher (42%) after bacteriological cure than after nonbacteriological cure (22%) and cured cows had a significantly lower SCC. In conclusion, independent of the treatment protocol, cows with an SCC <250,000 cells/mL before treatment showed a higher probability of bacteriological cure. It appears that successful treatment of clinical Staph. aureus mastitis with cefquinome is associated with an increased number of new infections with coagulase-negative staphylococci. Extended treatment improved clinical, but not bacteriological, cure rates compared with the standard treatment. These results indicate that extending treatment of clinical Staph. aureus mastitis with cefquinome should not be recommended.
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The effect of ice cream formulation on palatability and rate of eating. Appetite 2012. [DOI: 10.1016/j.appet.2012.05.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ethics: End-of-life decision-making in a pediatric patient with SMA type 2: The influence of the media. Neurology 2012; 78:e143-5. [DOI: 10.1212/wnl.0b013e318258f835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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A difficult conversation? The views and experiences of parents and professionals on the consent process for perinatal postmortem after stillbirth. BJOG 2012; 119:987-97. [DOI: 10.1111/j.1471-0528.2012.03357.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A Pilot Trial of Zinc in Patients with ALS (P04.153). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Waitlist mortality continues to be a limiting factor for all solid-organ transplant programs. Strategies that could improve this situation should be considered. We report the first ABO-incompatible lung transplantation in an infant. The recipient infant was ABO blood group A1 and the donor group B. The recipient was diagnosed with surfactant protein B deficiency, which is a fatal condition and lung transplantation is the only definitive therapy. At 32 days of age, a bilateral lung transplantation from a donation after cardiac death (DCD) donor was performed. Intraoperative plasma exchange was the only preparatory procedure performed. No further interventions were required as the recipient isohemagglutinins were negative before transplant and have remained negative to date. At 6 months posttransplant, the recipient is at home, thriving, with normal development. This outcome suggests that ABO-incompatible lung transplantation is feasible in infants, providing another option to offer life-saving lung transplantation in this age range.
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Poster Session 2: Thursday 8 December 2011, 14:00-18:00 * Location: Poster Area. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011. [DOI: 10.1093/ejechocard/jer208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Use of e-learning to enhance medical students' understanding and knowledge of healthcare-associated infection prevention and control. J Hosp Infect 2011; 79:368-70. [PMID: 21945066 DOI: 10.1016/j.jhin.2011.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 08/14/2011] [Indexed: 10/17/2022]
Abstract
An online infection prevention and control programme for medical students was developed and assessed. There was a statistically significant improvement (P<0.0001) in the knowledge base among 517 students after completing two modules. The majority of students who completed the evaluation were positive about the learning experience.
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Estimating the risk from sewage treatment plant effluent in the Sydney catchment area. WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2011; 63:1707-1715. [PMID: 21866772 DOI: 10.2166/wst.2011.408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study employed Quantitative Microbial Risk Assessment (QMRA) to estimate the gastrointestinal risks associated with Cryptosporidium and Giardia discharged from three STPs located within the Lake Burragorang catchment. The QMRA considered baseline and various hazardous event scenarios (e.g. plant failure and heavy rainfall). Under baseline conditions, the combined effect of constructed barriers, catchment barriers and dilution reduced pathogen numbers from the discharge of all three STPs by 10 to 14 orders of magnitude. This was sufficient for the risk to be well below currently mooted benchmarks of 'tolerable risk', even when relatively conservative assumptions were applied. For all hazardous event scenarios, the level of risk remained low, which illustrated the benefit of multiple barriers. Provisionally it appears that the STPs currently discharging into the waterways of the catchment do not pose an unacceptable or unmanageable risk to Sydney's drinking water consumers.
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Intense star formation within resolved compact regions in a galaxy at z = 2.3. Nature 2010; 464:733-6. [PMID: 20305639 DOI: 10.1038/nature08880] [Citation(s) in RCA: 274] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 02/01/2010] [Indexed: 11/09/2022]
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High molecular gas fractions in normal massive star-forming galaxies in the young Universe. Nature 2010; 463:781-4. [PMID: 20148033 DOI: 10.1038/nature08773] [Citation(s) in RCA: 766] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 12/22/2009] [Indexed: 11/09/2022]
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A new twist on an old problem: a case of pediatric meningitis caused by multidrug-resistant Streptococcus pneumoniae serotype 19A. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2008; 34:1-6. [PMID: 19051388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Recent studies show that multidrug-resistant Streptococcus pneumoniae serotype 19A continues to emerge as a cause of invasive pneumococcal disease after the introduction of Prevnar. We report a case of multidrug-resistant S. pneumoniae serotype 19A meningitis successfully treated with vancomycin and levofloxacin. This case reinforces the need for the empiric use of vancomycin in meningitis and the need for alternative treatments.
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Abstract
Congenital tracheal stenosis (CTS) is an uncommon condition that has challenged pediatric surgeons for decades. Patients with CTS can present with a wide spectrum of symptoms and varying degrees of severity. In addition, a variety of techniques have been devised to repair this malformation. A review of these procedures and our suggestions for clinical standards and practice guidelines will be presented in this paper. A retrospective review of the literature on CTS from 1964 to 31 March, 2006. There is not one standard technique for the repair of CTS, as individualized approach to each patient and airway lesion is necessary to optimize patient management; nevertheless there is a consensus about segmental resection and anastomosis being best for short segment stenosis while slide tracheoplasty is most effective for the long-segment ones. Conservative management is also an option for select group of patients with careful and close follow up. Survival following surgery over the years has improved, but mortality remained high, particularly in a specific subset of patients presenting at the age less than 1 month with associated cardiac malformations. In conclusion, CTS remains a significant challenge for pediatric surgeons. Additional research is required to improve our understanding of the pathogenesis of CTS, and to develop evidence-based treatment protocols for the entire spectrum of presentation including conservative management.
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Abstract
The bacterial contamination of the postpartum uterus is a frequent finding which by itself does not disturb the anatomical and histological restoration of tubular genital tract. The improper balance between uterine infection and the intrauterine antimicrobial self-defence mechanisms, however, often results in complications, such as puerperal metritis, clinical endometritis, pyometra and subclinical endometritis. After reviewing the bacteriology of uterine involution, and the predisposing factors for its bacterial complications, this paper defines the different clinical forms, and summarizes their pathology, furthermore, the recent progress in diagnostic considerations and principles of current treatments for these diseases of bovine genitals.
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Peripheral skin necrosis in the recipient of monochorionic twins complicated by twin-twin transfusion syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:717-9. [PMID: 17001755 DOI: 10.1002/uog.3826] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Twin-twin transfusion syndrome (TTTS) complicates approximately 15% of monochorionic, diamniotic twin pregnancies and if untreated carries a high perinatal loss rate of between 80% and 100%, depending on the stage. The underlying pathology in TTTS appears to be an imbalanced intertwin perfusion difference, secondary to functional unidirectional arteriovenous anastomoses within a monochorionic placenta. We report two cases of monochorionic twin pregnancy complicated by TTTS, in which the pregnancies were treated by serial aggressive amnioreduction. However, the recipient twin in each pregnancy developed 'ischemic damage' to a lower limb.
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A structural basis for the corrosion resistance of lead-iron-phosphate glasses: An X-ray absorption spectroscopy study. ACTA ACUST UNITED AC 2006. [DOI: 10.1080/13642818808208469] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Remote ischaemic preconditioning protects against cardiopulmonary bypass-induced tissue injury: a preclinical study. Heart 2006; 92:1506-11. [PMID: 16818489 PMCID: PMC1861036 DOI: 10.1136/hrt.2004.042366] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To test the hypothesis that remote ischaemic preconditioning (rIPC) reduces injury after cardiopulmonary bypass (CPB). DESIGN Randomised study with an experimental model of CPB (3 h CPB with 2 h of cardioplegic arrest). Twelve 15 kg pigs were randomly assigned to control or rIPC before CPB and followed up for 6 h. INTERVENTION rIPC was induced by four 5 min cycles of lower limb ischaemia before CPB. MAIN OUTCOME MEASURES Troponin I, glial protein S-100B, lactate concentrations, load-independent indices (conductance catheter) of systolic and diastolic function, and pulmonary resistance and compliance were measured before and for 6 h after CPB. RESULTS Troponin I increased after CPB in both groups but during reperfusion the rIPC group had lower concentrations than controls (mean area under the curve -57.3 (SEM 7.3) v 89.0 (11.6) ng.h/ml, p = 0.02). Lactate increased after CPB in both groups but during reperfusion the control group had significantly more prolonged hyperlactataemia (p = 0.04). S-100B did not differ between groups. Indices of ventricular function did not differ. There was a tendency to improved lung compliance (p = 0.07), and pulmonary resistance changed less in the rIPC than in the control group during reperfusion (p = 0.02). Subsequently, peak inspiratory pressure was lower (p = 0.001). CONCLUSION rIPC significantly attenuated clinically relevant markers of myocardial and pulmonary injury after CPB. Transient limb ischaemia as an rIPC stimulus has potentially important clinical applications.
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Tideswell health survey: a population survey of the health needs and service utilization of a farming community. Public Health 2005; 120:221-8. [PMID: 16360714 DOI: 10.1016/j.puhe.2005.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 06/08/2005] [Accepted: 09/19/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In the UK, there have been no epidemiological studies focusing on the general health status of rural communities, despite the prevalence of rural deprivation and the widely acknowledged link between poverty and ill health. The primary objective of this study was to test the null hypothesis that no differences existed between the health status of the farming and non-farming populations registered with one general practice, in order to inform a local health needs assessment. The secondary objective was to test the suitability of the research method as a model for a wider study. STUDY DESIGN A postal questionnaire survey was undertaken with the total farming population (n = 248) registered with Tideswell general practice, and matched with an equivalent random sample of non-farmers (n = 248) from the remainder of the practice list. The main outcome measures were income, general health status, quality of life (EQ5D), musculoskeletal problems, mental health status and service utilization. RESULTS Significant differences were found between the two groups. Farmers were identified as having health needs that were greater than those found in the local non-farming sample. In addition, the observed EQ5D value for farmers was found to be significantly lower than that found in social classes IV and V (0.78 vs 0.82) and the UK mean. CONCLUSIONS This modest controlled study is the first of its kind in the UK. Health inequalities and inequities were identified that may be generalizable to other UK hill farmers. However, a larger, wider epidemiological study across different types of farming groups is now required to gain a fuller understanding of the health status of this indigenous rural population. The methodology employed in this study was successful and could serve as a model for such a study.
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L2: Cross Border Epidemiology: When Pandemic Influenza Comes to the Northwest, 2004 – 2005. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s150b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
AIMS Currently cryptosporidiosis represents the major public health concern of water utilities in developed nations and increasingly, new species and genotypes of Cryptosporidium are being identified in which the infectivity for humans is not clear. The complicated epidemiology of Cryptosporidium and the fact that the majority of species and genotypes of Cryptosporidium cannot be distinguished morphologically makes the assessment of public health risk difficult if oocysts are detected in the raw water supplies. The aim of this study was to use molecular tools to identify sources of Cryptosporidium from the Warragamba catchment area of Sydney, Australia. METHODS AND RESULTS Both faecal and water samples from the catchment area were collected and screened using immunomagnetic separation (IMS) and immunofluorescence microscopy. Samples that contained Cryptosporidium oocysts were genotyped using sequence and phylogenetic analysis of the 18S rDNA, and the heat-shock (HSP-70) gene. Analysis identified five Cryptosporidium species/genotypes including C. parvum (cattle genotype), C. suis, pig genotype II, the cervid genotype and a novel goat genotype. CONCLUSIONS Monitoring and characterization of the sources of oocyst contamination in watersheds will aid in the development and implementation of the most appropriate watershed management policies to protect the public from the risks of waterborne Cryptosporidium. SIGNIFICANCE AND IMPACT OF THE STUDY This study has shown that quantification by IMS analysis can be combined with the specificity of genotyping to provide an extremely valuable tool for assessing the human health risks from land use activities in drinking water catchments.
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Abstract
The pharmacokinetics of ibafloxacin following single and repeated administration of an oral gel formulation and the effect of food intake were investigated in cats. Ibafloxacin is a chiral fluoroquinolone available for clinical use as a racemic mixture of the R- and S-enantiomers. Plasma concentrations of ibafloxacin and its metabolites were determined using microbiological, LC-MS-MS and enantioselective capillary zone electrophoresis assays. Ibafloxacin was absorbed rapidly [time of maximum concentration (tmax) 2-3 h], reaching a mean maximum concentration (Cmax) of approximately 2.1 and 1.6 microg/mL for R- and S-ibafloxacin, respectively, following a single oral administration of the racemate at 15 mg/kg. Once absorbed, ibafloxacin was metabolized to 7-hydroxy-ibafloxacin and mainly to 8-hydroxy-ibafloxacin. Following repeated oral administration, significant increases in Cmax and AUC of ibafloxacin and its less active metabolites (racemic or enantiomers) were observed between the first and the tenth day of treatment. This twofold exposure increase in concentrations of ibafloxacin and its metabolites may contribute additionally to the efficacy of this drug in the treatment of feline bacterial infections. Single and repeated doses of ibafloxacin were well tolerated by cats. Food promoted the absorption of ibafloxacin, doubling Cmax and increasing AUC and slightly delaying tmax. High concentrations of the metabolites, mainly 8-hydroxy- and 7-hydroxy-ibafloxacin were excreted in urine, either unchanged or as glucurono-conjugates.
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Abstract
The pharmacodynamic properties of ibafloxacin were investigated in micro-organisms isolated from cats. Minimal inhibitory concentrations (MIC) of ibafloxacin (racemate, R- and S-enantiomers) and its metabolites (7-hydroxy- and 8-hydroxy-ibafloxacin) and time-kill kinetics were determined against Gram-negative and Gram-positive bacteria isolated from dermal and respiratory and urinary tract infections in cats. Racemic ibafloxacin has a broad spectrum of bactericidal activity against Gram-negative and some Gram-positive bacteria. Escherichia coli and Pasteurella, Klebsiella and Staphylococcus spp. are commonly isolated from feline infections and all are susceptible to ibafloxacin (MIC90 < or = 0.5 microg/mL), whereas Pseudomonas aeruginosa, Proteus mirabilis and Streptococcus spp. are considered intrinsic resistant. Microbiological activity resides primarily in the S-enantiomer of ibafloxacin whereas the R-enantiomer is less active. Killing curves using concentrations of racemic ibafloxacin and 8-hydroxy-ibafloxacin, which are representative of the in vivo situation observed in cats, showed at least 99.9% reduction in viable bacterial isolates from feline clinical samples over 24 h. Bacterial eradication was achieved in cats with Cmax/MIC and AUC/MIC values much lower than the target values previously established in man and laboratory animals. Additional studies in dogs and cats are necessary to define more clearly the surrogate markers of antibacterial activity (i.e. Cmax/MIC, AUC/MIC ratios), which are associated with a good clinical response.
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Derivation of rate of arterio-arterial anastomotic transfusion between monochorionic twin fetuses by Doppler waveform analysis. Placenta 2004; 25:664-70. [PMID: 15193874 DOI: 10.1016/j.placenta.2004.01.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2004] [Indexed: 11/24/2022]
Abstract
We aimed to determine rates of interfetal transfusion along arterio-arterial (AA) anastomoses in monochorionic twins in vivo from analysis of Doppler waveform patterns. Twenty-one monochorionic twin pregnancies in which an AA anastomosis was identified antenatally underwent serial Doppler velocimetry. Unidirectional AA anastomotic flow rates increased with increasing gestational age (log y = 8 x 10(-9)x - 5 x 10(-8); p = 0.0002). The mean net rate of flow through an AA anastomosis at 28 weeks gestation was 7.6 x 10(-8) l/s (SD = 4.9 x 10(-8) l/s). This flow was significantly related to the distribution of arterio-venous (AV) anastomoses (p = 0.009) and birthweight discordancy (p = 0.006). We derived estimates of flow along individual AV anastomoses by assuming that net AA countertransfusion is shared equally among uncompensated AV anastomoses, and speculate that the median AV flow rate at 28 weeks is in the order of 6 x 10(-8) l/s. In conclusion, this study demonstrates that flow rates along AA anastomoses can be quantified antenatally. These are the first estimates of flow rates in vivo along placental anastomoses. Although AA net flows are modest, chronic unbalanced counterflow of this magnitude in the absence of compensatory superficial anastomoses could lead to significant haemodynamic compromise.
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Defective embryogenesis with angiotensin II receptor antagonists in pregnancy. BJOG 2003; 110:1038. [PMID: 14592593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Getting back into medicine. West J Med 2003. [DOI: 10.1136/bmj.326.7403.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Asphyxiating thoracic dystrophy (ATD), or Jeune syndrome, is a multisystem autosomal recessive disorder associated with a characteristic skeletal dysplasia and variable renal, hepatic, pancreatic, and retinal abnormalities. We have performed a genome wide linkage search using autozygosity mapping in a cohort of four consanguineous families with ATD, three of which originate from Pakistan, and one from southern Italy. In these families, as well as in a fifth consanguineous family from France, we localised a novel ATD locus (ATD) to chromosome 15q13, with a maximum cumulative two point lod score at D15S1031 (Zmax=3.77 at theta=0.00). Five consanguineous families shared a 1.2 cM region of homozygosity between D15S165 and D15S1010. Investigation of a further four European kindreds, with no known parental consanguinity, showed evidence of marker homozygosity across a similar interval. Families with both mild and severe forms of ATD mapped to 15q13, but mutation analysis of two candidate genes, GREMLIN and FORMIN, did not show pathogenic mutations.
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Abstract
Images of the molecular CO 2-1 line emission and the radio continuum emission from the redshift 4.12 gravitationally lensed quasi-stellar object (QSO) PSS J2322+1944 reveal an Einstein ring with a diameter of 1.5". These observations are modeled as a star-forming disk surrounding the QSO nucleus with a radius of 2 kiloparsecs. The implied massive star formation rate is 900 solar masses per year. At this rate, a substantial fraction of the stars in a large elliptical galaxy could form on a dynamical time scale of 108 years. The observation of active star formation in the host galaxy of a high-redshift QSO supports the hypothesis of coeval formation of supermassive black holes and stars in spheroidal galaxies.
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