Internal Medicine

BACKGROUND: There is a paucity of data on the underlying procoagulant–anticoagulant balance during extracorporeal membrane oxygenation (ECMO). We hypothesized that adult ECMO patients would have an imbalance between procoagulant and anticoagulant factors, leading to an abnormal underlying thrombin generation (TG) pattern. METHODS: Twenty adult venoarterial (VA) ECMO patients had procoagulant and anticoagulant factor levels measured temporally on ECMO day 1 or 2, day 3, and day 5. In heparin-neutralized plasma, underlying TG patterns, and sensitivity to activated protein C were assessed using calibrated automated thrombogram. TG parameters including lag time, peak TG, and endogenous thrombin potential (ETP) were compared against 5 normal plasma controls (3 males and 2 females) obtained from a commercial supplier. Thrombomodulin (TM) was added to some samples to evaluate for activated protein C resistance. RESULTS: Procoagulant factors (factor [F] II, FV, and FX) were mostly in normal...

We sincerely appreciate the editorial by Drs. Huang and Tseng, 1 commenting on our recent study published in Clinical and Molecular Hepatology 2 regarding the role of time-varying hepatitis B core-related antigen (HBcrAg) in predicting clinical relapse (CR) for chronic hepatitis B (CHB) patients who discontinued tenofovir or entecavir. We agree that nucleos(t) ide analogue (NA) cessation is generally safe with hepatitis B surface antigen (HBsAg) seroclearance, 3 which is the only treatment endpoint widely acceptable across guidelines. Unfortunately, it rarely occurs during long-term NA therapy. Treatment discontinuation without first achieving HBsAg seroclearance invariably leads to recurrence of viremia and could precipitate hepatitis flare and even life-threatening acute on chronic liver failure. The strategy of finite NA therapy, therefore, cannot be practiced without thorough consideration of the conceivable benefits and potential risks for an

Increased serum uric acid (UA) has been shown to directly promote oxidative stress. Recent studies point toward a role for oxidative stress in the pathogenesis of ascending aortic aneurysms (AscAAs). This study was designed to examine the relationship between serum UA concentrations, total antioxidant reductive capacity, and AscAAs. The serum UA concentrations, total antioxidant reductive capacity were compared in 60 patients with ascending aortic dilatation (ectasia group (3.8-4.3 cm), 34 patients; aneurysmal group (≥4.4 cm), 26 patients) vs. 30 control subjects. The patients were evaluated by a complete transthoracic echocardiographic examination including measurement of the aortic dimensions. The serum UA concentration and total antioxidant reductive capacity were significantly higher in patients with AscAAs. In multiple linear regression analysis, hypertension and serum UA concentration were significantly associated with aortic dilatation (β = 0.3, P = 0.03; β = 0.15, P < 0.0...

Iron deficiency anemia in toddlers can be prevented by introducing complementary foods alongside breastfeeding. Fish, rich in protein and iron, offers a valuable nutritional source for young children, but proper processing is crucial. This research investigated the impact of fish-based complementary food processing practices (known as MP-ASI in Indonesia) on the nutritional intake and hemoglobin levels of children under five in Tiro District, Pidie Regency. Using a quasi-experimental design, this study involved 40 toddlers from the stunting-prone area of Tiro District, Pidie Regency, along with their mothers as respondents. The toddlers, aged 12-36 months without severe illnesses, were included in the study. The intervention comprised educating and practicing complementary food processing. Beforeand-after intervention comparisons showed significant improvements in energy, carbohydrate, protein, zinc, and iron intake levels. Additionally, there was a notable increase in the average hemoglobin (Hb) level, rising by 1.06 g/dl after one month of fish-based complementary food processing intervention. In summary, this intervention effectively enhanced the nutritional quality of children's intake and increased their hemoglobin levels, contributing to the prevention of iron deficiency anemia in toddlers.

Background: High sensitivity C-reactive protein (hs-CRP), a sensitive marker of inflammation and tissue damage is an acute phase reactant. It is raised in hypertension and predicts cardiovascular outcome. Moreover elevated levels of inflammatory markers such as hs-CRP and altered lipid profile are commonly seen in hypertension which may develop cardiovascular events, hence, hs-CRP, lipid profile and nitric oxide (NO) have been incorporated in the study. The aims of this study were to find out a relationship of serum hs-CRP and dyslipidemia in hypertensives and to find out an association of serum hs-CRP with the risk for Cardiovascular disease (CVD). Methods: A case-control study was done among the patients visiting the outpatient department (OPD) of BP Koirala Institute of Health Sciences, Dharan, Nepal in which forty seven newly diagnosed hypertensives as cases and fifty age and sex matched healthy normotensives as controls, were enrolled in the study with the prior informed consen...

Background: Acute viral hepatitis is a common liver-associated abnormality encountered in clinical practice. The number of biochemical parameters is estimated to detect a hepatic abnormality, which can measure the severity and types of damage to hepatocytes, among which liver enzymes and bilirubin levels are assessed routinely which are raised in acute viral hepatitis.Objective: This study aims to assess the liver enzymes, such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, and calculation of AST to ALT ratio in acute viral hepatitis and to compare these parameters with the control group.Methodology: This study included a total of 81 subjects diagnosed with acute viral hepatitis as cases and age and sex-matched, the same number of healthy subjects as control. Serum levels of AST and ALT, alkaline phosphatase (ALP), and bilirubin were analyzed using standard methods. Serum AST to ALT ratio was calculated. Data analysis was done using SPSS Version 17.0...

Male breast cancer (MBC) is rare and consequently understudied. Here we present the case of contralateral breast cancer in a male patient nearly a quarter century following his initial breast cancer diagnosis and treatment. The epidemiology, risk factors, diagnosis, characterization, treatment, and prognosis of male breast cancer are reviewed. MBC accounts for <1% of all breast cancer with an estimated incidence nearly 1.25 per 100,000 person years. Our patient tested positive for ATM mutation of undetermined significance. More commonly in males, a BRCA2 mutation confers a >1 in 15 lifetime risk of breast cancer and is present in >11% of MBC patients, while BRCA1 is present in an estimated <1.5% of MBC patients. The risk of contralateral breast cancer developing in a male with a unilateral lesion is much higher than for a primary male breast cancer in the general population. Men tend to be diagnosed at a later age and stage than females. Prognosis for male and female bre...

Background To validate the k-adaptive-t autocalibrating reconstruction for Cartesian sampling (kat-ARC), an exclusive sparse reconstruction technique for four-dimensional (4D) flow cardiac magnetic resonance (CMR) using conservation of mass principle applied to transvalvular flow. Methods This observational retrospective study (2020/21-075) was approved by the local ethics committee at the University of East Anglia. Consent was waived. Thirty-five patients who had a clinical CMR scan were included. CMR protocol included cine and 4D flow using Kat-ARC acceleration factor 6. No respiratory navigation was applied. For validation, the agreement between mitral net flow (MNF) and the aortic net flow (ANF) was investigated. Additionally, we checked the agreement between peak aortic valve velocity derived by 4D flow and that derived by continuous-wave Doppler echocardiography in 20 patients. Results The median age of our patient population was 63 years (interquartile range [IQR] 54–73), and...

The compositional skills are analyzed to determine whether college students have improved their writing ability after the two years additional in the senior high school curriculum. This study examines the errors committed by first-year engineering students. There were 90 student respondents written outputs collected and subjected to Grammarly software. The researchers analyzed the data using the Scheffe test, comparing the difference between clarity, engagement, and delivery. Analysis of variance (ANOVA) was employed to test whether there is a significant difference among other variables. Findings revealed that clarity is the most common error committed by the student-respondents. The errors committed between male and female respondents do not show a difference. The K-12 graduates' compositional errors do not differ significantly from that in the Alternative Learning System (ALS) passers or the old basic education curriculum graduates. It is in delivery that students vary. This finding implies that college students' compositional skills still need strengthening. Instructors are encouraged to provide comprehensive activities and writing exercises to both genders, regardless of their curriculum. It is recommended that university language instructors identify specific interventions to help students struggling with writing. Therefore, providing enough written opportunities and practices is vital to make college students enhance their compositional skills.

agents, have been approved for ALL, AML, and MDS. We conducted a study to evaluate outcomes of pts with these diseases who relapse after alloHCT in the contemporary period with routine availability of these newer therapeutic agents. Methods: We performed a single-institution retrospective cohort study to review treatment strategies and outcomes of relapse post-alloHCT. We identified 420 adults who received their first alloHCT in 2010-2018 using any conditioning regimen or donor source. Overall, 115 (27%) pts experienced relapse (ALL=17/64 [27%], AML=67/242 [28%], MDS=31/114 [27%]) and were included in the analysis. Results: Myeloablative (54%) matched-unrelated donor grafts (50%) were the most common types of HCTs. Peripheral blood stem cell graft (49%) and bone marrow graft (48%) were used the most. Median time from alloHCT to relapse was 5 (range 1-65) months, and 83% of relapses occurred within the first year. Only 24% and 11% of pts experienced grade II-IV acute and any chronic graft-versus-host disease (GVHD) prior to relapse, respectively. Seven of 17 pts had Ph+ ALL. Mutation panel was tested in 56% of AML and MDS. Median follow-up period after relapse was 19 (range 6-80) months. The estimated survival after relapse is shown in figure . Table summarizes the treatments used for relapse after alloHCT. Targeted therapy was associated with a trend towards better survival compared to other therapies (Fig 2, HR 0.65, 95% CI 0.41-1.03, p=0.06). Matched unrelated (vs. matched sibling, HR 1.70, p=0.027) or haploidentical donor grafts (HR 2.69, p=0.003), presence of grade II-IV acute GVHD before relapse (HR 2.46, p<0.001), and <12 months from HCT to relapse (<6 vs. >12 months, HR 6.34, p<0.001; 6-12 vs. >12 months, HR 3.16, p=0.005) were adverse prognostic features with survival after relapse post-alloHCT (Table ). Conclusion: Outcomes of pts with ALL, AML, and MDS who relapse following alloHCT remain poor in the contemporary era when several newer therapies, including targeted agents, are available for their treatment. Targeted agents were used only in a minority of post-alloHCT relapses likely due to the combination of pt status, absence of the target mutation, the agents' availability, and other factors. Pts who developed grade II-IV acute GVHD and had shorter "disease-free" duration from unrelated or haploidentical donor grafts had the significantly shorter survival following relapse. More innovative treatment strategies to prevent and treat relapse post-alloHCT are needed.

partments. PDL-MSCs spontaneously produced high levels of IL-7 at I, III, and V passages. MSCs were able to support the development and long term maintenance of the BM precursor cells better than murine stromal cells and similar to normal BM human stromal cells. The mesenchymal-related antigens CD90, CD29, CD166,CD105 and CD44 were homogeneously detected by cytofluorimetric analysis. PDL-MSCs were negative for HLA-DR, CD2, CD3, CD7, CD14, CD33, CD34, CD45, CD68, S-100 antigens. Our study provides evidence that in human coronal periodontal ligament there is an approachable niche of MSCs showing the features of BM-derived MSCs. The ex vivo expansion of these cells, obtained from an easily accessible source, could represent a useful adjunct for genetic, transplantation and tissue-based clinical therapies.

Background: Although a dramatic decrease in AIDS progression has been observed after Highly Active Anti Retroviral Therapy (HAART) in both low-and high-resource settings, few data support that fact in low-resource settings. This study describes the incidence of AIDS-defining illnesses (ADI) after HAART initiation and analyzes their risk factors in a low-resource setting. A focus was put on CD4 cell counts and viral load measurements. Methods: 404 HIV-1-infected Senegalese adult patients were enrolled in a prospective observational cohort and data censored as of April 2008. A Poisson regression was used to model the incidence of ADIs over two periods and to assess its association with baseline variables, current CD4, current viral load, CD4 response, and virological response. Results: ADI incidence declined from 20.5 ADIs per 100 person-years, 95% CI = [16.3;25.8] during the first year to 4.3, 95% CI = [2.3;8.1] during the fourth year but increased afterwards. Before 42 months, the decrease was greater in patients with clinical stage CDC-C at baseline and with a viral load remaining below 1000 cp/mL but was uniform across CD4 strata (p = 0.1). After 42 months, 293 patients were still at risk. The current CD4 and viral load were associated with ADI incidence (decrease of 21% per 50 CD4/mm 3 and of 61% for patients with a viral load < 1000 cp/ mL). During the first four years, a uniform decline of ADI incidence was observed even in patients with low CD4-cell counts at HAART initiation as long as the viral load remained undetectable. An increase was noted later in patients with immunologic and virological failures but also in patients with only virological failure.

Postoperative delirium (POD) is a prevalent clinical entity characterized by reversible fluctuating altered mental status and cognitive impairment with acute and rapid onset a few days after major surgery. Postoperative cognitive decline (POCD) is a more permanent extension of POD characterized by prolonged global cognitive impairment for several months to years after surgery and anesthesia. Both syndromes have been shown to increase morbidity and mortality in postoperative patients making their multiple risk factors targets for optimization. In particular, nutrition imparts a significant and potentially reversible risk factor. Malnutrition and frailty have been linked as risk factors and predictive indicators for POD and less so for POCD. This review aims to outline the association between nutrition and perioperative cognitive outcomes as well as potential interventions such as prehabilitation.

IntroductionThe COVID-19 pandemic was a major public health threat and posed tremendous pressure to develop a cure for it. Apart from ongoing efforts in developing vaccines, a lot of empirical treatments were recommended, that may have expedited the use of antimicrobials. The main objective of this study was to explore if and how the pandemic posed pressure on antimicrobials in Nepal using semi-structured interviews (SSIs) among patients, clinicians and drug dispensers.MethodsA total of 30 stakeholders (10 each among clinicians, dispensers and COVID-19 patients) were identified purposively and were approached for SSIs. Clinicians and dispensers working in three tertiary hospitals in Kathmandu were first approached and were asked for their support to reach out to COVID-19 patients who were on follow-up at their out-patient department. SSIs were audio recorded, translated and transcribed into English, and were analyzed for thematic synthesis.ResultsOver-the-counter (OTC) uses of antib...

Background Plasmodium vivax is the main cause of malaria in Nepal. Relapse patterns have not been characterized previously. Methods Patients with P. vivax malaria were randomized to receive chloroquine (CQ; 25 mg base/kg given over 3 days) alone or together with primaquine (PQ; 0.25 mg base/kg/day for 14 days) and followed intensively for 1 month, then at 1- to 2-month intervals for 1 year. Parasite isolates were genotyped. Results One hundred and one (49%) patients received CQ and 105 (51%) received CQ + PQ. In the CQ + PQ arm, there were 3 (4.1%) recurrences in the 73 patients who completed 1 year of follow-up compared with 22 of 78 (28.2%) in the CQ-only arm (risk ratio, 0.146 [95% confidence interval, .046–.467]; P &lt; .0001). Microsatellite genotyping showed relatively high P. vivax genetic diversity (mean heterozygosity, 0.843 [range 0.570–0.989] with low multiplicity of infection (mean, 1.05) reflecting a low transmission preelimination setting. Of the 12 genetically homolog...

The development of neutralizing anti-factor VIII alloantibodies (inhibitors) in patients with severe hemophilia A may depend on the concentrate used for replacement therapy. We conducted a randomized trial to assess the incidence of factor VIII inhibitors among patients treated with plasma-derived factor VIII containing von Willebrand factor or recombinant factor VIII. Patients who met the eligibility criteria (male sex, age <6 years, severe hemophilia A, and no previous treatment with any factor VIII concentrate or only minimal treatment with blood components) were included from 42 sites. Of 303 patients screened, 264 underwent randomization and 251 were analyzed. Inhibitors developed in 76 patients, 50 of whom had high-titer inhibitors (≥5 Bethesda units). Inhibitors developed in 29 of the 125 patients treated with plasma-derived factor VIII (20 patients had high-titer inhibitors) and in 47 of the 126 patients treated with recombinant factor VIII (30 patients had high-titer inhibitors). The cumulative incidence of all inhibitors was 26.8% (95% confidence interval [CI], 18.4 to 35.2) with plasma-derived factor VIII and 44.5% (95% CI, 34.7 to 54.3) with recombinant factor VIII; the cumulative incidence of high-titer inhibitors was 18.6% (95% CI, 11.2 to 26.0) and 28.4% (95% CI, 19.6 to 37.2), respectively. In Cox regression models for the primary end point of all inhibitors, recombinant factor VIII was associated with an 87% higher incidence than plasma-derived factor VIII (hazard ratio, 1.87; 95% CI, 1.17 to 2.96). This association did not change in multivariable analysis. For high-titer inhibitors, the hazard ratio was 1.69 (95% CI, 0.96 to 2.98). When the analysis was restricted to recombinant factor VIII products other than second-generation full-length recombinant factor VIII, effect estimates remained similar for all inhibitors (hazard ratio, 1.98; 95% CI, 0.99 to 3.97) and high-titer inhibitors (hazard ratio, 2.59; 95% CI, 1.11 to 6.00). Patients treated with plasma-derived factor VIII containing von Willebrand factor had a lower incidence of inhibitors than those treated with recombinant factor VIII. (Funded by the Angelo Bianchi Bonomi Foundation and others; ClinicalTrials .gov number, NCT01064284; EudraCT number, 2009-011186-88.

Aim: Deltamethrin (DM), a hydrophobic and lipophilic substance used for insect control, easily accumulates in the body, increasing ROS production and causing mucosal inflammation and damage. The aim of this study was to explore the prophylactic effects of hesperidin on DM toxicity in periodontal membrane. Methods: The study was conducted for 14 days on 21 male Wistar albino rats. The experimental animals were divided into three groups (n=7): The Sham group received 0.9% NaCl (1 mL). The deltamethrin group received 0.5 mg/kg DM (1 mL, dissolved in dimethyl sulfoxide). The deltamethrin + hesperidin group received DM (0.5 mg/kg) + hesperidin (100 mg/kg) (both drugs dissolved in 1 mL dimethyl sulfoxide). All treatments were administered daily via the orogastric route for 14 days. At the end of the experiment, the rats were euthanized by cervical dislocation, and biochemical and histological analyses were performed. Results: The biochemical tests showed significantly higher malondialdehyde (MDA) levels in the deltamethrin group than in the Sham group. Combined application of hesperidin and deltamethrin resulted in significantly lower MDA levels in the deltamethrin + hesperidin group than in the deltamethrin group. Histopathological examination of the periodontal tissues of the deltamethrin group revealed cell degeneration at the alveolar bone-tooth junction, including atypical cells, irregularity in collagen fibers, dilatation and congestion of the blood vessels, and inflammatory cell infiltrates distributed in aggregate and solitary forms. The deltamethrin + hesperidin group showed substantially less cell degeneration. Conclusion: Hesperidin application helped alleviate deltamethrin toxicity by preventing oxidative stress and reducing cell degeneration.

BackgroundSarcopenia is a progressive loss of skeletal muscle mass whose pathophysiology has been proposed to possibly involve mechanisms of altered inflammatory status and endocrine function. Adiponectin has been shown to modulate inflammatory status and muscle metabolism. However, the possible association between adiponectin levels and sarcopenia is poorly understood. In order to fill this gap, in the present manuscript we aimed to summarize the current evidence with a systematic review and a meta-analysis of studies reporting serum adiponectin levels in patients with sarcopenia compared to non-sarcopenic controls.MethodsAn electronic search through Medline/PubMed, Cochrane Library, and Science Direct was performed till March 1, 2020. From the included papers, meta-analysis of cross-sectional studies comparing serum levels of adiponectin between patients with sarcopenia and controls was performed.ResultsOut of 1,370 initial studies, seven studies were meta-analyzed. Sarcopenic par...

The recommendation of rifampin-based shorter -and safer -regimens for tuberculosis preventive treatment (TPT) is progressively replacing monotherapy with isoniazid by different countries. The Brazilian Ministry of Health (MoH) approved the incorporation of the Rifapentine + isoniazid regimen (3HP) at the end of 2020, with free distribution in the Brazilian Unified Health System (SUS) started from the last quarter of 2021. The objectives were to describe the implementation of the IL-TB System (Information System of TPT Notification) and uptake of Rifapentine + isoniazid (3HP) and Isoniazid (6H or 9H) in Brazil. Methods: A quantitative observational and descriptive was performed using the IL-TB National System as the main data source, from January 2018 to December 2022. Results and discussion: There was a steady increase of the number of TPT prescription quarterly throughout the period, which reflects the implementation of the system itself and the progressive adherence of the health system to the non-compulsory notification of new TPT. The substitution of isoniazid (6H or 9H) by 3HP is progressing. The 3HP regimen represented less than 4% of the total administered by the end of 2021, reaching around 30% in the second half of 2022 and 40% in the last quarters of 2022. The study points not only to the need to expand TPT in the country, but also to accelerate 3HP uptake and to encourage the municipalities to notify to the IL-TB system, since there is still a high level of underreporting.

Loranthus micranthus (LM) is used in the treatment of diabetes and mental disorders in Nigerian folklore medicine. We studied the short-term memory behavior as well as the activity of acetylcholinesterase, antioxidant status and glycolytic flux in cerebrum and cerebellum of diabetic rats treated with LM extract. Histopathological evaluation was used to assess the level of damage on brain tissue due to diabetes complications. Treatment with LM improved short-term memory behavior, significantly reduced the levels of lipid peroxidation (LPO), increased glutathione (GSH) levels and enhanced the activities of antioxidant enzymes. Activities of glucose metabolism enzymes were augmented while acetylcholinesterase (AChE) activity was reduced by LM treatment compared with the untreated diabetic group. Histopathology evaluation revealed the possible influence of LM in reversing diabetes-induced damage in brain tissue. Further studies are required to accentuate the potentials of LM extract in assuaging diabetes-induced neurological deficits.

Sulphasalazine (Figure , SASP) is a colon-specific pro-drug used in controlling and treating the flare-ups of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. It is also effective in treating severe resistant rheumatoid and psoriatic arthritis . It consists of sulphapyridine (SP) linked to 5-aminosalicylic acid (5-ASA) by an azo bond. 5-ASA has been identified as the active therapeutic moiety of SASP, while its carrier moiety SP has been associated with observed adverse effects such as blood disorders (dyscrasias), hypersensitivity reactions, ulcerogenicity and oxidative stress which results in hepatotoxicity, nephrotoxicity and reversible male infer-

Objectives: Loranthus micranthus is widely used in Nigerian folklore treatment of male infertility and diabetes complications. We investigated this claim in rats rendered diabetic by streptozotocin (STZ). Methods: Induction of diabetes mellitus in adult male Wistar rats was by intraperitoneal injection of STZ (60 mg/kg). The diabetic rats were thereafter treated orally once/day with 5 mg/kg Gilbenclamide or L. micranthus (100 mg/kg or 200 mg/kg) and monitored for 14 days. Clinical observations, hormonal profile, oxidative stress parameters, glucose metabolism enzymes, histopathological examination, apoptotic marker immunoreactivity and western blotting in testes and sperm parameters were evaluated to examine effects of L. micranthus on STZ-diabetic rats. Results: L. micranthus treatment significantly reduced the blood glucose level (45.9% and 84.7% on the 7th and 14th post-treatment days, respectively); increased antioxidant status, improved microarchitecture of testes, reduced lipid peroxidation and increased BCl-2 protein expression in diabetic rats relative to control. Furthermore, treatment with L. micranthus increased steroidogenic enzymes activities, levels of steroid hormones and improved sperm quality, relative to control. The anti-diabetic and aphrodisiac properties exhibited by L. micranthus could be contingent on its ability to restore a balance to the compromised redox status that characterizes male reproductive dysfunction in diabetes.

To assess the mechanism by which the anorectic agent fenfluramine influences feeding, we examined in Macaca mulatta the effect of intragastric fenfluramine (2 mg/kg) on both feeding and the gastric emptying of saline and glucose test meals. Gastric emptying was measured by the dye-dilution technique, using chronic indwelling intragastric cannulas. The emptying of normal saline was inhibited by fenfluramine as was the initial bolus phase of the emptying of glucose. In contrast, the subsequent controlled phase of glucose emptying was unaffected in two out of four animals, slightly inhibited in one, and strongly inhibited in only one monkey. Rhesus monkeys trained to drink a glucose solution to satiety drank, on average, 21% less after fenfluramine. The emptying of the consumed glucose solution from the stomach was reduced by 39%, whereas gastric volume at satiety was reduced by only 10%. The reduction of intake was strongly related to the degree of inhibition of gastric emptying. Thes...

Gastric emptying was measured using a gamma camera in 22 patients with anorexia nervosa, in 10 patients of normal or high weight with bulimia nervosa and in 10 controls. Patients with anorexia nervosa were tested (1) while underweight and selecting their own diet (10 patients); (2) underweight, but receiving an adequate diet on an inpatient unit (refeeding diet) (12 patients); and (3) under refeeding diet conditions after weight gain (eight patients). Three meals, each labelled with technetium 99m-sulphur colloid, 3.7 MBq were used: (1) a mixed solid meal containing labelled poached egg; (2) 200 ml d-glucose solution, 0.5 kcal/ml, and (3) 200 ml physiological saline. Only gastric emptying rates of the solid meal and glucose solution were significantly delayed. Gastric emptying of saline was normal. The gastric disturbance was confined to patients with anorexia nervosa selecting their own diet. Patients receiving adequate nutrition on the ward had normal gastric emptying and weight gain in this group had no significant effect on emptying. Slow emptying was observed in patients who maintained a low weight solely by food restriction as well as in patients whose anorexia nervosa was complicated by episodes of bulimia. Thus, slow gastric emptying occurred when the quantity of food reaching the duodenum was sufficiently reduced to result in severe weight loss. Moreover, abnormal gastric emptying was seen only after the two meals that contained calories and were hypertonic to plasma, either of which properties could mediate the disturbance. Gastric emptying in bulimia nervosa was normal. Slow gastric emptying could exacerbate undereating in starving patients with anorexia nervosa by enhancing satiety.

Inhibition of gastric emptying leads to enhanced satiety and this mechanism may contribute to the undereating observed after administration of Cholecystokinin (CCK) and fenfiwanline, and in patients with anorexia nervosa . Pyloric smooth muscle bears specific CCK receptors and the evidence suggests that a major site of action for CCK satiety is in the periphery . CCK receptors are widespread in lire neonatal rat stomach but not in the brain and over the first two weeks of life binding in the stomach decreases and that in the brain increases . This and the finding that independent ingestion as well as gastric emptying are inhibited by CCK at birth suggest the stomach as its likely site of action in the neonatal rat . Fenfluramine inhibits feeding in animals and in patients with hulimia nervosa . In monkeys . fenfluramine inhibits gastric emptying and this action correlates with its feeding inhibition . Patients with anorexia nervosa who are acutely starving and rats maintained on a restricted diet have delayed gastric emptying . Anorexic patients showed abnormal reporting of both hunger and satiety, and, together with those with bulimia nervosa, often associated gastric contents with symptoms of eating disorder, indicating disturbed interpretation of gastric signals .

La fibrosis quística es una enfermedad genética de herencia autosómica recesiva, caracterizada por disfunción de las glándulas de secreción exocrina. Objetivo: Describir las características clínicas, genéticas y epidemiológicas de la fibrosis quística. Métodos: Estudio descriptivo, observacional de corte transversal que incluyó los nueve pacientes diagnosticados con fibrosis quística durante el año 2016 en Pinar del Río. Se estimó la frecuencia de signos ultrasonográficos prenatales, la edad y manifestaciones al momento del

Clinical teachers often observe interactions that may contribute to health care disparities, yet may hesitate to teach about them. A pedagogical model could help faculty structure teaching about health care disparities in the clinical setting, but to our knowledge, none have been adapted for this purpose. In this paper, we adapt an established model, Time-Effective Strategies for Teaching (TEST), to the teaching of health care disparities. We use several case scenarios to illustrate the core components of the model: diagnose the learner, teach rapidly to the learner's need, and provide feedback. The TEST model is straightforward, easy to use, and enables the incorporation of teaching about health care disparities into routine clinical teaching.

T he present study aims at analyzing scientific works published in periodicals indexed in electronic databases about the importance of a social support network to the donation of human milk through the partnership between Brazilian Human Milk Banks and the Military Firefighters Corps for receivers of human milk, counting from the network's first registered existence in Brazil until the year of 2015, and considering its social effects in the country and perhaps abroad. Methodology: The study is a critical review of the electronic scientific literature, searched from December 2014 to February 2015. Results: 110.098 works were found, then selected and later recovered after thoroughly meeting all the inclusion and exclusion criteria. A total of 25 scientific publications were recovered and read in full: 6 articles, 1 doctoral thesis, 8 master's dissertation, 5 latu sensu post-graduation studies, 3 monographs and 2 undergraduate dissertations. Conclusion: From the scientific evidence and also from the practical experience of the Brazilian Network of Human Milk Banks, built and consolidated in the last two decades, Brazil currently represents a role model to be followed by other countries regarding human milk donation.

Background: Kenya has a paediatric HIV burden of nearly 140,000 children, of which only 48% of those on antiretroviral therapy (ART) have achieved the desired viral suppression possibly due to vitamin D de ciency. We explored the in uence of vitamin D levels on treatment outcome. Method: We performed a cross-sectional study of 196 participants aged 3 -14 years; among them 98 HIV infected who received treatment between 2019 -2020 in Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya. The exposure was vitamin D levels, including de cient (<20 ng/ml), insu cient (≥20 -<30 ng/ml), and su cient (30 -50ng/ml). The outcome was optimal immune recovery (CD4 ≥ 500 cells/mm3) and optimal viral suppression (viral load ≤ 200 copies/ml). We compared difference in means for each vitamin D category between HIV infected and uninfected using independent t-test, multiple comparisons of vitamin D levels among age categories using ANOVA and post hoc test and Pearson correlation to correlate vitamin D levels, CD4 and viral load of HIV infected children. Results: Compared with HIV uninfected, HIV infected recorded mean age ± standard deviation of10.65±2.17 years with 39(39.8%) males vs. 6.68±2.81 years with 52(53.1%) males p<0.001; and the difference in vitamin D mean levels was statistically signi cant [28.21 ± 6.39 infected vs.30.88 ± 6.62 uninfected] t = 2.94, df =194, p = 0.004, 95%CI (0.90 -4.59). Among age categories, mean vitamin D varied signi cantly F (2,193) = 10.68, p =0.001; with higher levels observed between 1-4 years category {mean difference 4.64ng/ml, p = 0.02, [95%CI 1.49 -7.78]} and 5-9 years category {mean difference 4.33ng/ml, p = 0.001, [95%CI 1.89 -6.38]} as compared to 10 -14 years respectively. Additionally, children with optimal immune recovery recorded higher proportion of vitamin D de ciency and insu ciency (12.24% and 42.86%) as compared with sub optimally recovered 1.02% and 4.08%); while children with optimal viral suppression recorded higher proportion of vitamin D de ciency and insu ciency (8.16% and 30.61%) as compared with sub optimally suppressed (5.1% and 16.3%). Conclusion: Infections with HIV suppresses levels of vitamin D, but this has no in uence on CD4 counts and viral load status in children receiving ART.

To increase the current knowledge about the relationship between nutritional status and the digestive capacity of Siberian sturgeon (Acipenser baerii), we addressed the effect of starvationrefeeding and macronutrient composition on growth parameters and key digestive enzyme activities in A. baerii. A. baerii juveniles were fed four different diets for 3 weeks, then starved for 2 weeks and allowed to refed for 5 weeks with the same diets. Another group of fish were fed 10 weeks with the corresponding diets. Among 10-week fed fish, high protein diets promoted higher body weight values, while the lowest specific growth rate was observed in fish fed a low protein, medium carbohydrate, high lipid diet (p < 0.05). At the end of the experiment, in fish refed for 5 weeks following a feeding-starvation cycle and in 10-week fed animals, the higher levels of blood glucose, triglycerides and cholesterol were found in fish fed low protein diets (p < 0.05). In all treatments, 2 weeks of starvation decreased α-amylase activity in the intestine (p < 0.05), while 4 days of refeeding increased lipase (p > 0.05) and α-amylase activity in the intestine as well as pepsin in the stomach (p < 0.05). Our findings suggest that A. baerii maintains a high capacity to digest proteins and lipids after 2 weeks of starvation and that α-amylase can be used as an indicator of the nutritional status in fish submitted to starvation-refeeding cycles. Indeed, refeeding with high protein and CHO: L ratio diets after starvation could improve the growth rate of A. baerii in culture.

Using 3ZP-labelled oligonucleotides derived from the coding regions of dopamine Dr, D2 and D 3 receptor mRNAs we localized cells containing transcripts for these receptors in the human (hD~, hD2 ) and rat brain (rD~, rDz, rD3). Dopamine D~ receptor mRNA was detected at high levels in neurons of the caudate and putamen as well as in the nucleus accumbens in both human and rat brain. In the rat brain Dj receptor mRNA was also abundant in the olfactory tubercles and several thalamic nuclei. In both species D~ mRNA was absent from the neurons oftbe substantia nigra and the ventral tegmental area as well as from the globus pallidus medialis in humans and entopeduncular nucleus in rats. In contrast, dopamine D2 receptor mRNA was found in dopaminergic neurons of the substantia nigra pars compacta and of the ventral tegmental area. In addition high levels of D2 mRNA were detected in neurons of the caudate, putamen and accumbens nuclei, the olfactory tubercle and the anterior lobe of pituitary gland. In the rat the highest level of hybridization was found in the intermediate lobe of the pituitary gland. In the rat brain dopamine D~ mRNA was mainly detected in the Islands of Calleja and at lower levels in the anterior nucleus accumbens, the medial mammillary nucleus as well as in the bed nucleus of the stria terminalis. In general, a good agreement was found between the distribution of transcripts and binding sites labelled with the D, antagonist SCH 23390 or with the D2 ligand SDZ 205-502. For D~ receptors, the main exceptions were the absence of mRNA in the globus pallidus and the substantia nigra despite the high densities of binding sites in these regions. For D2 receptors, regions where binding sites but not mRNA were detected include the olfactory bulb, neocortex, hippocampus and superior colliculus.

ObjectiveThe study aimed to evaluate the effect of age on diabetes incidence by general and central adiposity after 3‐year follow‐up in adults with prediabetes.MethodsData were taken from a cohort of 1,184 subjects with prediabetes included in The Cohort Study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS). General adiposity was defined using body mass index (BMI), and central adiposity was defined with waist circumference and waist to height ratio. Data were analyzed by age groups 30 to 59 and 60 to 74 years. The association between adiposity and diabetes incidence was assessed using hazard ratios (HR).ResultsAdjusting for sociodemographic characteristics, lifestyles, and metabolic parameters, diabetes HR for central adiposity based on the waist circumference clinical cutoff were 2.14 (1.12‐4.09) and 1.48 (0.80‐2.74) for people aged 30 to 59 and 60 to 74 years, respectively. In the model additionally adjusted for BMI, diabetes HR were 2.65 (1.24‐5.65...

Background: Anemia associated with chronic kidney disease (CKD) often requires treatment with recombinant human erythropoietin (EPO). Hypoxia-inducible factor2prolyl hydroxylase inhibitors (PHIs) stimulate endogenous EPO synthesis and induce effective erythropoiesis by non-EPO effects. GSK1278863 is an orally administered small-molecule PHI. Study Design: Multicenter, single-blind, randomized, placebo-controlled, parallel-group study. Setting & Participants: Anemic non-dialysis-dependent patients with CKD stages 3-5 (CKD-3/4/5 group; n 5 70) and anemic hemodialysis patients with CKD stage 5D (CKD-5D group; n 5 37). Interventions: Patients with CKD-3/4/5 received placebo or GSK1278863 (10, 25, 50, or 100 mg), and patients with CKD-5D received placebo or GSK1278863 (10 or 25 mg) once daily for 28 days. Outcomes & Measurements: Primary pharmacokinetic and pharmacodynamic (increase and response rates in achieving the target hemoglobin [Hb] concentration, plasma EPO concentrations, reticulocyte count, and others]) and safety and tolerability end points were obtained. Results: Both CKD-3/4/5 and CKD-5D populations showed a dose-dependent increase in EPO concentrations and consequent increases in reticulocytes and Hb levels. Percentages of GSK1278863 participants with an Hb level increase . 1.0 g/dL (CKD-3/4/5) and .0.5 g/dL (CKD-5D) were 63% to 91% and 71% to 89%, respectively. Per-protocol-defined criteria, high rate of increase in Hb level, or high absolute Hb value was the main cause for withdrawal (CKD-3/4/5, 30%; CKD-5D, 22%). A dose-dependent decrease in hepcidin levels and increase in total and unsaturated iron binding were observed in all GSK1278863-treated patients. Limitations: Sparse pharmacokinetic sampling may have limited covariate characterization. EPO concentrations at the last pharmacodynamic sample (5-6 hours) postdose may not represent peak concentrations, which occurred 8 to 10 hours postdose in previous studies. Patients were not stratified by diabetes status, potentially confounding vascular endothelial growth factor and glucose analyses. Conclusions: GSK1278863 induced an effective EPO response and stimulated non-EPO mechanisms for erythropoiesis in anemic non-dialysis-dependent and dialysis-dependent patients with CKD.

Sexually transmitted infections (STIs) are a global health concern. Blood donation centres employ comprehensive screening measures to identify donors with STIs, including HIV, HBV, HCV, and syphilis ensuring the safety of the donated blood and protecting the recipients. Herein, we investigated the seroprevalence of STIs and risk factors related to multiple infections among rejected blood donors at the National Blood Transfusion Service (NBTS) in Angola. This was a cross-sectional study conducted with 1668 rejected blood donors serologically screened for anti-HBsAg, anti-HCV, anti-HIV, and anti-TP at the NBTS, located in Luanda, the capital city of Angola, between March 2022 to July 2023. Overall, HIV (11.2%), HBsAg (71.7%), HCV (9.30%), and Syphilis (8.80%) were detected. The multiple infection rate was 2.30%, from these, HIV/HBV (1.10%), HIV/HCV (0.60%), HIV/Syphilis (1.20%), HBV/HCV (8.0%), HBV/Syphilis (5.50%), and HCV/Syphilis (1.80%) coinfections, were detected. HIV and syphilis were related to age groups (p < 0.05). HBV was related to age group, areas of residence, occupation, and Rh factor (p < 0.05). HCV was related to areas of residence and educational level (p < 0.05). No relationship was observed between demographic characteristics with multiple infections (p > 0.05). Individuals aged over 40 years (OR: 2.48, p = 0.393), males (OR: 1.33, p = 0.639), non-urbanized regions (OR: 1.18, p = 0.594), low educational level (OR: 3.46, p = 0.222), and employed (OR: 1.34, p = 0.423), presented a higher likelihood of having multiple infections. Our results demonstrate a high rate of circulation of STIs among young blood donation candidates in Luanda. However, the prevalence, particularly that of HBV, is one of the highest in the sub-Saharan African region, suggesting that priority should be given to strengthening donor screening and considering the possibility of including nucleic acid-based screening techniques.

Introduction: Malaria continues to be the main cause of hospitalization and death in Angola, a sub-Saharan African country. In 2023, in the first quarter, 2,744,682 cases were registered, and of these 2,673 patients died due to the malaria disease. Previous studies showed that the ABO blood group can affect the progression of malaria to serious situations after P. falciparum infection while the sickle cell gene offers relative protection. Objective: We investigated changes in the blood count according to blood groups (ABO/Rh) and sickle cell trait in patients with malaria in Luanda, the capital city of Angola. Methodology: This was a longitudinal, prospective, and observational study with 198 patients hospitalized for malaria. Results: of the 198 patients studied, 13(6.6%) were ABRh(+), 4(2.0%) were ARh(-), 49(24.7%) were ARh(+), 42(21,2%) were BRh(+), 5(2.5%) were ORh(-), and 85(42.9%) were ORh(+). For sickle cell trait, 145(73.2%) were AA, 37(18.7%) were AS and 16(8.1%) were SS. N...

Background: Intravascular ultrasound (IVUS) has been used to characterize the natural history of atheroma and associated patterns of arterial remodelling. It is unknown whether remodelling and calcification is similar between coronary and peripheral arteries. Methods: Volumetric IVUS imaging was performed within superficial femoral artery or an epicardial coronary artery of 124 patients undergoing percutaneous intervention in the peripheral (n=31) or coronary (n=93) circulations, matched for age, gender and diabetic status. Clinical characteristics, vascular dimensions and calcification were compared. Results: Mean age was 70 years, 65% male and 61% diabetic. Hypertension (97 v 84%, p=0.07) and current smokers (23 v 10%, p=0.12) were more prevalent in the peripheral group. Peripheral atherosclerosis was more severe with greater percent atheroma volume (50.4±11.4 v 41.3±8.0%, p<0.001). Lumen volume (558±240 v 284±111 mm 3 , p<0.001) and external elastic membrane (EEM, 1093±306 v 488±184 mm 3 , p<0.001) volume were greater in the peripheral group. More peripheral images contain calcium (50.5±20.6 v 36.0±24.4%, p=0.004). A stronger correlation between atheroma volume and both lumen (r=0.65 v r=0.22, p=0.01 between groups) and EEM (r=0.89 v r=0.64, p=0.002 between groups) volumes were observed in the coronary group. Different patterns of remodelling and calcification within the artery wall are observed in the setting of plaque accumulation in peripheral and coronary territories. This suggests that local factors may influence the natural history of atherosclerosis within different vascular beds.

Background End-stage renal disease (ESRD) is a growing cause of morbidity worldwide. Protein malnutrition is common among patients with ESRD. Peritoneal dialysis (PD) offers greater lifestyle flexibility and independence compared to the widely used treatments for ESRD. This study aimed to assess the nutritional status and the quality of life (QOL) of Palestinian patients undergoing PD, as well as the variables affecting these two outcomes. Methods A cross-sectional study was conducted on patients receiving PD at

In 1994, our hospital reported a significant gender disparity in the treatment of peripheral artery disease (PAD). The objective of this study was to determine if this gender-based treatment disparity still persists after 15 years. Methods: A retrospective review of patients with PAD and carotid artery disease based on vascular laboratory studies was performed from January 2006 to February 2008. PAD was identified by ankle-brachial index < 0.9 or abnormal waveform. Treatable carotid artery disease was identified by symptomatic stenosis 60%-99% or asymptomatic stenosis 80%-99%. Patients with interventions before January 2006 were excluded. Demographics, risk factors, and interventions were recorded. Univariate and multivariate analyses were performed to identify risk factors and independent predictors of intervention. Results: Of 2,313 peripheral artery studies, 592 patients with PAD and no prior intervention were identified. Sixty-five (21.7%) of 299 men and 47 (16.0%) of 293 women underwent angioplasty, stenting, endarterectomy, or bypass grafting. This difference was not significant (P ‫؍‬ .077). However, by multivariate analysis of patients with critical limb ischemia, Caucasian race was an independent predictor of intervention (P ‫؍‬ .010; odds ratio [OR] 3.363). Of 3,505 carotid duplex studies, 253 patients with treatable carotid artery disease and no prior intervention were identified. Seventy-eight (52.7%) of 148 men and 43 (41.0%) of 105 women underwent carotid endarterectomy (CEA) or stenting. This difference was not significant (P ‫؍‬ .065). However, by multivariate analysis, Caucasian race was identified as an independent predictor of intervention (P ‫؍‬ .015, OR 3.033). Insurance status was not a predictor of intervention in either the PAD (P ‫؍‬ .70) or carotid artery disease cohort (P ‫؍‬ .99). Conclusion: Our data reveal that gender was not an independent predictor of intervention for PAD or carotid artery disease; however, Caucasian race independently predicted a greater likelihood of intervention in PAD patients with critical limb ischemia and in the carotid artery disease cohort. This study demonstrates the importance of performance assessments in uncovering unsuspected treatment disparities. (