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Joseph Arthur, Eduardo Bruera
The current opioid crisis has brought renewed attention and scrutiny to opioid prescriptions. When patients receiving opioid therapy for pain engage in nonmedical opioid use (NMOU) or diversion, untoward consequences can occur. New evidence suggests that patients with cancer might be at a higher risk of NMOU than was previously thought, but clinical evidence still supports the use of opioid analgesics as the gold standard to treat cancer-related pain, creating a dilemma in patient management. Clinicians are encouraged to adopt a universal precautions approach to patients with cancer receiving opioids, which includes screening all patients; discussing the risks, benefits, adverse effects and alternatives of opioid therapy; and providing education on safe use, storage and disposal...
December 4, 2018: Nature Reviews. Clinical Oncology
Berthold Koletzko
Glutamate (Glu) is the most abundant amino acid (AA) in human milk. Available information on Glu supply and metabolism was reviewed, based on an electronic literature search. In 22 cross-sectional global studies with 4,747 women, free Glu increases with lactation duration and contributes to about 38% of total and 63% of dispensable milk AA. Based on these data, a typical breastfed infant obtains a mean free Glu intake of 35.7 mg/kg body weight (bw; upper end of the normal range 134.6 mg/kg), while precisely collected longitudinal data indicate mean intakes of 40 mg/kg and upper range intakes of 70...
2018: Annals of Nutrition & Metabolism
Roy A Raad, Shailee Lala, Jeffrey C Allen, James Babb, Carole Wind Mitchell, Ana M Franceschi, Kaleb Yohay, Kent P Friedman
Rapidly enlarging, painful plexiform neurofibromas (PN) in neurofibromatosis type 1 (NF1) patients are at higher risk for harboring a malignant peripheral nerve sheath tumor (MPNST). Fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been used to support more invasive diagnostic and therapeutic interventions. However, PET/CT imparts an untoward radiation hazard to this population with tumor suppressor gene impairment. The use of FDG PET coupled with magnetic resonance imaging (MRI) rather than CT is a safer alternative but its relative diagnostic sensitivity requires verification...
October 2018: World Journal of Nuclear Medicine
Sara M El-Sayed, Mohamed A M Ali, Bahaa El-Dien M El-Gendy, Samar S Dandash, Yvette Issac, Reda Saad, Mohamed M Azab, Mohamed R Mohamed
Background Hepatitis C virus (HCV) infection poses a considerable threat to the public health. The current standard of care treatment with pegylated interferon-alpha in combination with ribavirin (PEG-IFN-α+RBV) is associated with significant side effects, poorly tolerated, and provides limited efficacy. The development of direct-acting antiviral agents (DAAs) targeting key viral enzymes essential for viral replication represents a significant milestone in the treatment of chronic HCV infection. Given its critical role in the viral polyprotein processing and the evasion of the host innate immunity, the NS3/4A protease has emerged as a promising drug target for the development of anti-HCV therapies...
December 3, 2018: Current Pharmaceutical Design
Andreas Jekell, Peter M Nilsson, Thomas Kahan
Background The development and risk potential of hypertension-induced left ventricular (LV) hypertrophy has been well described in epidemiological studies. Regression of LV hypertrophy reduces cardiovascular morbidity and mortality. However, the best treatment strategy is still debated, as well as the appropriate blood pressure target in these patients. Objective We here review the treatment of LV hypertrophy and the potential benefit on clinical outcomes, against a background of the epidemiology and pathophysiology...
December 2, 2018: Current Pharmaceutical Design
W Druml
Fever, arbitrarily defined as a core body temperature >38.3 °C, is present in 20-70 % of intensive care unit patients. Fever caused by infections is a physiologic reset of the thermostatic set-point and is associated with beneficial consequences, but may have negative sequelae with temperatures >39.5 °C. Fever of non-infectious and neurologic origin affects about 50 % of patients with elevated body temperature, presents as a pathologic loss of thermoregulation, and may be associated with untoward side effects at temperatures above 38...
November 28, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Muhammad Zahid Farooq, Sumiyya Sattar, Hina Afroz, Asfa Rasool
Hemorrhagic septicemia is a fatal disease of cattle and buffalo all over the world including Pakistan and it causes heavy economic losses every year. The poor farmers cannot bear this loss in the form of less milk production and heavy expenditures on the animal treatment. An enriched alum-precipitated vaccine with reduced dose was prepared and standardized and safety testing of enriched vaccine was performed in Swiss albino mice as well as in natural host. In this experiment, a total of 36 cattle both male and female of different age groups ranging from 4 months to 4 years were used...
November 26, 2018: Tropical Animal Health and Production
Joachim Mathes, Tilman Todenhöfer
Intravesical therapies have shown positive effects both on recurrence and progression of non-muscle-invasive bladder cancer. However, more than 50% of patients experience untoward side effects associated with treatment. In order to reduce the rate of patients who discontinue treatment due to side effects, prevention and effective management of treatment-related toxicity is essential.
July 2018: European Urology Focus
Noppachart Limpaphayom, Eitan Kohan, Aaron Huser, Malgorzata Michalska-Flynn, Sara Stewart, Matthew B Dobbs
BACKGROUND: Physical therapy (PT) alone is not always effective for treatment of congenital muscular torticollis (CMT). The adjunctive use of botulinum toxin (BTX) injection into the sternocleidomastoid, followed by PT, could provide correction and avoid more invasive surgery. Aims of the study were to review clinical and caregiver-reported outcomes of children with resistant CMT treated by BTX injection combined with a guided-PT program. METHODS: Medical records of consecutive children with resistant CMT treated by our protocol between 2010 and 2015 were reviewed...
November 16, 2018: Journal of Pediatric Orthopedics
Nancy J MacMullen, Linda F Samson
There is an uncontrollable epidemic of drug abuse, with the misuse of opioids the most alarming. Along with the increase in opioid abuse, there exists a concomitant upsurge in the number of neonates experiencing neonatal abstinence syndrome (NAS) due to the effects of the mother's withdrawal from the drug. Neonates experiencing NAS exhibit various nervous system, gastrointestinal, and respiratory untoward symptoms. Diagnosis is determined by taking an accurate maternal history and assessment of clinical signs and symptoms...
December 2018: Critical Care Nursing Clinics of North America
Rameez Sayyed, Mian Bilal Alam
The ability to identify and guide evaluation of the patient with cardiac disease represents a necessary skill for success in surgery of the foot and ankle. Common risk factors, such as diabetes and peripheral arterial disease, are encountered in podiatric practice. Recognition of patients at risk for cardiac disease and a predilection for sustaining a major adverse cardiac event perioperatively advocates for preoperative cardiology consultation. Identification of risk factors, assessment of functional capacity, and appropriate work-up mitigate any untoward cardiac events surrounding surgery...
January 2019: Clinics in Podiatric Medicine and Surgery
Jing Wang, Yun Fang, Subhashini Ramesh, Asma Zakaria, Maryann T Putman, Dan Dinescu, James Paik, Romergryko G Geocadin, Pouya Tahsili-Fahadan, Laith R Altaweel
BACKGROUND/OBJECTIVE: Prompt treatment of acute intracranial hypertension is vital to preserving neurological function and frequently includes administration of 23.4% NaCl. However, 23.4% NaCl administration requires central venous catheterization that can delay treatment. Intraosseous catheterization is an alternative route of venous access that may result in more rapid administration of 23.4% NaCl. METHODS: Single-center retrospective analysis of 76 consecutive patients, between January 2015 and January 2018, with clinical signs of intracranial hypertension received 23...
November 5, 2018: Neurocritical Care
Lubna Siddiqui, Harshita Mishra, Pawan Kumar Mishra, Zeenat Iqbal, Sushama Talegaonkar
Colon cancer is one of the fatal forms of cancer all round the world with a equal frequency of occurrence in both male and female population. Mutational changes and defects in APC (Adenomatous Polyposis Coli) and DNA mismatch repair genes accompanied by genetic chaos in oncogenic pathways leads to colon cancer. Intensive study on pathogenesis of colon cancer has been made to decipher the mechanisms underlying the development and progress of the disease so as to develop effective treatment. However, a complete therapeutic regimen is still not available for combating this deadly disease...
December 2018: Medical Hypotheses
Ismail Elbeshlawi, Mohamed S AbdelBaki
The introduction of paramagnetic contrast in the late 1980s constituted a paradigm shift boosting the efficacy of magnetic resonance imaging. Due to its high magnetic moment, gadolinium-based contrast agent made its way smoothly as the flagship paramagnetic contrast. With the widespread application, reports of untoward effects started to surface. Allergic reactions, nephrogenic systemic sclerosis, and deposition in brain tissue dented the safety profile of gadolinium-based contrast agent. Better understanding of these adverse effects prompted preventive measures...
September 2018: Pediatric Neurology
Laura A Vitale, Lawrence J Thomas, Li-Zhen He, Thomas O'Neill, Jenifer Widger, Andrea Crocker, Karuna Sundarapandiyan, James R Storey, Eric M Forsberg, Jeffrey Weidlick, April R Baronas, Lauren E Gergel, James M Boyer, Crystal Sisson, Joel Goldstein, Henry C Marsh, Tibor Keler
Limitations of immunotherapy include poorly functioning events early in the immune response cycle, such as efficient antigen presentation and T cell priming. CD40 signaling in dendritic cells leads to upregulation of cell surface costimulatory and MHC molecules and the generation of cytokines, which promotes effective priming of CD8+ effector T cells while minimizing T cell anergy and the generation of regulatory T cells. This naturally occurs through interaction with CD40 ligand (CD40L) expressed on CD4+ T-helper cells...
October 31, 2018: Cancer Immunology, Immunotherapy: CII
Feng Li, Jing Liang, Xiaogang Li
Tracheal stenosis may occur secondary to trauma, tumors, infections, and inflammatory and iatrogenic diseases. Patients with tracheal stenosis must be evaluated carefully and require comprehensive preoperative examination, including pulmonary function tests and radiographic studies. Two male patients (one 18 years of age and the other 46 years of age) with tracheal stenosis were scheduled for tracheal resection and reconstruction. They were given different modes of anesthesia (with and without intubation). Fiberoptic intubation was selected in the 18-year patient, and non-intubation was selected in 46-year patient...
November 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Patrick L F Zuber, Allisyn C Moran, Doris Chou, Françoise Renaud, Christine Halleux, Juan Pablo Peña-Rosas, Kavitha Viswanathan, Eve Lackritz, Robert Jakob, Elizabeth Mason, Smaragda Lamprianou, Christine Guillard-Maure
Pregnant women and their babies are among the populations most vulnerable to untoward health outcomes. Yet current standards for evaluating health interventions cannot be met during pregnancy because of lack of adequate evidence. The situation is even more concerning in low-income and middle-income countries, where the need for effective interventions is the greatest. Meeting the Sustainable Development Goals for health will require strengthened attention to maternal and child health. In this paper we examine ongoing initiatives aimed at improving the assessment of maternal interventions...
2018: BMJ Global Health
Umesh C Sharma, Swati D Sonkawade, Joseph A Spernyak, Sandra Sexton, Juliane Nguyen, Suraj Dahal, Kristopher M Attwood, Anurag K Singh, Jop H van Berlo, Saraswati Pokharel
BACKGROUND: Advances in radiotherapy for thoracic cancers have resulted in improvement of survival. However, radiation exposure to the heart can induce cardiotoxicity. No therapy is currently available to inhibit these untoward effects. We examined whether a small tetrapeptide, N-acetyl-Ser-Asp-Lys-Pro (Ac-SDKP), can counteract radiation-induced cardiotoxicity by inhibiting macrophage-dependent inflammatory and fibrotic pathways. METHODS AND RESULTS: After characterizing a rat model of cardiac irradiation with magnetic resonance imaging protocols, we examined the effects of Ac-SDKP in radiation-induced cardiomyopathy...
August 2018: Circulation. Heart Failure
Natalie A Krane, Jeffrey D Markey, Myriam Loyo
INTRODUCTION: Congenital unilateral lower lip palsy is an infrequently encountered condition that manifests as lower lip asymmetry during smiling, laughing, and crying. Treatment options are not well characterized. METHODS: The authors present the case of a 51-year-old woman who was referred for surgical intervention for facial paralysis. Physical examination demonstrated a symmetric face at rest that became asymmetric when smiling. The asymmetry, evident by inappropriate inferior displacement of the lower lip, was secondary to unilateral contraction and presence of the depressor labii inferioris...
October 22, 2018: Annals of Otology, Rhinology, and Laryngology
Xiang Ma, Jiai Hua, Kun Wang, Hongmei Zhang, Changli Zhang, Yafeng He, Zijian Guo, Xiaoyong Wang
Alzheimer's disease (AD) is a typical protein-misfolding disease. Aggregation of amyloid β-peptide (Aβ) plays a key role in the etiology of AD. The misfolding of Aβ results in the formation of β-sheet-rich aggregates and damages the function of neurons. A modified polyoxometalate (POM), [CoL(H2 O)]2 [CoL]2 [HAsV MoV 6 MoVI 6 O40 ] [CAM, L = 2-(1 H-pyrazol-3-yl)pyridine], was designed to disaggregate the Aβ aggregates, where L acts as an Aβ-targeting group and POM as a conformational modulator. X-ray crystallography shows that CAM is composed of a ε-Keggin unit and four coordination units...
November 5, 2018: Inorganic Chemistry
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