Bone health after RRBSO among BRCA1/2 mutation carriers: a population-based study / 부인종양

Objective@#Examine the risks of fractures and osteoporosis after risk-reducing bilateral salpingo-oophorectomy (RRBSO) among women with BRCA1/2 mutations. @*Methods@#In this retrospective population-based study in British Columbia, Canada, between 1996 to 2017, we compared risks of osteoporosis and fractures among women with BRCA1/2 mutations who underwent RRBSO before the age of 50 (n=329) with two age-matched groups without known mutations: 1) women who underwent bilateral oophorectomy (BO) (n=3,290); 2) women with intact ovaries who had hysterectomy or salpingectomy (n=3,290). Secondary outcomes were: having dual-energy X-ray absorptiometry (DEXA) scan, and bisphosphonates use. @*Results@#The mean age at RRBSO was 42.4 years (range, 26–49) and the median follow-up for women with BRCA1/2 mutations was 6.9 years (range, 1.1–19.9). There was no increased hazard of fractures for women with BRCA1/2 mutations (adjusted hazard ratio [aHR]=0.80; 95% confidence interval [CI]=0.56–1.14 compared to women who had BO; aHR=1.02; 95% CI=0.65–1.61 compared to women with intact ovaries). Among women who had DEXA-scan, those with BRCA1/2 mutations had higher risk of osteoporosis (aHR=1.60; 95% CI=1.00–2.54 compared to women who had BO; aHR=2.49; 95% CI=1.44–4.28 compared to women with intact ovaries). Women with BRCA1/2 mutations were more likely to get DEXA-scan than either control groups, but only 46% of them were screened. Of the women with BRCA1/2 mutations diagnosed with osteoporosis, 36% received bisphosphonates. @*Conclusion@#Women with BRCA1/2 mutations had higher risk of osteoporosis after RRBSO, but were not at increased risk of fractures during our follow-up. Low rates of DEXA-scan and bisphosphonates use indicate we can improve prevention of bone loss.

Comparison of Multi-Label U-Net and Mask R-CNN for panoramic radiograph segmentation to detect periodontitis

Purpose@#Periodontitis, the most prevalent chronic inflammatory condition affecting teeth-supporting tissues, is diagnosed and classified through clinical and radiographic examinations. The staging of periodontitis using panoramic radiographs provides information for designing computer-assisted diagnostic systems. Performing image segmentation in periodontitis is required for image processing in diagnostic applications. This study evaluated image segmentation for periodontitis staging based on deep learning approaches. @*Materials and Methods@#Multi-Label U-Net and Mask R-CNN models were compared for image segmentation to detect periodontitis using 100 digital panoramic radiographs. Normal conditions and 4 stages of periodontitis were annotated on these panoramic radiographs. A total of 1100 original and augmented images were then randomly divided into a training (75%) dataset to produce segmentation models and a testing (25%) dataset to determine the evaluation metrics of the segmentation models. @*Results@#The performance of the segmentation models against the radiographic diagnosis of periodontitis conducted by a dentist was described by evaluation metrics (i.e., dice coefficient and intersection-over-union [IoU] score). Multi-Label U-Net achieved a dice coefficient of 0.96 and an IoU score of 0.97. Meanwhile, Mask R-CNN attained a dice coefficient of 0.87 and an IoU score of 0.74. U-Net showed the characteristic of semantic segmentation, and Mask R-CNN performed instance segmentation with accuracy, precision, recall, and F1-score values of 95%, 85.6%, 88.2%, and 86.6%, respectively. @*Conclusion@#Multi-Label U-Net produced superior image segmentation to that of Mask R-CNN. The authors recommend integrating it with other techniques to develop hybrid models for automatic periodontitis detection.

Acupuncture as an adjunct to standard therapy for Pruritus in patients with Atopic Dermatitis: A patient- and assessor-blinded, randomized, placebo-controlled trial

Background@#Pruritus can impair quality of life in patients with atopic dermatitis. There is evidence that acupuncture reduces pruritus and disease severity, and improves quality of life. @*Objectives@#This study aimed to determine the efficacy of acupuncture in reducing pruritus intensity, disease severity, and medication use, and improving quality of life. @*Methods@#This was a patient- and assessor-blinded, randomized, placebo-controlled trial. Patients diagnosed with atopic dermatitis underwent twice-weekly acupuncture for 12 weeks, with an 8-week follow-up period. Baseline and weekly assessment were done using standard data collection forms and validated assessment tools. @*Results@#Thirty patients were randomized and 28 patients were eligible for the efficacy analysis. There were no significant differences in the baseline demographic and clinical characteristics between the True Acupuncture group (TA) (n=16) and Sham Acupuncture group (SA) (n=12). Both groups showed reduction in mean itch intensity (visual analogue scale, VAS) (p=0.024) but TA showed greater reduction (p=0.009) that was sustained after end of treatment. There was also a reduction in medication use in both groups. The comparable efficacy of SA to TA is attributed to similar peripheral receptive fields and stimulation of cutaneous C-fibers which depletes the neurotransmitters mediating pruritus and results in tachyphylaxis. Mild adverse events, such as petechiae and erythema, were noted in both groups and resolved spontaneously. @*Conclusion@#Acupuncture is a promising adjunct treatment in atopic dermatitis with significant reduction in pruritus, disease severity and medication use and a trend towards improved quality of life. Studies with larger sample size and comparison to acupuncture points farther from the true acupuncture points are recommended. @*Trial Registration@#Food and Drug Administration Philippine Health Research Registry ID PHRR171012-001696

Allocation of resources for health care in COVID-19 pandemic times: integrative review / Asignación de recursos para asistencia a la salud en tiempos de la pandemia de Covid-19: revisión integrativa / Alocação de recursos para assistência à saúde em tempos da pandemia de COVID-19: revisão integrativa

ABSTRACT Objective: To analyze information on resource allocation in the context of the COVID-19 pandemic, published in indexed scientific journals, from December 2019 to March 2020. Methods: This is an integrative literature review, which took place in March 2020. All databases were investigated and studies were found only in MEDLINE. After applying the established criteria, six articles were selected. Results: It was evident that the allocation of resources is carried out as the demands emerge. The fragility in presenting scientific-methodological evidence that can guide decision makers for assertive allocation of available resources is highlighted. The results showed that studies on this subject are incipient and need to be expanded. Final considerations: The need for health organizations and area authorities to be better prepared for the proper use of available resources, with allocation based on scientific evidence and maximization of resources is indicated.

RESUMEN Objetivo: Analizar las informaciones sobre la asignación de recursos en el contexto de la pandemia de COVID-19, publicadas en periódicos científicos indexados, en el período de diciembre de 2019 a marzo de 2020. Métodos: Se trata de revisión integrativa de la literatura, realizada en marzo de 2020. Han sido investigadas todas las bases de datos y encontrados estudios solamente en la MEDLINE. Después de la aplicación de los criterios establecidos, han sido seleccionados seis artículos. Resultados: Se evidenció que la asignación de recursos es realizada conforme emergen las demandas. Se destaca la fragilidad en la presentación de evidencia científico-metodológica que pueda orientar los tomadores de decisión para asignación asertiva de los recursos disponibles. Los resultados demostraron que estudios sobre esa temática son incipientes y necesitan ser ampliados. Consideraciones finales: Se indica la necesidad de las organizaciones de salud y las autoridades del área estar más bien preparadas para el uso adecuado de los recursos disponibles, con la asignación basada en evidencias científicas y maximización de los recursos.

RESUMO Objetivo: Analisar as informações sobre a alocação de recursos no contexto da pandemia de COVID-19, publicadas em periódicos científicos indexados, no período de dezembro de 2019 a março de 2020. Métodos: Trata-se de revisão integrativa da literatura, realizada em março de 2020. Foram investigadas todas as bases de dados e encontrados estudos somente na MEDLINE. Após a aplicação dos critérios estabelecidos, foram selecionados seis artigos. Resultados: Evidenciou-se que a alocação de recursos é realizada conforme emergem as demandas. Destaca-se a fragilidade na apresentação de evidência científico-metodológica que possa nortear os tomadores de decisão para alocação assertiva dos recursos disponíveis. Os resultados demonstraram que estudos sobre essa temática são incipientes e necessitam ser ampliados. Considerações finais: Indica-se a necessidade de as organizações de saúde e as autoridades da área estarem mais bem preparadas para o uso adequado dos recursos disponíveis, com a alocação baseada em evidências científicas e maximização dos recursos.

Early Detection of Bacillus anthracis From Saliva in Anticipation of a Bioterrorism Attack

Objective: To assess potential for early detection of oral infection by B. anthracis spores for preparedness of a bioterrorism attack. Material and Methods: The laboratory study used saliva with a range of initial anthrax concentrations, to compare detection by direct observation from conventional blood agar culture and by anthrax-specific PCR after a shorter culture in BHI broth. Three types of saliva were collected: stimulated saliva, unstimulated/whole saliva, and unstimulated/whole saliva with antibiotic treatment (for negative control). Using bivariate Kruskal-Wallis and Mann-Whitney tests for statistical analysis for factors that could affecting anthrax detection, significant differences between the test groups was assumed at p<0.05. Results: From unstimulated whole saliva heat shock treated at 62.50C, B. anthracis growth was detected with both methods. PCR detection from a BHI broth culture could shorten the time to diagnosis in comparison to conventional culture in blood agar. Conclusion: Saliva can provide useful samples for diagnosis of oropharyngeal anthrax. In comparison to conventional culture on blood agar, shorter-term culture in BHI broth provides potential for earlier detection and diagnosis.

Topical herbal preparation with anti-inflammatory and analgesic effects: Qualitative review of evidence

Background@#In the past musculoskeletal complaints were treated with topical preparations from medicinal plants until the advent of NSAIDs. However, because of the side effects of NSAIDs, interest has increased on going back to the use of topical traditional herbal medicines in patients with musculoskeletal pain.@*Objective@#This review was conducted to identify the active substance, its mechanism of action, pre-clinical and clinical studies and propose a topical herbal formulation balancing its analgesic and anti-inflammatory effect with skin care effect among patients with various somatic pain conditions.@*Methods@#This is a qualitative review of both local and international published medical literature to identify and summarize information on the use of topical herbal preparation for the treatment of musculo-skeletal pain.@*Results@#After the initial review, the authors identified six herbal preparations that have been investigated for its analgesic and anti-inflammatory properties in clinical trials. They eventually arrived at a consensus to consider the final combination of ginger, capsaicin, peppermint and virgin coconut oil. Gingerol, a naturally occurring plant phenol, is one of the major components of ginger known to have diverse pharmacologic effects including anti-oxidant, anti-apoptotic, and anti-inflammatory activities in vitro and in vivo. Capsaicin is a highly selective agonist for the transient receptor potential vanilloid 1 receptor expressed in nociceptive sensory nerves. The mechanisms underlying capsaicin-induced analgesia likely involve reversible ablation of nociceptor terminals. Local application of peppermint oil generates a long-lasting cooling effect on the skin and result to muscle relaxation. Ginger, capsicum and peppermint have been shown in clinical trials to relieve musculoskeletal pain and inflammation. Virgin coconut oil on the other hand has no analgesic effect but has been shown in some studies to be favorable for skin conditions and facilitate skin penetration of some substances. @*Conclusion@#Using combined preparation may have the advantage of complementation of its effect i.e. analgesic and anti-inflammatory effect of ginger, warm sensation of capsicum and the cold sensation of peppermint.

Herbal supplements for diabetes: A qualitative review of current evidence on local indigenous plants

Background@#Herbal supplementation has been used by diabetic patients, unfortunately it has regulatory, safety, and efficacy concerns.@*Objective@#This review was conducted to determine the best evidence in terms of the identified active substance, mechanism of action, pre-clinical and clinical studies of commonly used local herbal preparations.@*Methods@#This is a qualitative review of both local and international published medical literature to identify and summarize information on the use of herbal supplementation in diabetes. @*Results@#After the initial review, the authors identified thirteen herbal preparations that have been investigated for its anti-diabetic properties. Six have extensive studies including randomized controlled trials but cinnamon and fenugreek seed are not readily available locally. Their detailed review eventually focused on four locally available herbal preparations i.e. bitter melon, turmeric, aloe vera and banaba. They decrease glucose absorption and gluconeogenesis, improve glucose utilization and insulin production. Unlike conventional anti-diabetics, herbal preparations also have favorable effect on lipid metabolism and anti-oxidant effect. Bitter melon seems to be the best herbal preparation. But human studies of bitter melon showed it is inferior to conventional anti-diabetic drugs in terms of its anti-diabetic effect but better in terms of its effect on lipid metabolism and anti-oxidant properties. Turmeric, aloe vera and banaba have also been shown to have anti-diabetic effects. @*Conclusion@#In summary, herbal preparation may have multiple beneficial effect for patients with diabetes. Use of combined preparations can produce complementation of the effects and may be a promising approach to the use of herbal supplementation as treatment standard among patients with diabetes.

Atypical Contact Lens Related Corneal Ulcer Caused by Pasteurella Multocida

A 55-year-old healthy lady withhistory of regular contact lens (CL) use presented with 10 days history of progressive left eye blurring of vision, redness and pain. There was good CL hygiene practiced with no history of swimming, trauma or contact with domestic pets. Left eye vision was hand movement and right eye was 1/60, pinhole 6/18. On the left eye, there was a central, oval-shaped corneal infiltrate with an overlying large epithelial defect and stromal oedema, with significant anterior chamber cells and fibrin. B-mode ultrasound showed no vitritis. Intensive topical benzylpenicillin 10000iu/ml and topical gentamycin 1.4% hourly, homatropine 2% three times daily, oral doxycycline and oral ascorbic acid were started. The gram stain results showed gram positive cocci growth. Her ulcerimproved with the treatment and preservative-free dexamethasone 0.1% once daily was commenced to reduce inflammation and scarring. Interestingly, culture was reported as Pasteurella maltocida, a gram negative bacilli sensitive to penicillin, and so treatment was continued until the ulcer completely healed. She had central corneal scarring with best corrected vision of 6/24 in the left eye but was not keen on further surgery to improve her vision. Although it has not been previously reported, Pasteurella multocidacan cause CL related corneal ulcer with severe anterior chamber inflammation. This diagnosis should be considered even if there is trivial contact or no history of exposure to domestic animals.

Descemet Membrane Detachment Post-Phacoemulsification

We report the case series of phacoemulsification-related Descemet membrane detachment (DMD) encountered at a tertiary hospital in Kuala Lumpur. Case 1 was an iatrogenic DMD which was detected intraoperatively and managed early with good outcome. Case 2 and case 3 described unusual presentation of DMD which was initially undiagnosed. This report highlights the use of anterior segment optical coherence tomography (ASOCT) in detecting and confirming the correct diagnosis for DMD. With the aid of an experienced corneal specialist, the higher threshold for suspicious occurrence of DMD was confirmed using ASOCT. Treatment was tailored accordingly, with successful clearance of corneal oedema and visual recovery. This case series highlighted the importance of proper operative documentation and high threshold for suspicion for DMD in focal corneal oedema following an otherwise uneventful cataract surgery. It is concluded that ASOCT is an excellent tool to confirm diagnosis of DMD and success of treatment.

A 1-year-old female with maple syrup urine disease presenting with acrodermatitis-enteropathica-like lesions

@#<p>A 1-year-old female with maple syrup urine disease presenting with erythematous, partially eroded plaques on the trunk, anogenital area, and extremities experienced metabolic crisis. The skin lesions appeared at 11 months of age and was thought to result from amino acid imbalance secondary to erratic supplementation of specialized milk formula devoid of isoleucine, leucine, and valine. Serial urine monitoring showed persistent ketones and elevated serum leucine and valine. The patient was managed with emollients, intralipid 20%, and addition of isoleucine and valine supplements to counter the neurotoxic effect of leucine. After 8 days of proper feeding and continuous emollient application, the lesions improved and skin biopsy revealed superficial perivascular dermatitis. Although a decrease in erythema and desquamation was noted, the patient had persistent cerebral edema and continued to deteriorate.</p>

Emerging Roles of the Endolumenal Functional Lumen Imaging Probe in Gastrointestinal Motility Disorders

Gastrointestinal sphincters play a vital role in gut function and motility by separating the gut into functional segments. Traditionally, function of sphincters including the esophagogastric junction is studied using endoscopy and manometry. However, due to its dynamic biomechanical properties, data on distensibility and compliance may provide a more accurate representation of the sphincter function. The endolumenal functional lumen imaging probe (EndoFLIP) system uses a multi-detector impedance planimetry system to provide data on tissue distensibility and geometric changes in the sphincter as measured through resistance to volumetric distention with real-time images. With the advent of EndoFLIP studies, esophagogastric junction dysfunction and other disorders of the stomach and bowels may be better evaluated. It may be utilized as a tool in predicting effectiveness of endoscopic and surgical treatments as well as patient outcomes.

Viver em Instituição de Longa Permanência: o olhar do idoso institucionalizado / Living in Long-Term Institution: the view of the institutionalized elderly / Vivir en Institución de Largo Plazo: la visión de los mayores institucionalizados

O objetivo foi analisar a percepção do idoso institucionalizado sobre viver em uma Instituição de Longa Permanência para Idosos (ILPI), incluindo sua opinião em relação ao local e às dificuldades encontradas, ao modo de convivência diária com as pessoas da instituição (profissionais e residentes) e verificar, por meio de seus depoimentos, quais os motivos que o levaram a viver em uma ILPI. Foram utilizados dados da pesquisa realizada pela Fundação João Pinheiro, em 2011, na Região Metropolitana de Belo Horizonte, MG.

The objective was to analyze the perception of institutionalized elderly about living in Long-Term Institutions, including their view of the place and the difficulties, daily living so with the people of the institution (professionals and residents) and verify, through their statements, what are the reasons to live there. Data from a survey carried out were used by Fundação João Pinheiro in 2011, in the Metropolitan Region of Belo Horizonte, Minas Gerais.

El objetivo fue analizar la percepción de los ancianos institucionalizados sobre la vida en instituciones de largo plazo, incluyendo su visión del lugar y las dificultades, la vida cotidiana así con las personas de la institución (profesionales y residentes) y verificar, a través de sus declaraciones. Cuáles son las razones para vivir allí. Los datos de una encuesta realizada fueron utilizados por la Fundação João Pinheiro en 2011, en la Región Metropolitana de Belo Horizonte, Minas Gerais.

Profile of patients with brain tumors and the role of nursing care / Perfil dos pacientes com tumores cerebrais e o papel do enfermeiro / Perfil de pacientes con tumores cerebrales y el papel de la enfermería

ABSTRACT Objective: to describe the profile of 200 patients with central nervous system tumors (CNST), and the role of the nursing care. Method: prospective, quantitative and descriptive analysis of medical records of 200 patients with TSNC. Results: a total of 61% of our patients had benign CNST and 39% had malignant tumors. The extent of patient dependence, according to the Karnofsky Performance Status scale, was significantly greater for patients with malignant CNST (p < .05), indicating that these patients needed more support with their activities of daily living. Conclusion: patients with CNST need specialized care, with specific guidance regarding their disease and aspects of daily living after treatment. Thus, the nurse can function as a key element for the effectiveness of care provided to patients and family members with the aim of enhancing the quality of life of all those affected, directly or indirectly, by the disease.

RESUMO Objetivo: descrever o perfil de 200 pacientes com tumores no sistema nervoso central (TSNC) e o papel do cuidado em enfermagem. Método: análise prospectiva, quantitativa e descritiva de prontuários de 200 pacientes com TSNC. Resultados: 61% dos pacientes possuíam TSNC benignos e 39% tumores malignos. O grau de dependência do paciente de acordo com a Escala de Karnofsky foi significativamente maior para pacientes com tumores malignos (P <0,05), indicando que estes precisam de maior esforço e, consequentemente, apoio em suas atividades diárias. Conclusão: Pacientes com TSNC necessitam de cuidados especializados, com orientações específicas a respeito de sua doença e aos aspectos da sua vida diária após o tratamento. Assim, o enfermeiro pode ser um elemento-chave para a eficácia dos cuidados prestados aos pacientes e familiares com o objetivo de melhorar a qualidade de vida de todas as pessoas afetadas, direta ou indiretamente, pela doença.

RESUMEN Objetivo: describir el perfil de los 200 pacientes con tumores del sistema nervioso central (TSNC) y el papel de la enfermería. Método: análisis prospectivo, cuantitativo y descriptivo de los registros médicos de 200 pacientes con TSNC. Resultados: 61% de los pacientes tenían TSNC benignos y 39% tumores malignos. El grado de la dependencia de los pacientes según la Escala de Karnofsky fue significativamente mayor en los pacientes con tumores malignos (P <0,05), lo que indica que estos pacientes necesitan más apoyo en las actividades diarias. Conclusión: los pacientes con tumores cerebrales requieren atención especializada, con directrices específicas sobre su enfermedad y aspectos de la vida diaria después del tratamiento. Por lo tanto, los enfermeros pueden ser un elemento clave para la eficacia de la atención prestada a los pacientes y sus familias con el objetivo de mejorar la calidad de vida de las personas afectadas por la enfermedad.

An Orbital Solitary Fibrous Tumor: Report of Two Cases with Different Presentation

Solitary fibrous tumour (SFT) is a rare spindle-cell neoplasm that can occur in the orbit. We report two cases of orbital SFT in a 35-year-old female and a 28-year-old male with different presentations. First patient presented with slowly progressive left lateral upper lid mass which is firm in consistency and non tender. Patient had non axial proptosis as the mass compressed the globe inferonasally. There was also funduscopy evidence of choroidal folds superotemporally. There is slight impairment of vision on the left eye comparing to right eye. Meanwhile, the second patient presented with a painless diffuse swelling of left upper eyelid. It was soft in consistency, non fluctuate and no opening or pus discharge noted. There is mild mechanical ptosis, however there was no proptosis and no evidence of compression into the globe nor visual impairment.Computed tomography (CT) imaging revealed a well circumscribed and contrast enhanced soft tissue mass intraorbital extraconal mass in both cases. However in the first case, the tumour was at the level of lacrimal gland with compression of the globe, while in second case, it was superior and posterior to the left lacrimal gland with no globe compression. Both patients underwent complete resection of their tumors. The histological findings showed alternating hypercellular and hypocellular areas composed of bland spindle cells with a fibrous stroma. The strong immunoreactivity for CD34 supported the diagnosis of orbital SFT. There was no recurrence at the 2nd and 3rd year follow-up visits for both patients. SFT should be considered as one of the differential diagnosis of an orbital tumor. The combination of CT scan, histologic findings and immunohistochemical staining provide accurate diagnosis. En bloc excision of the tumour is the mainstay of treatment.

Patterns of Polypoidal Choroidal Vasculopathy among a Multiracial Population in a Malaysian Hospital

Polypoidal choroidal vasculopathy (PCV) is a retinal disorder characterized by aneurismal polypoidal lesions in choroidal vasculature. PCV appears to preferentially affect pigmented individuals and is considerably high among Asians. Most reports on patterns of PCV around Asia are based on a homogenous race (e.g. Chinese, Japanese) and very few descriptions from a multiracial population like those seen in Malaysia. The present study aimed to describe the demographic features, clinical and investigative characteristics of PCV in a multiracial group at Universiti Kebangsaaan Malaysia Medical Centre (UKMMC). Ninety one eyes of 86 PCV patients, comprising of Chinese (65.1%), Malays (31.4%), Indians (2.3%) and Eurasian (1.2%) were retrospectively reviewed. All underwent complete ophthalmic examination and investigations. Mean patient age was 70.4 years with a male preponderance (59.3%), and mostly unilateral presentation (94.1%). The logMAR mean presenting visual acuity was 0.78 ± 0.64. Polypoidal vascular lesions were located generally within the macula area (86.8%), manifesting mainly as submacular hemorrhage (59.3%). Interestingly a number of eyes (43.9%) had associated drusen. Optical coherence tomography largely demonstrated exudative changes (75.9%) and almost all patients (97.7%) had loss of external limiting membrane (ELM) and IS/OS interface. On indocyanine green angiography, majority of eyes had multiple polyps (82.4%) with ‘cluster’ (58.2%) being the commonest configuration. In conclusion, although the patterns of PCV in UKMMC were mainly similar to other Asian patients, a number of our patients had associated drusen. This indicates that PCV in our population could be a variant of neovascular age related macular degeneration and not solely idiopathic in nature.

Evaluation of Gastroesophageal Reflux Disease Using the Bravo Capsule pH System

Gastroesophageal reflux disease (GERD) is a disease predominantly seen in the West but there is a rising trend in Asia. Ambulatory 24-hour catheter-based pH monitoring has been the de facto gold standard test for GERD that correlates symptoms with acid reflux episodes. However, drawbacks such as patients' discomfort, and catheter displacement render the test as cumbersome and error-prone. The Bravo pH wireless system is designed to be user-friendly and has an added advantage of prolonged pH monitoring. The system is comparable to the catheter-based pH monitoring system in terms of diagnostic yield and symptom-reflux association. Indications include evaluation of patients with refractory GERD symptoms and prior to anti-reflux surgery. Bravo utilizes a wireless pH-sensing capsule with a complete prepackaged system, and a data processing software. The capsule may be positioned indirectly using endoscopic or manometric landmarks or under direct endoscopic guidance. Optimal threshold cut-off values are yet to be standardized but based on available studies, for the Asian population, it may be recommended for total % time pH < 4 of 5.8 over 48 hours. Cost is a limitation but capsule placement is relatively safe although technical failures may be seen in small percentage of cases.

Comportamiento de la mortalidad por la Enfermedad de Parkinson en Chile en el periodo 1990-2009 / Mortality behavior of Parkinson's disease in Chile 1990-2009

Introducción. La Enfermedad de Parkinson ocupa el cuarto lugar dentro de las enfermedades neurodegenerativas en el mundo. Objetivo. Describir el comportamiento de las tasas de mortalidad por la Enfermedad de Parkinson en el periodo de 20 años (1990 a 2009) en Chile. Materiales y Métodos. Los datos de mortalidad fueron obtenidos del Departamento de Estadísticas e Información de Salud del Ministerio de Salud de Chile. Se seleccionaron muertes según la Clasificación Internacional de Enfermedades versiones 9 y 10. Se ajustaron las tasas mediante el método de estandarización directo. Para el análisis de tendencia de tasas de mortalidad se utilizaron modelos de regresión de joinpoint. Resultados. Entre 1990 y 2009 hubo 4910 muertes por la Enfermedad de Parkinson (2565 hombres y 2345 mujeres). En este periodo la tasa de mortalidad ajustada aumentó de 0,94 a 2,0 por 100.000 habitantes. La mayor mortalidad ocurrió en hombres (1,19 a 2,54 por 100.000 habitantes versus mujeres 0,75 a 1,62 por 100.000 habitante). El mayor aumento de la mortalidad ocurrió en el periodo 1999-2002 (47,8%), mientras que entre los años 2002 y 2009 el aumento sólo fue de 2,5%. Similar comportamiento se evidenció en mujeres (45,3% y 2,4% respectivamente). Discusión y Conclusión. La tasa de mortalidad por la Enfermedad de Parkinson se ha duplicado en el curso de dos décadas en Chile. Este efecto podría deberse a mayor capacidad diagnóstica o a un aumento genuino en la mortalidad. Se deben investigar las causas de este comportamiento.

Introduction. Parkinson's disease is the fourth in neurodegenerative diseases in the world. Objective. To describe the behavior of mortality rates of Parkinson's disease in a span of 20 years (1990 to 2009) in Chile. Materials and Methods. Mortality data were obtained from the Department of Health Information and Statistics of the Ministry of Health of Chile. Deaths according to the International Classification of Diseases versions 9 and 10 were selected. Rates were adjusted by the method of direct standardization. For trend analysis of mortality rates Joinpoint Regression models were used. Results. Between 1990 and 2009 there were 4910 deaths by Parkinson's disease (2565 men and 2345 women). The adjusted mortality rate increased from 0.94 to 2.0 per 100,000 populations between 1990 and 2009. The Parkinson's disease mortality rate doubled during the study period with sex differences, being higher in men (1.19 to 2.54 per 100,000 in men versus 0.75 to 1.62 per 100,000 in women) between 1990 and 2009. Conclusion. The mortality rate for Parkinson's disease has doubled in the course of two decades. This effect could be due to greater diagnostic capacity or to a genuine increase in mortality. It is necessary to investigate the causes of such increase and of gender differences.

Bilateral Retinal Vasculitis: A Presumed Case of Ocular TB without Inflammation

A 17-year-old male student of Indonesian parentage presented with two weeks history of progressive painless bilateral visual deterioration. There was no contact with tuberculosis (TB)-infected patients and parents claimed that all immunization including BCG was completed. However, BCG scar was not apparent. Visual acuity was 6/36 and 6/60 in the right and left eyes respectively. The anterior and vitreous chambers were quiet. Funduscopic examination revealed retinal vasculitis with perivascular exudates, branch vein occlusion, neovascularization and macular oedema. Fluorescein angiography confirmed large areas of capillary non-perfusion and leaking new vessels. Mantoux test was positive and full regime anti-TB therapy was instituted. HIV screening was negative. Three days later, an immunosuppressive dose of oral steroid was started. Both eyes received intensive laser photocoagulation. Interestingly, there was no development of vitritis throughout.

Molecular divergence in the timeless and cpr genes among three sympatric cryptic species of the Anopheles triannulatus complex

Anopheles triannulatus s.l. is a malaria vector with a wide geographic distribution, ranging from Argentina-Nicaragua and Trinidad. Here we analysed sequences of two genes, timeless and cpr, to assess the genetic variability and divergence among three sympatric cryptic species of this complex from Salobra, central-western Brazil. The timeless gene sequences did not conclusively differentiate Anopheles halophylus and An. triannulatus species "C". However, a partial separation has been observed between these species and An. triannulatus s.s. Importantly, the analysis of the cpr gene sequences revealed fixed differences, no shared polymorphisms and considerable genetic differentiation among the three species of the An. triannulatus complex. The results confirm that An. triannulatus s.s., An. halophylus and An. triannulatus species C are distinct taxa, with the latter two likely representing a more recent speciation event.

Direct protection of cultured neurons from ischemia-like injury by minocycline / 대한해부학회지

Minocycline, a tetracycline antibiotic, is now known to protect cells via an anti-inflammatory mechanism. We further explored this effect using an in vitro model of ischemia-like injury to neurons. Coculturing neurons with microglia, the brain's resident immune cell, modestly increased cell death due to oxygen and glucose deprivation (OGD), compared to neurons alone. Treatment of cocultures with minocycline decreased cell death to a level significantly lower than that of neurons alone. Treatment of cocultures with minocycline or inhibitors of various immune mediators, also led to decreased cell death. Importantly, treatment of neuron cultures without added microglia with these same inhibitors of tissue plasminogen activator, matrix metalloproteinases, TNF-alpha and inducible nitric oxide synthase as well as minocycline also led to decreased cell death. Thus, anti-inflammatory treatments appear to be directly protective of neurons from in vitro ischemia.