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Introducción: La toma de decisiones compartida (TDC) es un proceso colaborativo que involucra al paciente y al profesional para llegar a una decisión conjunta sobre su atención. Objetivos: Evaluar el conocimiento, la actitud y la aplicación de la TDC entre los profesionales de la salud involucrados en el tratamiento del cáncer de mama (CM). Material y método: Estudio transversal basado en un cuestionario online ad hoc envia- do por varias sociedades profesionales relacionadas con el CM. Este evaluó el grado de conocimiento, actitud, aptitud y uso de la TDC por los profesionales implicados en el manejo del CM. Resultados: La mayoría refirieron conocer los conceptos y los fundamentos sobre la TDC, sin embargo, fueron pocos los profesionales (<30%) que usan la TDC en práctica clínica habitual. Los mastólogos y los profesiona- les que trabajan en Unidades de Mastología refirieron tener mayor conocimiento sobre los fundamentos de la TDC (85.6% vs 76.4%; p < 0.05) y tener más experiencia en su utilización (34.4 vs 24.3; p<0.05). Las principales ventajas destacadas fueron la satisfacción del pacien- te, la mejora en la relación médico-paciente y la reducción del estrés del paciente al ayudarlo a comprender su enfermedad. En cuanto a los obstáculos, destacó la falta de apoyo institucional, la falta de recursos y la falta tiempo en la consulta. Todos los encuestados coin- cidieron que la TDC es una herramienta necesaria para proporcionar una asistencia medica de alta calidad. Conclusiones: Se deben diseñar nuevas políticas para la adecuada formación de los profesionales en la integración de la TDC en la práctica clínica, preparándolos para utilizar la TDC con los recursos y el tiempo adecuados.
Introduction: Shared decision making (SDM) is a collaborative process that involves the patient and the professional to reach a joint decision about care. Objetives: To evaluate the knowledge, attitude and application of SDM among health professionals involved in the treatment of breast cancer (BC). Material and method: Cross-sectional study based on an ad hoc online questionnaire sent by various professional societies to professionals involved in the management of BC. A questionnaire was developed to evaluate the degree of knowledge, attitude, aptitude and use of SDM by the parti- cipating professionals. Results: Most reported knowing the concepts and fundamentals of SDM; however, few professionals (<30%) use SDM in routine clinical prac- tice. Mastologists and professionals who work in Mastology Units reported having greater knowledge about the fundamentals of SDM (85.6% vs 76.4%; p <0.05) and having more experience in its use (34.4 vs 24.3; p <0.05). The main advantages highlighted were patient sa- tisfaction, improved doctor-patient relationship, and reduced patient stress by helping them understand their illness. Regarding the obs- tacles, he highlighted the lack of institutional support, resources and time in the consultation. All respondents agreed that SDM is a neces- sary tool to provide high-quality medical care. Conclusions: New policies should be designed for the adequate training of profes- sionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time.
Subject(s)
Breast Neoplasms , Physician-Patient Relations , Decision Making , Decision Making, SharedABSTRACT
Background and Objectives@#Hypoxia is frequently used to enhance stem cell function. However, the optimal level of hypoxia for growth and function of human embryonic stem cell-derived mesenchymal stem cells (hES-MSCs) is yet to be determined. The purpose of this study was to find the optimal level of hypoxia for hES-MSCs and characteristics of hES-MSCs cultured under these optimal hypoxic conditions. @*Methods@#and Results: Cell viability and changes in the morphology of hES-MSCs were determined through cell proliferation and CCK-8 assay. The hES-MSCs were preconditioned under various hypoxic conditions (0.5∼5% O2 and 24∼72 h). The expression of cytokines in each culture condition was compared using cytokine array analysis. The morphology of hES-MSCs did not change under various hypoxic culture conditions. hES-MSCs viability after 48 h incubation in 2% O2condition was higher than that in normoxic condition. HIF1α expression was increased up to six folds after 48 h of hypoxic preconditioning. HIF1α expression in hES-MSCs peaked after 48 h of incubation in 1% O2 condition. The expressions of PDGF-BB, IGFBP-6, VEGF-A, and angiogenin were increased after hES-MSCs were incubated for 48 h in 2% O2 condition. @*Conclusions@#The hES-MSCs viability and expressions of PDGF-BB, IGFBP-6, VEGF-A, and angiogenin increased after 48 h incubation in 2% O2 condition.
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Background and Objectives@#Hypoxia is frequently used to enhance stem cell function. However, the optimal level of hypoxia for growth and function of human embryonic stem cell-derived mesenchymal stem cells (hES-MSCs) is yet to be determined. The purpose of this study was to find the optimal level of hypoxia for hES-MSCs and characteristics of hES-MSCs cultured under these optimal hypoxic conditions. @*Methods@#and Results: Cell viability and changes in the morphology of hES-MSCs were determined through cell proliferation and CCK-8 assay. The hES-MSCs were preconditioned under various hypoxic conditions (0.5∼5% O2 and 24∼72 h). The expression of cytokines in each culture condition was compared using cytokine array analysis. The morphology of hES-MSCs did not change under various hypoxic culture conditions. hES-MSCs viability after 48 h incubation in 2% O2condition was higher than that in normoxic condition. HIF1α expression was increased up to six folds after 48 h of hypoxic preconditioning. HIF1α expression in hES-MSCs peaked after 48 h of incubation in 1% O2 condition. The expressions of PDGF-BB, IGFBP-6, VEGF-A, and angiogenin were increased after hES-MSCs were incubated for 48 h in 2% O2 condition. @*Conclusions@#The hES-MSCs viability and expressions of PDGF-BB, IGFBP-6, VEGF-A, and angiogenin increased after 48 h incubation in 2% O2 condition.
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BACKGROUND/AIMS: For the clinical application of stem cell therapy, functional enhancement is needed to increase the survival rate and the engraftment rate. The purpose of this study was to investigate functional enhancement of the paracrine effect using stem cells and hepatocyte-like cells and to minimize stem cell homing by using a scaffold system in a liver disease model. METHODS: A microporator was used to overexpress Foxa2 in adipose tissue-derived stem cells (ADSCs), which were cultured in a poly(lactic-co-glycolic acid) (PLGA) scaffold. Later, the ADSCs were cultured in hepatic differentiation medium for 2 weeks by a 3-step method. For in vivo experiments, Foxa2-overexpressing ADSCs were loaded in the scaffold, cultured in hepatic differentiation medium and later were implanted in the dorsa of nude mice subjected to acute liver injury (thioacetamide intraperitoneal injection). RESULTS: Foxa2-overexpressing ADSCs showed greater increases in hepatocyte-specific gene markers (alpha fetoprotein [AFP], cytokeratin 18 [CK18], and albumin), cytoplasmic glycogen storage, and cytochrome P450 expression than cells that underwent the conventional differentiation method. In vivo experiments using the nude mouse model showed that 2 weeks after scaffold implantation, the mRNA expression of AFP, CK18, dipeptidyl peptidase 4 (CD26), and connexin 32 (CX32) was higher in the Foxa2-overexpressing ADSCs group than in the ADSCs group. The Foxa2-overexpressing ADSCs scaffold treatment group showed attenuated liver injury without stem cell homing in the thioacetamide-induced acute liver injury model. CONCLUSIONS: Foxa2-overexpressing ADSCs applied in a scaffold system enhanced hepatocyte-like differentiation and attenuated acute liver damage in an acute liver injury model without homing effects.
Subject(s)
Animals , Mice , Cytochrome P-450 Enzyme System , Cytoplasm , Dipeptidyl Peptidase 4 , Fetal Proteins , Glycogen , Keratin-18 , Liver Diseases , Liver Failure, Acute , Liver , Mesenchymal Stem Cells , Methods , Mice, Nude , RNA, Messenger , Stem Cells , Survival RateABSTRACT
BACKGROUND: The heterogeneity of histological findings in preclinical diet-induced nonalcoholic fatty liver disease (NAFLD) animal models is highly challenging. Here, we aimed to evaluate the feasibility and stability of repeated liver biopsy in NAFLD animal models. METHODS: Heterogeneity of diet-induced NAFLD was evaluated at different time points in 52 high-fat diet (HFD), 35 methionine choline-deficiency diet (MCD), and 166 western diet (WD) induced NAFLD mice. Serial liver biopsies (left lateral, right medial, and left medial lobes) were performed monthly for up to 3 months. Mortality rates and changes in food intake, body weight, and liver enzymes were assessed. RESULTS: At 12 weeks, of the HFD animals, 14% and 30% did not develop steatosis and lobular inflammation, respectively; of the MCD animals, 7% did not develop lobular inflammation; and of the WD animals, 14% and 51% did not develop steatosis and lobular inflammation, respectively. The mortality rate of repeated liver biopsy was 1.62% (2/123 mice died). Repeated liver biopsy can be used to trace disease progression. Although body weight, food intake, and liver enzymes slightly changed after biopsy, all recovered within a week. Repeated liver biopsy did not affect the degrees of inflammation and steatosis of the other liver lobes. CONCLUSION: The diet-induced NAFLD models were quite heterogeneous. Our results suggest that the repeated liver biopsy before treatment was applicable and stable in this NAFLD animal study.
Subject(s)
Animals , Mice , Biopsy , Body Weight , Diet , Diet, High-Fat , Diet, Western , Disease Progression , Eating , Inflammation , Liver , Methionine , Models, Animal , Mortality , Non-alcoholic Fatty Liver Disease , Population CharacteristicsABSTRACT
BACKGROUND/AIMS@#A number of clinical trials reported varying effects of cholesterol lowering agents in nonalcoholic fatty liver disease (NAFLD) patients. We, therefore, assessed the changes in hepatic steatosis and NAFLD activity score (NAS) after treatment with cholesterol lowering agents in NAFLD patients by metaanalysis.@*METHODS@#The Cochrane Library, the MEDLINE, and the Embase databases were searched until May 2015, without any language restrictions, for randomized controlled trials (RCTs) and nonrandomized studies (NRSs). Additional references were obtained from review of bibliography of relevant articles. The quality of evidence was assessed using the grading of recommendations assessment, development and evaluation guidelines.@*RESULTS@#Three RCTs (n = 98) and two NRSs (n = 101) met our study inclusion criteria (adult, NAFLD, liver biopsy). Liver biopsy was performed in all five studies, but only the three studies reported NAS. Ezetimibe significantly decreased NAS (standardized mean difference [SMD], –0.30; 95% confidence interval [CI], –0.57 to –0.03) but not hepatic steatosis in RCT (SMD, –0.1; 95% CI, –0.53 to 0.32), while the effect was significant for both NAS and intrahepatic content in NRSs (SMD, –3.0; 95% CI, –6.9 to 0.91).@*CONCLUSIONS@#Ezetimibe decreased NAS without improving hepatic steatosis.
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The Atlas project on substance use is a global WHO project that aims to collect and disseminate data on resources for the prevention and treatment of substance use disorders. Information on resources available in the WHO Eastern Mediterranean Region was first published in 2012. The Atlas questionnaire was updated in 2014 and data were collected in all WHO Member States. All countries of the Region submitted the Atlas questionnaire. This report presents the latest key information on resources for the prevention and treatment of substance use disorders in the Eastern Mediterranean Region based on the responses of the countries to the questionnaire. Current estimates show that the burden attributable to drug use disorders in the Region is high. Health system resources for the prevention and treatment of substance use disorders vary across countries, but are generally still insufficient to provide adequate care and treatment for people with these disorders. Countries need to strengthen prevention and treatment of substance use disorders, particularly by increasing coverage of treatment interventions
Subject(s)
Surveys and Questionnaires , Health Resources , Mediterranean Region , World Health Organization , Databases, FactualABSTRACT
Objective: The effect of Lithium on central nervous system is well known but due to paucity of literature on scavenging effect of Lithium, this study was undertaken to see Lithium toxicity on cerebellar Purkinje neurons
Study Design: Experimental study
Place and Duration of study: This study was carried out at Animal House, JPMC, Karachi from April 2012 to June 2012
Materials and Methods: Fifteen male albino rats of 195-245 grams were selected and divided into three major groups A, B, and C. Each major group consisted of 5 animals
Time period of this study was 12 weeks. Group A served as control group which was given normal healthy lab diet and B was the Lithium Carbonate-treated group
Group C received Lithium carbonate in powder form and injection Methylcobalamin [B12] intraperitoneally
Lithium carbonate was given at a dose of 20mg/kg/day to group B and C for 12 weeks, and Methylcobalamin was injected at a dose of 200jng/kg/day/bwt. Purkinje cell count was performed with a counting reticule under light microscope
Results: The present study concluded that Lithium carbonate when administered the 12 weeks cause the significant decrease of Purkinje cell count and Methylcobalamin restored the cerebellar cell count
Conclusion: In the light of this study it was concluded that that Lithium carbonate causes significant permanent loss of permanent Purkinje cell neuron but Methylcobalamin provided neuroprotective effect and restored the cell count
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The percentage of extrapulmonary tuberculosis [EPTB] among new and relapse tuberculosis cases in South Asia [Afghanistan, Pakistan, India, and Bangladesh] ranged from 19% to 23% in 2014. While tuberculosis was reportedly more prevalent in males, a higher preponderance of EPTB was observed in females. National tuberculosis control programs are highly focused on pulmonary tuberculosis. This creates gaps in the surveillance, diagnosis, and study of EPTB among females, which is especially pronounced in the South Asian setting. We have reviewed recently published literatures from January 2010 to June 2016 reporting EPTB in females with a view to evaluate the current epidemiology, risk factors, diagnostic modalities, and treatment outcomes. We report significant gaps in the surveillance of EPTB among women in South Asia, emphasizing the need for greater focus on EPTB in females to overcome current surveillance and knowledge gaps
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The use of bronchoscopes has increased in tuberculosis [TB] diagnostics to circumvent the diagnostic challenges that are associated with low sputum volume and smear-negative TB. In healthcare facilities situated in low income countries that have a high burden of TB, adequate decontamination of bronchoscopes is a challenge and often overlooked to save on time and costs. This amplifies the risk of outbreaks and pseudo-outbreaks due to Mycobacterium tuberculosis and nontuberculosis mycobacteria. In this minireview, we review published literature of contaminated bronchoscopes causing pseudo-outbreaks of M. tuberculosis and nontuberculosis mycobacteria in an effort to determine common sources, and possible mitigation strategies in low-resource settings
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Background: Ultrasound guided percutaneous nephrostomy may relieve the urinary tract obstruction but may have complications
Objective: To determine the frequency of complications of Ultrasound guided, percutaneous nephrostomy by seldinger technique for obstructive uropathy
Methodology: This was a descriptive cross-sectional study of 196 patients with obstructive uropathy who were treated with ultrasound guided percutaneous nephrostomy done by Seldinger's technique. The patients were followed up for 15 days for the complications like sepsis, hemorrhage, pleural effusion and displacement of catheter.Data was entered and analyzed by using SPSS version 14
Results: Sepsis occurred in 1 [0.51%], major hemorrhage in 1 [0.51%], minor hemorrhage in 3 [1.53%], pleural effusion in 1 [0.51%], displacement of PCN catheter in 11 [5.61%] and no complications occurred in 179 [91.33%] patients
Conclusion: The most common complications rate for the ultrasound guided percutaneous neprhostomy by Seldinger's technique are displacement of PCN catheter, hemorrhage and sepsis
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Urologic Diseases , Ultrasonography , Cross-Sectional StudiesABSTRACT
Objective: To determine the pattern of breast disease presentation in different age groups presenting to Cantonment General Hospital Rawalpindi
Study Design: A retrospective descriptive study
Place and Duration: Conducted at Department of General Surgery, Cantonment General Hospital Rawalpindi from 1st January 2005 to 31st December 2010
Methodology: All patients operated during the study period from 1stJanuary 2005 to 31st December 2010 for breast diseases irrespective of their age and sex were included in the study. Exclusion criteria were non availability of histopathology or culture reports in the patient's files. Age at presentation Symptoms, clinical features, investigations, operative findings and specimen reports were recorded and submitted for analysis
Results: A total of 362 patients were included. Fibro adenoma was the commonest [36.46%]. Breast abscess [23.76%] was the 2nd commonest and fibrocystic disease [20.17%] was the 3rd common disease in our study. Carcinoma breast was the 4th common disease [11.88%] found in females. Lump breast was the most common symptom present in 310 [85.16%] patients. Pain in the breast was found in 59.66%, while pain and lump were present in 40.60% of patients. Among carcinoma breasts, intra ductal carcinoma was the commonest [67.44%] with the mean age of 43 years followed by malignant phylloides tumour [16.28%] with the mean age of 39 years
Conclusion: Fibro adenoma is the commonest disease but the pattern is rapidly changing towards fibrocystic disease especially in young females. Incidence of Inflammatory disease increases in peak reproductive age group. Carcinoma breast presents late in our setups
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Background: Pattern of bladder cancer is the second most common malignancy in urinary bladder
Objectives: To determine pattern of presentation, histopathology and management of urinary bladder cancer and to enlist the risk factors of urinary bladder cancer in patients reporting from District Rahim Yar Khan, adjacent districts of Sindh and Balochistan
Materials and Methods: This descriptive study was based on retrospective collection of data and conducted at Sheikh Zayed Hospital, Rahim Yar Khan, for a period of 3 years from 1[st] January, 2009 to 31[st] December, 2011
Results: During 3 years period of study, a total of 54 patients reported. The median age was 65 years. History of painless haematuria with lower urinary tract symptom was most common presentation in [80%], haematuria alone in [15%] and upper urinary tract symptoms were 5%. Eight percent cases of urinary bladder cancer were detected on ultrasound due to above symptoms. Twenty percent of urinary bladder cancer were detected incidentally on ultrasonography for some other problems. Complete Transurethral Resection of Bladder Tumor in single growth was done in 40 [74%] of patients. In 14 patients multiple bladder growths were detected on Cystoscopy. Intravesical Mitomycin-C and BCG were given in 70%. In our study the main risk factor was cigarette smoking and Hukkah [70%], in 20% of patient niswar [snuff] and other chemical exposure was seen. In 10% patients whose age was less than 30 years no risk factor was found. Histopathologically, transitional cell carcinoma 90.7%, adenocarcinoma 4.7% and squamous cell carcinoma 1.8%. 70% patients were treated with transurethral resection of bladder tumor with chemotherapy and immunotherapy, 20% with radiotherapy. In 10% patient's only symptomatic treatment was done due to multiple systemic disorders. One average, 18 new cases of urinary bladder cancer were registered at Sheikh Zayed Hospital, Rahim Yar Khan in every year
Conclusion: Our study revealed that bladder cancer was present in old age, and among male predominantly. Majority of the patients presented with painless hematuria and histopathological findings showed that transitional cell carcinoma was predominant type. Majority of the patients were treated with transurethral resection of tumor with chemotherapy. There is need for the more epidemiologic indices in our region. This study suggests early detection of high risk group and support the development of preventive measures
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Background: The incidence of end stage renal disease [ESRD] is between 100-150 new cases per million per year, with a disease burden of 27000 new cases each year in Pakistan. The treatment of first choice for these patients is renal transplantation, which is available to only 5% of patients, rest have no other option except to resort to dialysis to sustain their life
Objective: The objective of the study was to critically review and analyze the data of patients on the basis of etiology, dialysis type and outcome during the last three years so as to improve the patient care
Patients and Methods: In this descriptive study, all the patients, who underwent dialysis during three years [2009-2011] was retrieved from the statistics department. Variables of interest were identified. Data was collected, entered and analyzed in SPSS version 15. The results were then compared with national and international studies on the subject
Results: In this study, a total of 457 patients under went dialysis at the centre and 14687 dialysis sessions were performed during the period under study. Male to female ratio was 1.6:1 and mean age was 44.15 years. Hypertension [70%] was the major cause of ESRD. Fifty three percent patients had an arterio-venous fistula and 23.63% were suffering from hepatitis [C] before the first dialysis. Average survival was 7.7 months and 46.17% deaths were recorded
Conclusion: The management of ESRD being very expensive, government alone with a less than 0.5 to 0.8 percent of the GDP allocation for health cannot extend this facility to all the sufferers. The society should follow healthy life style practices so as the preventable causes of ESRD such as hypertension and DM can be controlled. Social groups should be formed in which these patients should actively participate, encourage and guide each other to improve their quality of life
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Background: In patients suffering from End Stage Renal Disease [ESRD] life can only be sustained by renal replacement therapy, including renal transplant or dialysis, which can be peritoneal dialysis or hemodialysis. Adequate dose of hemodialysis must be offered to patients for better quality of life. Hemodialysis adequacy, Kt/V, is one of the most important issues influencing the survival of patients on maintenance hemodialysis. Some patients do not achieve target Kt/V even with extended treatment time or by increasing blood flow rates. These patients have poor quality of life because of toxic effects of uremia, decreased appetite, metabolic complications of renal failure. These selected patients can be offered adequate dialysis by increasing dialysate flow rate, hence achieving adequate Kt/V, so quality of life can be improved
Objective: This study was conducted to determine the effect of increasing dialysate flow rate from 500 ml/min to 800 ml/min on achieved Kt/V, in under dialyzed patients who were on thrice weekly regular hemodialysis and were not achieving required Kt/V
Patients and Methods: This cross sectional study was conducted in hemodialysis unit, Sheikh Zayed Hospital, Rahim Yar Khan from 1 st November 2011 to 3 Oth April 2012. We included 100 regular under dialyzed patients using Fresenius 4008S dialysis machines, equipped with online clearance modules [OCM] to measure Kt/V. The patients were dialyzed for 4 hours, at dialysate flow rates 500ml/min and then 800ml/min each session. OCM-based single pool Kt/V was noted at the end of each dialysis session. The difference between two Kt/V was noted
Results: When 100 underdialyzed patients who were previously dialyzed at Qd 500ml/min, were offered 4 hour dialysis with Qd of 800ml/min, 87% patients achieved target Kt/V of > 1.2. While 13% still did not achieved target Kt/V. So a significant number of patients were able to have adequate dialysis
Conclusion: Some patients did not achieved required target Kt/V>1.2 on conventional dialysate flow rate of 500ml/min despite of extended treatment time and optimized blood flow rates and hence were underdialyzed. But they achieved Kt/V > 1.2 when dialyzed for 4 hours at Qd 800ml/min. So it is concluded that better dialysis can be offered to these selected patients by increasing dialysate flow rate from 500ml/min to 800ml/mm, achieving better Kt/V and thus quality of life can be improved
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Recurrent pleural effusions are relatively uncommon and as clinicians we keep drug induced pleural effusion lower in our list of differentials. Pramipexole induced recurrent pleural effusion can be life threatening if not recognized early and has been reported in literature only a few times. A 44 years old man with history of traumatic brain injury presented with pneumonitis and p leural effusion which was tapped. Patient returned with pleural effusion within 2 weeks and a careful analysis of all the risk factor and drugs revealed that the most likely etiology was chronic use of Pramipexole leading to recurrent pleural effusion and early pulmonary fibrosis. Pramipexole induced recurrent pleural effusion can cause significant morbidity and should be recognized early. Physician prescribing this medication should be aware of this rare side effect of the medication
Subject(s)
Humans , Male , Benzothiazoles/adverse effects , Pneumonia , Pulmonary Fibrosis , RecurrenceABSTRACT
Patients' opinion regarding services has acquired great importance. Patient satisfaction is playing an increasingly important role in quality of care reforms and health-care delivery. The study aimed to measure patient satisfaction in a tertiary care hospital in order to know the patients' perspectives and expectations of the services and make appropriate improvements accordingly. This was a crosssectional study conducted at the Out-patient and Inpatient Departments of the Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, for a period of 8 months from October 2008 till June 2009. Sample size was 246 patients; which included 123 participants from Out-patient and In-patient departments each. Patients aged 18 and above, of both genders, who gave informed written consent, were consecutively recruited for the study. Learning disabled patients, frankly psychotic and those with severe cognitive impairment and severe co-morbid physical illnesses were excluded. Performa was filled in by the participants for their demographic details. The Client Satisfaction Questionnaire-8 was then orally administered in the native language [Urdu/Punjabi] to assess the degree of patient satisfaction. Among the participants, 72% were mostly satisfied, 18.7% mildly satisfied and 9.3% dissatisfied with the psychiatric care. Age was significantly associated with satisfaction however no such associations could be found for gender and economic status. Majority of the patients were satisfied with the psychiatric services. The younger people were more satisfied. Gender and economic status had no influence on patient satisfaction