Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification

Objective@#We performed a meta-analysis of epidemiological results for the association between occupational exposure as a firefighter and cancer as part of the broader evidence synthesis work of the IARC Monographs program. @*Methods@#A systematic literature search was conducted to identify cohort studies of firefighters followed for cancer incidence and mortality. Studies were evaluated for the influence of key biases on results. Random-effects meta-analysis models were used to estimate the association between ever-employment and duration of employment as a firefighter and risk of 12 selected cancers. The impact of bias was explored in sensitivity analyses. @*Results@#Among the 16 included cancer incidence studies, the estimated meta-rate ratio, 95% confidence interval (CI), and heterogeneity statistic (I2) for ever-employment as a career firefighter compared mostly to general populations were 1.58 (1.14–2.20, 8%) for mesothelioma, 1.16 (1.08–1.26, 0%) for bladder cancer, 1.21 (1.12–1.32, 81%) for prostate cancer, 1.37 (1.03–1.82, 56%) for testicular cancer, 1.19 (1.07–1.32, 37%) for colon cancer, 1.36 (1.15–1.62, 83%) for melanoma, 1.12 (1.01–1.25, 0%) for non-Hodgkin lymphoma, 1.28 (1.02–1.61, 40%) for thyroid cancer, and 1.09 (0.92–1.29, 55%) for kidney cancer. Ever-employment as a firefighter was not positively associated with lung, nervous system, or stomach cancer. Results for mesothelioma and bladder cancer exhibited low heterogeneity and were largely robust across sensitivity analyses. @*Conclusions@#There is epidemiological evidence to support a causal relationship between occupational exposure as a firefighter and certain cancers. Challenges persist in the body of evidence related to the quality of exposure assessment, confounding, and medical surveillance bias.

Severity of Daytime Sleepiness and Parkinsonian-Like Symptoms in Korean Adults Aged 50–64 Years

Background@#and Purpose While excessive daytime sleepiness can predate Parkinson’s disease in late-life, its association with parkinsonian-like (P-L) symptoms in middle age are unknown. Since neurodegeneration can appear decades before a diagnosis of Parkinson’s disease, identifying clinical features associated with this early progression is important. The purpose of this study was to determine the association of daytime sleepiness with P-L symptoms in a population-based sample of middle-aged Korean adults. @*Methods@#During 2013 and 2014, daytime sleepiness and P-L symptoms were assessed in 2,063 males and females aged 50–64 years who were participating in the Korean Genome and Epidemiology Study. The severity of daytime sleepiness was quantified by the score on the Epworth Sleepiness Scale (ESS). Self-reported P-L symptoms included nine motor disorders commonly associated with Parkinson’s disease. Participants with parkinsonism and related conditions are excluded. @*Results@#The prevalence of excessive daytime sleepiness (ESS score >10) was 7.0%. The frequencies of P-L symptoms ranged from 0.5% (for “trouble buttoning buttons”) to 18.4% (for “handwriting smaller than it once was”). After adjustment for covariates and multiple testing, the relative odds of P-L symptoms comparing the 80th and 20th percentiles of ESS scores was 1.6 (p=0.001) for “voice is softer than it once was,” 2.1 (p<0.001) for “balance when walking is poor,” and 1.5 (p=0.002) for “loss of facial expression.” The prevalence of excessive daytime sleepiness increased from 6.3% to 19.8% when the number of symptoms increased from zero to three (p=0.004). @*Conclusions@#In Korean adults aged 50–64 years, daytime sleepiness is significantly associated with P-L symptoms. Whether coexisting daytime sleepiness and P-L symptoms predate extrapyramidal and other impairments in later life warrants further investigation.

Clinical studies of dapagliflozin in pediatric patients: a rapid review

The oral sodium-glucose cotransporter 2 inhibitor, dapagliflozin, is used to treat kidney disease, heart failure, and diabetes in adults, but has not been well studied in pediatrics, and does not have a recognized place in therapy in current practice guidelines. The purpose of this review is to summarize studies that have investigated the efficacy of dapagliflozin in pediatric patients. A systematic review was performed to identify clinical studies of oral dapagliflozin in children 0 to 17 years. Studies were identified through searches of Scopus, Web of Science, PubMed, Google Scholar, Embase, clinical trial registries, research registries, and key journals through August 2022. The Cochrane scoring system was used to assess the methodological quality of the included randomized trials. Five studies were reviewed and included in this analysis. Dapagliflozin at a dose of 5 to 10 mg was utilized in adolescents and young adults with heart failure, chronic kidney disease with proteinuria, type 1 diabetes, or type 2 diabetes. Studies evaluating dapagliflozin in type 1 diabetes evaluated single doses while the other studies monitored long-term use. Dapagliflozin was overall considered to be safe and effective in the studies included in this review, but further studies in larger populations and over extended periods of time are necessary.

Axial Spondyloarthritis: Current Advances, Future Challenges

Axial spondyloarthritis (axSpA) is a chronic inflammatory joint disease with a predilection for the spine. It affects young adults and has the potential to have a major impact on quality of life, not only because of the chronic pain and fatigue, but also because of the potential for marked disability related to spinal ankylosis. Early detection of axSpA remains a major challenge, for which there is a heightened sense of urgency since it has been shown that earlier intervention with biologics can alter the progression of radiographic change in the spine. Advances in the genetics of axSpA have highlighted a number of candidate genes conferring susceptibility to the disease, but there is evidence of environmental factors playing a role as well. Recently studies in both clinical and experimental axSpA have implicated alterations in the gut microbiome as playing a key role, and the immunology of the gut-joint axis is becoming better understood. The unmet needs which are shaping the research agenda include improvement in early case identification, sensitive and specific biomarkers which could accurately reflect disease activity and severity, improved understanding of the common pathways of inflammation in the skin, eye and gut in axSpA, and novel therapeutic targets which could have curative potential.

The spread of radiology in India from 1941 to 1956

This commentary discusses how the reasoning behind the founding of Tata Memorial Hospital (TMH), India's first specialized cancer hospital, was influential in setting up a larger infrastructure of cancer care in India. I show how the arguments that led to the use of radium at TMH enabled the value that TMH placed upon radiology to permeate other institutions around India, ultimately establishing radium as an essential element of cancer care.

Baroreflex Control of Heart Rate in Mice Overexpressing Human SOD1: Functional Changes in Central and Vagal Efferent Components / 神经科学通报·英文版

Excessive reactive oxygen species (ROS) (such as the superoxide radical) are commonly associated with cardiac autonomic dysfunctions. Though superoxide dismutase 1 (SOD1) overexpression may protect against ROS damage to the autonomic nervous system, superoxide radical reduction may change normal physiological functions. Previously, we demonstrated that human SOD1 (hSOD1) overexpression does not change baroreflex bradycardia and tachycardia but rather increases aortic depressor nerve activity in response to arterial pressure changes in C57B6SJL-Tg (SOD1)2 Gur/J mice. Since the baroreflex arc includes afferent, central, and efferent components, the objective of this study was to determine whether hSOD1 overexpression alters the central and vagal efferent mediation of heart rate (HR) responses. Our data indicate that SOD1 overexpression decreased the HR responses to vagal efferent nerve stimulation but did not change the HR responses to aortic depressor nerve (ADN) stimulation. Along with the previous study, we suggest that SOD1 overexpression preserves normal baroreflex function but may differentially alter the functions of the ADN, vagal efferents, and central components. While SOD1 overexpression likely enhanced ADN function and the central mediation of bradycardia, it decreased vagal efferent control of HR.

Periapical Wires Result in Less Curve Correction Than Pedicle Screw Constructs in Idiopathic Scoliosis

STUDY DESIGN: Retrospective study.PURPOSE: The objective of this study was to compare percent correction between apical and periapical pedicle screw (PS) and sublaminar wire constructs for Cobb correction and coronal balance correction.OVERVIEW OF LITERATURE: The current gold standard for deformity correction in adolescent idiopathic scoliosis (AIS) are PS constructs. Sublaminar wires provide an alternative means of fixation when PS fixation cannot be safely performed. Two previous studies have compared percent curve correction between sublaminar wires and PSs, with conflicting conclusions.METHODS: The study was a retrospective review of Lenke type 1 curves with minimum follow-up of at least 1 year. Cases were divided into two groups: constructs using apical/periapical sublaminar wires (SL group) versus PS only constructs (PS group). Percent Cobb correction and coronal balance were compared between the two groups at 1 year. A multivariable regression model was used to determine the impact of apical/periapical wires on percent Cobb correction and coronal balance at 1 year when accounting for additional variables.RESULTS: The cohort included 71 patients who were predominantly female (80.2%), with average age of 14.2 years. Only 21 (29.5%) of constructs utilized apical/periapical sublaminar wires. There was a significant difference in percent Cobb correction at 1 year for the PS and SL groups (70.26% vs. 60.09%, p=0.05). No difference was observed in overall coronal balance. A multivariable model revealed that apical/periapical wires were negatively associated with percent Cobb correction at 1 year (coefficient=−8.49, p=0.023), while total implant density of the construct was positively associated with correction (coefficient=24.2, p<0.001).CONCLUSIONS: Use of PSs in the apical and periapical zones resulted in improved percent Cobb correction at 1 year in patients with AIS Lenke type 1 curves. Sublaminar wires remain a useful surgical option and result in equivalent coronal balance compared to PSs.

Do medical students studying in the United Kingdom have an adequate factual knowledge of basic life support? / 世界急诊医学杂志（英文）

BACKGROUND@# Healthcare professionals have a duty to maintain basic life support (BLS) skills. This study aims to evaluate medical students' factual knowledge of BLS and the training they receive.@*METHODS@# A cross-sectional, closed-response questionnaire was distributed to the first- and fourth-year students studying at institutions in the United Kingdom. The paper questionnaire sought to quantify respondent's previous BLS training, factual knowledge of the BLS algorithm using five multiple choice questions (MCQs), and valuate their desire for further BLS training. Students received 1 point for each correctly identified answer to the 5 MCQ's.@*RESULTS@#A total of 3,732 complete responses were received from 21 medical schools. Eighty percent (n=2,999) of students completed a BLS course as part of their undergraduate medical studies. There was a significant difference (P<0.001) in the percentage of the fourth-year students selecting the correct answer in all the MCQ's compared to the first-year students except in identifying the correct depth of compressions required during CPR (P=0.095). Overall 10.3% (95% CI 9.9% to 10.7%) of respondents correctly identified the answer to 5 MCQ's on BLS: 9% of the first-year students (n=194) and 12% of the fourth-year students (n=190). On an institutional level the proportion of students answering all MCQ's correctly ranged from 2% to 54% at different universities. Eighty-one percent of students (n=3,031) wished for more BLS training in their curriculum.@*CONCLUSION@# Factual knowledge of BLS is poor among medical students in the UK. There is a disparity in standards of knowledge across institutions and respondents indicating that they would like more training.

Total hip arthroplasty for posttraumatic osteoarthritis following acetabular fracture: A systematic review of characteristics, outcomes, and complications / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture.</p><p><b>METHODS</b>Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords "acetabular", "fracture", "arthroplasty", and "post traumatic arthritis" published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies.</p><p><b>RESULTS</b>With 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28%-63%), implant loosening (1%-24%), and infection (0%-16%). The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%.</p><p><b>CONCLUSION</b>Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.</p>

Quality of life and urolithiasis: the patient - reported outcomes measurement information system (PROMIS)

ABSTRACT Background: With a high rate of recurrence, urolithiasis is a chronic disease that impacts quality of life. The Patient Reported Outcomes Measurement Information System is an NIH validated questionnaire to assess patient quality of life. We evaluated the impact of urolithiasis on quality of life using the NIH-sponsored PROMIS-43 questionnaire. Materials and Methods: Patients reporting to the kidney stone clinic were interviewed to collect information on stone history and demographic information and were asked to complete the PROMIS-43 questionnaire. Quality of life scores were analyzed using gender and age matched groups for the general US population. Statistical comparisons were made based on demographic information and patient stone history. Statistical significance was P<0.05. Results: 103 patients completed the survey. 36% of respondents were male, the average age of the group was 52 years old, with 58% primary income earners, and 35% primary caregivers. 7% had never passed a stone or had a procedure while 17% passed 10 or more stones in their lifetime. Overall, pain and physical function were worse in patients with urolithiasis. Primary income earners had better quality of life while primary caregivers and those with other chronic medical conditions were worse. Patients on dietary and medical therapy had better quality of life scores. Conclusions: Urolithiasis patients subjectively have worse pain and physical function than the general population. The impact of pain on quality of life was greatest in those patients who had more stone episodes, underscoring the importance of preventive measures. Stone prevention measures improve quality of life.

A second reported malignancy in a patient with Morquio syndrome

Morquio syndrome is a rare lysosomal storage disease that affects multiple organ systems. However, it is rarely associated with malignancy. We present the case of a 30-year old man with Morquio syndrome associated with gastric adenocarcinoma. This case also demonstrates two other findings that have not been previously described in patients with Morquio syndrome - malrotation of brainstem and cerebellum, without clinical neurologic deficit, and persistence of fetal lobulation in the kidneys.

Obtención, evaluación y congelación de semen de antilope adulto (Addax nasomaculatus) del Zoo-Parque Lecocq de Montevideo-Uruguay / Collection, evaluation and freezing of sperm antilope adult (Addax nasomaculatus) of the Lecocq Zoo-Park in Montevideo-Uruguay

La criopreservación de semen es una importante biotecnología reproductiva que viene siendo utilizada con éxito desde hace casi 50 años que busca promover la conservación del germoplasma masculino. Si bien en la actualidad se han desarrollado sistemas electrónicos automatizados portátiles, muchos técnicos continúan utilizando el método convencional de congelación por su practicidad, bajo costo y su buena eficiencia. En este trabajo, utilizando protocolos estandarizados para la evaluación reproductiva de machos de otras especies se presentan datos preliminares sobre obtención, evaluación y congelación de gameto masculino de antílopes adultos (Addax nasomaculatus). Se obtuvo el semen de tres antílopes machos adultos, registrándose volumen, color, motilidad, vigor, vitalidad, concentración y morfología. El semen fue congelado por el método convencional y preservado en nitrógeno a -196 C. Los machos respondieron satisfactoriamente al método de sedación y extracción de semen. Tanto la evaluación del semen fresco como del semen congelado mostraron datos preliminares aceptables que validan la metodología utilizada y estimulan a continuar trabajando con esta especie dada su condición de animales en cautiverio y en peligro de extinción.

For almost 50 years sperm cryopreservation has been an important reproductive biotechnology that promotes the conservation of male germplasm. While today automated portable electronic systems have been developed, many technicians continue to use the conventional method of freezing for its practicality, low cost and efficiency. In this work we present preliminary data using standard protocols for assessing reproductive males of other species, about evaluation and freezing of adult antelope (Addax nasomaculatus) male gamete. Semen from three adult male antelope was obtained; we registered volume, color, motility, vigor, vitality, concentration and morphology. The semen was frozen by the conventional method and preserved under -196 C nitrogen. Males responded satisfactorily to the method of sedation and extraction of semen. The evaluation of fresh and frozen semen showed acceptable preliminary data that validate the methodology and encourage them to continue working with this species because of their status of animals in captivity and in danger of extinction.

Interobserver and Test-Retest Reproducibility of T1ρ and T2 Measurements of Lumbar Intervertebral Discs by 3T Magnetic Resonance Imaging

OBJECTIVE: To investigate the interobserver and test-retest reproducibility of T1ρ and T2 measurements of lumbar intervertebral discs using 3T magnetic resonance imaging (MRI). MATERIALS AND METHODS: This study included a total of 51 volunteers (female, 26; male, 25; mean age, 54 ± 16.3 years) who underwent lumbar spine MRI with a 3.0 T scanner. Amongst these subjects, 40 underwent repeat T1ρ and T2 measurement acquisitions with identical image protocol. Two observers independently performed the region of interest measurements in the nuclei pulposi of the discs from L1–2 through L5–S1 levels. Statistical analysis was performed using intraclass correlation coefficient (ICC) with a two-way random model of absolute agreement. Comparison of the ICC values was done after acquisition of ICC values using Z test. Statistical significance was defined as p value < 0.05. RESULTS: The ICCs of interobserver reproducibility were 0.951 and 0.672 for T1ρ and T2 mapping, respectively. The ICCs of test-retest reproducibility (40 subjects) for T1ρ and T2 measurements were 0.922 and 0.617 for observer A and 0.914 and 0.628 for observer B, respectively. In the comparison of the aforementioned ICCs, ICCs of interobserver and test-retest reproducibility for T1ρ mapping were significantly higher than T2 mapping (p < 0.001). CONCLUSION: The interobserver and test-retest reproducibility of T1ρ mapping were significantly higher than those of T2 mapping for the quantitative assessment of nuclei pulposi of lumbar intervertebral discs.

The construct of psychopathy in a Chilean prison population

Objective:To test the four-factor model of the Hare Psychopathy Checklist - Revised (PCL-R) empirical construct of psychopathy in a Chilean prison population by using instruments that supply different types of data.Methods:Two hundred and nine male inmates of the Prison of Los Andes, Chile, were evaluated. Confirmatory factor analysis was carried out with the PCL-R and the Self-Report of Psychopathy - III - Short Form (SRP-III-SF).Results:The distributions of total PCL-R and SRP-III-SF scores were normal (Kolmorogov-Smirnov [K-S] = 1.04, p = 0.230; K-S = 0.812, p = 0.525, respectively), with means of 20.9±6.8 for the former and 61.6±15.2 for the latter. Model fit was good for the PCL-R (Tucker Lewis index [TLI] = 0.96; root mean square error of approximation [RMSEA] = 0.04) and for the SRP-SF (TLI = 0.94, RMSEA = 0.04).Conclusions:The results obtained with the PCL-R and the SRP-SF showed adequate fit to the empirical four-factor model of psychopathy and support this model. As foreseeable, fit was better for the PCL-R, which combines several sources of information.

Teamwork education improves trauma team performance in undergraduate health professional students / 보건의료교육평가

PURPOSE: Effective trauma resuscitation requires efficient and coordinated care from a team of providers; however, providers are rarely instructed on how to be effective members of trauma teams. Team-based learning using Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) has been shown to improve team dynamics among practicing professionals, including physicians and nurses. The impact of TeamSTEPPS on students being trained in trauma management in an undergraduate health professional program is currently unknown. We sought to determine the impact of TeamSTEPPS on team dynamics among undergraduate students being trained in trauma resuscitation. METHODS: We enrolled teams of undergraduate health professional students from four programs: nursing, physician assistant, radiologic science, and respiratory care. After completing an online training on trauma resuscitation principles, the participants completed a trauma resuscitation scenario. The participants then received teamwork training using TeamSTEPPS and completed a second trauma resuscitation scenario identical to the first. All resuscitations were recorded and scored offline by two blinded research assistants using both the Team Emergency Assessment Measure (TEAM) and Trauma Team Performance Observation Tool (TPOT) scoring systems. Pre-test and post-test TEAM and TPOT scores were compared. RESULTS: We enrolled a total of 48 students in 12 teams. Team leadership, situational monitoring, and overall communication improved with TeamSTEPPS training (P= 0.04, P=0.02, and P=0.03, respectively), as assessed by the TPOT scoring system. TeamSTEPPS also improved the team's ability to prioritize tasks and work together to complete tasks in a rapid manner (P<0.01 and P=0.02, respectively) as measured by TEAM. CONCLUSIONS: Incorporating TeamSTEPPS into trauma team education leads to improved TEAM and TPOT scores among undergraduate health professionals.

Can the Perinatal Information System in Peru be used to measure the proportion of adverse birth outcomes attributable to maternal syphilis infection? / ¿Se puede utilizar el Sistema Informático Perinatal del Perú para medir la proporción de resultados adversos del nacimiento atribuibles a sífilis materna?

OBJECTIVE: To describe the capacity of Peru's Perinatal Information System (Sistema Informático Perinatal, SIP) to provide estimates for monitoring the proportion of stillbirths and other adverse birth outcomes attributable to maternal syphilis. METHODS: A descriptive study was conducted to assess the quality and completeness of SIP data from six Peruvian public hospitals that used the SIP continuously from 2000 - 2010 and had maternal syphilis prevalence of at least 0.5% during that period. In-depth interviews were conducted with Peruvian stakeholders about their experiences using the SIP. RESULTS: Information was found on 123 575 births from 2000 - 2010 and syphilis test results were available for 99 840 births. Among those 99 840 births, there were 1 075 maternal syphilis infections (1.1%) and 619 stillbirths (0.62%). Among women with syphilis infection in pregnancy, 1.7% had a stillbirth, compared to 0.6% of women without syphilis infection. Much of the information needed to estimate the proportion of stillbirths attributable to maternal syphilis was available in the SIP, with the exception of syphilis treatment information, which was not collected. However, SIP data collection is complex and time-consuming for clinicians. Data were unlinked across hospitals and not routinely used or quality-checked. Despite these limitations, the SIP data examined were complete and valid; in 98% of records, information on whether or not the infant was stillborn was the same in both the SIP and clinical charts. Nearly 89% of women had the same syphilis test result in clinical charts and the SIP. CONCLUSIONS: The large number of syphilis infections reported in Peru's SIP and the ability to link maternal characteristics to newborn outcomes make the system potentially useful for monitoring the proportion of stillbirths attributable to congenital syphilis in Peru. To ensure good data quality and sustainability of Peru's SIP, data collection should be simplified and information should be continually quality-checked and used for the benefit of participating facilities.

OBJETIVO: Describir la capacidad del Sistema Informático Perinatal (SIP) del Perú para proporcionar estimaciones que permitan vigilar la proporción de mortinatos y otros resultados adversos del nacimiento atribuibles a sífilis materna. MÉTODOS: Se llevó a cabo un estudio descriptivo para evaluar la calidad y la integridad de los datos del SIP correspondientes a seis hospitales públicos peruanos que utilizaron el SIP de forma continuada del 2000 al 2010, y presentaron una prevalencia de sífilis materna de como mínimo 0,5% durante ese período. Se realizaron entrevistas exhaustivas con interesados directos de Perú acerca de sus experiencias con el uso del SIP. RESULTADOS: Se obtuvo información sobre 123 575 nacimientos ocurridos del 2000 al 2010 y se dispuso de resultados de pruebas serológicas de sífilis correspondientes a 99 840 nacimientos. Se produjeron 1 075 casos de sífilis materna (1,1%) y 619 mortinatos (0,62%). El 1,7% de las mujeres con sífilis gestacional tuvieron un mortinato, en comparación con el 0,6% de las mujeres sin infección sifilítica. En el SIP se disponía de gran parte de la información necesaria para calcular la proporción de mortinatos atribuibles a sífilis materna, a excepción de la información sobre el tratamiento de la sífilis, que no se recopiló. Sin embargo, la recopilación de datos del SIP es compleja y exige a los médicos clínicos dedicar tiempo. Los datos de los diferentes hospitales no estaban vinculados, no se utilizaban habitualmente ni se sometían a controles de calidad. A pesar de estas limitaciones, los datos del SIP analizados estaban completos y eran válidos; en 98% de los registros, la información sobre si se trataba o no de un mortinato coincidía entre el SIP y las historias clínicas. En casi 89% de las mujeres los resultados de las pruebas serológicas de sífilis eran los mismos en las historias clínicas y el SIP. CONCLUSIONES: El gran número de infecciones sifilíticas notificadas en el SIP del Perú y la capacidad de vincular las características maternas con los resultados de los recién nacidos hacen que el sistema sea potencialmente útil para vigilar la proporción de mortinatos atribuibles a sífilis congénita en Perú. Con objeto de garantizar la buena calidad de los datos y la sostenibilidad del SIP en Perú, es preciso simplificar la recopilación de datos y mantener un control permanente de la calidad de la información, que debe utilizarse en beneficio de los establecimientos participantes.

Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: 2014 updates

The Saudi Association for Pulmonary Hypertension [previously called Saudi Advisory Group for Pulmonary Hypertension] has published the first Saudi Guidelines on Diagnosis and Treatment of Pulmonary Arterial Hypertension back in 2008. [1] That guideline was very detailed and extensive and reviewed most aspects of pulmonary hypertension [PH]. One of the disadvantages of such detailed guidelines is the difficulty that some of the readers who just want to get a quick guidance or looking for a specific piece of information might face. All efforts were made to develop this guideline in an easy-to-read form, making it very handy and helpful to clinicians dealing with PH patients to select the best management strategies for the typical patient suffering from a specific condition. This Guideline was designed to provide recommendations for problems frequently encountered by practicing clinicians involved in management of PH. This publication targets mainly adult and pediatric PH-treating physicians, but can also be used by other physicians interested in PH

Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: general management for pulmonary hypertension

Treatment of pulmonary hypertension [PH] patients is challenging and should only be initiated after a comprehensive diagnostic evaluation. Such treatment should ideally be done in specialized centers with full capability for hemodynamic measurements, having access to a broad range of PAH therapies, and adequate experience in the management of critically ill patients. The following discussion is intended to review the general measures and the non-specific [supportive] therapy used in managing PH patients, while the specific therapy will be discussed in a subsequent different article

Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: medical and surgical management for pulmonary arterial hypertension

Prior to the availability of the pulmonary arterial hypertension [PAH]-specific therapy, PAH was a dreadful disease with a very poor prognosis. Better understanding of the complex pathobiology of PAH has led to a major therapeutic evolution. International regulatory agencies have approved many specific drugs with different pharmacologic pathways and routes of administration. In the year 2013, two new drugs with great potentials in managing PAH have been added to the treatment options, macitentan and riociguat. Additional drugs are expected to come in the near future. A substantial body of evidence has confirmed the effectiveness of pulmonary arterial hypertension [PAH]-specific therapies in improving the patients' symptomatic status and slowing down the rate of clinical deterioration. The newer modern medications have significantly improved the survival of patients with PAH, it remains a non-curable and fatal disease. Lung transplantation [LT] remains the only therapeutic option for selected patients with advanced disease who continue to deteriorate despite optimal therapy

Repeat selective laser trabeculoplasty can be effective in eyes with initial modest response

To evaluate the effectiveness of repeat selective laser trabeculoplasty [SLT] in eyes exhibiting only a modest response upon initial treatment. Retrospective chart review was conducted of 51 eyes that received initial 360 degree SLT [SLT1] and subsequent SLT [SLT2] from 2003-2011 at a large academic ophthalmology practice. Successful response [S] was a post-treatment 12 month mean IOP reduction >/= 20% from baseline, while modest response [M] was <20% reduction over the same time. Chi-squared and log rank analyses were used to determine if success after SLT2 depended on having successful [S1] or modest [M1] response after SLT1. IOP was significantly reduced from baseline in both SLT1 and SLT2. The proportion of eyes with S2 was not significantly different between those with initial M1 or S1 [36.67% vs. 52.38%, respectively; P = 0.26]. Log rank analysis revealed no differences between M1 and S1 in determining SLT2 success [P = 0.41]. This outcome was similar when the analyses were performed for the right and left eye independently. The proportion of eyes that successfully responded to repeat SLT did not differ based upon whether the response to initial SLT was successful or modest. This raises the possibility that repeat SLT should not be excluded as an option for those eyes that have only a modest initial response