Caregiver burden of the elderly in a selected urban community, Chittoor district, Andhra Pradesh

Background: In India, families are the primary source of support in caring for the elderly, whereas the potential group of family caregivers is shrinking. Caregivers need greater recognition and support to help them care for the elderly and to maintain their own health and well-being. Assessment of the perceived burden of caregivers helps identify those in need of support. Methods: A cross-sectional questionnaire-based study was conducted to estimate the perceived level of caregiver burden in families of elderly and to identify the association between selected socio-demographic characteristics of the caregivers and the level of caregiver burden. The caregivers of 50 elderly people categorized as mild and moderate dependents as per the Katz index of Independence were included in the study. The Zarith caregiver burden scale was used to evaluate their perceived level of caregiver burden. Results: Thirty-two (64%) caregivers were found to experience a mild to moderate perceived level of caregiver burden. An ordinal regression analysis between other burdens/responsibilities (predictor) of the caregiver and the perceived level of caregiver burden showed a significant association (?2; p=0.009) between the two. An odds ratio of 6.7 (95% CI, 2.22 to 22.7; p=0.00115) showed that as the predictor increased, the event (caregiver burden) increased as well. Conclusions: The majority of the caregivers suffer from a mild to moderate perceived level of caregiver burden. They experience more burden when they hold additional responsibility of caring for the elderly.

The Lack of Nutritional Competency among the Medical Practitioners and Medical Students: A Systematic Review

Objective: This systematic review addressed the effects of the competency level of medical students, physicians, and practitioners in nutrition education for optimum patient care. It also addresses the perceived inadequate didactic contact hours of nutrition education. Method: There were 55 studies selected, and 25 were used for this review including quantitative and qualitative studies. The data were divided into four groups: quantitative data, qualitative data, reports, and news articles. The categorization of the literature was as follows: 17 quantitative, 2 qualitative, 4 news articles, 1 manual, and 1 symposium report. These were evaluated to produce a credible qualitative meta-analysis of available data. Data Sources: The systematic review used databases and citation indexes including Embosses, PubMed, JAMA Network, Medline, Elsevier, and Oxford Academics, these include journals, reports of Symposiums, and news articles to ascertain evidence-based data Results: The findings of this review revealed the significant effect inadequate contact nutrition education has on the competency level of medical students, physicians, and practitioners. Limitations: Limitations of this review include several external factors. Although universities are expected to implement approximately 44 hours of nutrition education for the competency level of medical students and physicians during their tenure, this may not be the case at all schools. Many offer only 15-25 didactics hours. In addition, in some cases, the comparisons are not equal but the researcher was unable to establish the hours and a basic curriculum structure.

Correlation on the level of adherence to self-care activities and blood glucose control of adult patients with type 2 diabetes mellitus seen in the Outpatient Department of a tertiary hospital in Baguio City – A cross-sectional study

Introduction@#Type 2 Diabetes Mellitus (T2DM) remains one of the leading causes of mortality in the Philippines. Studies have reported that good adherence to self-care activities significantly aid in glycemic control. However, previous studies revealed a low adherence to diabetes self-care activities. Moreover, only few studies were done in the local setting assessing the level of adherence to self-care activities and correlating the two; hence, the immense need for the assessment of level of adherence to self-care activities among patients with T2DM.@*Objective@#This study aims to determine the level of adherence to self-care activities and correlate it with the glycemic control among T2DM patients seen in the outpatient department in a tertiary hospital in Baguio City.@*Methods@#This cross-sectional study was done using a survey questionnaire adapted from the Summary Diabetes Self-Care Activities Questionnaire version 2000. Glycemic control was determined using the latest valid HbA1c results. One hundred adult diabetic patients were included in the study. Participants were selected in the Family Medicine and Internal Medicine OPD Clinics through systematic random sampling method. Data collected were analyzed using descriptive and inferential statistics.@*Results@#Results revealed that majority of the sample population had undesirable self-care activity (69%), and poor glycemic control (69%). Statistical analysis revealed that proper adherence to either exercise (0.003) or compliance to medications (0.012) both have a significant relationship with glycemic control. Overall score (0.003) on one hand revealed a highly significant relationship with glycemic control.@*Conclusion@#Incorporating the different self-care activities namely diet, exercise, blood sugar testing, foot care, smoking cessation, and compliance to medication all together has a significant relationship with glycemic control among diabetic patients. Clinicians must emphasize proper adherence to self-care activities because of the high number of patients with undesirable self-care activities.

Impact of Universal Suicide Risk Screening in a Pediatric Emergency Department: A Discrete Event Simulation Approach / 대한의료정보학회지

Objectives@#The aim of this study was to use discrete event simulation (DES) to model the impact of two universal suicide risk screening scenarios (emergency department [ED] and hospital-wide) on mean length of stay (LOS), wait times, and overflow of our secure patient care unit for patients being evaluated for a behavioral health complaint (BHC) in the ED of a large, academic children’s hospital. @*Methods@#We developed a conceptual model of BHC patient flow through the ED, incorporating anticipated system changes with both universal suicide risk screening scenarios. Retrospective site-specific patient tracking data from 2017 were used to generate model parameters and validate model output metrics with a random 50/50 split for derivation and validation data. @*Results@#The model predicted small increases (less than 1 hour) in LOS and wait times for our BHC patients in both universal screening scenarios. However, the days per year in which the ED experienced secure unit overflow increased (existing system: 52.9 days; 95% CI, 51.5–54.3 days; ED: 94.4 days; 95% CI, 92.6–96.2 days; and hospital-wide: 276.9 days; 95% CI, 274.8–279.0 days). @*Conclusions@#The DES model predicted that implementation of either universal suicide risk screening scenario would not severely impact LOS or wait times for BHC patients in our ED. However, universal screening would greatly stress our existing ED capacity to care for BHC patients in secure, dedicated patient areas by creating more overflow.

Round spermatid injection into human oocytes: a systematic review and meta-analysis / 亚洲男科学杂志(英文版)

Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction. This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection (ROSI), a technique which utilizes immature precursors of spermatozoa for fertilization. An electronic search was performed to identify relevant articles published through October 2018. Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included. Fertilization rate, pregnancy rate, and resultant delivery rate were assessed following ROSI. Meta-analysis outcomes were analyzed using a random-effects model. Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers. The fertilization rate after ROSI was 38.7% (95% confidence interval [CI]: 31.5%-46.3%), while the pregnancy rate was 3.7% (95% CI: 3.2%-4.4%). The resultant delivery rate was low, with 4.3% of embryo transfers resulting in a delivery (95% CI: 2.3%-7.7%). The pregnancy rate per couple was 13.4% (95% CI: 6.8%-19.1%) and the resultant delivery rate per couple was 8.1% (95% CI: 6.1%-14.4%). ROSI has resulted in clinical pregnancies and live births, but success rates are considerably lower than those achieved with mature spermatozoa. While this technique may be a feasible alternative for men with azoospermia who decline other options, couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.

Relationship between right ventricular pacing and non-sustained ventricular arrhythmias in patients with dual-chamber pacemaker and normal range left ventricular ejection fraction

Background@#Right ventricular pacing (RVP) increases heart failure, AF, and death rates in pacemaker patients and ventricular arrhythmias (VAs) in defibrillator patients. However, the impact of RVP on VAs burden and its clinical significance in pacemaker patients with normal range LVEF of > 50–55% remains unknown. We sought to evaluate the relationship of RVP and VAs and its clinical impact in a pacemaker patient population. @*Methods@#Records of 105 patients who underwent de novo dual-chamber pacemaker implant or a generator change (Medtronic™ or Boston Scientific™) for AV block and sinus node disease at a tertiary care center between September 1, 2015, and September 1, 2016, were retrospectively reviewed. @*Results@#Data from 105 patients (51% females, mean age 76 ± 1 years, mean LVEF 61 ± 0.7%) without history of VAs (98.2%) were reviewed over 1044 ± 23 days. Dependent patients (100% RVP) exhibited the lowest VAs burden when compared to  1/h of PVC runs and increasing PVC runs/h were significantly associated with hospitalization (p = 0.04) and all-cause mortality (p = 0.03), respectively. @*Conclusions@#In pacemaker patients with normal range LVEF (> 50–55%), 100% RVP is associated with the lowest burden of NSVT. Furthermore, patients with < 1% RVP also exhibit low VA burden; however, intermittent RVP seems to significantly correlate with non-sustained VAs.

A comparison of the relative efficiency of ICSI and extended culture with epididymal sperm versus testicular sperm in patients with obstructive azoospermia / 亚洲男科学杂志(英文版)

This is a retrospective cohort study comparing blastocyst transfer outcomes following intracytoplasmic sperm injection utilizing epididymal versus testicular sperm for men with obstructive azoospermia. All cases at a single center between 2012 and 2016 were included. Operative approach was selected at the surgeon's discretion and included microepididymal sperm aspiration or testicular sperm extraction. Blastocyst culture was exclusively utilized prior to transfer. The primary outcome was live birth rate. Secondary outcomes included fertilization rate, blastulation rate, euploidy rate, and implantation rate. A mixed effects model was performed. Seventy-six microepididymal sperm aspiration cases and 93 testicular sperm extraction cases were analyzed. The live birth rate was equivalent (48.6% vs 50.5%, P = 0.77). However, on mixed effects model, epididymal sperm resulted in a greater likelihood of fertilization (adjusted OR: 1.37, 95% CI: 1.05-1.81, P = 0.02) and produced a higher blastulation rate (adjusted OR: 1.41, 95% CI: 1.1-1.85, P = 0.01). As a result, the epididymal sperm group had more supernumerary blastocysts available (4.3 vs 3, P < 0.05). The euploidy rate was no different. Pregnancy rates were no different through the first transfer cycle. However, intracytoplasmic sperm injection following microepididymal sperm aspiration resulted in a greater number of usable blastocysts per patient. Thus, the true benefit of epididymal sperm may only be demonstrated via a comparison of cumulative pregnancy rates after multiple transfers from one cohort.

The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors

Background/Aims@#The management of small, incidentally discovered nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) has been a matter of debate. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a tool used to identify and risk-stratify PNETs. This study investigates the concordance rate of Ki67 grading between EUS-FNA and surgical pathology specimens in NFPNETs and whether certain NF-PNET characteristics are associated with disease recurrence and disease-related death. @*Methods@#We retrospectively reviewed the clinical history, imaging, endoscopic findings, and pathology records of 37 cases of NFPNETs that underwent pre-operative EUS-FNA and surgical resection at a single academic medical center. @*Results@#There was 73% concordance between Ki67 obtained from EUS-FNA cytology and surgical pathology specimens; concordance was the highest for low- and high-grade NF-PNETs. High-grade Ki67 NF-PNETs based on cytology (p=0.028) and histology (p=0.028) were associated with disease recurrence and disease-related death. Additionally, tumors with high-grade mitotic rate (p=0.005), tumor size >22.5 mm (p=0.104), and lymphovascular invasion (p=0.103) were more likely to have poor prognosis. @*Conclusions@#NF-PNETs with high-grade Ki67 on EUS-FNA have poor prognosis despite surgical resection. NF-PNETs with intermediate-grade Ki67 on EUS-FNA should be strongly considered for surgical resection. NF-PNETs with low-grade Ki67 on EUSFNA can be monitored without surgical intervention, up to tumor size 20 mm.

Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.

Proton-pump inhibitor use does not affect semen quality in subfertile men / 亚洲男科学杂志(英文版)

Proton-pump inhibitors (PPIs) are among the most widely used drugs worldwide. PPI use has recently been linked to adverse changes in semen quality in healthy men; however, the effects of PPI use on semen parameters remain largely unknown specifically in cases with male factor infertility. We examined whether PPI use was associated with detrimental effects on semen parameters in a large population of subfertile men. We retrospectively reviewed data from 12 257 subfertile men who had visited our fertility clinic from 2003 to 2013. Patients who reported using any PPIs for >3 months before semen sample collection were included; 7698 subfertile men taking no medication served as controls. Data were gathered on patient age, medication use, and conventional semen parameters; patients taking any known spermatotoxic medication were excluded. Linear mixed-effect regression models were used to test the effect of PPI use on semen parameters adjusting for age. A total of 248 patients (258 samples) used PPIs for at least 3 months before semen collection. In regression models, PPI use (either as the only medication or when used in combination with other nonspermatotoxic medications) was not associated with statistically significant changes in semen parameters. To our knowledge, this is the largest study to compare PPI use with semen parameters in subfertile men. Using PPIs was not associated with detrimental effects on semen quality in this retrospective study.

Systematic Review and Comparative Meta-Analysis of Outcomes Following Pedicled Muscle versus Fasciocutaneous Flap Coverage for Complex Periprosthetic Wounds in Patients with Total Knee Arthroplasty

BACKGROUND: In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA. METHODS: A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis. RESULTS: A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported. CONCLUSIONS: Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.

Vioxx redux – or how I learned to worry about industry-sponsored clinical trials.

I read with interest Mark Wilson’s recent article, “The New England Journal of Medicine: commercial conflict of interest and revisiting the Vioxx scandal”. I believe this is an important contribution that underlines the aphorism “Those who don’t know history are doomed to repeat it.” As Vioxx is a seminal example, it is important to place it in its proper context, examining if this malfeasance extends beyond the VIGOR study. While the epicentre of this conflict of interest surely begins with the sponsor, I believe the following essay demonstrates that this wave of egregiously unethical behaviour can exist and be propagated only with the complicity of academic investigators, medical journals, a flawed peer-review system and an uncritical medical readership. Perhaps the most troubling is that the factors that coalesced into the Vioxx scandal are, if anything, more ubiquitous today, mandating increased vigilance to decrease the probability of “getting fooled” again.

Insurance coverage for male infertility care in the United States / 亚洲男科学杂志(英文版)

Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of how male infertility care is covered by insurance in the United States. We begin with an appraisal of the costs of male infertility care, then examine the state insurance laws relevant to male infertility, and close with a discussion of why insurance coverage for male infertility is important to both men and women. Importantly, we found that despite infertility being classified as a disease and males contributing to almost half of all infertility cases, coverage for male infertility is often excluded from health insurance laws. Excluding coverage for male infertility places an undue burden on their female partners. In addition, excluding care for male infertility risks missing opportunities to diagnose important health conditions and identify reversible or irreversible causes of male infertility. Policymakers should consider providing equal coverage for male and female infertility care in future health insurance laws.

Predictors of sperm recovery after cryopreservation in testicular cancer / 亚洲男科学杂志(英文版)

Our objective was to identify predictors of improved postthaw semen quality in men with testicular cancer banking sperm for fertility preservation. We reviewed 173 individual semen samples provided by 67 men with testicular germ cell tumor (TGCT) who cryopreserved sperm before gonadotoxic treatment between 1994 and 2010 at our tertiary university medical center. Our main outcomes measures were independent predictors for the greater postthaw total motile count (TMC) in men with TGCT. Men with NSGCT were more likely to be younger (P median fresh TMC each had increased odds of a postthaw TMC greater than median postthaw TMC. Interestingly, age, advanced cancer stage (II or III), rapid freezing protocol, and motility enhancer did not show increased odds of improved postthaw TMC in our models. In conclusion, men with TGCT or poor fresh TMC should consider preserving additional vials (at least 15 vials) before oncologic treatment. Density gradient purification should be routinely used to optimize postthaw TMC in men with TGCT. Larger, randomized studies evaluating cancer stage and various cryopreservation techniques are needed to assist in counseling men with TGCT regarding fertility preservation and optimizing cryosurvival.

[Oops! I forgot HIV]: Resident physician self-audits and universal HIV screening

Innovations are needed to increase universal HIV screening by primary care providers. One potential intervention is self-audit feedback, which describes the process of a clinician reviewing their own patient charts and reflecting on their performance. The effectiveness of self-audit feedback was investigated using a mixed methods approach. A total of 2111 patient charts were analyzed in a quantitative pre-post intervention study design, where the intervention was providing self-audit feedback to all internal medicine residents at one institution through an annual chart review. Qualitative data generated from the subsequent resident focus group discussions explored the motivation and mechanism for change using a knowledge-attitude-behavior framework. The proportion of primary care patients screened for HIV increased from 17.9% [190/1060] to 40.3% [423/1051]. The adjusted odds ratio of a patient being screened following resident self-audited feedback was 3.17 [95% CI 2.11, 4.76, p < 0.001]. Focus group participants attributed the improved performance to the self-audit feedback. Self-audit feedback is a potentially effective intervention for increasing universal HIV screening in primary care. This strategy may be most useful in settings where [1] baseline performance is low, [2] behavioral change is provider-driven, and [3] resident trainees are targeted

Thimerosal as discrimination: vaccine disparity in the UN Minamata Convention on mercury.

When addressing toxins, one unmistakable parallel exists between biology and politics: developing children and developing nations are those most vulnerable to toxic exposures. This disturbing parallel is the subject of this critical review, which examines the use and distribution of the mercury (Hg)-based compound, thimerosal, in vaccines. Developed in 1927, thimerosal is 49.55% Hg by weight and breaks down in the body into ethyl-Hg chloride, ethyl-Hg hydroxide and sodium thiosalicylate. Since the early 1930s, there has been evidence indicating that thimerosal poses a hazard to the health of human beings and is ineffective as an antimicrobial agent. While children in the developed and predominantly western nations receive doses of mostly no-thimerosal and reduced-thimerosal vaccines, children in the developing nations receive many doses of several unreduced thimerosal-containing vaccines (TCVs). Thus, thimerosal has continued to be a part of the global vaccine supply and its acceptability as a component of vaccine formulations remained unchallenged until 2010, when the United Nations (UN), through the UN Environment Programme, began negotiations to write the global, legally binding Minamata Convention on Hg. During the negotiations, TCVs were dropped from the list of Hg-containing products to be regulated. Consequently, a double standard in vaccine safety, which previously existed due to ignorance and economic reasons, has now been institutionalised as global policy. Ultimately, the Minamata Convention on Hg has sanctioned the inequitable distribution of thimerosal by specifically exempting TCVs from regulation, condoning a two-tier standard of vaccine safety: a predominantly no-thimerosal and reduced-thimerosal standard for developed nations and a predominantly thimerosal-containing one for developing nations. This disparity must now be evaluated urgently as a potential form of institutionalised discrimination.

Capacity building and policy development in Belize marine protected areas, an example for Caribbean integrated coastal management / Desarrollo de capacidades y desarrollo de políticas en áreas marinas protegidas de Belice, un ejemplo para la gestión integrada de la costa del Caribe

Sustainability science can, through capacity building, allow for integrated stakeholder management of the vital Caribbean marine ecosystems. We did a capacity building exercise in two major coral reef areas in Southern Belize. The key outcome was a six-month personal/professional action plan developed by each participant about tactics for leading, educating and supporting issues regarding sustainable development and tactics for collaboration to influence policy decisions. Our results can be applied across the Caribbean. Rev. Biol. Trop. 62 (Suppl. 3): 287-291. Epub 2014 September 01.

La ciencia de la sostenibilidad puede, a través del desarrollo de capacidades, permitir la gestión integrada de los actores interesados en estos ecosistemas marinos vitales del Caribe. Realizamos un ejercicio de desarrollo de capacidades en dos importantes arrecifes de coral al sur de Belice. El resultado clave fue el desarrollo de un plan de acción personal/profesional de seis meses para cada participante sobre técnicas para liderar, educar y apoyar los problemas acerca del desarrollo sostenible y técnicas para influir en decisiones políticas. Nuestros resultados se pueden ejecutar a lo largo de todo el Caribe.

Anticancer Properties of Novel Rhenium Pentylcarbanato Compounds against MDA-MB- 468(HTB-132) Triple Node Negative Human Breast Cancer Cell Lines.

Aim: To study the efficacy of novel rhenium compounds to treat triple node negative breast cancer. Study Design: Six (6) novel rhenium pentycarbanato compounds (PC1-6) were synthesized and triple node negative breast cancer cell lines HTB-132 and Balb/c mouse kidney cell lines were treated with each of them for 48 hours. The results were analyzed by a common trypan blue cell death assay system and statistically analyzed. Place and Duration: The compounds were synthesized, analyzed and evaluated at the Department of Chemistryof Morgan State University, Baltimore, Maryland and the Pharmaceutical Sciences Department of Elizabeth City State University campus of the University of North Carolina system. Methodology: The novel rhenium compounds were synthesized from one-pot reactions of Re2(CO)10 with the corresponding α-diimine ligands in 1-pentanol.The compounds were characterized spectroscopically. The cell lines were cultured by standard cell culture procedure and treated with each of the six compounds in DMSO for 48 hours with a negative control and a DMSO vehicular control along with a cisplatin positive control.The cytotoxicity was evaluated by standard trypan blue assay and the results were statistically analyzed. Results: The trypan blueassay reveals that these compounds have significant cytotoxicity against MDA-MB-468 (HTB-132) triple node negative breast cancer cell lines and are less nephrotoxic than cisplatin. Conclusion: The novel rhenium compounds PC 1-6 can potentially find applications in the treatment of highly malignant triple node negative breast cancer.

Purinas y ácido úrico en pre-eclampsia: interacciones fisiopatológicas y proyecciones en investigación / Uric acid and purine plasma levels as plausible markers for placental dysfunction in pre-eclampsia

Uric acid is the final metabolite of purine break down, such as ATP, ADP, AMP, adenosine, inosine and hypoxanthine. The metabolite has been used broadly as a renal failure marker, as well as a risk factor for maternal and neonatal morbidity during pre-eclamptic pregnancies. High purine levels are observed in pre-eclamptic pregnancies, but the sources of these purines are unknown. However, there is evidence that pre-eclampsia (mainly severe pre-eclampsia) is associated with an increased release of cellular fragments (or microparticles) from the placenta to the maternal circulation. These in fact could be the substrate for purine metabolism. Considering this background, we propose that purines and uric acid are part of the same physiopathological phenomenon in pre-eclampsia (i.e., placental dysfunction) and could become biomarkers for placental dysfunction and postnatal adverse events.