Integrated primary healthcare delivery of hypertension and diabetes services: A task analysis of nurses and doctors in Rural Philippines

Objectives@#This study aimed to describe the roles and responsibilities of doctors and nurses in managing conditions like hypertension and diabetes in rural areas.@*Methods@#This study employed a cross-sectional study design using the task analysis methodology. A self-administered questionnaire derived from a national health practice guideline was used. A combination of frequency, criticality, and performance was assessed to identify tasks that needed attention by educators and policymakers.@*Results@#Of the 142 health workers who participated in the study, 81% were nurses and 19% were doctors. The tasks most frequently performed by these professionals were taking vital signs (88.7%), recording patient history (87.3%), and advising patients on regular follow-ups (86.6%). In terms of criticality, the top three tasks were performing diagnostic tests for acute chest pain (50.8%), diagnosing neurological disorders (49.2%), and referring patients for specialized tests at other facilities (43.6%). However, the tasks perceived as most challenging or outside their capability were the Fagerstorm test for assessing nicotine dependence (57.5%), the AUDIT tool for identifying binge drinkers (55.5%), and fundoscopy for diagnosing diabetic retinopathy (54%).@*Conclusion@#The primary care practice of the participants typically involved tasks that are centered on health promotion or disease prevention. Many of the tasks are shared by doctors and nurses, with some highly critical tasks performed less frequently due to a lack of training. Pre-service courses may need to be revised to ensure that health professionals have the required skills to carry out shared tasks.

Evaluating the Effectiveness of Low Pressure Carbon Dioxide as a Hurdle in Raw Milk Storage

Aims: To evaluate the effectiveness of low pressure carbon dioxide as a hurdle in raw milk storage. Study Design: Milk samples were stored at under low pressure carbon dioxide at 29°C for 6 hours and the microbial quality of milk was compared with control milk. Place and Duration of Study: Department of Dairy Microbiology, Verghese Kurien Institute of Dairy and Food Technology (VKIDFT), Kerala Veterinary and Animal Sciences University, Mannuthy between January 2020 and December 2020. Methodology: Milk samples were collected from an organized farm. The initial microbial quality of milk was determined and samples were carbonated to a pressure of 20 psi and stored for six hours 29°C, uncarbonated milk sample kept at 29°C acted as the control. The microbial quality of the carbonated milk and uncarbonated milk was determined after storage in terms of total viable count, coliform count and gram negative organism count. Results: Significant growth suppression (P=0.05) of bacteria was observed in the carbonated milk. Total Viable count showed a suppression of 1.05 log cfu/ml while coliforms showed a suppression of 1.3 log cfu/ml. The greatest log reduction was observed in gram negative organisms with a difference of 2.2 log cfu/ml and psychrotrophic organisms with 1.54 log cfu/ml. Conclusion: Carbon dioxide was found to be an effective bacteriostatic agent which could be used for extending the keeping quality of raw milk. The bacteriostatic action could be due to anaerobic conditions developed by carbon dioxide and also due to the increased acidity of the medium.

Coping and well-being of school-aged children in a quarantined environment during the COVID- 19 pandemic

BACKGROUND@#School-aged children bear a lot of difficulties and discomforts brought about by the new normal during the COVID-19 pandemic.@*OBJECTIVES@#This study aimed to examine the general well-being of children during the pandemic, how the children are coping with all the challenges, and parents' strategies to help their children cope@*METHODOLOGY@#This study utilized a descriptive correlational research design with purposive sampling. Data was collected through an online survey. The standardized Kidcope-Child version was utilized to measure children's coping, while the Pediatric Quality of Life Inventory (PedsQL)™ 4.0 Short Form 15 Generic Core Scales was utilized to measure the children's well-being.@*RESULTS@#A total of 134 parents participated in the study. No significant relationship was found between the age, sex, and coping strategies of the children, as well as between the age and well-being of children. Male children experienced more difficulty in physical functioning (p-value= 0.028), social functioning (p-value= 0.017), and overall well-being (p-value= 0.031) compared to female children. The computed mean for parents' helping strategies was between 2.67 to 2.78, which lies between the categories of sometimes (2) to always (3).@*CONCLUSION@#School-aged children were found to be using more positive coping strategies than negative coping strategies during the pandemic. They have “sometimes” to “almost no” experience of difficulty in terms of the five functions of well-being. Parents used the six fundamental tasks of parenting to help their children cope.

Isolation of Klebsiella pneumoniae and Acinetobacter radioresistens from Dish Wash Scrubbers

Aims: To identify predominant microorganisms in dish washing scrubbers collected from ten different sources. Study Design: Collection of dish wash scrubbers from different sources, pour plating of appropriately prepared dish wash scrub suspensions and subsequent isolation and identification of predominant isolates. Assessment of antibiotic susceptibility of the selected isolates by disc diffusion assay. Place and Duration of Study: April, 2018 - June 2018. Methodology: A total of 10 dish wash scrubbers (synthetic green scrubber pads free from any anti-bacterial preservatives belonging to the same brand) were collected from various sources. Appropriately prepared dish wash scrub suspensions in peptone water were pour plated on Plate Count Agar (PCA) and MacConkey agar. Predominant colonies selected from the plates based on the colony morphology were subjected to Grams staining, catalase, oxidase, indole, citrate, urease tests and genotypic identification by 16S ribosomal RNA sequencing. The identified isolates were tested for their susceptibility to eight antibiotics by disc diffusion method. Results: Irrespective of the sample source, most of the dish wash scrubbers sampled harbored similar types of colonies. From the colonies obtained two of them were identified by 16S rRNA sequencing and subsequent blasting as Klebsiella pneumoniae and Acinetobacter radioresistens. The isolates were deposited in the NCBI database with accession numbers MK032217 (Klebsiella pneumoniae RSV02) and MK032134 (Acinetobacter radioresistens RSV 01). These isolates were tested for their susceptibility to different antibiotics and Acinetobacter radioresistens RSV 01 was found to be more antibiotic susceptible than Klebsiella pneumoniae RSV02. Conclusion: Observations of this study confirm the potential role of dish wash scrubbers as vehicle for potential pathogens and their ability to act as cross contaminating agents in food processing environments.

Influence of apical preparation size and final irrigation protocol on the debridement of oval root canals

Abstract This study assessed the influence of apical preparation size and final irrigation protocol on the debridement of the apical third of oval root canals of mandibular molars. Seventy-seven distal roots were divided into 7 groups (n = 11): Control: without instrumentation or irrigation; Group 30CI: ProTaper Next (up to size 30; PTN) + conventional irrigation (CI); Group 30UAI: PTN + ultrasonically activated irrigation (UAI); Group 30XPF: PTN + XP-endo Finisher (XPF); Group 40CI: PTN + ProDesign Logic (up to size 40; PDL) + CI; Group 40UAI: PTN + PDL + UAI; and Group 40XPF: PTN + PDL + XPF. The total volume of irrigating solutions used per root canal in all the experimental groups was 33 mL of 2.5% sodium hypochlorite (NaOCl) and 6 mL of 17% ethylenediaminetetraacetic acid (EDTA). After specimen processing and histological analysis under a digital microscope (100x), the percentages of untouched canal walls (UCW) and remaining debris (RD) were assessed using Image J software. A descriptive and exploratory analysis was conducted, indicating that the data failed to meet the assumptions of an analysis of variance. Therefore, generalized linear models were used to assess the effects of the different instrumentation and irrigation protocols, as well as the interaction among them, on the percentage of UCW and RD. No significant difference was found among the irrigation protocols regarding the percentage of UCW, irrespective of apical preparation size (p>0.05). However, UCW and RD were significantly lower in groups 40CI, 40UAI and 40XPF than in groups 30CI, 30UAI and 30XPF (p<0.05). The percentage of RD was significantly lower in the UAI and XPF groups than in the CI groups, irrespective of apical preparation size (p<0.05). The difference between preparation sizes 30 and 40, with respect to RD, was higher when CI was used (p<0.05). In conclusion, instrumentation up to apical preparation size 40 resulted in lower percentages of UCW and RD than up to apical preparation size 30. Use of UAI or XPF resulted in lower percentages of RD than CI.

Resumo Este estudo avaliou a influência do tamanho do preparo apical e do protocolo de irrigação final sobre o debridamento do terço apical de canais radiculares ovais de molares inferiores. Setenta e sete raízes distais foram selecionadas e divididas em 7 grupos (n = 11): Grupo controle: sem instrumentação nem irrigação; Grupo 30IC, ProTaper Next (até o tamanho 30; PTN) + irrigação convencional (IC); Grupo 30IAU, PTN + irrigação ativada ultrassonicamente (IAU); Grupo 30XPF, PTN + XP-endo Finisher (XPF); Grupo 40IC, PTN + ProDesign Logic (até o tamanho 40; PDL) + IC; Grupo 40IAU, PTN + PDL + IAU; e Grupo 40XPF, PTN + PDL + XPF. Os volumes totais dos irrigantes utilizados por canal radicular em todos os grupos experimentais foram 33 mL de hipoclorito de sódio (NaOCl) a 2,5% e 6 mL de ácido etilenodiamino tetracético (EDTA) a 17%. Após o processamento dos espécimes e a análise das secções histológicas sob um microscópio digital (100x), as porcentagens de paredes não instrumentadas (PNI) e detritos remanescentes (DR) foram avaliadas utilizando-se o software Image J. Uma análise descritiva e exploratória foi realizada, indicando que os dados não atenderam aos pressupostos de uma análise de variância. Modelos lineares generalizados foram, portanto, utilizados para avaliar os efeitos dos diferentes protocolos de instrumentação e irrigação, bem como da interação entre eles, sobre as porcentagens de PNI e DR. Não houve diferença significativa entre os protocolos de irrigação final quanto à porcentagem de PNI, independentemente do tamanho do preparo apical (p>0,05). Entretanto, as porcentagens de PNI e DR foram significativamente menores nos grupos 40IC, 40IAU e 40XPF do que nos grupos 30IC, 30IAU e 30XPF (p<0,05). A porcentagem de DR foi significativamente menor nos grupos em que se utilizou a IAU ou o XPF do que naqueles em que se utilizou a IC, independentemente do tamanho do preparo apical (p<0,05). A diferença entre os tamanhos de preparo apical 30 e 40 com relação aos DR foi maior quando se utilizou a IC (p<0,05). Concluiu-se que a instrumentação até um preparo apical de tamanho 40 resultou em menores porcentagens de PNI e DR do que até um preparo apical de tamanho 30. A utilização da IAU ou do XPF resultou em uma menor porcentagem de DR do que a utilização da IC.

Resident involvement in the prostatic urethral lift: implementing innovative technology in an academic setting / 亚洲男科学杂志(英文版)

Adoption of the prostatic urethral lift (PUL) as a treatment for benign prostatic hyperplasia highlights the importance of training residents with novel technology without compromising patient care. This study examines the effect of resident involvement during PUL on patient and procedural outcomes. Retrospective chart review was conducted on all consecutive PUL cases performed by a single academic urologist between October 2017 and November 2019. Trainees in post-graduate year (PGY) 1-3 are considered junior residents, while those in PGY 4-6 are senior residents. The International Prostate Symptom Score (IPSS) and quality of life (QOL) scores were used to measure outcomes. Simple and mixed-effects linear regression models were used to compare differences. There were 110 patients with a median age of 66.4 years. Residents were involved in 73 cases (66.4%), and senior residents were involved in 31 of those cases. Resident involvement was not associated with adverse perioperative outcomes with respect to the number of implants fired, the percentage of implants successfully placed, or the postoperative catheterization rate. After adjustment for confounding factors, junior residents were associated with significantly longer case length compared to the attending alone (+12.6 min, P = 0.003) but senior residents were not (+2.4 min, P = 0.59). IPSS and QOL scores were not significantly affected by resident involvement (P = 0.12 and P = 0.21, respectively). The presence of surgeons-in-training, particularly those in the early stages, prolongs PUL case length but does not appear to have an adverse impact on patient outcomes.

Inteligência artificial: novas soluções para velhos problemas / Artificial intelligence and dysphagia: novel solutions to old problems

ABSTRACT Dysphagia management, from screening procedures to diagnostic methods and therapeutic approaches, is about to change dramatically. This change is prompted not solely by great discoveries in medicine or physiology, but by advances in electronics and data science and close collaboration and cross-pollination between these two disciplines. In this editorial, we will provide a brief overview of the role of artificial intelligence in dysphagia management.

A comparative study on concurrent chemoradiation using cisplatin versus carboplatin in the management of locoregionally advanced non-small cell lung cancer

Background: Concurrent chemoradiation is considered the standard care for locoregionally advanced non-small cell lung cancer. This study aimed to compare the treatment response, progression free survival and treatment toxicities between cisplatin and carboplatin based concurrent chemoradiation.Methods: Between October 2015 and September 2017, 60 eligible patients were enrolled and divided into two arms of 30 patients each. Arm A received EBRT to chest (60Gy/30 fractions) with concurrent weekly Injection Cisplatin 35mg/m2. Arm B received EBRT to chest (60Gy/30 fractions) with concurrent weekly Injection Carboplatin at a dose of AUC-2. Early treatment response was assessed at 1 month and late treatment response at 6 months after completion of radiation using RECIST criteria. Treatment toxicities was assessed using RTOG toxicity criteria. All statistical analysis was carried out using SPSS version 21.Results: Most patients were in the age range of 61-70 years. Mean age of presentation was 67.53±11.038 years in Arm A and 66.03±12.794 years in Arm B. Median follow up was 16 months for both arms. Response rate of was slightly better in Arm A (73.3% versus 60%). 1 year PFS rate was 53.33% in Arm A and 36.67% in Arm B. Median time to progression was better in Arm A (11 months vs 10 months). Toxicities were almost comparable in both the arms.Conclusions: Use of carboplatin in combination with radiation therapy is comparable to cisplatin in terms of treatment outcomes with better compliance and lower toxicity.

Perspectives on the clinical development of immunotherapy in prostate cancer / 亚洲男科学杂志(英文版)

Despite impressive survival benefits with immunotherapy in patients with various solid tumors, the full potential of these agents in prostate cancer has yet to be realized. Sipuleucel-T demonstrated a survival benefit in this population, indicating that prostate cancer is an immunoresponsive disease; however, these results have not been matched by other agents. A large trial with ipilimumab in prostate cancer failed to meet its primary objective, and small trials with PD-1/PD-L1 inhibitors did not yield a significant improvement in overall response. However, several late-stage clinical trials are underway with other vaccines in prostate cancer. Reports of clinical benefit with immunotherapies, particularly when used in combination or a select population, have provided the framework to develop sound clinical trials. Understanding immunogenic modulation, antigen spread, biomarkers, and DNA-repair defects will also help mold future strategies. Through rational patient selection and evidence-based combination approaches, patients with prostate cancer may soon derive durable survival benefits with immunotherapies.

Assessment of aflatoxin M1 in breast milk of lactating mothers in Papua New Guinea

@#Aflatoxin M1 (AFM1) is a secondary metabolite in the breast milk of lactating mothers who consume foodstuffs infected by the fungi Aspergillus flavus and Aspergillus Parasiticus. The concentration of AFM1 in breast milk of lactating mothers is of major public health concern, because it can negatively affect the health of their babies. The major objective of this study was to assess the AFM1 concentration in the breast milk of lactating mothers in Papua New Guinea (PNG). This was a prospective cross-sectional study carried out between 2011 and 2015 in three of the four Regions in PNG: the National Capital District (NCD) in the Southern Region; Eastern Highlands (EHP) and Western Highlands (WHP) provinces in the Highlands Region; and East New Britain (ENB) and Manus provinces in the Islands Region. The Susu Mama, Well-Baby and Paediatric clinics in the General Hospitals in each of the selected provinces in the three regions were the primary sites for this study. A solid phase competitive Enzyme-Linked Immunosorbent Assay (ELISA 96 Microwell plates) was used for the quantification of AFM1 in breast milk from consented lactating mothers. A total of 874 lactating mothers and their babies participated in this study. The mean age of the mothers was 28.0 ±5.5 years. The age range of all the babies was 2 to 6 weeks. 76.1% (665/874) of all breast milk samples analyzed had detectable levels of AFM1. The concentration of AFM1 was above 10.00ppt in 89 (10.2%) of the 874 breast milk samples (which, according to the Australia / New Zealand / Austria safe cut-off limits for AFM1, makes them unsafe for consumption by the babies). The mean AFM1 concentration in the breast milk samples from lactating mothers in EHP (7.99ppt) was higher than that in the samples from the other 4 provinces in the present study. AFM1 concentration was above 10.00ppt in 14 (4.6%) of the 300 breast milk samples from NCD, in 62 (31.0%) of the 200 samples from EHP, in 10 (4.5%) of the 220 samples from ENB and in 3 (3.0%) of the 100 samples from WHP. In order to reduce the AFM1 concentrations in breast milk of lactating mothers, basic nutrition education, aggressive advocacy, social mobilization, awareness campaigns, including communication with all relevant target groups and the relevant policy makers are urgently required.

Melanomes malins primitifs anorectaux

Le melanome malin primitif anorectal represente 0;5 a 1 de toutes les tumeurs de cette region. C'est une pathologie agressive avec un pronostic souvent reserve. La rarete de cette localisation de melanome malin nous a pousses a en faire le point a partir des observations marocaines

Anterior Lumbar Interbody Fusion: Two-Year Results with a Modular Interbody Device

STUDY DESIGN: Retrospective case series. PURPOSE: To present radiographic outcomes following anterior lumbar interbody fusion (ALIF) utilizing a modular interbody device. OVERVIEW OF LITERATURE: Though multiple anterior lumbar interbody techniques have proven successful in promoting bony fusion, postoperative subsidence remains a frequently reported phenomenon. METHODS: Forty-three consecutive patients underwent ALIF with (n=30) or without (n=11) supplemental instrumentation. Two patients underwent ALIF to treat failed posterior instrumented fusion. The primary outcome measure was presence of fusion as assessed by computed tomography. Secondary outcome measures were lordosis, intervertebral lordotic angle (ILA), disc height, subsidence, Bridwell fusion grade, technical complications and pain score. Interobserver reliability of radiographic outcome measures was calculated. RESULTS: Forty-three patients underwent ALIF of 73 motion segments. ILA and disc height increased over baseline, and this persisted through final follow-up (p4 mm occurred in 12% of patients. There were eight surgical complications (19%): one major (reoperation for nonunion/progressive subsidence) and seven minor (five subsidence, two malposition). CONCLUSIONS: The use of a modular interbody device for ALIF resulted in a high rate of radiographic fusion and a low rate of subsidence. The large endplate and modular design of the device may contribute to a low rate of subsidence as well as maintenance of ILA and lordosis. Previously reported quantitative radiographic outcome measures were found to be more reliable than qualitative or categorical measures.

Spatial distribution of Guaiacum sanctum (Zygophyllaceae) seedlings and saplings relative to canopy cover in Palo Verde National Park, Costa Rica / Distribución espacial de Guaiacum sanctum (Zygophyllaceae) en relación con la cobertura de dosel en el Parque Nacional Palo Verde, Costa Rica

The spatial distribution of individuals is a fundamental property of most species and constitutes essential information for the development of restoration and conservation strategies, especially for endangered plant species. In this paper we describe the spatial distribution of different size classes of the endangered tropical tree Guaiacum sanctum and the effect of canopy cover on spatial aggregation. Adult G. sanctum were located and mapped in a 50ha plot in Palo Verde National Park, Costa Rica. Seedlings, saplings and juveniles were mapped to the nearest centimetre and permanently marked in three 50x50m subplots. Within each subplot spatial aggregation was assessed using Ripley’s K statistic and canopy opening readings were performed every 5m using a densitometer. Kriging spatial interpolation and Monte Carlo simulations were used to determine if average canopy cover differed among size classes. Individuals of G. sanctum were spatially aggregated at all size classes with seedlings being the most frequent size class in all subplots. Seedlings were found predominantly in areas with significantly higher canopy cover. In contrast, juveniles were more likely found in areas with higher light availability. The high number of seedlings, saplings, and juveniles relative to adults suggests that populations of G. sanctum in PVNP are expanding. Light availability and canopy structure are important factors shaping the spatial distribution of this species. The contemporary demographic structure of G. sanctum is dependent on forest gap dynamics and changes in human disturbance during the past 25 years.

La distribución espacial es una característica fundamental de las especies y es importante para el desarrollo de estrategias de conservación y manejo. Aquí presentamos la distribución espacial de varias etapas de desarrollo del árbol tropical Guaiacum sanctum, una especie en vías de extinción. Todos los adultos de G. sanctum se geo-referenciaron en una parcela de 50ha en el Parque Nacional Palo Verde. Las plántulas, los briznales y juveniles se mapearon en tres sub-parcelas de 50x50m. En cada sub-parcela se estimó la agregación espacial de los individuos mediante la K de Ripley. Observamos que los individuos de G. sanctum se encuentran siempre agregados, sin importar en que etapa de desarrollo se encuentren. Registramos la apertura del dosel cada 5m con un densiómetro y mediante una extra-polación espacial (Krigin) determinamos que las plántulas se agregan con mayor frecuencia en áreas con abundante cobertura de dosel, mientras que es más probable encontrar juveniles agregados en áreas con una mayor incidencia de luz. Las plántulas son los individuos más abundantes, esta distribución de edades nos sugiere que esta población probablemente está en expansión. Concluimos que el régimen lumínico y la cobertura de dosel son factores que afectan significativamente la distribución espacial del Guayacán Real.

Pesticide exposure during pregnancy and low birth weight.

Background: Limited epidemiologic studies have investigated the effects of pesticide exposure during pregnancy on low birth weight in offspring in rural China. Methods: A survey of a total of 503 women was conducted in Ling county of Shandong Province of China following delivery from 1 November 2009 to 8 February 2010. Results: After adjustment for confounding and compared with no pesticide exposure, multiple logistic regression showed a non-significant increased likelihood of low birth weight for both children of mothers exposed to pesticides when not pregnant (OR = 1.80, 95% CI: 0.62, 5.22) and mothers exposed to pesticides during pregnancy (OR = 2.42, 95% CI: 0.73, 8.08); multiple linear regression showed a non-significant reduced birth weight for both children of mothers exposed to pesticides when not pregnant (β=–0.59, p=0.28) and mothers exposed to pesticides during pregnancy (β=–0.89, p=0.15). Conclusions: Exposure to pesticides during pregnancy was associated with a non-significant increase in low birth weight in this rural Chinese population. Future studies using larger sample sizes and longer follow-up periods are warranted.

Factors affecting the internal brain drain of Saudi healthcare professionals

To investigate factors affecting the internal brain drain of healthcare professionals in the Kingdom of Saudi Arabia. A cross-sectional study was conducted using an anonymous self-administered online questionnaire sent to all Saudi students enrolled in healthcare profession programs in North America. The data was collected between January and March 2008 at the University of Illinois at Chicago, Chicago, Illinois, United States of America. Results were analyzed using logistic regression analyses. A total of 377 completed questionnaires were returned. Results revealed that 71% of respondents intended to return to work within the 2 major urban cities [Riyadh and Jeddah]. Respondents who completed their undergraduate studies in a large city were more likely to work in the same city [odds ratio [OR]=3.2; p=0.000; 95% confidence interval [CI] = 2.0-5.2]. Furthermore, 51% of the students were willing to work in a rural area for a 50% or more increase in their salary. Finally, men were more willing to work in a rural area for a financial incentive [OR=2.3; p=0.006, 95% CI = 1.3-4.3]. This study suggests that realistic financial incentives would probably not suffice to attract Saudi healthcare providers to rural areas. The provision of medical schools in smaller cities and rural areas is predicted to be a more effective method for improving the current maldistribution of healthcare providers

Unusual, metastatic, or neuroendocrine tumor of the pancreas: a diagnosis with endoscopic ultrasound-guided fine-needle aspiration and immunohistochemistry

To determine the yield of endoscopic ultrasound-guided fine-needle aspiration [EUS-FNA] in combination with immunostains in diagnosing unusual solid pancreatic masses [USPM] in comparison with pancreatic adenocarcinoma [ACP]. All EUS-FNA of solid pancreatic masses performed with a 22-gauge needle were included. Data on clinical presentations, mass characteristics, presence of pancreatitis, yield of tissue, and final diagnosis were compared between the two groups. On site cytopathology was provided and additional passes were requested to perform immunostains. Two hundred and twenty-nine cases with either adenocarcinoma or USPM were included. The median age of the cohort was 65 years. ACP [210/229, 92%] accounted for the majority of the cases. The USPM included neuroendocrine [NET] masses [n=13], metastatic renal carcinoma [n=3], metastatic melanoma [n=l], lymphoma [n=l], and malignant fibrous histiocytoma [n=l]. Subjects with ACP were significantly more likely to present with loss of weight [P=0.02] or obstructive jaundice [P<0.001]. Subjects with ACP were more likely to have suspicious/atypical FNA biopsy results as compared with USPM [10% vs 0%]. The sensitivity of EUS-FNA with immunostains was 93% in ACP as compared with 100% in USPM. Diagnostic accuracy was higher in USPM as compared with ACP [100% vs 93%]. EUS-FNA using a 22-gauge needle with immunostains has excellent diagnostic yield in patients with USPMs, which is comparable if not superior to the yield in pancreatic adenocarcinoma

For an International Decade of the Mind

The International Decade of the Mind Project seeks to harness science across multiple disciplines to discover how human “mind” emerges from the biological activity of human brains. Given the complexity of the human brain, with approximately 1011 neurons each with 104 connections, the effort will be daunting and require resources and expertise from many nations. The Decade of the Mind Project began as a United States initiative in 2007 and expanded to Europe in 2009 and then Asia in 2010. Here we advocate for a team-based approach to the Decade of the Mind initiative, where each nation contributes to the overall scientific effort with its own indigenous scientific expertise.

Multigenerational inheritance and clinical characteristics of three large pedigrees with early-onset type 2 diabetes in Jamaica / Herencia multigeneracional y características clínicas de la diabetes tipo 2 de inicio temprano en tres árboles genealógicos grandes de Jamaica

OBJECTIVE: To document the existence and clinical characteristics of three large families with multigenerational inheritance of early-onset type 2 diabetes in Jamaica. METHODS: Three probands from large families with multigenerational inheritance of early-onset type 2 diabetes in at least three generations were detected at the University Hospital of the West Indies in Jamaica. Each proband at the time of diagnosis was < 25 years of age, was lean, and did not require insulin therapy. Clinical, metabolic, and genetic assessments were undertaken to profile the diabetes in the three families. RESULTS: Three pedigrees-BK, SU, and CA-consisting of 38, 48, and 113 members, respectively, with multigenerational inheritance of early-onset type 2 diabetes in at least three generations, were investigated. The mean age at diagnosis of the three pedigrees was 31.5 ± 2.9 years, with 10 persons detected below 25 years of age. Findings suggestive of overweight, insulin resistance, low insulin secretion, dyslipidemia, and mild intra-abdominal obesity were present. Islet cell antibodies and sequence variants in MODY1 to -6 genes were absent. CONCLUSIONS: Large families demonstrating multigenerational inheritance of diabetes and other characteristics consistent with early-onset type 2 diabetes are present in the Jamaican population.

OBJETIVO: Documentar la presencia de herencia multigeneracional de la diabetes de tipo II de inicio temprano en tres familias jamaiquinas grandes y describir sus características clínicas. MÉTODOS: En el Hospital Universitario de West Indies en Jamaica, se detectaron tres probandos de familias grandes en las que se observó herencia multigeneracional de la diabetes tipo 2 de inicio temprano en al menos tres generaciones. Al momento del diagnóstico, cada probando tenía # 25 años de edad, era delgado y no necesitó insulinoterapia. Se emprendieron estudios clínicos, metabólicos y genéticos con el fin de determinar las características particulares de la diabetes que presentan estas tres familias. RESULTADOS: Se investigaron tres árboles genealógicos -BK, SU y CA- conformados por 38, 48 y 113 miembros, respectivamente. Cada árbol presentaba herencia multigeneracional de diabetes tipo 2 de inicio temprano en al menos tres generaciones. En los tres árboles genealógicos, la media de la edad al momento del diagnóstico fue de 31,5 ± 2,9 años y 10 personas tenían menos de 25 años. Se observaron signos indicativos de sobrepeso, resistencia insulínica, baja secreción de insulina, dislipidemia y obesidad intrabdominal leve. No se hallaron anticuerpos contra las células de los islotes ni variantes en la secuencia de los genes MODY1 a MODY6. CONCLUSIONES: Algunas familias grandes de la población jamaiquina presentan herencia multigeneracional de la diabetes y otras características indicativas de diabetes tipo 2 de inicio temprano.

Towards the design of new and improved drilling fluid additives using molecular dynamics simulations

During exploration for oil and gas, a technical drilling fluid is used to lubricate the drill bit, maintain hydrostatic pressure, transmit sensor readings, remove rock cuttings and inhibit swelling of unstable clay based reactive shale formations. Increasing environmental awareness and resulting legislation has led to the search for new, improved biodegradable drilling fluid components. In the case of additives for clay swelling inhibition, an understanding of how existing effective additives interact with clays must be gained to allow the design of improved molecules. Owing to the disordered nature and nanoscopic dimension of the interlayer pores of clay minerals, computer simulations have become an increasingly useful tool for studying clay-swelling inhibitor interactions. In this work we briefly review the history of the development of technical drilling fluids, the environmental impact of drilling fluids and the use of computer simulations to study the interactions between clay minerals and swelling inhibitors. We report on results from some recent large-scale molecular dynamics simulation studies on low molecular weight water-soluble macromolecular inhibitor molecules. The structure and interactions of poly(propylene oxide)-diamine, poly(ethylene glycol) and poly(ethylene oxide)-diacrylate inhibitor molecules with montmorillonite clay are studied.

Durante a exploração de óleo e gás um fluido de perfuração é usado para lubrificar 'bit' da perfuradora, manter a pressão hidrostática, transmitir sensores de leitura, remover resíduos da rocha e inibir o inchamento da argila instável baseada nas formações dos folhelhos. O aumento das preocupações ambientais bem como a legislação resultante levou à procura de novos fluidos de perfuração com componentes biodegradáveis. No caso dos aditivos para inibir o inchamento das argilas o entendimento das interações entre os aditivos e as argilas tem que ser adquirido para permitir o projeto de moléculas commelhores propriedades. Devido à natureza desordenada da dimensão nanoscópica dos nano poros dos minerais argilosos, simulações computacionais têm se tornado uma ferramenta poderosa para estudar as interações entre o inchamento da argila e o inibidor. Neste trabalho revisamos brevemente o histórico do desenvolvimento de fluidos técnicos de perfuração, o impacto ambiental dos fluidos de perfuração e o uso de simulações computacionais para estudar as interações entre os fluidos de perfuração e os inibidores do inchamento. Nós reportamos resultados para alguns estudos baseados em simulações de dinâmica molecular em larga escala em uma solução aquosa de baixo peso molecular com solutos compostos por macromoléculas inibidoras. A estrutura e as interações entre inibidores compostos por polipropileno óxido, polietileno óxido e moléculas e a argila montmorilonita são estudadas.

The GABA A-Receptor 2 (GABRG2) Gene in obsessive-compulsive disorder / O gene do receptor GABA A-2 (GABRG2) no transtorno obsessivo-compulsivo

OBJECTIVE: The γ-aminobutyric acid type A (GABA A) system may be implicated in obsessive-compulsive disorder, based on its major role in modulation of anxiety and its function as the principal inhibitory neurotransmitter system in the cortex. In addition, glutamatergic/GABAergic mechanisms appear to play a role in the pathophysiology of obsessive-compulsive disorder, making the GABA A receptor-γ2 (GABργ2) gene a good candidate for susceptibility in this disorder. METHOD: 118 probands meeting DSM-IV criteria for primary obsessive-compulsive disorder and their available parents were recruited for participation in this study and informed consent was obtained. An NciI restriction site polymorphism in the second intron was genotyped and data was analyzed using the Transmission Disequilibrium Test. RESULTS: In total, 61 of the participating families were informative (i.e., with at least one heterozygous parent). No biases were observed in the transmission of either of the two alleles (χ2 = 0.016, 1 d.f., p = 0.898) to the affected probands in the total sample. CONCLUSION/DISCUSSION: While these results do not provide support for a major role for the GABA A receptor-γ2 in obsessive-compulsive disorder, further investigations of this gene in larger samples are warranted.

OBJETIVO: O sistema gabaérgico tipo A (GABA A) pode estar implicado no transtorno obsessivo-compulsivo devido ao seu grande papel na modulação da ansiedade e da sua função como o principal neurotransmissor inibidor no córtex. Além disso, mecanismos glutamatérgicos/gabaérgicos parecem desempenhar um papel na fisiopatologia do transtorno obsessivo-compulsivo, tornando o gene do receptor GABA A-γ2 (GABRG2) um bom gene candidato para a suscetibilidade genética a este transtorno. MÉTODO: 118 probandos que preencheram os critérios do DSM-IV para transtorno obsessivo-compulsivo primário e seus pais (quando disponíveis) foram recrutados para a participação neste estudo; consentimento informado foi obtido. Um polimorfismo no sítio de restrição da enzima NciI, localizado no íntron 2, foi genotipado e os dados foram analisados utilizando-se o Teste de Desequilíbrio de Transmissão. RESULTADOS: No total, 61 das famílias participantes foram informativas (ou seja, com pelo menos um progenitor heterozigoto). Não foi observado desequilíbrio de transmissão de qualquer um dos dois alelos (χ2 = 0,016, 1 g.l., p = 0,898) aos probandos afetados. CONCLUSÃO/DISCUSSÃO: Apesar de estes resultados não fornecerem suporte para um papel importante para o gene GABA A-γ2 no transtorno obsessivo-compulsivo, novas investigações desse gene em amostras maiores são justificadas.