Emergency Medicine with Advanced Surgery Protocols: A Review.

One of the most burning issues in health system is the concern of handling patients that requires emergency surgery. Emergency general surgery is done on both traumatic and nontraumatic acute disorders. Severe traumatic injury and bleeding is one of the causing agents for high mortality rate globally. Another group of patients that are in need of emergency surgery are those with heart failure, and in this particular paper, we analyzed emergency medicine with advanced surgery protocols focusing on gastric cancer, cardiac surgery, and bleeding as well as coagulopathy following traumatic injury.

Type 2 Diabetes Mellitus (T2DM) and Carbohydrate Metabolism in Relation to T2DM from Endocrinology, Neurophysiology, Molecular Biology, and Biochemistry Perspectives.

Type 2 diabetes mellitus (T2DM) is a severe disease caused by metabolic disorders, particularly carbohydrate metabolism disorders. The disease is a fatal global trouble characterised by high prevalence rates, causing death, blindness, kidney failure, myocardial infarction, amputation of lower limps, and stroke. Biochemical metabolic pathways like glycolysis, gluconeogenesis, glycogenesis, and glycogenolysis are critical pathways that regulate blood glucose levels with the glucokinase (GK) enzyme playing a central role in glucose homeostasis. Any factor that perturbs the aforementioned biochemical pathways is detrimental. Endocrinological, neurophysiological, and molecular biological pathways that are linked to carbohydrate metabolism should be studied, grasped, and manipulated in order to alleviate T2DM global chaos. The challenge, howbeit, is that, since the body is an integration of systems that complement one another, studying one "isolated" system is not very useful. This paper serves to discuss endocrinology, neurophysiology, and molecular biology pathways that are involved in carbohydrate metabolism in relation to T2DM.

A Critical Scrutiny on Liposomal Nanoparticles Drug Carriers as Modelled by Topotecan Encapsulation and Release in Treating Cancer.

The medical field is looking for drugs and/or ways of delivering drugs without harming patients. A number of severe drug side effects are reported, such as acute kidney injury (AKI), hepatotoxicity, skin rash, and so on. Nanomedicine has come to the rescue. Liposomal nanoparticles have shown great potential in loading drugs, and delivering drugs to specific targeted sites, hence achieving a needed bioavailability and steady state concentration, which is achieved by a controlled drug release ability by the nanoparticles. The liposomal nanoparticles can be conjugated to cancer receptor tags that give the anticancer-loaded nanoparticles specificity to deliver anticancer agents only at cancerous sites, hence circumventing destruction of normal cells. Also, the particles are biocompatible. The drugs are shielded by attack from the liver and other cytochrome P450 enzymes before reaching the desired sites. The challenge, however, is that the drug release is slow by these nanoparticles on their own. Scientists then came up with several ways to enhance drug release. Magnetic fields, UV light, infrared light, and so on are amongst the enhancers used by scientists to potentiate drug release from nanoparticles. In this paper, synthesis of liposomal nanoparticle formulations (liposomal-quantum dots (L-QDs), liposomal-quantum dots loaded with topotecan (L-QD-TPT)) and their analysis (cytotoxicity, drug internalization, loading efficiency, drug release rate, and the uptake of the drug and nanoparticles by the HeLa cells) are discussed.

The Use of Bacteria in Cancer Treatment: A Review from the Perspective of Cellular Microbiology.

Cellular microbiology, which is the interaction between harmful microbes and infected cells, is important in the determination of the bacterial infection processes and in the progression of data of different cellular mechanisms. The therapeutic role of bacteria has gained attention since the known methods such as radiation, chemotherapy, and immunotherapy have got drawbacks. Bacteria have demonstrated a favorable impact in treating cancer through eradication of tumors. Bacteria, in cancer treatment, have proven to be promising and have been shown in some of the previous work that it can successfully suppress the growth of tumors. In this paper, we analyzed the difficulties and settlement for using bacteria in cancer therapy as well the mechanisms in which bacteria works in order to achieve tumor eradication. Future works may focus on the use of bacteria along with other treatments in order to achieve effective tumor therapy.

Preparation of PCL Electrospun Fibers Loaded with Cisplatin and Their Potential Application for the Treatment of Prostate Cancer.

Prostate cancer is a global fatal type of cancer. It is a type of cancer that affect men. Signs and symptoms of the disease include blood in the urine, pain when one micturates, and difficulties in penis erection. Cisplatin chemotherapy is a principal treatment normally given to the prostate cancer patients. Nonetheless, on its own, cisplatin loses efficacy once administered due to liver pass effects and other biochemical attacks. In this paper, we looked at preparation of PCL nanoparticles loaded with cisplatin and their potential for the treatment of prostate cancer. PCL nanoparticles protect cisplatin from biochemical attack, thus increasing drug efficacy. Incorporation of P-glycoprotein inhibitors in PCL nanoparticles (NPs) loaded with cisplatin could improve prostate cancer treatment even more.

Biochemical Behaviours of Salmeterol/Fluticasone Propionate in Treating Asthma and Chronic Obstructive Pulmonary Diseases (COPD).

Chronic obstructive pulmonary diseases (COPD) and asthma are fatal. The respiratory tract may be blocked, robbed of the adequate amounts of oxygen; hence, death ensues if a quick medical attention is not provided. The treatment available for the duo are inhaled corticosteroids (ICS). The ICS can work synergically with LABAS (long-acting ß 2-antagonists) and so many other medicines like bronchodilators. The drugs used for the treatment of asthma and COPD are metabolised once in the body system and at the same time exerting the therapeutic effect provided the concentration of the drug is within the therapeutic window. The CYP3A isoforms metabolise the ICS, in this case, salmeterol and fluticasone propionate (FP). Methods of administration are not limited to inhalation. Specific doses are prescribed accurately paying attention to factors like age, gender, race, and genetic makeup since these affect drug metabolisms. Generally, the ICS work by translocating glucocorticoid receptors to the nucleus from the cytosol. The mechanism is potentiated by the ß-antagonists and this brings about an anti-inflammatory effect which is greater than either of the two drugs alone. Once this happens, it is not necessary to increase ICS dose. The ICS, in addition, cause more production of ß-receptors by activating the ß-receptor genes. This mode of action begets the LABAs' bronchodilator-effects. The challenge is that ICS are not limited only to "double" therapy. Analysing such therapies is daunting since coadministration interferes with pharmacology and pharmacokinetics of drugs. This work focuses on salmeterol/fluticasone propionate combination and aspects which has to do with administration, monitoring, metabolism, toxicity, and adverse effects.

Screening for rheumatic heart disease: evaluation of a focused cardiac ultrasound approach.

BACKGROUND: Rheumatic heart disease (RHD) remains a major public health problem worldwide. Although early diagnosis by echocardiography may potentially play a key role in developing active surveillance, systematic evaluation of simple approaches in resource poor settings are needed. METHODS AND RESULTS: We prospectively compared focused cardiac ultrasound (FCU) to a reference approach for RHD screening in a school children population. FCU included (1) the use of a pocket-sized echocardiography machine, (2) nonexpert staff (2 nurses with specific training), and (3) a simplified set of echocardiographic criteria. The reference approach used standardized echocardiographic examination, reviewed by an expert cardiologist, according to 2012 World Heart Federation criteria. Among the 6 different echocardiographic criteria, first tested in a preliminary phase, mitral regurgitation jet length≥2 cm or any aortic regurgitation was considered best suited to be FCU criteria. Of the 1217 subjects enrolled (mean, 9.6±1 years; 49.6% male), 49 (4%) were diagnosed with RHD by the reference approach. The sensitivity of FCU for the detection of RHD was 83.7% (95% confidence interval, 73.3-94.0) for nurse A and 77.6% (95% confidence interval, 65.9-89.2) for nurse B. FCU yielded a specificity of 90.9% (95% confidence interval, 89.3-92.6) and 92.0% (95% confidence interval, 90.4-93.5) according to users. Percentage of agreement among nurses was 91.4%. CONCLUSIONS: FCU by nonexperts using pocket devices seems feasible and yields acceptable sensitivity and specificity for RHD detection when compared with the state-of-the-art approach, thereby opening new perspectives for mass screening for RHD in low-resource settings.

Guía de práctica clínica de la ESC 2014 sobre el diagnóstico y manejo de la miocardiopatía hipertrófica / No disponible

No disponible

A putative placebo analysis of the effects of LCZ696 on clinical outcomes in heart failure.

AIMS: Although active-controlled trials with renin­angiotensin inhibitors are ethically mandated in heart failure with reduced ejection fraction, clinicians and regulators often want to know how the experimental therapy would perform compared with placebo. The angiotensin receptor-neprilysin inhibitor LCZ696 was compared with enalapril in PARADIGM-HF. We made indirect comparisons of the effects of LCZ696 with putative placebos. METHODS AND RESULTS: We used the treatment-arm of the Studies Of Left Ventricular Dysfunction (SOLVD-T) as the reference trial for comparison of an ACE inhibitor to placebo and the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity-Alternative trial (CHARM-Alternative) as the reference trial for comparison of an ARB to placebo. The hazard ratio of LCZ696 vs. a putative placebo was estimated through the product of the hazard ratio of LCZ696 vs. enalapril (active-control) and that of the historical active-control (enalapril or candesartan) vs. placebo. For the primary composite outcome of cardiovascular death or heart failure hospitalization in PARADIGM-HF, the relative risk reduction with LCZ696 vs. a putative placebo from SOLVD-T was 43% (95%CI 34­50%; P < 0.0001) with similarly large effects on cardiovascular death (34%, 21­44%; P < 0.0001) and heart failure hospitalization (49%, 39­58%; P < 0.0001). For all-cause mortality, the reduction compared with a putative placebo was 28% (95%CI 15­39%; P < 0.0001). Putative placebo analyses based on CHARM-Alternative gave relative risk reductions of 39% (95%CI 27­48%; P < 0.0001) for the composite outcome of cardiovascular death or heart failure hospitalization, 32% (95%CI 16­45%; P < 0.0001) for cardiovascular death, 46% (33­56%; P < 0.0001) for heart failure hospitalization, and 26% (95%CI 11­39%; P < 0.0001) for all-cause mortality. CONCLUSION: These indirect comparisons of LCZ696 with a putative placebo show that the strategy of combined angiotensin receptor blockade and neprilysin inhibition led to striking reductions in cardiovascular and all-cause mortality, as well as heart failure hospitalization. These benefits were obtained even though LCZ696 was added to comprehensive background beta-blocker and mineralocorticoid receptor antagonist therapy.

Efficacy of epicardially delivered adipose stroma cell sheets in dilated cardiomyopathy.

AIMS: Few studies have assessed the effects of cell therapy in non-ischaemic cardiomyopathies which, however, contribute to a large number of cardiac failures. Assuming that such conditions are best suited for a global delivery of cells, we assessed the effects of epicardially delivered adipose tissue-derived stroma cell (ADSC) sheets in a mouse model of dilated cardiomyopathy based on cardiac-specific and tamoxifen-inducible invalidation of serum response factor. METHODS AND RESULTS: Three weeks after tamoxifen administration, the function of the left ventricle (LV) was assessed by echocardiography. Twenty-nine mice were then allocated to control (n = 9, non-transgenic), sham (n = 10, transgenic non-treated), and treated (n = 10, transgenic) groups. In the treated group, 3 × 10(6) allogeneic ADSCs were cultured for 2 days onto temperature-responsive polymers and the generated sheets were then transplanted over the surface of the heart. In 10 additional mice, the sheet was made of green fluorescent protein (GFP)-labelled ADSCs to track cell fate. Function, engraftment, and fibrosis were blindly assessed after 3 weeks. In the non-treated group, fractional shortening declined compared with baseline, whereas the sheet application resulted in its stabilization. This correlated with a lesser degree of LV remodelling, as LV end-diastolic and end-systolic diameters did not differ from baseline values. Many GFP(+) cells were identified in the epicardial graft and in the myocardium. Treated animals also displayed a reduced expression of the stress-induced atrial natriuretic factor and beta-myosin heavy chain genes. These protective effects were also accompanied by a reduction of myocardial fibrosis. CONCLUSION: These results strongly suggest the functional relevance of epicardially delivered cell-seeded biomaterials to non-ischaemic heart failure.

First evaluation using a validated scale of the risk of congestive heart failure among hypertensive patients treated by general practitioners (O-PREDICT survey).

BACKGROUND: Routine management of hypertensive adults is based on assessment of risk factors for coronary artery disease; risk factors for heart failure (HF) remain poorly investigated despite the key role of hypertension in HF development. AIM: To assess the components of HF risk in hypertensive adults in primary care, compare physicians' estimations of HF and global cardiovascular risks with established calculation algorithms, and assess the concordance of these algorithms. METHODS: O-PREDICT was a transverse, observational, multicentre French survey conducted in 2006 among general practitioners who included the first hypertensive, non-HF patient seen in each of three age classes (<60, 60-70, >70 years). Estimations of HF and global cardiovascular risks (at 4 and 10 years, respectively) were performed subjectively during the consultation and calculated a posteriori according to algorithms from the Framingham cohort and the European SCORE database, respectively. For each of these methods, patients were stratified into four risk categories (i.e., no, low, moderate, high). RESULTS: One thousand five hundred and thirty seven physicians recruited 4523 patients (61% men; 64.5+/-10.9 years; systolic blood pressure 149.9+/-15.4 mmHg); most (67.2%) patients had one or two cardiovascular/HF risk factors (dyslipidaemia 48.8%, left ventricular hypertrophy 25.3%, diabetes 18.8%, coronary artery disease 8.8%, valvulopathy 6.1%); the number increased with advancing age and in men versus women. According to the Framingham algorithm, the risk of HF (mean 5.4+/-8.5%; 13.4% of patients at high risk) increased with advancing age (p<0.001), nearly doubling for each decade increase. According to the European SCORE system, global cardiovascular risk (mean 5.4+/-4.3%) was moderate or elevated in 48.1% of patients. Concordance between physicians' estimations and theoretical calculations for HF and global risks was poor, as was concordance between algorithms (kappa(w)=0.28, 0.12, 0.11, respectively). CONCLUSION: More than one in 10 hypertensive patients seen in primary care is at high risk of HF at 4 years according to the Framingham model; this algorithm appears to offer additional information to that provided by the SCORE system. Physicians' estimations of risks correlated poorly with algorithm calculations, suggesting that the use of these tools in general practice should be encouraged.

Neuropatia dolorosa isolada: uma variante da doença de Fabry / Isolated painful neuropathy: an atypical variant of Fabry disease

A doença de Anderson-Fabry é uma desordem de acúmulo lisossomial causada por deficiência da enzima alfa-galactosidase A (@-Gal A), relacionada com mutação recessiva no cromossomo X, resultando em acúmulo de glicolípides nas células endoteliais, nas células musculares lisas, nas células periteliais vasculares, e, variavelmente, nos neurônios e células ganglionares. O quadro clínico inicia-se na adolescência, com dores intensas e recorrentes nas extremidades, seguidas por angioceratomas, distrofia corneana, insuficiência renal e comprometimento cardíaco. Pacientes com dosagem de ?-Gal A extremamente baixa tendem a evoluir para óbito ao redor dos 40 anos de idade devido à insuficiência renal, infarto do miocárdio ou acidente vascular cerebral. Comprometimento isolado ou do coração ou do rim está relacionado com dosagem ao redor de 1 a 10% da @-Gal A. Descrevemos um paciente de 63 anos, masculino, apresentando, exclusivamente, acroparestesia dolorosa crônica e intensa, com dosagem não detectável de @-Gal A e comprometimento exclusivo de nervos periféricos, principalmente de fibras finas. Biópsia de pele mostrou ausência de nervos intraepidérmicos. A Doença de Fabry com neuropatia exclusiva é uma variante ainda não descrita.

Anderson-Fabry disease is a lysosomal storage disorder caused by a deficiency of the enzyme alpha-galactosidase (@-Gal A) related to recessive mutation carried on the X chromosome, resulting in glicolipid accumulation in the cytoplasm of endothelial cells, smooth muscle cells, and perithelial cells of blood vessels, and variably in neurons and ganglionic cells. Clinical onset of the disease occurs during adolescence with recurrent episodes of severe pain in the extremities, followed by angiokeratomas, cornea dystrophy, renal insufficiency and cardiac involvement. Patients that have extremely low @-Gal A activity are likely to evolve to death at about 40 years of age due to renal failure, heart attack or brain stroke. We present a 63 year-old man, showing exclusively chronic and severe painful acroparesthesia, with undetectable @-Gal A and exclusive involvement of peripheral nerves, mainly thin fibers. Skin biopsy showed no intraepidermal nerve fibers. Fabry disease manifested with exclusive peripheral neuropathy is a variant not yet described.

[Management of the patient with chronic coronary artery disease]. / Prise en charge du patient coronarien chronique.

All patients with suspected angina need rapidly further cardiological examinations to check the diagnosis and fix the prognosis (at least clinical and risk factor evaluations and a resting ECG). The initial non-invasive strategy should include an echocardiography and a stress test (exercise ECG, stress echocardiography or perfusion scintigraphy), followed, in the majority of cases, by a coronary angiography. Lifestyle changes are mandatory and are fully part of secondary prevention: cigarette smoking withdrawal, mediterranean diet (fruit, vegetables, fish and poultry), weight loss, moderate alcohol consumption, increased omega-3 fatty acids and regular physical activity. Pharmacological therapy of stable coronary artery disease should associate short-acting nitrates (in case of angina), and systematically aspirin and statin. A beta-blocker should be used as a first-line therapy, particularly in the post-infarction setting or in case of left ventricular dysfunction. In case of contraindication, a calcium inhibitor or a long-acting nitrate should be choosen. ACE inhibitors are indicated in patients with left ventricular dysfunction, hypertension or diabetes and should also be considered in high-risk patients. The combination aspirin plus clopidogrel is required for at least one month after insertion of a nude stent, 12 months after an active stent or an acute coronary syndrome.

Long-term efficacy of myoblast transplantation on regional structure and function after myocardial infarction.

BACKGROUND: Transplantation (Tx) of skeletal myoblasts (SM) within an infarcted myocardium improves global left ventricular (LV) function, although a direct systolic effect remains controversial. METHODS AND RESULTS: Global and regional LV functions were studied in a sheep model (n=16) of infarction before (baseline), and 4 (M4), and 12 (M12) months after in-scar injections of autologous SM or culture medium (CM). LV end-diastolic volume (EDV), ejection fraction (EF), wall motion score (WMS), and systolic myocardial velocity gradient (MVG) across the scar were measured by echocardiography with tissue Doppler imaging. Parameters were similar at baseline between groups. At M4, Tx of SM reduced the postinfarction increase in EDV (72+/-8 versus 105+/-13 mL in the CM group, P<0.05) and the decrease in EF (48+/-5 versus 33+/-3% in the CM group, P=0.006) although it improved WMS (5.4+/-1.2 versus 13+/-2.2 in the CM group, P<0.01) and SMVG (0.60+/-0.13 versus -0.04+/-.13 seconds(-1) in the CM group, P<0.05). Results were similar at M12. In-scar accumulation of myotubes and SM were detected in all Tx animals up to M12, with co-expression of fast and slow isoforms of the myosin heavy chain (MHC) (30% of the fibers versus 0% in the normal skeletal muscle) and decreased collagen density (30+/-2% versus 73+/-3%, P<0.0001). CONCLUSIONS: For up to 1 year, Tx of SM limits postinfarction EF deterioration and improves systolic scar function through colonization of fibrosis by skeletal muscle cells with expression of both MHC isoforms, which may confer to the graft the ability to withstand a cardiac-type workload.