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1.
Pak J Biol Sci ; 25(3): 218-225, 2022 Jan.
Article in English | MEDLINE | ID: mdl-35234012

ABSTRACT

<b>Background and Objective:</b> The association of rs7903146 polymorphism of TCF7L2 gene with Type 2 diabetes mellitus found almost in all ethnic groups. Therefore, the current study focused on estimating this association in the Azerbaijan population for the 1st time. <b>Materials and Methods:</b> A study was conducted on 110 patients with Type 2 diabetes mellitus and 115 healthy controls. The biochemical parameters were analyzed and calculated with an independent t-test and Fisher exact test. DNA extracted from the blood samples run in PCR. PCR was used to detect the presence of TCF7L2 rs7903146 C/T polymorphism and the products of the PCR were visualized in a 1.5% gel electrophoresis. <b>Results:</b> According to the obtained data, T allele and TT genotype of rs7903146 polymorphism strongly correlated with the risk for Type 2 diabetes (odds ratio of 1.68 for T allele and p = 0.007, odds ratio of 3.9 for TT genotype, p = 0.0028). These results were adjusted by applying the recessive model (p = 0.003). Moreover, the biochemical parameters also show a significant difference in the fasting glucose level (p = 0.0001), fasting insulin (p = 0.0001), BMI (p = 0.0002) and age (p = 0.015) inpatient and control groups. <b>Conclusion:</b> Based on the results, the TCF7L2 rs7903146 (C>T) polymorphism is the genetic risk factor related to Type 2 diabetes in the Azerbaijan population.


Subject(s)
Diabetes Mellitus, Type 2 , T Cell Transcription Factor 1 , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/genetics , Gene Frequency , Genetic Predisposition to Disease , Genotype , Humans , Polymorphism, Genetic , Polymorphism, Single Nucleotide , T Cell Transcription Factor 1/genetics , Transcription Factor 7-Like 2 Protein/genetics
2.
Eur J Health Law ; : 1-18, 2021 Oct 22.
Article in English | MEDLINE | ID: mdl-34706327

ABSTRACT

Significant changes in the field of Azerbaijan's healthcare legislation came just at the time when the coronavirus (COVID-19) pandemic broke out in the world. The end of 2019 was supposed to lay the groundwork for the introduction of the country's long-awaited health insurance - a landmark change in terms of national healthcare transformation; although the Law 'On health insurance' was adopted in the 1990s, its implementation was per se frozen for many years due to various reasons. Therefore, the pandemic complicated the process even more. It also coincided with significant updates of the Law 'On human organs and tissues donation and transplantation', which comes into force in 2022, and legislation related to disability. Thus, this paper focuses on recent changes in healthcare legislation; analyses system of health insurance, updated transplantation and disability laws. It gives an overview of the developments that accompany the process of legislation transformation.

3.
Heliyon ; 7(5): e06946, 2021 May.
Article in English | MEDLINE | ID: mdl-34027160

ABSTRACT

Exploration and determination of the hydro-geo-electrical characteristics of an aquifer can be done by applying the forward (initial multi-layers), and the inverse (final layered) models for interpreting the DC-resistivity (VES) and TEM data. So, 22 VES using Schlumberger configuration (AB/2 = 500-700m) and 12 TEMS using in-loop configuration (square, ℓ = 200m) were carried out at the West El-Minia selected area for studying the Oligocene Clastic and Carbonate aquifers. VESs were interpreted for studying the shallow resistive and conductive layers, as well as faults delineation. TEMs were interpreted for shallow and deep conductive layers discrimination. The VES and TEM inverse models were examined with the drilling data and construed the subsurface into four units; dry Oligocene Clastics (173-467 Ω.m), dry limestone (273-374 Ω.m), saturated Oligocene Clastics (Oligocene aquifer) (2-107 Ω.m), then saturated fractured Eocene limestone to shaly limestone (5-188 Ω.m). Groundwater depths (62-131m) and thicknesses variation were estimated, as well as the faults location. Two hydro-geo-electrical sections were built for simulating the resistivity values and their connotations, and managing in choosing the promised locations for drilling wells. The ramp-off time effect was studied and found that ∼50-∼100m shallow high resistive thickness didn't defined from the TEM data in which the max penetration depth was 672m. The available well logging data were analysed to reveal the pure saturated zones, the volume of shale of 0%-100% and the porosity values of ∼9%-∼35% in the Oligocene aquifer and of ∼4%-∼15.5% in the carbonate aquifer. So, the forward and inverse models application and soundings integration are considered robust tools for estimating and simulating the aquifer characteristics.

4.
Int J Ment Health Addict ; 16(4): 975-980, 2018 Aug.
Article in English | MEDLINE | ID: mdl-30581376

ABSTRACT

This paper discusses methodological issues that emerged during the design and implementation of a large-scale survey of licensed social workers in the USA. Benefits and challenges of survey research are identified. The paper provides recommendations for future workforce studies and surveys that assess behavioral health problems.

5.
Trop Anim Health Prod ; 50(5): 1005-1010, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29411225

ABSTRACT

The aim of this study was to evaluate the effects of dietary supplementation of Morinda lucida leaf meal (MLLM) on the haematology, biochemical and organ changes of broiler chickens. One hundred and ninety-eight day-old Marshall broiler chicks were completely randomised into 6 treatments in a 3 × 2 factorial arrangement of three levels of M. lucida leaf meal supplementation (0, 0.1 and 0.2 g/kg) with or without medication. The treatment consisted of both negative (without MLLM and routine medication) and positive (containing no MLLM but with routine medication) control groups while each treatment was replicated thrice. MLLM-supplemented diets and routine medication decreased (p < 0.05) the white blood cell count compared to the negative control. Dietary supplementation with MLLM in combination with normal routine medication increased (p < 0.05) total serum protein when compared with treatment group without MLLM and routine medication. Dietary supplementation with MLLM and routine medication reduced (p < 0.05) serum creatinine concentration of the broiler chickens. Birds fed with 0.2 g/kg MLLM supplement coupled with medication and those on negative control had higher (p < 0.05) creatinine values. Serum enzyme activities reduced (p < 0.05) following supplementation. MLLM supplementation recorded no significant effect (p > 0.05) on the liver, kidney, heart and gizzard. M. lucida leaf meal can be compared to routine medication for improved health status of broiler chickens. Dietary inclusion with 0.1 g/kg MLML combined with routine medication could be used in producing healthy and safe chickens.


Subject(s)
Animal Feed/analysis , Animal Nutritional Physiological Phenomena , Diet/veterinary , Dietary Supplements , Morinda/chemistry , Animals , Chickens , Gizzard, Avian/drug effects , Heart/drug effects , Kidney/drug effects , Liver/drug effects , Plant Leaves/chemistry
6.
J Med Life ; 9(4): 363-368, 2016.
Article in English | MEDLINE | ID: mdl-27928439

ABSTRACT

The Emergency Department (ED) has the highest workload in a hospital, offering care to patients in their most acute state of illness, as well as comforting their families and tending to stressful situations of the physical and psychological areal. Method. A cross-sectional survey of 366 Emergency Unit staff members including medical doctors, medical residents, medical nurses and ward aids, was undergone. Study participants came from four periphery hospitals in the Moselle Department of Eastern France with similar workforce and daily patient loads statistics. The instruments used were the Perceived Stress Scale PSS-10 and the Brief COPE questionnaire. Conclusions. Perceived work overload and overall stress is strongly related to work hours and tend to have a stronger influence on doctors than on the nursing staff. Substance use is a common coping method for medical interns, consistent with prior research. The regular assessment of the ED staff perception of stress and stress related factors is essential to support organizational decisions in order to promote a better work environment and better patient care.


Subject(s)
Adaptation, Psychological , Emergency Medicine , Emergency Service, Hospital , Health Care Surveys , Stress, Psychological/psychology , Adult , Cross-Sectional Studies , Female , France/epidemiology , Humans , Male , Marital Status , Risk Factors , Stress, Psychological/epidemiology , Surveys and Questionnaires , Workforce
7.
J Anim Physiol Anim Nutr (Berl) ; 100(6): 1191-1202, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27870288

ABSTRACT

This study was carried out to investigate the effect of dietary supplementation with molecular or nano-clay binders on biochemical and histopathological examination of organs of turkeys fed diets contaminated with aflatoxin B1. Two hundred and sixteen unsexed 1-day-old British United Turkeys were randomly allotted to nine diets in a 3 × 3 factorial arrangement of diets supplemented with no toxin binder, molecular toxin binder (MTB) and nano-clay toxin binder, each contaminated with 0, 60 and 110 ppb aflatoxin B1 respectively. There were three replicates per treatment with eight turkeys per replicate. Biochemical analyses, organ weights and histopathological changes of some organs were examined at the end of the study which lasted for 84 days. Turkeys fed diets supplemented with molecular and nano-binders showed higher (p < 0.001) total serum protein, reduced (p < 0.001) serum uric acid and GGT concentration values when compared with those fed aflatoxin-contaminated diets supplemented with no binder. Turkeys fed aflatoxin-contaminated diets supplemented with no binder had increased (p < 0.001) AST and ALT concentration when compared with other treatments. The heaviest (p < 0.001) liver and intestinal weight was noticed with turkeys fed diets supplemented with no binder and contaminated with 110 ppb aflatoxin B1 . Pathologically, there was no visible morphological alteration noticed in all turkeys fed uncontaminated diets and nano-clay-supplemented group. Hepatic paleness, hepatomegaly and yellowish discolouration of the liver were observed with turkeys fed diets containing no binder but contaminated with 60 and 110 ppb aflatoxin B1. Intestinal histopathological changes such as goblet cell hyperplasia, villous atrophy and diffuse lymphocytic enteritis were more prominent in turkeys fed diets containing no toxin binder and MTB. In conclusion, there were improved biochemical parameters and reduced deleterious effects of aflatoxin B1 in turkeys fed diet supplemented with clay binders. However, the improvement was more conspicuous in the nano-clay-supplemented group than molecular clay group.


Subject(s)
Aflatoxins/toxicity , Aluminum Silicates/chemistry , Animal Feed/analysis , Turkeys/physiology , Aflatoxins/chemistry , Animals , Clay , Diet/veterinary , Dietary Supplements , Female , Food Contamination , Male , Turkeys/blood
8.
J Thromb Haemost ; 11(1): 81-91, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23137413

ABSTRACT

BACKGROUND: The CYP2C19 genotype is a predictor of adverse cardiovascular events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) treated with clopidogrel. OBJECTIVES: We aimed to evaluate the cost-effectiveness of a CYP2C19*2 genotype-guided strategy of antiplatelet therapy in ACS patients undergoing PCI, compared with two 'no testing' strategies (empiric clopidogrel or prasugrel). METHODS: We developed a Markov model to compare three strategies. The model captured adverse cardiovascular events and antiplatelet-related complications. Costs were expressed in 2010 US dollars and estimated using diagnosis-related group codes and Medicare reimbursement rates. The net wholesale price for prasugrel was estimated as $5.45 per day. A generic estimate for clopidogrel of $1.00 per day was used and genetic testing was assumed to cost $500. RESULTS: Base case analyses demonstrated little difference between treatment strategies. The genetic testing-guided strategy yielded the most QALYs and was the least costly. Over 15 months, total costs were $18 lower with a gain of 0.004 QALY in the genotype-guided strategy compared with empiric clopidogrel, and $899 lower with a gain of 0.0005 QALY compared with empiric prasugrel. The strongest predictor of the preferred strategy was the relative risk of thrombotic events in carriers compared with wild-type individuals treated with clopidogrel. Above a 47% increased risk, a genotype-guided strategy was the dominant strategy. Above a clopidogrel cost of $3.96 per day, genetic testing was no longer dominant but remained cost-effective. CONCLUSIONS: Among ACS patients undergoing PCI, a genotype-guided strategy yields similar outcomes to empiric approaches to treatment, but is marginally less costly and more effective.


Subject(s)
Acute Coronary Syndrome/economics , Acute Coronary Syndrome/therapy , Aryl Hydrocarbon Hydroxylases/genetics , Genetic Testing/economics , Health Care Costs , Percutaneous Coronary Intervention/economics , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/genetics , Acute Coronary Syndrome/mortality , Aryl Hydrocarbon Hydroxylases/metabolism , Cerebrovascular Disorders/etiology , Clopidogrel , Computer Simulation , Cost-Benefit Analysis , Cytochrome P-450 CYP2C19 , Decision Support Techniques , Disease-Free Survival , Drug Costs , Gene Frequency , Genetic Predisposition to Disease , Hemorrhage/etiology , Humans , Insurance, Health, Reimbursement/economics , Kaplan-Meier Estimate , Markov Chains , Medicare/economics , Models, Economic , Myocardial Infarction/etiology , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Pharmacogenetics/economics , Phenotype , Piperazines/economics , Piperazines/metabolism , Piperazines/therapeutic use , Platelet Aggregation Inhibitors/economics , Platelet Aggregation Inhibitors/metabolism , Platelet Aggregation Inhibitors/therapeutic use , Prasugrel Hydrochloride , Predictive Value of Tests , Quality-Adjusted Life Years , Risk Assessment , Risk Factors , Thiophenes/economics , Thiophenes/metabolism , Thiophenes/therapeutic use , Thrombosis/economics , Thrombosis/genetics , Thrombosis/prevention & control , Ticlopidine/analogs & derivatives , Ticlopidine/economics , Ticlopidine/metabolism , Ticlopidine/therapeutic use , Time Factors , Treatment Outcome , United States
9.
Ann Anat ; 193(5): 403-11, 2011 Oct 20.
Article in English | MEDLINE | ID: mdl-21802916

ABSTRACT

OBJECTIVES: The presence of c-kit positive neurons in sensory ganglia has been verified in various species but not in humans. Our aim has been to identify whether human primary trigeminal neurons label with c-kit/CD117 and thus, whether data gathered in animal studies can be extrapolated to humans. We also intended to establish whether, and which non-neuronal cells also label with c-kit in the trigeminal ganglion. METHODS: Human adult trigeminal ganglia from eight cadavers were processed for immunohistochemistry on paraffin embedded samples using monoclonal antibodies for CD117/c-kit, and three additional trigeminal ganglia were used for transmission electron microscopy (TEM). To evaluate which neuronal type (A or B) was labeled with c-kit, we evaluated the same neurons on adjacent sections labeled with antibodies for neurofilaments (NF). RESULTS: c-kit has labeled trigeminal neurons (TNs), mast cells and interstitial cells (ICs) within the trigeminal ganglion. c-kit+TNs were NF-and thus were strongly presumed to be nociceptive, as such neurons are known to be NF-poor. c-kit+ICs with long and moniliform processes intermingled with the satellite glial cells (SGCs) of the neuronal envelopes. TEM evaluations confirmed this mixed composition of the neuronal envelopes and demonstrated that the perineuronal ICs are in fact interstitial Cajal-like cells (ICLCs) and/or telocytes. CONCLUSIONS: c-kit+TNs were objectified in humans and strongly presumed to be nociceptive. TNs envelopes mostly consist of SGCs, but are also combined with ICLCs/telocytes.


Subject(s)
Neurons/metabolism , Proto-Oncogene Proteins c-kit/metabolism , Trigeminal Ganglion/metabolism , Aged , Female , Humans , Immunohistochemistry , Interstitial Cells of Cajal/cytology , Interstitial Cells of Cajal/metabolism , Male , Microscopy, Electron, Transmission , Middle Aged , Neurons/cytology , Neurons/ultrastructure , Trigeminal Ganglion/cytology , Trigeminal Ganglion/ultrastructure
10.
J Med Life ; 3(2): 200-5, 2010.
Article in English | MEDLINE | ID: mdl-20968210

ABSTRACT

INTRODUCTION: Since there have been a number of empirical observations that may lead to the conclusion of an increasing rate of risk behaviors in Romanian students, such as aggression, over-competitive conduct and lack of collaboration, immorality, peer pressure and even an increasing rate of suicide, and suicide attempts, we have undergone a study to indentify if there is a high rate of risk type personality patterns that may lead to these deportments. MATERIAL AND METHODS: We have selected a total number of 500 students from the three largest universities in Bucharest, Romania--"Carol Davila" University of Medicine and Pharmacy (UMF), Bucharest Polytechnics University (UPB), and the Bucharest Academy of Economical Studies (ASE). All subjects received a questionnaire containing four diagnostic tools and several demographics questions. We have chosen the Twenty Item Toronto Alexithymia Scale (TAS20), the Jenkins Activity Survey (JAS-13) and the Anger-In Questionnaire for type C personality pattern. We have also added the Columbia stress analysis questionnaire for the evaluation of stress levels and coping capacity at the moment the subjects were interviewed. RESULTS: Columbia stress survey results confirm that there is a high stress level among students of all universities, but a more detailed stratification by university, gender and analyzed factor shows a very high F factor and T factor positive responses. Alexithymia, Type A and Type C personality patterns show a much higher prevalence than the general population, especially in medical students. We have found higher frequencies in men for all of the three studied parameters CONCLUSIONS: Approaching alexithymia and type A behavior both by cognitive methods and by assessing and addressing consequential risk factors should become an issue among universities.


Subject(s)
Stress, Psychological , Students, Pharmacy/psychology , Students, Premedical/psychology , Adolescent , Affective Symptoms/psychology , Female , Humans , Male , Personality , Risk-Taking , Romania , Surveys and Questionnaires , Type A Personality , Universities , Young Adult
11.
Eur J Surg Oncol ; 33(7): 868-73, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17258882

ABSTRACT

AIM: To evaluate the risk of recurrence of hepatocellular cancer (HCC) after liver transplantation (LT). METHODS: The clinical records of 104 patients with HCC in the explanted liver were examined. RESULTS: HCC recurrence occurred in 12 patients. Recurrence was observed in all patients with a single nodule greater than 5 cm. Among the 5 patients with more than 3 tumours with a maximum diameter of 4.5 cm, no recurrence occurred. The survival rates were 81% and 64% at 1 and 5 years, respectively; the recurrence-free survival at 1 and 5 years was, respectively, 93% and 82%. Pre-LT alpha-fetoprotein (AFP) increased at a greater magnitude in patients who experienced recurrence, compared to those who did not. Tumour diameter, differentiation, satellitosis, AFP and the magnitude of AFP increase were predictive of recurrence. The 1- and 5-year recurrence-free survival for the 68 patients who had a single nodule up to 5 cm, or up to 3 nodules all less than 4.5 cm and with a maximum cumulative diameter of 8 cm, or more than 3 nodules all less than 2.5 cm, were 95% and 92%, respectively. For the 13 patients not meeting these criteria, the 1- and 5-year recurrence-free survival was, respectively, 75% and 54% (log Rank test p=0.019). CONCLUSIONS: Patients with more than 3 small HCC nodules before LT could still have a good outcome without recurrence. A rapid increase in AFP could be useful in identifying patients with a greater risk of post-LT HCC recurrence.


Subject(s)
Carcinoma, Hepatocellular/epidemiology , Liver Neoplasms/epidemiology , Liver Transplantation , Neoplasm Recurrence, Local/epidemiology , Adult , Aged , Biomarkers, Tumor/blood , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/surgery , Female , Follow-Up Studies , Humans , Incidence , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Male , Middle Aged , Neoplasm Recurrence, Local/blood , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk Factors , Survival Rate , United Kingdom/epidemiology , alpha-Fetoproteins/metabolism
12.
J Interprof Care ; 20(6): 655-64, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17095443

ABSTRACT

Our purpose was to evaluate the interdisciplinary aspects of Project MAINSTREAM, a faculty development program that trained 39 competitively selected health professional tutors in substance abuse education. Mid-career faculty fellows (tutors) from 14 different health professions across the US dedicated 20% of their academic time for two years to Project MAINSTREAM. Teams of three fellows carried out curricular enhancement and service-learning field project requirements in mentored Interdisciplinary Faculty Learning Groups (IFLGs). Formative and summative evaluations were conducted via written questionnaires and confidential telephone interviews. The importance of interdisciplinary education was rated positively (mean of 3.57 on 1 - 5 scale). Using 18 parameters, fellows preferred interdisciplinary over single disciplinary teaching (means ranged from 3.40 - 4.86), and reported high levels of benefit from their interdisciplinary collaborations (means ranged from 3.53 - 4.56). Fellows reported that interdisciplinary educational collaborations were feasible (3.31) at their home institutions. The majority (63%) said that their trainees, colleagues, supervisors and institutions valued interdisciplinary training either "highly" or "somewhat", but 22% did not value it. The fellows identified scheduling conflicts (3.46), and lack of faculty rewards (3.46) such as pay or credit toward promotion, as two barriers that they encountered.


Subject(s)
Education, Professional/methods , Interprofessional Relations , Models, Educational , Substance-Related Disorders , Adult , Faculty , Female , Humans , Male , Middle Aged
13.
Blood Press Monit ; 11(2): 87-90, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16534410

ABSTRACT

OBJECTIVE: To perform validation for an arm-type oscillometric TM-2655 device (A&D Company Ltd, Tokyo, Japan) for blood pressure measurement according to the British Hypertension Society protocol. METHODS: Eighty-five study participants (33 men and 52 women) were included in the study. Mean age was 52.9+/-15.0 years, systolic blood pressure range was 84-208 mmHg and diastolic blood pressure range was 48-120 mmHg. For each participant, three readings of TM-2655 were compared with sequential auscultatory measurements by two trained independent observers. The observers used a calibrated mercury sphygmomanometer and dual stethoscope. The results were graded according to the British Hypertension Society protocol 1993. RESULTS: The average difference between mercury sphygmomanometer and TM-2655 readings for systolic blood pressure was -1.0+5.2 mmHg (mean+/-SD) and for diastolic blood pressure -0.9+/-4.7 mmHg. The proportions of values agreeing to within 5, 10 and 15 mmHg were 72.5, 93.7 and 99.6% for systolic blood pressure and 78.8, 96.9 and 100% for diastolic blood pressure between the observers and the device (A/A British Hypertension Society grade). CONCLUSIONS: The TM-2655 device achieved British Hypertension Society grade A/A and therefore can be recommended for blood pressure measurement in an adult population.


Subject(s)
Blood Pressure Determination/instrumentation , Adult , Aged , Blood Pressure Monitors/standards , Female , Humans , Hypertension/diagnosis , Male , Middle Aged , Observer Variation , Oscillometry/instrumentation , Sphygmomanometers
14.
Dig Liver Dis ; 38(6): 415-9, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16527551

ABSTRACT

BACKGROUND: Diabetes after total pancreatectomy is commonly described as 'brittle' with most series reporting outcomes after resection for pancreatitis alone. The aim of this study was to determine glycaemic control in patients resected for benign and malignant disease. METHODS: A retrospective analysis of all patients undergoing total pancreatectomy (1989-2003) from a single institution was done. Data of diabetic control were obtained from case notes, general practitioners and telephonic consultation. Comparison was made against a matched type 1 diabetic population. RESULTS: Forty-seven patients with a median age of 59 years (range 17-85 years) and median follow-up of 50 months (range 5-136 months) were identified. Thirty-five underwent primary resection with 11 receiving completion procedures. Thirty were for malignancy (19 deceased) and 17 for benign/indeterminate histology (2 deceased). Thirty-three patients were available for detailed follow-up. There was no significant difference between median HbA(1c) of the study group and the control (8.2% versus 8.1%). The majority of patients reported diabetic control and daily performance as excellent or good. Resection for pancreatitis gave poorer subjective control (p < 0.05) than those resected for malignancy. Two patients required in-patient treatment for diabetic complications, with no deaths related to diabetes observed. CONCLUSION: Diabetes after total pancreatectomy is not necessarily associated with poor glycaemic control and in the majority results in equivalent biochemical control compared to a normal type 1 diabetic population.


Subject(s)
Diabetes Mellitus/etiology , Pancreatectomy , Pancreatitis, Chronic/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Blood Glucose/analysis , Diabetes Mellitus, Type 1/etiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies
15.
Aliment Pharmacol Ther ; 21(4): 479-84, 2005 Feb 15.
Article in English | MEDLINE | ID: mdl-15710000

ABSTRACT

INTRODUCTION: With the rising incidence of oesophageal cancer, palliative treatment has an increasingly important role. With median survival unlikely to exceed 6 months, in advanced disease the palliative therapy chosen must not hasten patient's demise. AIM: To establish the outcome of both modern and historical palliative treatment in oesophageal tumours, with emphasis on the aetiology and outcome of iatrogenic perforation. METHODS: Patients with oesophageal or cardia carcinoma treated within the West Midlands between 1992 and 1996 were identified retrospectively. Information was gathered from hospital case notes and the regional cancer intelligence unit with hospitals visited to capture data. All episodes were entered into a dedicated database. RESULTS: Of the 3660 patients who were treated, 2529 received palliation as primary treatment, with 5259 palliative procedures performed; 164 iatrogenic perforations were recorded; 83 were due to diagnostic endoscopy (endoscopic perforation) with the reminder due to interventional palliative procedures. Median survival from all forms of palliation was 138 days. Following perforation survival was 95 days after interventional palliative procedure and 58 days after endoscopic perforation (P > 0.05). Thirty-day mortality after emergency surgery was 11.8% with mean survival of 7.5 months. CONCLUSION: Perforation at diagnostic endoscopy is associated with substantial mortality despite rapid intervention. Patients with suspected cancer must be investigated with extreme care to reduce iatrogenic complications.


Subject(s)
Cardia , Esophageal Neoplasms/therapy , Esophageal Perforation/etiology , Palliative Care , Stomach Neoplasms/therapy , Aged , Esophageal Perforation/therapy , Esophagoscopy/adverse effects , Female , Humans , Male , Medical Audit , Middle Aged , Retrospective Studies , Survival Analysis
16.
Subst Abus ; 26(3-4): 5-15, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16837406

ABSTRACT

OBJECTIVE: This study evaluated the effects of a national interdisciplinary faculty development program, Project MAINSTREAM, on creating curriculum enhancement in health professional education. METHOD: Thirty-nine faculty completed a two-year, part-time fellowship program featuring interdisciplinary collaboration, mentoring, training meetings, and Internet-based instructional materials. The main vehicle for curricular change was a required collaborative education project to develop trainees' core competencies in substance abuse prevention services. RESULTS: Fellows used a variety of approaches to implement 123 curricula and provide 66,995 hours of training to 10,170 trainees. Ninety percent of the training hours occurred in required courses, a potential indication of sustainability. Fellows indicated that a majority of the offerings would be sustained beyond the fellowship. CONCLUSION: Project MAINSTREAM shows promise as a model for achieving durable curriculum change in response to the public health crisis associated with a workforce untrained to deliver substance abuse services.


Subject(s)
Education, Medical , Faculty, Medical , Fellowships and Scholarships , Substance-Related Disorders/rehabilitation , Clinical Competence , Computer-Assisted Instruction , Cooperative Behavior , Curriculum , Education , Humans , Internet , Interprofessional Relations , Mentors , Substance-Related Disorders/prevention & control , United States
17.
Subst Abus ; 26(3-4): 17-20, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16837407

ABSTRACT

The purpose of this paper is to describe the development and implementation of community-based, service-learning field projects by 30 health professional faculty fellows of Project MAINSTREAM, a faculty development program on substance abuse. The fellows worked together for two years in 10 Interdisciplinary Faculty Learning Groups (IFLGs), which consisted of three academics of different disciplines. The ten projects are viewed within the context of service- learning and are based on a balance between the provision of services to the community and furthering the learning objectives of Project MAINSTREAM.


Subject(s)
Alcoholism/rehabilitation , Cooperative Behavior , Faculty , Fellowships and Scholarships , Health Personnel/education , Interprofessional Relations , Smoking Prevention , Substance-Related Disorders/rehabilitation , Adolescent , Adult , Alcoholism/prevention & control , Child , Curriculum , Faculty, Medical , Family Practice/education , Health Education , Health Services Needs and Demand , Humans , Mass Screening , Program Development , Substance-Related Disorders/prevention & control
19.
Atherosclerosis ; 156(2): 357-61, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11395032

ABSTRACT

An increased cholesterogenesis has been described in obese dyslipidemic type 2 diabetic patients and in a small number of patients with poor glucose control. So far, it is not clear if increased cholesterogenesis in type 2 diabetes is related to the degree of glycemic control or depends on the commonly associated dyslipidemia or both. Therefore, the aim of the present study was to investigate the relationships among cholesterogenesis and degree of metabolic control in a group of non-obese normolipidemic type 2 diabetic patients. Fifty four (25 men and 29 postmenopausal women) non-obese type 2 diabetic patients with cholesterol and triglyceride plasma levels, respectively, below 6.40 and 2.85 mmol/l and 20 normal subjects matched for age and sex were studied. Endogenous cholesterol synthesis was evaluated by the determination of 24-h urinary mevalonate excretion (MVA). In the diabetic group the mean glycated hemoglobin was 8.47+/-2.2% (range 4.6-14.6%), the mean total cholesterol, triglycerides, HDL and LDL cholesterol were, respectively, 4.86+/-0.7, 1.64+/-0.5, 1.19+/-0.3 and 2.87+/-0.7 mmol/l. The mean 24-h MVA urine excretion rates were 1.41+/-0.3 micromol/24 h in control subjects and 1.66+/-0.7 micromol/24 h in diabetics (P=0.05). In diabetics, urinary mevalonate excretion was significantly correlated with glycated hemoglobin concentrations (HbA(1c)) (r=0.65; P=0.0001) and body mass index (BMI) (r=0.33; P=0.009). In the multivariate analysis both HbA(1c) and BMI were independent predictors of urinary mevalonate. These data demonstrate that lower the degree of blood glucose control, higher is the whole body cholesterol production even in the absence of overt dyslipidemia. In conclusion, the relationship between mevalonate excretion rate and glycated hemoglobin gives further weight to the importance of intensive blood-glucose control in diabetic disease and adds a new element to the list of potentially atherogenic factors strictly related to hyperglycemia in type 2 diabetic patients.


Subject(s)
Blood Glucose/analysis , Cholesterol/metabolism , Diabetes Mellitus, Type 2/metabolism , Energy Metabolism , Hemoglobin A/analysis , Mevalonic Acid/urine , Aged , Biomarkers/analysis , Body Mass Index , Body Weight , Cholesterol/analysis , Diabetes Mellitus, Type 2/diagnosis , Female , Humans , Male , Mevalonic Acid/metabolism , Middle Aged , Probability , Reference Values , Risk Assessment
20.
Biochim Biophys Acta ; 1512(2): 215-24, 2001 Jun 06.
Article in English | MEDLINE | ID: mdl-11406098

ABSTRACT

To identify membrane-associated polypeptides present in Torpedo nicotinic acetylcholine receptor (AChR)-rich membranes, we used hydrophobic photolabeling with [(3)H]diazofluorene ([(3)H]DAF) and 1-azidopyrene (1-AP) to tag the membrane proteins which were then identified by amino-terminal sequence analysis of labeled fragments isolated from proteolytic digests by sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by reverse-phase high-performance liquid chromatography. In addition to AChR subunits, identified polypeptides include the 95 kDa alpha-subunit of the (Na(+)+K(+))-ATPase, the 89 kDa voltage-gated chloride channel (CLC-0), the 105 kDa SITS-binding protein, and 32 and 34 kDa polypeptides identified as Torpedo homologues of the mitochondrial membrane ATP/ADP carrier protein and the voltage-dependent anion channel (VDAC), respectively. Further, individual amino acids that reacted with [(3)H]DAF and therefore likely to be in contact with lipid were identified in the transmembrane segment M3 of the alpha-subunit of the (Na(+)+K(+))-ATPase and in a putative transmembrane beta-strand in VDAC. Collectively these results demonstrate that [(3)H]DAF/1-AP photolabeling provides an effective method for tagging the membrane-associated segments of polypeptides in a way that makes it easy to isolate the labeled polypeptide or polypeptide fragments by fluorescence and then to identify amino acids at the lipid-protein interface by (3)H release.


Subject(s)
Cell Membrane/chemistry , Membrane Proteins/analysis , Membrane Proteins/chemistry , Receptors, Nicotinic/analysis , Amino Acid Sequence , Animals , Annexins/chemistry , Binding Sites , Cattle , Diazonium Compounds , Electrophoresis, Polyacrylamide Gel , Fluorenes , Fluorescent Dyes , Humans , Molecular Sequence Data , Molecular Weight , Peptide Fragments/chemistry , Peptide Fragments/isolation & purification , Photoaffinity Labels , Porins/chemistry , Protein Subunits , Pyrenes , Rats , Receptors, Nicotinic/chemistry , Sequence Alignment , Sequence Homology, Amino Acid , Sodium-Potassium-Exchanging ATPase/chemistry , Sodium-Potassium-Exchanging ATPase/isolation & purification , Torpedo , Tritium , Voltage-Dependent Anion Channels
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