Radiation exposure to caregivers from patients undergoing common radionuclide therapies: a review.

The contribution of radionuclide therapies (RNTs) to effective patient treatment is widely appreciated. The administration of high doses has necessitated investigating the potential radiation hazard to caregivers from patients undergoing RNTs. This work aimed to review the literature regarding measured effective doses to caregivers from such patients. The main selection criterion was the presence of real radiation exposure measurements. The results were categorised according to the treatment protocol and dose parameters. Analysis of the collected data demonstrated that the measured effective dose values were within the dose constraints defined by the International Commission on Radiological Protection, provided that the radiation protection instructions were followed by both patients and caregivers. In conclusion, the radiation risk for caregivers was almost negligible. In this context, treatments could be administered more often on an outpatient basis, once cost-effectiveness criteria were established and radiation protection training and procedures were appropriately applied.

Synchronous colorectal liver metastasis: a network meta-analysis review comparing classical, combined, and liver-first surgical strategies.

BACKGROUND: In recent years, the management of synchronous colorectal liver metastasis has changed significantly. Alternative surgical strategies to the classical colorectal-first approach have been proposed. These include the liver-first and combined resections approaches. The objectives of this review were to compare the short- and long-term outcomes for all three approaches. METHODS: A systematic review of comparative studies was performed. Evaluated endpoints included surgical outcomes (5-year overall survival, 30-day mortality, and post-operative complications). Pair-wise and network meta-analysis (NMA) were performed to compare survival outcomes. RESULTS: Eighteen studies were included in this review, reporting on 3,605 patients. NMA and pair-wise meta-analysis of the 5-year overall survival did not show significant difference between the three surgical approaches: combined versus colorectal-first, mean odds ratio (OR) 1.02 (95% CI 0.8-1.28, P = 0.93); liver-first versus colorectal-first, mean OR 0.81 (95% CI 0.53-1.26, P = 0.37); liver-first versus combined, mean OR 0.80 (95% CI 0.52-1.24, P = 0.41). In addition NMA of the 30-day mortality among the three approaches also did not observe statistical difference. Analysis of variance showed that mean post-operative complications of all approaches were comparable (P = 0.51). CONCLUSION: There are considerable differences in the peri-operative management of synchronous CLM patients. This meta-analysis demonstrated no clear statistical surgical outcome or survival advantage towards any of the three approaches.

Impact of a single-day multidisciplinary clinic on the management of patients with liver tumours.

PURPOSE: Multidisciplinary cancer clinics may improve patient care. We examined how a single-day multidisciplinary liver clinic (mdlc) affected care recommendations for patients compared with the recommendations provided before presentation to the mdlc. METHODS: We analyzed the demographic and clinicopathologic data of 343 patients assessed in the Johns Hopkins Liver Tumor Center from 2009 to 2012, comparing imaging and pathology interpretation, diagnosis, and management plan between the outside provider (osp) and the mdlc. RESULTS: Most patients were white (n = 259, 76%); median age was 60 years; and 146 were women (43%). Outside providers referred 182 patients (53%); the rest were self-referred. Patients travelled median of 83.4 miles (interquartile range: 42.7-247 miles). Most had already undergone imaging (n = 338, 99%) and biopsy (n = 194, 57%) at the osp, and a formal management plan had been formulated for about half (n = 168, 49%). Alterations in the interpretation of imaging occurred for 49 patients (18%) and of biopsy for 14 patients (10%). Referral to the mdlc resulted in a change of diagnosis in 26 patients (8%), of management plan in 70 patients (42%), and of tumour resectability in 7 patients (5%). Roughly half the patients (n = 174, 51%) returned for a follow-up, and 154 of the returnees (89%) received treatment, primarily intraarterial therapy (n = 88, 57%), systemic chemotherapy (n = 60, 39%), or liver resection (n = 32, 21%). Enrollment in a clinical trial was proposed to 34 patients (10%), and 21 of the 34 (62%) were accrued. CONCLUSIONS: Patient assessment by our multidisciplinary liver clinic had a significant impact on management, resulting in alterations to imaging and pathology interpretation, diagnosis, and management plan. The mdlc is an effective and convenient means of delivering expert opinion about the diagnosis and management of liver tumours.

Association between use of air-conditioning or fan and survival of elderly febrile patients: a prospective study.

Elderly individuals are more susceptible to excess summer heat. We sought to examine whether the use of cooling systems (air-conditioning or fan) affected the clinical outcomes of elderly febrile patients. We prospectively followed elderly (≥ 75 years old) febrile patients requesting the medical services of the SOS Doctors (a network of physicians performing house-call visits) from July 10 to August 20, 2011. Patients who used cooling systems ("users") were compared with those who did not ("non-users") regarding mortality, clinical outcome of primary illness (improvement or deterioration), and emergency hospitalization. Prospectively collected data were available for 339 individual elderly febrile patients. "Users" had lower mortality (10 % vs. 19 %, p < 0.05) than "non-users"; no difference was noted on clinical improvement (85 % vs. 76 %, p = 0.11) and emergency hospitalization rates (21 % vs. 30 %, p = 0.16). No difference was noted between users of air-conditioning and fan regarding mortality or clinical improvement, but fan use was associated with more hospitalizations (37 % vs. 19 %, p < 0.05). On multivariate analysis (assessing daily ambient temperature, use of cooling systems, patient age, and living conditions), the sole variable significantly associated with mortality was the non-use of cooling systems [odds ratio (OR): 2.18, 95 % confidence interval (CI): 1.06-4.50]. The use of air-conditioning or fan during hot summer periods appeared to be beneficial for elderly febrile patients living in a large city. Large prospective studies are warranted in order to provide further insight into potential individual and public health initiatives aiming to alleviate the impact of excess summer heat on the health of elderly patients.

Impact of complications on long-term survival after resection of colorectal liver metastases.

BACKGROUND: Postoperative complications may have an adverse effect not only on short-term but also long-term outcome among patients having surgery for cancer. A retrospective series of patients who had surgery for colorectal liver metastases (CLM) was used to assess this association. METHODS: Patients who had surgery with curative intent for CLM from 2000 to 2009 were included. The impact of postoperative complications, patient characteristics, disease stage and treatment on long-term survival was analysed using multivariable Cox regression models. RESULTS: A total of 251 patients were included. The median age was 58 (interquartile range 51-68) years and there were 87 women (34.7 per cent). A minor or major postoperative complication developed in 41 and 14 patients respectively, and five patients (2.0 per cent) died after surgery. The 5-year recurrence-free (RFS) and overall survival rates were 19.5 and 41.9 per cent respectively. Multivariable analysis revealed that postoperative complications independently predicted shorter RFS (hazard ratio (HR) 2.36, 95 per cent confidence interval 1.56 to 3.58) and overall survival (HR 2.34, 1.46 to 3.74). Other independent predictors of shorter RFS and overall survival included lymph node metastasis, concomitant extrahepatic disease, a serum carcinoembryonic antigen level of at least 100 ng/dl, and the use of radiofrequency ablation (RFS only). The severity of complications also correlated with RFS (P = 0.006) and overall survival (P = 0.001). CONCLUSION: Postoperative complications were independently associated with decreased long-term survival after surgery for CLM with curative intent. The prevention and management of postoperative adverse events may be important oncologically.

Antimicrobials as an adjunct to pilonidal disease surgery: a systematic review of the literature.

Surgical site infection (SSI) after pilonidal disease surgery can lead to serious complications. We systematically searched the PubMed, Scopus, and ClinicalTrials.gov databases for studies evaluating the use of antimicrobials as an adjunct to pilonidal disease surgery. We identified 12 eligible studies [nine randomized controlled trials (RCTs), three retrospective cohort studies], enrolling a total of 1,172 patients. No difference was observed when single-dose prophylaxis was compared to no prophylaxis or to a long course of antibiotics (seven studies, 690 patients). Similarly, gentamicin collagen sponges (GCS) did not appear to be beneficial when compared with no GCS (with primary or secondary closure; four studies, 402 patients). One study (80 patients) reported faster healing and lower SSI and recurrence rates with GCS than a 7-day course of antibiotics. The clinical heterogeneity precluded a formal meta-analysis. Although the generalization of our findings may be limited by the relative paucity and clinical heterogeneity of the existing studies, prophylactic antibiotics or GCS did not appear to be beneficial in promoting healing or reducing SSI or recurrence rates. Large, double-blind, placebo-controlled RCTs are warranted in order to further elucidate this issue.

Optical absorbance of doped Si quantum dots calculated by time-dependent density functional theory with partial electronic self-interaction corrections.

The optical properties of Si quantum dots (QDs) with phosphorous and aluminum dopants have been calculated with the recently tested Heyd-Scuseria-Ernzerhof (HSE) density functionals to ascertain the effect of functional corrections to electronic self-interaction. New results have been obtained for 20 crystalline and amorphous structures of Si(29) and Si(35) quantum dots and are compared to our previous results obtained using the PW91∕PW91 functionals. The bandgaps are greater in magnitude and shifted to higher energies in HSE calculations compared to PW91 calculations, and the absorption spectrum is blueshifted in HSE. Trends in the shifts of absorbances due to doping are similar for both sets of calculations, with doped QDs absorbing at lower photon energies than undoped QDs. Consistent with previous results, the bandgaps of QDs are found to decrease as the size of the QD increases, and the absorption spectra of amorphous QDs are redshifted compared to those of crystalline structures. The molecular orbitals involved in the transitions with the largest oscillator strengths show that the electron density moves towards the surface of the quantum dot as the structure is excited. The lifetimes of photoexcited states were found to differ substantially between the two functionals due to their sensitivity to the overlaps of initial and final orbitals. Comparison with available experimental and independent theoretical results supports the conclusion that the HSE functional better matches experimental results due to the partial inclusion of Hartree-Fock exchange.

Long-acting somatostatin analogues decrease blood transfusion requirements in patients with refractory gastrointestinal bleeding associated with angiodysplasia.

BACKGROUND: Gastrointestinal angiodysplasias (GIADs) may be the cause of recurrent bleeding, despite endoscopic treatment. AIM: To evaluate the effect of long-acting somatostatin analogues on blood transfusion requirements, in patients with refractory bleeding due to GIADs. METHODS: Consecutive patients with recurrent bleeding from GIADs were enrolled. They received somatostatin analogue treatment for at least 6 months. The efficacy was evaluated in terms of blood transfusions, frequency of bleeding episodes and haemoglobin level during 6 months of treatment (Period During) compared to a 6-months' period before treatment (Period Before). RESULTS: Fifteen patients were enrolled from 2007 to 2010. The median duration of somatostatin analogue treatment was 12 months (range: 6-36). The number of transfusions significantly decreased in Period During compared with Period Before [median number: 2 (0-14) vs. 10 (6-24); P < 0.001]. The percentage of patients who experienced a bleeding event was lower during somatostatin analogues treatment (20% vs. 73%; P = 0.01). The mean haemoglobin level was significantly higher when somatostatin analogues were offered [median: 10 g/dL (9-13) vs. 7 (5-8.5); P < 0.001]. None of the patients discontinued treatment due to side effects. CONCLUSIONS: Long-acting somatostatin analogues treatment decreased transfusion needs in patients with refractory bleeding from gastrointestinal angiodysplasias. Bleeding episodes were limited and haemoglobin improved during treatment. Long-acting somatostatin analogues may represent an option for the management of patients with chronic bleeding due to gastrointestinal angiodysplasias.

Underestimation of Clostridium difficile infection among clinicians: an international survey.

The objective of this investigation was to document clinicians' awareness regarding the incidence and severity of Clostridium difficile-associated diarrhea (CDAD). An international electronic survey was conducted among corresponding authors of articles indexed by PubMed and published during the last 10 years in 'Core Clinical Journals'. A total of 1,163 clinicians answered (response rate 59%); most of the responses were submitted from North America (54.6%), Europe (32.2%), and Asia/Pacific (11.6%). Only 2.2% of the participants answered correctly all four questions, while 14.1% answered all questions incorrectly. Regarding each question, 10.8% of the participants correctly estimated current CDAD treatment failure or recurrence rates to be around 40%, 33.4% correctly estimated the ratio of antibiotic-associated colitis attributed to C. difficile to be around 60%, 72.7% correctly responded that almost all antibiotics are associated with CDAD, and 41.7% correctly responded that any patient is at risk for CDAD. Almost half (44.4%) of the respondents considered CDAD to be underestimated. Participants from North America scored higher than those from Europe or Asia/Pacific (p < 0.001). Participants considering CDAD to be overestimated (3.4%) had the lowest mean score of correct answers. Among a clinically diverse international sample of physicians with academic expertise, there was an inadequate level of awareness of the magnitude and clinical importance of CDAD.

Comparison of morbidity of elderly patients in August and November in Attica, Greece: a prospective study.

BACKGROUND: In our clinical practice, we have experienced a consistent increase in the morbidity of elderly in Greece during August. METHODS: We prospectively analysed and compared the morbidity of elderly patients (≥ 75 years old) between August and November of the same year (2010), using data from the SOS Doctors (a network of physicians performing house call visits). RESULTS: We analysed data on 739 and 738 elderly patient house-calls in August and November, respectively. Overall, the most common diagnoses were cardiovascular (17.6%), musculoskeletal (10.7%), gastrointestinal (9.5%), respiratory (8.5%), renal/genitourinary (8.1%), and neurologic/psychiatric (7.9%). In August, patients were older (p < 0.01), carried a heavier burden of disease (as inferred by specific types of comorbidity and associated medical conditions), were more frequently recommended emergency hospitalization (p < 0.01) and had a worse outcome of primary illness (p < 0.05). Mortality of elderly visited in August was significantly higher compared to November (5% vs. 2%, p < 0.01). The sole independent predictor of mortality was patient's bedridden status [adjusted odds ratio (OR) = 5.59, 95% confidence intervals (CI) 2.83-11.06, p < 0.001]. The identified independent predictors of recommendation for emergency hospitalization were patient's lethargic status [OR = 2.88 (1.80, 4.59), p < 0.001], fever [OR = 2.55 (1.84, 3.54), p < 0.001], heat stroke [OR = 2.08 (1.19, 3.64), p = 0.01], Alzheimer's disease [OR = 1.77 (1.15, 2.72), p = 0.01] and bedridden status [OR = 1.45 (1.07, 1.97), p < 0.05]. CONCLUSION: Morbidity and mortality of elderly patients was significantly higher in August compared with November, substantiating the informal term 'Augustitis' for the Greek elderly. Large, prospective population-based studies are warranted to further enlighten this field.

Economic crises and mortality: a review of the literature.

BACKGROUND: Studies evaluating the association of economic variables with mortality have produced mixed findings. OBJECTIVE: We sought to evaluate whether economic crises confer increase in mortality. METHODS: We reviewed studies analysing mortality in the general population in periods of economic crisis compared with periods prior to or after the crisis, by searching PubMed, Scopus, Cochrane and the World Wide Web. RESULTS: Eleven studies were included in this review; they referred to economic crises that occurred in Russia, South Korea, as well as South or Central American, African or European countries (5, 2, 2, 1 and 1 studies respectively). Periods of economic crises were associated with the increase in all-cause mortality in seven out of eight studies that reported specific relevant data and increase in cardiovascular mortality in six out of seven studies. Increase in mortality because of respiratory infections, chronic liver disease, suicides, homicides and mortality in infants was noted in association with economic crises in all 5, 4, 6, 5 and 3 studies, respectively, that reported specific relevant data. Mortality from transport accidents decreased with economic crises in five out of six studies. CONCLUSION: Economic crises in less affluent countries are accompanied with the increase in all-cause mortality, as well as mortality from most of the major specific causes. Further data are needed to establish the effect of economic crises on mortality in more affluent countries. We believe that the above-mentioned association could be attributed to increased psychosocial stress during such periods, among other factors. Public health authorities should be aware of this issue and consider appropriate preventive and control measures.

[The genetic polymorphism of MTHFR gene in schizophrenia]. / Polimorfismul genetic al genei MTHFR in schizofrenie.

UNLABELLED: The 677C > T polymorphism of the MTHFR gene, resulting in hyperhomocysteinemia, has been shown to be implicated in the aetiology of schizophrenia. Previous studies showed that A1298 C polymorphism seems not to be related to schizophrenia. AIM OF THE STUDY: To analyze two genetic polymorphisms of the MTHFR gene, 677C > T and A1298 C in 44 patients with schizophrenia and evaluate its relationship with the risk of schizophrenia and with some clinical aspects. MATERIAL AND METHOD: We determined the presence of the 677C > T and A1298 C mutations of the MTHFR gene in 44 inpatients with schizophrenia and in 35 normal controls. The patients were assessed by psychiatric examination and scalar evaluation. RESULTS: 28 (66,7%) of the patient group had the T allele of the 677C > T genetic polymorphism, compared to 11 (34,3%) subjects of the control group. The intensity of the positive, negative and general symptoms was slightly higher in the patients presenting the T allele. The A1298C missense mutation was more frequent between control subjects (57,5%) compared to the patient group (39%). The intensity of the positive symptoms was slightly increased in the patients with the missense mutation in the position 1298, but the intensity of the negative and general symptoms did not differ. CONCLUSIONS: Our study confirms the role of the 677C > T genetic polymorphism in the susceptibility for schizophrenia. The relationship between A1298C genetic polymorphism and schizophrenia was not demonstrated in our study.

[The effects of computer-use on adolescents]. / Efectele utilizarii calculatorului la copii si adolescenti.

Computers continue to play a vital role in today's generation. The need for information about the effects of computers on their users also increases. The purpose of this study is to investigate how children and adolescents use a computer and to explore the beneficial and harmful effects of computer use on children's mental and physical health. The studied group of samples comprised 69 subjects, aged between 13 and 18 years, who answered to a questionnaire. The parents of the children also answered another questionnaire with the same subject. Data have been statistically processed using the program SPSS. The results were obtained about computer use and the pathological use was identified. Some children spend much time on computers, 4% more than five hours/day. 41% of the parents believe that the usage of the computer is favorable to the children's mental and physical health and development, 49% of parents believe that the computer may be harmful. 1.4% of the children had pathological use of the computer.