Comorbidities of deformational plagiocephaly in infancy: A scoping review.

AIM: While deformational plagiocephaly (DP) is suspected to be associated with comorbidities, their nature and prevalence are unclear. This scoping review aims to report DP comorbidities occurring until the age of 2 years, their prevalence and whether they depend on the child's age and sex. METHODS: Relevant studies were identified by searching the Cochrane, MEDLINE, EMBASE, PubMed and EBSCO databases from 1992 to 30 April 2021. Data on study characteristics, comorbidities and assessment instruments were extracted and qualitatively synthesised. Risk of bias was assessed and studies with high risk of bias were excluded. RESULTS: Studies meeting selection criteria (n = 27) often evaluated groups from tertiary clinics, implying selection bias. Studies reported on developmental delay (n = 16), limited speech production (n = 1), auditory (n = 3), visual (n = 3), mandibular (n = 3) and neurological impairments (n = 1). The data did not allow prevalence calculation or modifying effect of sex. Due to biased data, the review provided no evidence on DP comorbidities. Weak evidence suggested that in the selective samples, DP was associated with motor and language delays in the first year. CONCLUSION: Due to biased data, no evidence on comorbidity in infants with DP was available. Our study underlined the need of risk of bias assessment in scoping reviews.

Postoperative Analgesia Management Evaluation in the Postanesthesia Unit: An Exploratory Analysis Based on Patient and Surgery Characteristics.

PURPOSE: Several methods have been proposed for postoperative pain management, including administration of opioid analgesics, epidural analgesia, and perineural and infiltrative techniques; however, data are lacking on the relationship between pain intensity, patients' age and gender, and surgery duration. DESIGN: Prospective, observational, single-center study. METHODS: The study included patients greater than or equal to 18 years old who underwent surgery with different anesthesia types, grouped according to the American Society of Anesthesiologists' physical status classification score. The McGill Pain Questionnaire was used to assess postoperative pain intensity. The postoperative pain evaluation was performed in the first 5 minutes on entering the postanesthesia care unit (PACU), and at 30 minutes and 24 hours after the operation. RESULTS: Our results showed a significant negative relationship between pain intensity as assessed at 5 and 30 minutes postoperatively and age. Postoperative pain intensity at 24 hours was significantly lower after low-risk surgeries lasting up to 1 hour; pain intensity was also significantly lower at 30 minutes following epidural anesthesia. When nonsteroidal anti-inflammatory drugs were not administered in the PACU, pain intensity was significantly lower at 5 minutes, 30 minutes, and 3 hours. CONCLUSIONS: Postoperative analgesic administration should be conducted in accordance with age and surgery type. Additionally, epidural anesthesia can reduce the immediate postoperative pain intensity.

A Scoping Review on the Status of Female Breast Cancer in Asia with a Special Focus on Nepal.

This study aimed to provide updated evidence on the status of female breast cancer and cancer treatment facilities in Asia, with a special focus on Nepal. This review used search phrases that included, breast neoplasm or cancer, health status, epidemiology, breast cancer survivors, cancer care facilities, Asia, Nepal. Researchers examined databases from January 2011 to December 2020 (PubMed, PMC, Google Scholar, and the reference lists of included papers). Studies of any design and reviews, were included in the study, except for qualitative studies. The study findings are presented in a narrative synthesis format using Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews. An initial search resulted in 974 papers, and 896 were reviewed after being checked for duplication using the Zotero software. Accordingly, utilizing the inclusion and exclusion criteria, 188 publications were selected, and after review of titles and abstracts, an additional 98 papers were removed for different reasons. Finally, the study looked at 90 female breast cancer papers. Results showed that the number of cases of breast cancer is growing all around the world, including in Asia and Nepal. Age, early menarche, late menopause, nulliparity, positive family history, excessive fat consumption, alcohol, and smoking are all frequent risk factors for breast cancer found in Asian women. Breast self-examination, clinical breast examination, and mammography screening are common methods for detecting breast carcinoma. Chemotherapy, radiation, and modified mastectomy are commonly used options for treatment. The number of breast cancer survivors is growing throughout the world, indicating better clinical care. There is a paucity of survival data in many Asian countries, including Nepal. There is also a scarcity of health workforce specialized in cancer care and treatment, as well as a few health facilities that are available to treat cancer cases in many Asian countries, including Nepal.

Evaluation of the Integrated Health Information System (IHIS) in Public Hospitals in Cyprus Utilizing the DIPSA Framework.

INTRODUCTION: The Ministry of Health of the Republic of Cyprus has implemented an Integrated Health Information System (IHIS) in two hospitals. However, no evaluation of IHIS has been conducted to assess its safety, efficiency and effectiveness. The proper utilization of IHIS is essential for the provision of quality healthcare services. AIM: The purpose of this study was to evaluate the current IHIS in public hospitals in Cyprus utilizing the DIPSA evaluation framework. METHODS: A total of 309 subjects, including doctors, nurses and other healthcare professionals, participated in the study. The DIPSA evaluation framework assessed the users' perception in five categories namely, satisfaction, collaboration, system quality, safety and procedures, using Likert scale and 3 open questions. Correlation between the categories was assessed using the Pearson correlation coefficient, and multiple regression analysis was used to examine the relationship between the demographic characteristics and categories. Data analysis was done using SPSS v24. RESULTS: All five categories were rated moderately, between 2.5 and 3, by the participants. All categories were correlated (P < 0.01). Multiple regression analysis indicated the need for improvement between the professionals (mainly doctors and nurses) and the categories. The open questions pointed out the need for improvement in all 3 factors examined (Technology, Human Factor, Organization). DISCUSSION: The moderately rated categories, in the Cyprus IHIS, suggest that there is a lot of room for improvement. Some interventions are suggested that could positively and simultaneously affect one or more categories.

Development of an Evaluation Framework for Health Information Systems (DIPSA).

INTRODUCTION: Use of Integrated Health Information Systems (IHIS) for the provision of healthcare services benefits both healthcare professionals and patients, while requiring continuous evaluation and upgrading to fully support its role. AIM: The main purpose of the study was to develop an evaluation framework for hospitals utilizing IHIS, within the three main areas identified as Human factor, Technology and Organization. MATERIAL AND METHODS: The questionnaire consisted of 43 questions, with 17 questions (related to categories procedures, system quality and satisfaction), 25 questions (related to categories, safety and collaboration) and 1 question related to accessibility to the system (within the category system quality). Three open questions were added to evaluate users' perception on what was needed for the improvement of health services in their respective hospitals for all 3 variables being evaluated. The open questions were included to allow participants to express their opinion in a more detailed setting. A database was developed, and the data were processed and analyzed. RESULTS: Factor analysis formed 5 categories for the evaluation framework. Cronbach's alpha coefficient was found in all categories to be above > 0.85. CONCLUSION: Evaluation frameworks can be designed, developed and implemented by using different methodologies. For an evaluation framework to be effective it should be designed and implemented based on the aims and purpose of the research and the specific needs of the particular healthcare setting or hospital. Considering the categories satisfaction, collaboration, safety, system quality, procedures, and by using Likert scale and open questions in the current study, DIPSA can provide a holistic image of IHIS by evaluating any hospital system.

Evaluation of an Integrated Health Information System (HIS) in a Public Hospital in Cyprus: A Pilot Study.

Health information systems can improve the quality of services in healthcare. Evaluation of health information systems in hospitals is a very complex process, and it is more effective when different aspects are considered. The present work aims to develop an evaluation framework of an integrated HIS in order to improve the quality of healthcare services provided in Cyprus. Qualitative and quantitative methods were used, that measured three aspects of the system: technology, human factor and organization. Preliminary results showed that while participants seem to agree with the potential benefits of the integrated HIS, safety of data within the HIS is seen as a problem. Qualitatively, the study pointed to 3 factors that might improve the current integrated HIS: increasing interdisciplinary cooperation, training of staff, and upgrading the infrastructure. Further studies will provide a comprehensive picture for Cyprus, so that appropriate measures can be proposed and put in action.

Heat-related mortality in Cyprus for current and future climate scenarios.

Extreme temperatures have long been associated with adverse health impacts, ranging from minor illness, to increased hospitalizations and mortality. Heat-related mortality during summer months is likely to become an increasing public health problem in future due to the effects of climate change. We performed a health impact assessment for heat-related mortality for the warm months of April-September for the years 2004 to 2009 inclusive, for the city of Nicosia and for Cyprus as a whole, based on separately derived exposure-response functions. We further estimated the potential future heat-related mortality by including climate projections for southern Europe, which suggest changes in temperature of between 1°C and 5°C over the next century. There were 32 heat-related deaths per year in Cyprus over the study period. When adding the projected increase in temperature due to climate change, there was a substantial increase in mortality: for a 1°C increase in temperature, heat related mortality in Cyprus was estimated to double to 64 per year, and for a 5°C increase, heat-related mortality was expected to be 8 times the baseline rate for the warm season (281 compared with 32). This analysis highlights the importance of preparing for potential health impacts due to heat in Cyprus, particularly under a changing climate.

Exchange of extracellular L-glutamate by intracellular D-aspartate: the main mechanism of D-aspartate release in the avian retina.

D-aspartate is present in significant concentrations throughout the nervous tissue but its physiological role is still under discussion. Here, we report the process of d-aspartate release in retinal cells. [(3)H]-d-aspartate release occurs through a glutamate/aspartate exchange mechanism using excitatory amino acid transporters. This process is sodium-dependent and it is not prevented by glutamate receptor antagonists such as MK-801, DNQX or AIDA nor mimicked by glutamatergic agonists like kainate, NMDA or trans-ACPD. In vitro experiments indicate that the great majority of d-aspartate release is performed by neuronal cells and to a much lower extent by glial cells. This glutamate-mediated release process is mimicked by the competitive glutamate transporter antagonist l-trans-PDC and inhibited by the non-competitive transporter antagonist TBOA. Instead of the classical calcium-dependent exocytosis or transporter-reversal mediated neuronal release, d-aspartate efflux in the retina occurs mostly, if not exclusively, via an exchange of external l-glutamate by d-aspartate predominantly present in the cytoplasmatic compartment of neurons. These data also suggest that this process narrows down the specificity of excitatory signaling in the microenvironment of the synapses, reinforcing NMDA receptor activation by d-aspartate at the cost of reduction in the overall activation of excitatory amino acid receptors promoted by l-glutamate.

Nicotinic acetylcholine receptor activation reduces skeletal muscle inflammation of mdx mice.

Mdx mice develop an inflammatory myopathy characterized at different ages by myonecrosis with scattered inflammatory infiltrates followed by muscular regeneration and later persistent fibrosis. This work aimed to verify the putative anti-inflammatory role of nicotinic acetylcholine receptor (nAChR) in the mdx muscular lesion. Mitigation of myonecrosis and decreased TNFα production were accompanied by increased numbers of F4/80 macrophages expressing nAChRα7. In vivo treatment with nicotine attenuated muscular inflammation characterized by reduced metalloprotease MMP-9 activity, TNFα and NFkB content and increased muscular regeneration. Our data indicate that nAChR activation influences local inflammatory responses in the muscular lesion of mdx mice.

Nanoscopic cationic methacrylate star homopolymers: synthesis by group transfer polymerization, characterization and evaluation as transfection reagents.

Seven star polymers with degrees of polymerization (DPs) of the arms from 10 to 100 and dimensions in the nanometer range were prepared using sequential group transfer polymerization of 2-(dimethylamino)ethyl methacrylate (DMAEMA, hydrophilic positively ionizable monomer) and ethylene glycol dimethacrylate (hydrophobic neutral cross-linker). The polymers were characterized in tetrahydrofuran by gel permeation chromatography and static light scattering to determine the molecular weights and the weight-average number of arms for each sample. The number of arms of the star polymers varied from 20 to 72. Aqueous solutions of the star polymers were studied by turbidimetry, hydrogen ion titration, and dynamic light scattering to determine their cloud points, pKs, and hydrodynamic diameters. The cloud points of the larger star polymers, with arm DP 30-100, were found to be 29-34 degrees C, almost independent of the DP of the arms. Similarly, the pKs of all star polymers were calculated to range between 6.7 and 7.0, again independent of the arm DP. In contrast, the hydrodynamic diameters of the star polymers strongly depended on the DP of the arms. In particular, by increasing the DP of the arms from 20 to 100, the hydrodynamic diameters in water increased from 7 to 31 nm. All star polymers were evaluated for their ability to transfect human cervical HeLa cancer cells with the modified plasmid pRLSV40 with the enhanced green fluorescent protein as the reporter gene. Our results showed that as the DP of the arms of the DMAEMA star homopolymers increased from 10 to 100, the overall transfection efficiency decreased, with the star polymer with DP of the arms of 10 emerging as the best transfection reagent. Systematic variation of the amounts of star polymer and plasmid DNA used in the transfections led to an optimization of the performance of this star polymer, yielding overall transfection efficiencies of 15%, comparable to the optimum overall transfection efficiency of the commercially available transfection reagent SuperFect of 13%.