The effectiveness of telemedicine in the management of chronic heart disease - a systematic review.

OBJECTIVE: The primary objective of this systematic review is to assess the effectiveness of telemedicine in managing chronic heart disease patients concerning improvement in varied health attributes. DESIGN: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. SETTING: We adopted a logical search process used in two main research databases, the Cumulative Index to Nursing and Allied Health Literature and PubMed (MEDLINE). Four reviewers meticulously screened 151 abstracts to determine relevancy and significance to our research objectives. The final sample in the literature review consisted of 20 articles. MAIN OUTCOME MEASURES: We looked for improved medical outcomes as the main outcome measure. RESULTS: Our results indicated that telemedicine is highly associated with the reduction in hospitalisations and readmissions (9 of 20 articles, 45%). The other significant attributes most commonly encountered were improved mortality and cost-effectiveness (both 40%) and improved health outcomes (35%). Patient satisfaction occurred the least in the literature, mentioned in only 2 of 20 articles (10%). There was no significant mention of an increase in patient satisfaction because of telemedicine. CONCLUSIONS: We concluded that telemedicine is considered to be effective in quality measures such as readmissions, moderately effective in health outcomes, only marginally effective in customer satisfaction. Telemedicine shows promise on an alternative modality of care for cardiovascular disease, but additional exploration should continue to quantify the quality measures.

The effect of some cryoprotectants on dromedary camel frozen-thawed semen.

The cryopreserved camel semen is often associated with poor quality and fertility. This study aimed to improve the dromedary frozen semen quality by comparing the efficiency of four cryoprotectant agents (CPAs) on sperm freezability. Semen samples were collected from seven male Maghrabi camels, diluted with Shotor diluent supplemented with glycerol (Sh-G), dimethyl formamide (DMF, Sh-DF), dimethyl sulfoxide (DMSO, Sh-DS) or ethylene glycol (EG, Sh-EG), all at 6% final concentration, and the samples were subjected to cryopreservation. The results revealed the superiority of Sh-DF over Sh-G and Sh-DS in terms of post-thaw motility (55.83 ± 2.20 vs. 47.50 ± 4.33 and 45.00 ± 2.89%, respectively), sperm membrane (49.00 ± 0.58, 39.33 ± 3.33 and 42.67 ± 1.45%, respectively) and acrosomal integrities (53.00 ± 0.58, 57.33 ± 0.88 and 52.33 ± 1.45%, respectively). Sh-EG group showed the lowest post-thaw motility, plasma membrane and acrosome integrities (12.50 ± 1.44, 22.67 ± 1.45 and 30.67 ± 1.45, respectively). In conclusion, the protocols of dromedary camel semen cryopreservation could be enhanced using 6% DMF as a cryoprotectant agent.

Maternal and developmental toxicity in mice by aminophenylnorharman, formed from norharman and aniline.

9-(4'-Aminophenyl)-9H-pyrido [3,4-b] indole (aminophenylnorharman, APNH) is a novel mutagenic heterocyclic amine, produced by the reaction of norharman with aniline in the presence of S9 mix. In the present study, the maternal and developmental toxicity of APNH were investigated in ICR mice administered oral doses of 0, 0.625, 1.25, 2.5 or 5 mg/kg/day on gestational days (GD) 6 through 15 or 0, 5, 10, or 20 mg/kg on GD 12. Maternal and foetal parameters were evaluated on day 18 of gestation. Foetuses of dams treated on GD 6-15 were examined for external and skeletal malformations and variations, and foetuses of dams treated on GD 12 were inspected for cleft palate. Maternal death occurred when APNH was administered at 5 mg/kg/day on GD 6-15. No significant decrease in body weight gain during the administration period was observed at doses of 2.5 mg/kg/day or less when applied on GD 6-15. Adverse changes in general condition of dams were observed in the groups treated at doses of 2.5 mg/kg/day and above on GD 6-15, whereas no adverse effects on dams were noted even when APNH was applied at a fairly high dose on GD 12. Intracytoplasmic vacuolation in hepatocytes, necrosis of proximal tubular epithelial cells and desquamation of necrotic epithelial cells in the tubular lumen were observed in dams treated with APNH at 2.5 or 5 mg/kg/day on GD 6-15. Increased preimplantation loss was observed at 5 mg/kg/day and post-implantation loss was observed at 2.5 mg/kg/day and above when applied on GD 6-15, or at 20 mg/kg when applied on GD 12. Foetal body weight was decreased by APNH in a dose-dependent manner. The frequency of external malformations (cleft palate) was significantly increased in the group treated with APNH at 2.5 mg/kg/ day on GD 6-15 compared to the controls. However, there were no foetuses with cleft palate even when APNH was given at 20 mg/kg on GD 12. No significant increases in skeletally malformed foetuses were found in any APNH-treated group. The frequency of lumbar ribs was increased dose dependently. This study demonstrated the developmental toxicity of a mutagenic compound, APNH, in mice at maternally toxic doses, and that cleft palate observed in term foetuses resulted from the adverse effect of APNH on the maternal environment during organogenesis. More detailed studies are warranted to assess the possible risks to pregnant women from exposure to APNH.

Effects of cysteamine, fsh and estradiol-17beta on in vitro maturation of porcine oocytes.

Porcine cumulus-oocyte complexes (COCs) were cultured for 48 h with addition or absence of exogenous estradiol-17beta (E2; 1 microg/mL) in the maturation medium (mM199). The medium was supplemented with sodium pyruvate (0.1 mg/mL), 10% (v/v) FCS, various concentrations of FSH (0, 1 and 10 microg/mL) and with or without cysteamine (150 microM). When supplemented with E2, cysteamine enhanced the rates of germinal vesicle breakdown (GVBD) and maturation to metaphase-II (M-II) in COCs cultured in the medium with 0 and 1 microg/mL FSH (P<0.05). Among COCs cultured with FSH, oocytes cultured with 1 microg/mL FSH and E2 but without cysteamine showed the lowest rates of GVBD and M-II. The rates were, however, significantly increased when cysteamine was added to the same medium or by increasing FSH concentration to 10 microg/mL in the maturation medium. E2 significantly inhibited the rates of GVBD and M-II in COCs cultured without FSH and cysteamine (a group of oocytes with spontaneous maturation). When COCs were cultured in TCM 199 with 1 or 10 microg/mL FSH, with or without E2 (1 microg/mL) and fertilized in vitro, the rates of male pronucleus formation were not increased by increasing FSH concentration, but the addition of cysteamine to the maturation medium significantly enhanced the rates in the same FSH treatment. The results indicate that E2 inhibits spontaneous GVBD and maturation to M-II of porcine oocytes and that a low concentration of FSH (1 microg/mL) is not sufficient to induce full nuclear maturation, compared with 10 microg/mL FSH, but that it can complete nuclear maturation with cysteamine and E2. However, the cytoplasmic maturation is promoted only by the addition of cysteamine in the medium.