RESUMO
BACKGROUND: Human rights are for all, regardless of age. The older adults are seen as vulnerable because biological, psychological and social ageing predispose the ageing person to frailty, infirmity, and in many cases dependency, setting the older person apart from the rest of the population in need of special protection and rights. Although the implementation of legislation, policies, and a package of integrated programmes and projects to cater to the needs of older persons had helped them to uplift their status, more has to be done to stem the increase of the reach of laws in a more fruitful manner. AIM: To develop a colloquial structured Healthcare Policies & Programmes Awareness Questionnaire and assess the awareness about the government healthcare provisions and benefits available for senior citizens among health professionals, older patients, and their caregivers. METHODS: This study was conducted in two phases, the development of the questionnaire consisting of relevant healthcare national policies and programmes followed by a cross sectional pilot study on 335 participants. RESULTS: The level of awareness was only 45.6% among health professionals followed by 26.4% & 22.2% of awareness among the caregivers and the older adults respectively. CONCLUSION: There is a huge gap between the healthcare providers and healthcare takers knowledge due to which the preventive and promotive care of older adults is poor in our country. There is a need to strengthen institutions and mechanism that can more systematically promote interaction between researchers, policymakers and other stakeholders who can influence the uptake of the research findings in a synergistic manner.
Assuntos
Cuidadores , Política de Saúde , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Pessoal de Saúde , Humanos , Projetos PilotoRESUMO
Positive serology for dengue and/or scrub typhus infection with/without positive malarial smear (designated as mixed or co-infection) is being increasingly observed during epidemics of acute undifferentiated febrile illnesses (AUFIs). We planned to study the clinical and biochemical spectrum of co-infections with Plasmodium sp., dengue virus and scrub typhus and compare these with mono-infection by the same organisms. During the period from December 2012 to December 2013, all cases presenting with AUFIs to a single medical unit of a referral centre in Garhwal region of the north Indian state of Uttarakhand were retrospectively selected and categorised aetiologically as co-infections, malaria, dengue or scrub typhus. The groups thus created were compared in terms of demographic, clinical, biochemical and outcome parameters. The co-infection group (n = 49) was associated with milder clinical manifestations, fewer, milder and non-progressive organ dysfunction, and lesser need for intensive care, mechanical ventilation and dialysis as compared to mono-infections. When co-infections were sub-grouped and compared with the relevant mono-infections, there were differences in certain haematological and biochemical parameters; however, this difference did not translate into differential outcomes. Scrub typhus mono-infection was associated with severe disease in terms of both morbidity and mortality. Malaria, dengue and scrub typhus should be routinely tested in all patients with AUFIs. Co-infections, whether true or due to serological cross-reactivity, appear to be a separate entity so far as presentation and morbidity is concerned. Further insight is needed into the mechanism and identification of the protective infection.
Assuntos
Coinfecção/epidemiologia , Dengue/epidemiologia , Febre de Causa Desconhecida/epidemiologia , Malária/epidemiologia , Tifo por Ácaros/epidemiologia , Adolescente , Adulto , Idoso , Dengue/complicações , Dengue/patologia , Feminino , Febre de Causa Desconhecida/etiologia , Hospitais , Humanos , Índia/epidemiologia , Malária/complicações , Malária/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tifo por Ácaros/complicações , Tifo por Ácaros/patologia , Adulto JovemRESUMO
PURPOSE: During bone-marrow biopsy, one third of patients score their pain as moderate or severe. Combination of analgesic and hypnotic is effective at reducing pain, but prolonged medical surveillance is necessary. The objective of the study was to assess the effectiveness and ease of use of the equimolar nitrous oxide-oxygen mixture (nitrous oxide), a short acting analgesic with little sedative effect, during bone-marrow biopsy. METHODS: As part of a non-controlled prospective observational study, patients undergoing a bone-marrow biopsy received nitrous oxide as an adjuvant to local anaesthesia. Facemask was self-maintained. A questionnaire was given after completion of the procedure to assess the pain (with a numerical-rating scale [RS] ranging from 0 to 10) as the main criterion and the ease of the procedure, the tolerance, and satisfaction, as secondary criteria. The physician noted adverse reactions. RESULTS: Nineteen women and 21 men were included. The median age was 51 years. Ninety percent of patients felt slight pain, less than 5 out of 10 on the RS. Only one patient had difficulty in keeping the mask. A patient experienced nausea and four presented a fleeting euphoria noticed by the physician. Ninety-five of patients wished to use nitrous oxide again should further bone-marrow examinations be necessary. CONCLUSION: Nitrous oxide is an effective analgesic when performing bone-marrow biopsies. Ten percent of patients feel a moderate to severe pain instead of one third. Despite some mild side effects, there is a very good appreciation by patients. Since this study, the authors routinely use nitrous oxide.
Assuntos
Analgésicos não Narcóticos/administração & dosagem , Biópsia por Agulha/efeitos adversos , Exame de Medula Óssea , Medula Óssea/patologia , Óxido Nitroso/administração & dosagem , Oxigênio/administração & dosagem , Dor/etiologia , Dor/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
Acquired von Willebrand syndrome (AvWS) is a relatively rare bleeding disorder. It has been reported in association with myeloproliferative disorders, autoimmune diseases, plasma cell dyscrasias and certain drugs. Cefotaxime is a third generation cephalosporin widely used for surgical prophylaxis and as empirical treatment of bacterial meningitis. We report a case of a transient AvWS in association with cefotaxime therapy.
Assuntos
Cefotaxima/efeitos adversos , Doenças de von Willebrand/induzido quimicamente , Adulto , Cefotaxima/uso terapêutico , Seguimentos , Humanos , Masculino , Resultado do Tratamento , Doenças de von Willebrand/diagnóstico , Doenças de von Willebrand/tratamento farmacológicoRESUMO
We show that the recently demonstrated absence of the usual discontinuity for massive spin 2 with a Lambda term is an artifact of the tree approximation, and that the discontinuity reappears at one loop.
RESUMO
In a formal study, we have identified increasing age, pretreatment renal impairment and diabetes mellitus as risk factors for the development of intravenous immunoglobulin-induced renal failure. Identification of these characteristics in potential recipients should alert clinicians to the associated increased risk of this serious complication.
Assuntos
Injúria Renal Aguda/etiologia , Doenças Hematológicas/terapia , Imunoglobulinas Intravenosas/efeitos adversos , Injúria Renal Aguda/epidemiologia , Fatores Etários , Idoso , Anemia Hemolítica Autoimune/complicações , Anemia Hemolítica Autoimune/terapia , Intervalos de Confiança , Complicações do Diabetes , Doenças Hematológicas/complicações , Hemofilia A/complicações , Hemofilia A/terapia , Humanos , Incidência , Nefropatias/complicações , Razão de Chances , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/terapia , Púrpura Trombocitopênica Trombótica/complicações , Púrpura Trombocitopênica Trombótica/terapia , Fatores de RiscoRESUMO
Interleukin-1beta(IL-1beta) and tumour necrosis factor-alpha (TNF-alpha) are potent bone resorbing cytokines that may contribute to the development of the osteolytic bone disease observed in patients with multiple myeloma (MM). Although these factors have been identified in cultures of bone marrow mononuclear cells isolated from patients, the identity of the cells responsible for producing IL-1beta and TNFalpha remains unclear. Using a sensitive dual-colour fluorescence in situ hybridization (FISH) technique and a two-colour immunofluorescence method we have investigated the expression of the mRNA and protein, for IL-1beta and TNFalpha, by individual bone marrow plasma cells from patients with MM and monoclonal gammopathy of undetermined significance (MGUS). The mRNA for IL-1beta and TNFalpha was identified in all cells expressing the immunoglobulin light chain from all patients with MM and MGUS. However, the IL-1beta protein could not be detected in cytoplasmic light chain positive cells in any of the patients examined. In contrast, the TNFalpha protein was detected in clonal plasma cells from patients with both MM and MGUS. Interestingly, the IL-1beta and TNFalpha mRNA and proteins were readily detected within a small proportion of the non-plasma cells from patients with both MM and MGUS. These data suggest that myeloma cells in vivo are able to produce TNFalpha but not IL-1beta. In addition, a small proportion of accessory cells are likely to be able to contribute to the production of both ILbeta and TNFalpha.
Assuntos
Interleucina-1/metabolismo , Paraproteinemias/metabolismo , Plasmócitos/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Idoso , Idoso de 80 Anos ou mais , Feminino , Imunofluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/metabolismo , RNA Mensageiro/metabolismoAssuntos
Adenocarcinoma/complicações , Autoanticorpos/imunologia , Doenças Autoimunes/etiologia , Fator VIII/imunologia , Hemofilia A/etiologia , Recidiva Local de Neoplasia/complicações , Neoplasias da Próstata/complicações , Adenocarcinoma/imunologia , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/imunologia , Evolução Fatal , Hemofilia A/imunologia , Hemorragia/etiologia , Humanos , Masculino , Recidiva Local de Neoplasia/imunologia , Neoplasias da Próstata/imunologiaRESUMO
Interleukin-6 (IL-6) is an important growth factor for human myeloma cells in vitro and in vivo. However, the identity of the cells producing IL-6 in vivo in patients with multiple myeloma (MM) remains the subject of debate. We have developed a sensitive dual-colour fluorescence in situ hybridization (FISH) technique to investigate the expression of IL-6 mRNA by individual bone marrow plasma cells from patients with multiple myeloma, monoclonal gammopathy of undetermined significance (MGUS) and healthy subjects. IL-6 mRNA could be identified in all immunoglobulin light chain (IgLC) expressing cells from all patients with MM and MGUS. The IL-6 protein could also be detected by direct immunofluorescence in all plasma cells (cytoplasmic light chain positive) from all patients with MM and MGUS. Furthermore, it was also possible to demonstrate cytoplasmic IL-6 staining of plasma cells from patients with MM by flow cytometric analysis. In contrast, neither the IL-6 mRNA or protein could be detected in normal plasma cells from healthy bone marrow donors. These data demonstrate that plasma cells from patients with MM and MGUS express the IL-6 mRNA and synthesize the IL-6 protein and support the hypothesis that autocrine synthesis of IL-6 is of importance in patients with MM.