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Wir gehen wir in diesem Text der Frage nach den Zusammenhängen zwischen Supervision und ethischer Reflexion in Care-Organisationen nach. Dabei gehen wir von zwei Fallbeispielen aus dem Krankenhaus – eines aus der Supervisionspraxis und eines aus einem partizipativen Forschungsprojekt – aus. Wir definieren zunächst das Beratungsformat Supervision, halten fest, dass Supervision einen ethischen Rahmen braucht und beschreiben die ethischen Richtlinien als Teil des Kontrakts. Konflikte sind in Care-Organisationen und in sorgenden Beziehungen unvermeidbar, unter anderem, weil diese Beziehungen asymmetrisch sind und weil ihnen Widersprüche zugrunde liegen. Die daraus resultierenden Dilemmata werden oft genug an die Supervision herangetragen, damit ist Supervision ein Ort der ethischen Reflexion. Wir beschreiben Verbindendes und Trennendes zwischen Supervision und ethischer Fallbesprechung. Für jeden dieser ethischen Reflexionsorte ist es von Bedeutung, explizit zu machen, auf welchen ethischen Grundlagen sie beruhen. Wir beziehen uns in unserem Text und in Bezug auf die Supervision auf die feministische Care-Ethik mit ihren zentralen Konzepten Vulnerabilität, Achtsamkeit, Bezogenheit und relationale Autonomie, sowie Narrativität, die wir im Text explorieren und beschreiben das Wesen von Caring Institutions (Tronto 2013). Wir kommen zu dem Schluss, dass Supervision zweifelsohne ein Ort für die Beratung zu ethischen Themen und Fragen sein kann und sehen die Art und Weise, wie mit ethischen Dilemmata und Konflikten im Rahmen von Supervision umgegangen wird, in care-ethischen und prozessethischen Diskursen und Grundlagen verortet. Die Supervision ist daher als ein Ort der care-ethischen Reflexion zu bezeichnen. Sie ermöglicht das Ansprechen und Kommunizieren von strukturellen und organisationalen Problemen und kann so auf mehreren Ebenen dazu beitragen, dass aus einer Care-Organisation eine Caring Institution wird.

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After decades of community mobilizing and a protracted legal battle, Maya villages in southern Belize won a watershed Indigenous land rights victory in the Caribbean Court of Justice in 2015. Since then, the state has criminalized environmental defenders, violated communal land rights, and is argued by Maya activists and alcaldes (village leaders) to be operating in discriminatory bad faith. Accordingly, this Grassroots article casts critical light on a recent flashpoint conflict between the Government of Belize and Maya of Toledo District related to Free Prior and Informed Consent (FPIC). The article is directly informed by both the grounded knowledge of an autonomous movement engaged in frontline resistance, and participatory research that is rooted in a politics and spirit of "accompliceship." The structural analysis we offer from an explicitly anticolonial standpoint is instructive about the historical-imperial processes, social forces, and economic logics that underpin conventional approaches to both "development" and the state's duty to consult local communities. Ultimately, the article reveals the forms of political conflict and environmental degradation that continue to emerge globally at the conjuncture of capitalist development, (postcolonial) state power, and struggles for Indigenous self-determination.er, and struggles for Indigenous self-determination.

Digital transformation (DT) refers to the changes in ways of working and business offering caused by adoption of digital technologies in an organization. Small and medium-sized enterprises (SMEs) are struggling with this transformation because of their limited resources and know-how. Thus, SMEs need practical grassroots-level help for DT that allows the companies to analyze where they stand in digitalization, and how they should proceed. This article discusses how SMEs can be supported in their DT by utilizing the DT model consisting of four consecutive phases for supporting companies’ systematic development of digitalization. The article focuses on the first phase of the DT model, positioning, where company’s digitalization status is analyzed in detail, and development ideas are identified. The positioning phase was conducted for 19 SMEs in Northern Ostrobothnia, Finland. The results indicate that the used process and tools were suitable to support SMEs for analyzing their digitalization status and identifying areas for improvement. The DT model and piloted tools have been published as a free-of-charge ApuaDigiin.fi online service to facilitate their widespread use in the future. In this way, public regional business development authors or research organizations can utilize the online service while supporting the digitalization of SMEs.

Objectifs : Déterminer la séroprévalence des infections transmissibles par transfusion de produits sanguin labiles chez les donneurs de sang à l’hôpital Nianankoro Fomba de Ségou. Patients et Méthodes : Il s'agissait d'une étude rétrospective, descriptive effectuée chez les donneurs de sang de Janvier à Décembre 2016 à l’unité de la banque de sang de l’hôpital Nianankoro Fomba de Ségou. Les tests rapides ont été utilisés pour le dépistage des infections recommandées par l’OMS. Résultats : 3941 donneurs ont été colligés. L’âge moyen était de 31,21± 8,7 ans (Extrêmes : 18-60 ans). Le sex- ratio M/F était de 15,63. Les donneurs familiaux et les nouveaux donneurs de sang prédominaient avec respectivement 91,4% et 81%. La séroprévalence du VIH, de l’hépatite B, de l’hépatite C, et de la syphilis était respectivement de 5,30% ; 11% ; 2,40% et 5,40%. La séroprévalence du VIH, de l’hépatite B, de l’hépatite C et de la Syphilis était plus élevée chez les primo-donneurs de sang avec respectivement ; 4,62%, 9,69%, 2,11% et 4,69%. Conclusions : La séroprévalence du VIH, de l’hépatite B, de l’hépatite C et la syphilis est élevée chez les donneurs familiaux et les primo- donneurs d’où l’importance de fidéliser les donneurs bénévoles de sang

Introduction : La sphère oculaire est une localisation rare de la tuberculose. Nous rapportons un cas de cette infection à localisation oculaire chez une jeune fille malienne. Décrire les lésions oculaires au cours d’une infection tuberculeuse. Observation :Il s’agit d’une étude de cas clinique descriptive concernant une fillette de 13 ans, reçue en consultation dans notre service pour rougeur et baisse de l’acuité à l’œil droit évoluant progressivement depuis quelques mois. Malgré les multiples consultations et traitements reçus, les symptômes persistaient et s’aggravaient insidieusement. Dans ses antécédents, nous n’avons pas trouvé de notion de traumatisme oculaire, ni de contage tuberculeux. L’examen ophtalmologique révèle une uvéite antérieure granulomatose avec baisse importante de l’acuité visuelle. L’examen des crachats est négatif, en revanche, l’IDR à la tuberculine est phlycténulaire avec un diamètre d’induration > 35mm. Le traitement anti tuberculeux selon le protocole du Programme Nationale de Lutte contre la Tuberculose (PNLT) a permis une amélioration clinique et fonctionnelle rapide, puis la guérison de la patiente. Conclusion : Le diagnostic de la tuberculose oculaire est difficile dans les pays en voie de développement. Il nécessite la mise à disposition de nouveaux outils diagnostics et une collaboration multidisciplinaire

Objectif: Décrire les caractéristiques épidémiologiques et les modalités de prise en charge préventive des patients. Résultats : Cent cinquante-deux (152) patients ont consulté suite à une exposition au risque d’infection rabique principalement à la suite d’une morsure par un chien (133cas/152). Aucun animal mordeur n’a été mis en observation. La majorité (90%) provenait de Dakar. L’âge médian était de 22 ans [1 - 90 ans] et les hommes étaient les plus touchés avec un sex ratio (H/F) de 1,8. Les blessures de catégorie II étaient les plus fréquentes (100 cas). Près de deux tiers des personnes exposées ont été prises en charge dans les 48 heures. La quasi-totalité des patients avaient bénéficié du protocole Zagreb mais environ 41% d’entre eux avaient abandonné leur prophylaxie post exposition (PPE) en cours de suivi, soit un taux de complétude de 59%. Conclusion : Composante essentielle de la lutte contre la rage, la prophylaxie post exposition doit être améliorée par la sensibilisation et la collaboration avec les services vétérinaires. Tout ceci dans l’esprit du one health ou santé unique ainsi que l’amélioration de l’accessibilité financière des vaccins et des immunoglobulines antirabiques

Objectifs : Evaluer l’impact du counseling pour le dépistage VIH en salle de travail chez les patientes n’ayant pas bénéficié de cette activité lors des CPN. Méthodes et matériels : L’étude s’est déroulée au CSRéf de la commune v de Bamako du 1er janvier au 31décembre 2014. L’échantillonnage était systématique, portait sur toutes les parturientes admises en salle de travail avec une dilatation cervicale à 4cm ou plus et dans le post- partum immédiat avec un âge gestationnel ≥ 28SA ou un poids fœtal ≥1000g. Le test par bandelette a été utilisé après consentement éclairé des patientes .La confirmation a été faite avec l’immunocomb II VIH1 et 2 Bi spot. Résultats :L’étude a rapporté que 4,34% (380) des parturientes n’ont pas fait le dépistage VIH lors du suivi prénatal. En salle d’accouchement, ces 380 parturientes ont bénéficié toutes d’un conseil dépistage volontaire au VIH. Nous avons enregistré 11 cas de refus. Sur les 369 parturientes ayant fait le test, 37 étaient positifs au VIH soit 10%. L’âge moyen était de 27ans ±07 ; non instruite (58,9%) vivant dans un régime polygamique (65,9) ; un suivi prénatal fait (95,12%) ; 93% suivi dans les structures citées PTME. Les antirétroviraux ont été administrés à toutes les mères et aux nouveau- nés vivants. Conclusion : Au regard de la fréquence élevée (10%) des cas positifs dans notre étude, il est nécessaire de poursuivre les activités de Conseil et Dépistage Volontaire en salle d’accouchement pour permettre à l’ensemble des femmes enceintes qui accouchent dans nos structures sanitaires de bénéficier des interventions de la PTME

Le granulome inguinal ou encore appelé donovanose, désigne une maladie provoquée par la bactérie Klebsiella Granulomatis. Il se manifeste par des ulcères indolores au niveau de l'appareil génital. Nous rapportons un cas clinique qui illustre une présentation clinique atypique de la forme des granulomes inguinaux inflammatoires sur hydrocèle bilatérale chez le même patient. Le patient a bénéficié d’une exérèse de lymphœdème plus la cure bilatérale de l’hydrocèle.

L’érysipèle est une dermohypodermite bactérienne aiguë non nécrosante, affectant le plus souvent les membres inférieurs. Les facteurs favorisant sa survenue sont l’existence d’une porte d’entrée (plaies traumatiques négligées, intertrigo), le lymphœdème, l’obésité et la dépigmentation volontaire. La complication la plus fréquente est la récidive. Les autres complications incluent notamment abcédassions, la fasciite et les bactériémies. Nous rapportons une première observation malienne d’érysipèle chez un nourrisson de 8 mois, de sexe féminin, amené en consultation dans l’unité dermatologique de l’hôpital régional de Gao pour l’installation brutale d’une grosse jambe rouge plus notion de fièvre et de frissons. Le diagnostic a été porté devant une tuméfaction du membre inférieur droit rouge, chaude et douloureuse surmontée de bulles tendues associée à une adénopathie inguinale et une leucocytose à l’hémogramme. Un traitement à base d’antibiotique associé à un pansement et le repos a été instauré. L’évolution a été émaillée par la disparition des lésions en dix jours. Le diagnostic positif est fondé sur la clinique renforcé par la recherche de l’origine streptococcique.

When a team gets sport successes to level profesional, generates the topics that will be investigated such as the key factors of the succes. The main aim of this study is to analyze the influencie of different factors like the sports context, the social context and training aspects in the success of the Club Baloncesto Conquero through direct perception of thirteen informants associated with the team and the basketball in Huelva. An interview was carried out, related with those factors and the keys to success. The results revealed that workforce planning along the great work of coaching staff, medical staff and physical trainer have been key to the team gets sport successes.

Objectif : L'objectif de cette étude était d'étudier les connaissances, les attitudes, et les pratiques sur les infections buccodentaires des élèves de trois écoles coraniques de Koutiala. Matériel et méthodes : Nous avons réalisé une étude prospective de type descriptif qui a duré six mois allant du 20 Février au 20 Août 2015 sur 300 élèves de trois écoles coraniques de la ville de Koutiala. Les données ont été recueillies à partir des fiches d'enquêtes, saisies et analysées avec le logiciel Epi Info 3.5.4.Résultats : Le sexe masculin a été le plus représenté avec 57,67%. Le sex ratio = 0,73. La tranche d'âge la plus représentée était celle de 8 – 12 ans avec 52% avec un âge moyen de 17 ans et des extrêmes de 8 et 26 ans. Dans notre étude 98,33% des élèves avaient une notion de connaissance sur les infections bucco-dentaires et ces informations étaient données par les parents/ainés dans 60% des cas. Les élèves définissaient la carie comme étant une sorte de cancer ou maladie contagieuse dans 60%des cas. Ils affirmaient que les personnes qui ne se brossaient pas correctement les dents étaient les plus susceptibles de faire la carie dans 93,33% des cas. Dans notre étude 61,33% des élèves disaient que la carie se transmet par le manque d'hygiène buccodentaire (HBD) ; 33,33% des élèves disaient que l'utilisation des brosses à dent + bonne HBD sont les moyens de lutte contre les infections buccodentaires. Les élèves dans 66,67 % des cas conseillaient à leur ami d'aller lui-même au centre de santé et ils pensaient dans 93,33% des cas qu'une bonne HBD prévient les infections buccodentaires. Les élèves disaient se brosser les dents tous les jours dans 98% des cas et ils avaient fait une consultation chez le chirurgien dentiste dans 8,67% des cas. Conclusion : Cette étude montre que les élèves avaient une connaissance sur les infections buccodentaires, les causes et les préventions contre les maladies buccodentaires. Des efforts doivent être fournis en matière de promotion, de prévention, de dépistage et de prise en charge des infections en milieu scolaire et universitaire sans oublier les écoles coraniques tout en intégrant les parents d'élèves dans les processus

Introduction : Les encéphalites aigües sont une cause majeure de morbidité et de mortalité en pédiatrie ; le but de notre étude était d'étudier les aspects épidémiologiques et cliniques des encéphalites aigües chez les enfants âgés de 0 à 15 ans dans le département de pédiatrie du CHU Gabriel Toure. Méthodologie : Il s'est agi d'une étude descriptive sur 12 mois du 1er Janvier au 31 Décembre 2015 au département de pédiatrie du CHU Gabriel Toure Bamako Mali. Tous les dossiers présentant une encéphalite aigüe ont été inclus. Résultats : Ainsi 34 dossiers d'enfants présentant une encéphalite aigüe sur un total de 4727 hospitalisés en pédiatrie ont été analysés soit une fréquence de 0,72%. Environ Quarante sept pour cent (47,1%) des enfants avaient un âge compris entre 12 et 59 mois. Le sex- ratio était de 1,8 en faveur des garçons ; la fièvre plus la convulsion étaient présente dans 70,6%, suivie du coma 41,2%. Le taux de mortalité était 6%, et 64,7% ont gardés des séquelles neurologiques. Conclusion : Les encéphalites aigües constituent une cause importante de séquelles neurologiques chez l'enfant à cause des difficultés diagnostiques et de prise en charge

Objective The objective of this study is to analyze the influence of mental illness on the oral health status of psychiatric patients. Materials And Methods We performed a prospective, transverse and descriptive study based on the observation of the oral lesions in the patients received in psychiatric consultation. It took place in the department of Psychiatry of the Center Hospitalo Universitaire of Point G for one month (from June to July 2014). The target population was known psychiatric patients followed and / or hospitalized during the study period. The data were collected from the medical files and a questionnaire and entered and analyzed with the software Epi info fr 6.0. In 54.40% of patients, brushing of teeth was performed once daily and twice daily in 26.10% of cases. Results During the study period, 130 patients were selected according to our inclusion criteria, of which 70.0% were male with a sex ratio of 2.3. The age group 25-34 was the most represented, 31.50%. The majority of our patients had dental abrasion, or 90.80% of the cases. The CAD / D index of our population was 5.22. Halitosis and oral dryness were common in patients with chronic psychosis, respectively 63.5% and 56.90% of cases. Gingivorrhage was observed in 61.10% of patients with chronic psychosis. Conclusion This study shows the high frequency of oral infection in a psychiatric setting, hence the interest of a partnership between mental health professionals and those in the oral cavity. Keywords : Oral infections ; psychiatry ; buccal dryness, CAD index ; Point G Hospital

Aim: To examine the characteristics, management and outcomes of cesarean scar pregnancies at a single tertiary obstetric centre over a three-year period. Method: A retrospective study was performed on 8 cases of cesarean scar pregnancy identified between January 2009 and June 2012 from the medical files. Results: The mean gestational age was 58.2 days (35-120). The average time for β-hCG levels to return to normal values after treatment for cesarean scar pregnancy was 3.4 weeks (2-6). The mean number of previous cesarean sections was 1.9 (1-4) and the mean interval time after the last cesarean section was 20 months (10-48). Laparotomy with excision of the sac and primary repair (n=5) and methotrexate (n=3) were the modalities of management. Conclusion: Cesarean scar pregnancy is a potentially life-threatening complication of pregnancy that constitutes a diagnostic and therapeutic challenge. Decision on treatment modality should be determined on individualized basis depending on factors such as gestational age, β-hCG levels, fetal cardiac activity, desire of future fertility and the experience and facilities available.

Aim: Flow mediated dilatation (FMD) is a good sonographic indicator of early atherosclerotic changes which reflects endothelial functions by measuring dilatation of peripheral arteries in response to physical stressors. In this study, we aimed to measure FMD on brachial artery of patients with psoriasis which reflects endothelial dysfunction and compare to that of healthy volunteers. Methods: 30 patients with psoriasis and 31 control subjects matched in terms of age, gender, and demographic characteristics were included to this observational, case-control study. FMD was measured on the nondominant arm of the subjects by using sonographic techniques. Results: The patients and controls were similar in terms of sex, gender, smoking, arterial blood pressure, and body mass index. FMD values, reflecting endothelial functions, were tended to be lower in psoriasis group than healthy controls; however this difference was not statistically significant (7.7 ± 3.1 vs. 8.6 ± 2.8, respectively; p = 0.247). Conclusion: These results support that presence of psoriasis is not a risk factor for future cardiovascular disease development. Prospective, multi-center, large scale studies including control group are needed in order to clarify this issue.

Aim: Laparoscopic cholecystectomy (LC) has become the standard treatment method of cholelithiasis. The chronic cholecystitis and cholelithiasis are the most common pathologies seen in gallbladder disease, accompanying hyperplastic and dysplastic lesions. Methods: 568 laparoscopic cholecystectomy procedures performed between 2008-2013 were analyzed. Clinical details and histopathological data were retrieved from the records. The variety of morphological changes in the diseased gall bladder were correlated with the clinical findings. Chronic cholecystitis and cholelithiasis were put into two groups. A single sample when taken from each neck-corpus and fundus of the gallbladder in the first group, two samples were taken from each site and gallbladder was mapped and examined as a whole in the second group. Results: The sex distribution of the cases was 525 (92.4%) and 43 (7.6 %) male (F/M: 12.1). Median age was 45.5 ± 12.7 years (range: 18-82), median operative time was 60.2 minutes (range: 17-200). Indications for surgery, were chronic cholecystitis in 525 (92.4 %), acute cholecystitis in33 (4.4 %), and gallbladder polyps in 6 (1 %). Acalculous cholecystitis was present in 2 patient(% 0.35) who were operated. Most common pathology noted in our study was chronic cholecystitis seen in 442 cases (%74). Other benign lesions were cholesterosis in 36 (%6) and acute cholecystitis in 28 (%.4). Various other associated lesions and variants of cholecystitis were also encountered. A total of six malignant lesions of gallbladder were observed, which included six cases of incidental adenocarcinomas. By increasing the sample size in gallbladder we saw an increase in the rate of metaplasia (p=0,009), dysplasia (p=0,009), epithelial hyperplasia (p=0.003), and carsinoma (p=0.008) statistically. Conclusion: By increasing the sample size in gallbladder we saw an increase in the rate of metaplasia, dysplasia and carcinoma statistically.

Aim: Coronary artery ectasia (CAE)is described as the dilatation of all or a portion of the coronary arteries by 1.5 times or more wider than the diameter of adjacent normal coronary artery segment. The incidence of CAE varies between 1.5 to 5%. Although the etiology of CAE has not been enlightened, it is generally considered to be a variant of coronary atherosclerosis. In our study, the association between atherosclerotic risk factors and coronary artery disease in patients with coronary artery ectasia was investigated. Methods: Between January 2008 - May 2012 , 5595 patients were screened retrospectively. Atherosclerotic risk factors were determined in all patients. Patients were grouped as the CAE with coronary artery disease (CAD) and the CAE who had no CAD. Results: CAE was diagnosed in 135 (2.4%) patients. The mean age was 62.2 years and 81.5% were male. 71.1% of the patients had CAD. In CAE patients with CAD, diabetes mellitus (DM) and hypertension (HT) was significantly higher in frequency than CAE patients without CAD. In logistic regression analysis, the presence of DM was increased the risk of CAD 2.59-fold, HT was increased the risk of CAD 3,39-fold. Between the two groups there was no significant difference for other atherosclerotic risk factors. Right coronary arteries were the most common vascular involvement (45.9%). Conclusion: In our study, the frequency of CAE was determined as 2.4%. DM and HT which are well-known risk factors for CAD, were seen more frequently in CAE patients with CAD.

Mushroom poisoning is still a serious health problem for Turkey. The mushroom species which cause fatal mushroom poisoning have been reported to contain at least 98% alpha-amanitin. The knowledge of the poisonous mushroom species including alpha- amanitin is important for the treatment and prevention of these poisonings. In this review, the mushrooms containig alpha-amanitin and causing deadly mushroom poisinings were listed and given information about their poisonus effects. According to literature, nine poisonous mushroom species which include alpha-amanitin have so far been reported from Turkey. These are Lepiota brunneoincarnata; Lepiota castanea; Lepiota helveola; Lepiota subincarnata; Amanita phalloides; Amanita verna; Amanita virosa; Conocybe filaris and Galerina marginata.

Objective: To investigate the prognostic value of the time-dependent changes of hematological parameters in patients with acute organophosphate poisoning. Methods: All patients admitted to emergency departments from 2010 through 2013 due to organophosphate poisoning were enrolled in the study. Demographic data, route of exposure, serum cholinesterase levels, complete blood count results of 5 consecutive days, mechanical ventilation requirement, length of stay in hospital, and outcomes were recorded. Results: Mechanically ventilated patients had higher leukocyte and neutrophil counts than nonventilated patients during the whole follow-up period, and both of them had a trend of decrease in both patient groups. There was no difference between patient groups in terms of lymphocyte counts at day 1, but mechanically ventilated patients had lower lymphocyte counts than nonventilated patients after day 2. Hemoglobin levels had a trend of decrease during the whole follow-up period in both patient groups. Conclusion: The parameters obtained from complete blood count can be used as sensitive follow-up parameters in patients with acute organophosphate poisoning by serial measurement.

Aim: The aim of this study is to detect the adequacy and quality of cervico-vaginal sampling in different age groups. Method: As a screening test, cervico-vaginal smears were obtained from 1179 women was admitted to Obstetrics and Gynecology Clinic of Bozok University Hospital between September 2012 and April 2013. Patients were grouped according to their ages. Patients under 20 years were designated as adolescents, patients between 20 and 44 years represented fertile period and patients 45 years and over were defined as menopausal patients. All the smears were evaluated by the same pathologist. Transformation Zone detection is required for sufficient and appropiate smear sampling. Kruskal Wallis H Tests were used for statistical analysis. Values under 0.05 were accepted as significant. Mann Whitney U test was performed for detecting the origin of significance. Results: Among 1179 patients, 14 of them were adolescents (1.18%), 752 of them belonged to fertile period group (63.78%) and 413 of them were menopausal patients (35.02%). In these groups smear sampling sufficiency and quality detected as; 64.20% in adolescents, 72.90% in fertile period and 59.95% in menopausal patients. Among smears with inflammation, 7 of them were adolescents (50%), 470 of them were in fertile period group (62,50%) and 158 cases were in menopause group (38,25%). Only 1 patient diagnosed as ASC-US (0,08%) and no other premalignant lesion was detected. There was a statistical difference between groups (p

Aim: To investigate the effects of hypertension on the placenta and fetus in pregnancy. Method: 25 hypertensive pregnants, 114 control women, and their infants were included in the study. Results: There was significant correlation between to the body mass index, weight before pregnancy, gestational week, hematocrit, birth weight, placenta size and weight between two groups (p=.002, .003, .003, .004, .000, .050, .032, respectively). The age, gravida, parity, abortus, living child, height, weight gain in pregnancy, hemoglobin, placenta diameter and thickness, volume of clot were similar between groups. Conclusion: As a result, hypertension in pregnancy affects the development of the fetus and placenta as well.

Myopericarditis is an inflammatory disease of the both myocardial and pericardial tissues, and resulting from different etiologies. Viral agents such as coxsackie virus type B, adenovirus, and echovirus are the most common leading cause of this disease and it usually occurs following viral upper respiratory tract infections. Although there are different clinical features according to ages groups, some common findings such as tachycardia incompatible with fever, deeply heared heart sounds, and heart failure can be seen. Clinical findings often mimics a myocardial infarction. Diagnosis of this disease is made by the evaluation of the clinical condition, electrocardiography, echocardiography and elevation of the cardiac enzymes. Because it is mortality, discrimination of myopericarditis from myocardial infarction is very important. Herein, we report a 13 year-old-girl with the diagnosis of myopericarditis presenting with chest pain, electrocardiographic changes mimicking myocardial infarction and elevated cardiac enzymes and also aimed to emphasize the importance of accurate diagnosis of this disease.

Mondor’s disease of the penis is a rare entity characterized by thrombosis in the dorsal penile vein. Unlike anxiety resulting from this condition which is conservatively treated, recognizing this disease is quite easy with Doppler ultrasonography. Peyronie’s disease and sclerosing lymphangitis are considered in the differential diagnosis of Mondor’s disease. In this present case report we aimed to present ultrasonography findings and briefly review the literature in a male patient diagnosed with Mondor's disease who admitted with rope like stiffness on the dorsal side of penis mimicking Peyronie's disease.

Aim: The aim of this retrospective study was to evaluate the correlation between histopathological and clinical diagnosis of the endometrial samplings and examine the relevance of the indications. Method: Endometrial biopsies of 495 patients who applied to Bozok University School of Medicine between October 2012 and October 2014 were included this study. Data were obtained from patients file in electronic background and the archives of Department of Medical Pathology. Results: The most frequent indication of endometrial biopsies was abnormal uterine bleeding (283 cases-57.2%). Among the biopsies which were performed with the indication of abnormal uterine bleeding (283 cases), the most common diagnosis was proliferative endometrium (108 cases-38.2%). Among the endometrial biopsies which were done with the clinical diagnosis of cervical polyp, 17 cases (60.7%) were diagnosed as endometrial polyp histopathologically. One case was diagnosed as adenocarcinoma histopathologically. Conclusion: As a result, it is suggested that the gynecologist should be more selective in endometrial biopsy practice.

Acute febrile neutrophilic dermatosis also known as Sweet Syndrome is an inflammatory skin disease with an unknown etiopathogenesis, characterized clinically by sudden onset, painful papules, nodules and plaques and histopathologically dense dermal neutrophilic infiltrate. Malignancies, drugs, infections, systemic inflammatory diseases and rarely pregnancy are all considered in the etiology. Here is a patient diagnosed as Sweet Syndrome, with lesions appeared shortly after delivery in her first pregnancy and in the last trimester in her second pregnancy. Her lesions quickly responded to systemic steroid treatment.

Enterococcus species rarely cause bacterial meningitis without predisposing factors such as trauma, brain surgery, etc. In this study, we present a bacterial meningitis case caused by Enterococcus faecalis (E. faecalis) in a 13-year-old male who was found dead at home. One hundred and forty two cm tall, 37 kg weight male had admitted to hospital two days after the beginning of complaints such as weakness, headache, swelling of left eye, nausea and vomiting. Body temperature was 37.3 oC, leucocyte count 22100/ mm3, and CRP 71 g/dl at the hospital admission. Antibiotic treatment with amoxicillin/clavulanic acid (625 mg) was given to the patient but he was found dead in his house the day after. In autopsy; yellow-green purulant liquid in left frontoparietal zone, fullness of meningeal vessels and oedema was seen in brain. Isolated bacteria in cerebrospinal fluid (CSF) was identificated as E. faecalis by mini API 32 Strep®. Postmortem microbiological sampling in autopsy and defining etiologic agents is important for rare meningitis cases in which antemortem identification could not be done before death.

Objectif : l'objectif de cette étude est de déterminer la prévalence et les facteurs associés à l'insuffisance pondérale chez les personnes vivant avec le VIH sous antirétroviral suivies à Cotonou. Méthodes : Il s'est agi d'une étude transversale, descriptive et analytique. La population d'étude est constituée par les personnes vivant avec le VIH sous antirétroviral, suivies à Cotonou. L'insuffisance pondérale a été définie par un indice de masse corporelle inférieur à 18,5 kg/m2. Résultats : Au total 305 patients ont été inclus. On a noté une prédominance féminine (79%). L'âge moyen était de 38,1± 5,4 ans avec une prédominance des sujets âgés de moins 40 ans (56%). L'insuffisance pondérale est observée chez 24 patients soit une prévalence de 7,87%. Les facteurs associés à l'insuffisance pondérale sont le sexe féminin (p=0,0384), un bas niveau socio-économique (p=0,0009), un apport énergétique bas (p=0,0007), une durée de traitement antirétroviral de moins d'un an (p=0,0075), la mauvaise observance du traitement (p=0,0002), l'analphabétisme (p=0,0000), la présence de lipoatrophie (p=0,0000) et l'absence de lipohypertrophie (p=0,0189). Conclusion : L'insuffisance pondérale persiste chez les personnes vivant avec le VIH à l'ère du traitement antirétroviral hautement actif Mots clés: Insuffisance pondérale, VIH, Cotonou, Bénin

In the present paper we describe the on-land field operations integrated in the TOMO-ETNA experiment carried out in June-November 2014 at Mt. Etna volcano and surrounding areas. This terrestrial campaign consists in the deployment of 90 short-period portable three-component seismic stations, 17 Broadband seismometers and the coordination with 133 permanent seismic station belonging to Italy’s Istituto Nazionale di Geofisica e Vulcanologia (INGV). This temporary seismic network recorded active and passive seismic sources. Active seismic sources were generated by an array of air-guns mounted in the Spanish oceanographic vessel “Sarmiento de Gamboa” with a power capacity of up to 5200 cubic inches. In total more than 26,000 shots were fired and more than 450 local and regional earthquakes were recorded. We describe the whole technical procedure followed to guarantee the success of this complex seismic experiment. We started with the description of the location of the potential safety places to deploy the portable network and the products derived from this search (a large document including full characterization of the sites, owners and indication of how to arrive to them). A full technical description of the seismometers and seismic sources is presented. We show how the portable seismic network was deployed, maintained and recovered in different stages. The large international collaboration of this experiment is reflected in the participation of more than 75 researchers, technicians and students from different institutions and countries in the on-land activities. The main objectives of the experiment were achieved with great success.

La alta diversidad de especies de carnívoros del Perú puede generar problemas al momento de decidir los taxa y temas sobre los que deben dirigirse los esfuerzos de investigación. En este trabajo se evalúa el esfuerzo de investigación en base al número de publicaciones realizadas para cada familia y especie de carnívoro en el Perú. Asimismo, se señalan los vacíos de información relevantes para la conservación de cada especie y se presenta la primera evaluación de las prioridades de investigación sobre este grupo animal en el Perú. Se registró 145 publicaciones sobre carnívoros peruanos realizadas desde el año 1943. El número de publicaciones presentó grandes diferencias entre taxa, entre temas estudiados y entre las ecorregiones en las que se realizaron las investigaciones. Según la escala de prioridades propuesta, la especie que debe ser estudiada con mayor prioridad es el coatí andino Nasua olivacea y la de menor prioridad es el ocelote Leopardus pardalis. Los resultados de nuestro trabajo resaltan la urgencia de realizar investigaciones sobre ciertas especies de carnívoros de las que existen pocos datos publicados, tanto a nivel local como global, y que se distribuyen en pocas ecorregiones del Perú. Tanto la escala de prioridades de investigación como la lista de vacíos de información serán de utilidad para guiar esfuerzos logísticos y financieros de investigadores particulares, instituciones privadas y gubernamentales.

MI Spagnuolo, MP Cicalese, E Bruzzese, MA Caiazzo, S Di Caro, V Squeglia, A GuarinoDepartment of Paediatrics, University Federico II, Naples, ItalyBackground: Children with intestinal failure need parenteral nutrition to survive, and the only alternative is intestinal transplantation which still entails high mortality. The aim of this study was to compare the outcomes in candidates and noncandidates for intestinal transplantation, and to compare the outcomes with and without transplant surgery.Patients and methods: The clinical records of children admitted to hospital from 1997 to 2008 because of intestinal failure were reviewed for etiology of intestinal failure, age at start of parenteral nutrition, duration of parenteral nutrition, indications for intestinal transplantation, and outcome.Results: Thirty-four children were enrolled. Median age at start of parenteral nutrition was 13.1 (median 20.7) months. There was no difference in survival rate between candidates and noncandidates for intestinal transplantation. Survival was significantly higher in candidates who did not undergo intestinal transplantation than in children who underwent intestinal transplantation (P < 0.001).Conclusion: Candidates for intestinal transplantation who did not undergo transplant surgery had a better outcome than children who underwent transplant surgery.Keywords: intestinal transplantation, intestinal failure, parenteral nutrition, children

DL Waters1, RN Baumgartner2, PJ Garry3, B Vellas41Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; 2Department of Epidemiology and Population Health, University of Louisville, Louisville, Kentucky, USA; 3Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA; 4Department of Internal Medicine and Geriatric Medicine, University Hospital Center of Toulouse, Gerontopole, Toulouse, FranceAbstract: Sarcopenia is the loss of skeletal muscle mass and function with aging. Although the term sarcopenia was first coined in 1989, its etiology is still poorly understood. Moreover, a consensus for defining sarcopenia continues to elude us. Sarcopenic changes in the muscle include losses in muscle fiber quantity and quality, alpha-motor neurons, protein synthesis rates, and anabolic and sex hormone production. Other factors include basal metabolic rate, increased protein dietary requirements, and chronic inflammation secondary to age-related changes in cytokines and oxidative stress. These changes lead to decreased overall physical functioning, increased frailty, falls risk, and ultimately the loss of independent living. Because the intertwining relationships of these factors are complex, effective treatment options are still under investigation. The published data on sarcopenia are vast, and this review is not intended to be exhaustive. The aim of this review is to provide an update on the current knowledge of the definition, etiology, consequences, and current clinical trials that may help address this pressing public health problem for our aging populations.Keywords: aging, muscle loss, nutrition, physical activity

Serena Ferrari, Marianna Cannoletta, Matteo Generali, Lucia Cazzato, Angelo CagnacciDepartment of Obstetrics, Gynecology, and Pediatrics, Azienda Ospedaliero, Universitaria di Modena, ItalyAbstract: Since their introduction in 1959, development of hormonal contraceptives has been ongoing, with the ultimate aim of creating not only an effective and safe contraceptive method, but also a drug able to meet the need for treatment of other conditions, such as acne, seborrhea, and hirsutism, with few or no side effects. With this objective, a new progestin, chlormadinone acetate (CMA), has been developed as a derivative of progesterone for ­contraception. This new molecule has been introduced in combination with ethinylestradiol (EE) 30 µg as a safe ­contraceptive with antiandrogenic properties. Many clinical studies have investigated this new oral combination and found it to be safe, with a Pearl Index similar to that of other combined hormonal contraceptives. CMA, because of its antiandrogenic properties, has been also considered effective for resolution of acne, seborrhea, and hirsutism. The data show it to be a safe molecule in terms of glucose and lipid metabolism. No major weight changes have been linked with its use, and it seems to be the only progestin able to reduce fat mass during use. The CMA-EE combination is well tolerated and acceptable to women. Adverse events related to its use are similar to those reported with other third-generation ­contraceptives. We can conclude that CMA-EE is an effective, safe, and well tolerated ­antiandrogenic hormonal contraceptive.Keywords: chlormadinone acetate, acne, weight, metabolism, safety, hormonal contraceptive

Efrossini Dima1,2*, Nikoletta Rovina1,2*, Christina Gerassimou2, Charis Roussos1,2,3, Christina Gratziou2,31“Sotiria” Hospital for Diseases of the Chest, Department of Respiratory Medicine, University of Athens, Medical School, Athens, Greece; 2“M. Simos” Laboratories, Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens, Athens, Greece; 3Asthma and Allergy Center, Evgenidion Hospital, Pulmonary and Critical Care Department, Medical School, University of Athens, Athens, Greece; *These authors contributed equally to this workBackground: Despite a number of important differences in the pathogenesis, course, and prognosis, asthma and chronic obstructive pulmonary disease (COPD) have many features in common. Furthermore, smoking induces considerable overlap in pathogenesis and clinical features between these conditions. This study aimed to reveal what inflammatory patterns prevail in clinically established diagnosis groups, including overlap phenotypes of asthma and COPD, and to evaluate the correlation with airway reversibility and hyperreactivity in these overlapping conditions.Methods: A total of 110 patients (17 healthy subjects; 16 “healthy” smokers; 46 asthma patients: 24 smokers and 22 non-smokers; and 31 COPD patients: 10 COPD patients with reversibility and 21 without) participated in the study. Induced sputum, reversibility testing, methacholine and adenosine 5’monophosphate (AMP) provocation challenges, and skin prick testing were performed. Airways inflammation was assessed by differential cell counts, and cytokines (interleukin-8 [IL-8] and tumor necrosis factor-alpha [TNF-α]) were measured in induced sputum by enzyme-linked immunosorbent assay (ELISA).Results: COPD patients with reversibility had increased sputum neutrophils, IL-8, and TNF-α levels compared to smoking asthmatics. No difference was found in inflammatory cells and cytokines between COPD subgroups. Sputum neutrophilia was inversely correlated with the change in forced expiratory volume in one second (ΔFEV1) in smoking asthmatic patients (r = -0.563, P = 0.036). No correlation was found between airway hyperresponsiveness (AHR), either with methacholine or AMP, and inflammation in asthmatic patients, regardless of smoking. Reversibility was not correlated with inflammation in COPD patients. However, the response to AMP challenge was correlated with sputum neutrophils (r = 0.844, P = 0.001).Conclusion: Although overlaps exist in the disease characteristics of asthma and COPD, the combination of lung function testing, sputum induction, and AHR reveals information that facilitates the distinction between these diseases, allowing clinicians to better tailor their therapy.Keywords: asthma, COPD, smoking, lung function, airway hyperresponsiveness

Paul A Bourne1, Denise Eldemire-Shearer1, Tomlin J Paul1, Janet LaGrenade1, Christopher AD Charles21Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston, Jamaica; 2King Graduate School, Monroe College, New York and Center for Victim Support, Harlem Hospital Center, New York, NY, USAObjective: To assess trends in the use of private and public health care services among Jamaicans over a 15-year period (1991–2007).Design and methods: Statistics on the use of health care services were taken from the Jamaica Survey of Living Conditions (JSLC) for the 15-year period 1993 to 2007. Use of hospital services were represented in income quintiles and compared for private and public facilities. The difference in percentage use between public and private was compared by quintiles over the period and the variability in those differentials assessed.Results: This study highlights the increasing use of private services by increasing wealth, exaggerated for the wealthiest quintile. There is a widening of the differences in utilization between public and private centers as income level increases (P < 0.001).Conclusions: Internal and external economic conditions influence the use of private and public health care services in Jamaica. Although the relative increase in the cost (to the user) of public health care is more than that for private health care, the actual cost to use the public health care system is still significantly cheaper than using the private system. Lower income health care users tend to take the lesser cost option.Keywords: health care utilization, public–private health differentials

Son V Pham1, Phuong-Chi T Pham2, Phuong-Mai T Pham3, Jeffrey M Miller4, Phuong-Thu T Pham5, Phuong-Anh T Pham61Bay Pines VA Medical Center, Department of Cardiology, Bay Pines, FL, USA; 2Department of Medicine, Nephrology Division, UCLA-Olive View Medical Center, 3Department of Medicine, Greater Los Angeles VA Medical Center, 4Department of Medicine, Hematology-Oncology Division, UCLA-Olive View Medical Center, 5Department of Medicine, Nephrology Division, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 6Mercy General Hospital, Heart and Vascular Institute, Department of Cardiology, Sacramento, CA, USAAbstract: In patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), both periprocedural acute myocardial infarction and bleeding complications have been shown to be associated with early and late mortality. Current standard antithrombotic therapy after coronary stent implantation consists of lifelong aspirin and clopidogrel for a variable period depending in part on the stent type. Despite its well-established efficacy in reducing cardiac-related death, myocardial infarction, and stroke, dual antiplatelet therapy with aspirin and clopidogrel is not without shortcomings. While clopidogrel may be of little beneficial effect if administered immediately prior to PCI and may even increase major bleeding risk if coronary artery bypass grafting is anticipated, early discontinuation of the drug may result in insufficient antiplatelet coverage with thrombotic complications. Optimal and rapid inhibition of platelet activity to suppress ischemic and thrombotic events while minimizing bleeding complications is an important therapeutic goal in the management of patients undergoing percutaneous coronary intervention. In this article we present an overview of the literature on clinical trials evaluating the different aspects of antithrombotic therapy in patients undergoing PCI and discuss the emerging role of these agents in the contemporary era of early invasive coronary intervention. Clinical trial acronyms and their full names are provided in Table 1.Keywords: acute coronary syndrome, percutaneous coronary intervention, aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitors, bivalirudin

Anita Nordenson2, Anne Marie Grönberg1,2, Lena Hulthén1, Sven Larsson2, Frode Slinde11Department of Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; 2Department of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska Academy at University of Gothenburg, SwedenAbstract: Malnutrition is a serious condition in chronic obstructive pulmonary disease (COPD). Successful dietary intervention calls for calculations of resting metabolic rate (RMR). One disease-specific prediction equation for RMR exists based on mainly male patients. To construct a disease-specific equation for RMR based on measurements in underweight or weight-losing women and men with COPD, RMR was measured by indirect calorimetry in 30 women and 11 men with a diagnosis of COPD and body mass index

Alissa Lockwood1, John Patka2, Marina Rabinovich2, Katleen Wyatt2, Prasad Abraham21Department of Pharmacy, Parkland Health System, Dallas, TX, USA; 2Department of Pharmacy and Drug Information, Grady Health System, Atlanta, GA, USAAbstract: Since its US Food and Drug Administration (FDA) approval in 1974, sodium nitroprusside (SNP) has been fraught with controversy in regards to its safety. Over the years, a growing concern related to SNPs propensity to cause cyanide (CN) toxicity culminated into a series of case reports that led the FDA to develop a black-box warning with dose limitations of

Ignacio Jáuregui Lobera1, Pilar León Lozano2, Patricia Bolaños Ríos3, Juan Romero Candau2, Gregorio Sánchez del Villar y Lebreros4, M Teresa Morales Millán1,5, M Teresa Montaña González1,5, Lourdes Andrés Martín2, Isabela Justo Villalobos2, Nuria Vargas Sánchez21Área de Nutrición y Bromatología, Universidad Pablo de Olavide; 2Colegio Oficial de Farmacéuticos; 3Instituto de Ciencias de la Conducta; 4Instituto de Enseñanza Secundaria “Murillo”; 5Facultad de Farmacia, Universidad de Sevilla, Sevilla, SpainBackground: Research conducted to date into the primary prevention of eating disorders (ED) has mainly considered the provision of information regarding risk factors. Consequently, there is a need to develop new methods that go a step further, promoting a change in attitudes and behavior in the target population.Objective: This study describes an adaptation of the Girls’ Group model to the Spanish context, the main objective being to compare two types of intervention, ie, one based on this model and the other following the traditional approach of providing information. The ultimate aim was to implement a prevention program that reduces the risk factors and boosts the protection factors that have been empirically shown to be related to ED.Methods: On the basis of previous research on the primary prevention of ED, and taking into account recognized risk and protective factors, the following topics were addressed: nutritional aspects; self-esteem; coping strategies; the ideal image of what is attractive and role of the media; and body image. The total sample (174 girls and 197 boys) was divided into 12 work groups, six for the intervention group (one school) and six for the control group (two schools). School-based input (intervention group) was provided by a pharmacist, a psychologist, a qualified nutritionist/dietician, and specialist support staff (psychologists and/or educators) and teachers of the three schools.Results: Participation in the intervention group reduced body dissatisfaction (F = 13.41; P < 0.01), the drive to thinness (F = 10.79; P < 0.01), and the influence of the media with respect to the esthetic body shape model (F = 13.90; P < 0.01), while self-esteem (F = 7.34; P < 0.01) and the use of coping strategies (F = 13.74; P < 0.01) both improved. There was also an improvement in the eating habits of participants, with better outcomes being achieved when intervening with females.Conclusions: The present study shows that in the primary prevention of eating disorders, better outcomes are achieved by new models which target the attitudes and behavior of adolescents rather than focusing solely on the provision of risk information to raise awareness.Keywords: coping strategies, adolescence, primary prevention, eating disorders, positive psychology

Ozgul Muneyyirci-Delale1,2, Anuja Gupta1,2, Cynthia Abraham1, Ashadeep Chandrareddy1, Charles H Bowers Jr2, Jed B Cutler2Departments of Obstetrics and Gynecology, 1SUNY Downstate Medical Center, 2Kings County Hospital Center, Brooklyn, New York, USAObjective: To manage patients with dysfunctional uterine bleeding (DUB) according to endometrial thickness.Methods: A retrospective chart review of 49 patients who reported 8 or more days of bleeding was performed. They were then divided into three groups based on endometrial thickness (mm): less than 6, 6–11, and greater than 11. These three groups were treated with combined oral contraceptive pills (OCP), conjugated estrogen plus progesterone and megestrol respectively. Patients given megestrol also underwent endometrial biopsy before treatment. Patients recorded the degree of bleeding each day for one month after starting treatment.Results: Mean endometrial thickness in the combined OCPs, conjugated estrogen plus progesterone and megestrol groups were 4, 8 and 14 mm, respectively. Combined OCPs decreased bleeding from 46 to 8 days (P < 0.05, n = 8). Conjugated estrogen plus progesterone decreased the number of days of bleeding from a mean of 41 to 9 (P < 0.01, n = 16). Megestrol decreased bleeding from 54 to 3 days (P < 0.001, n = 25). 52% of patients given megestrol had endometrial hyperplasia.Conclusion: These results support the effectiveness of treating patients with DUB according to endometrial thickness.Keywords: DUB, abnormal uterine bleeding, endometrium, hyperplasia, megestrol acetate

Maurizio Destro1, Nora Crikelair2, Joseph Yen2, Robert Glazer 1Azienda Ospedaliera della Provincia di Pavia, Stradella (PV), Italy; 2Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USAObjective: This post hoc analysis evaluated the efficacy and safety of triple therapy with amlodipine/valsartan+hydrochlorothiazide (Aml/Val+HCTZ) vs dual therapy with Aml+HCTZ in stage 2 hypertensive patients.Methods: The analysis included patients from an eight-week, multicenter, double-blind study, randomized to Aml/Val 10/160 mg or Aml 10 mg groups, who received add-on HCTZ 12.5 mg at week 4 if mean sitting systolic blood pressure (msSBP) was >130 mmHg.Results: Of the patients receiving Aml/Val+HCTZ and Aml+HCTZ, 98% (N = 133/136) and 96% (N = 200/208) completed the study, respectively. Baseline characteristics were similar across groups (Caucasians, 80.2%; diabetics, 14.8%; age, 58.6 years [28.2% ≥ 65 years]; body mass index, 31 kg/m2; mean sitting blood pressure (msBP), 171.5/95.5 mmHg [18% msSBP ≥ 180 mmHg]). Aml/Val+HCTZ provided significantly greater msBP reductions from baseline to week 8 than Aml+HCTZ (30.5/13.8 vs 24.3/8.3 mmHg, P < 0.0001). The incremental msBP reduction (week 4 to 8) with HCTZ added to Aml/Val was greater than when added to Aml (6.9/3.5 vs 3.1/1.0 mmHg, P < 0.01). Treatments were well tolerated with similar overall incidence of adverse events (Aml/Val+HCTZ: 33.8%, Aml+HCTZ: 33.2%).Conclusion: Aml/Val+HCTZ provided significantly greater BP reductions than Aml+HCTZ in patients with stage 2 hypertension. Aml/Val+HCTZ triple therapy may be a suitable option for patients requiring more than two agents to reach target BP.Keywords: amlodipine, valsartan, stage 2 hypertension, HCTZ, triple therapy

Maria J Santana1, David Feeny2, Justin Weinkauf1, Roland Nador1, Ali Kapasi1, Kathleen Jackson1, Marianne Schafenacker1, Dalyce Zuk1, Dale Lien11Lung Transplant Program, University of Alberta Hospital, Edmonton, Alberta, Canada; 2The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USAObjective: To assess the use of patient-reported outcome (PROs) measures in the routine clinical care of lung–heart transplant patients. We assessed whether the addition of PROs in routine clinical care affected the duration of the consultation and patient’s and clinician’s views.Method: Consecutive lung–heart transplant patients visiting the outpatient clinic, University of Alberta Hospital, completed the Chronic Respiratory Questionnaire (CRQ) and the Health Utilities Index (HUI) on touchscreen computers. Information on the patient’s responses was made available to the members of the transplant team prior to the encounter with the patient. The duration of clinical encounters was noted. At the end of every visit, clinicians completed a questionnaire on the usefulness of having PRO information available. After 6 months patients completed a survey of their experiences.Results: The final patient sample consisted of 172 patients with a mean (SD) age of 52 (13.3) years old; 47% were female; 68% were organ recipients and 32% candidates. The transplant team, comprising four pulmunologists, two nurses, and one pharmacist had an average of 9 years of practical experience in pulmunology. The mean duration of patient–clinician encounters in minutes was 15.15 (4.52). Ninety-eight percent of patients indicated that they would be happy to complete the CRQ and HUI at every clinic visit. Ninety-one percent of the assessments completed by clinicians showed complete satisfaction with the use of PROs in routine practice. Further, the clinicians developed guidelines for the use of PRO information in clinical practice.Conclusions: The incorporation of PRO measures in the routine clinical care of lung–heart transplant patients resulted in a reduction of the duration of patient–clinician encounters. The experience was well accepted by patients and clinicians. We conclude that the routine use of PROs in lung–heart transplant patients has become standard practice.Keywords: patient-reported outcome measures, Chronic Respiratory Questionnaire, Health Utilities Index, routine clinical care, lung transplant

Mark J Schuuring1,2, Jeroen C Vis1,2, Marielle G Duffels1, Berto J Bouma1, Barbara JM Mulder1,21Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands; 2Interuniversity Cardiology Institute of The Netherlands, Utrecht, The NetherlandsAbstract: Pulmonary arterial hypertension (PAH) is a progressive disease with poor survival outcome. PAH is classified by the 2009 updated clinical classification of pulmonary hypertension and a major subgroup is PAH due to congenital heart disease (CHD) with systemic-to-pulmonary shunt. CHD-PAH is a result of systemic-to-pulmonary shunting and chronic increased flow that ultimately results in adaptations of pulmonary vasculature and endothelial dysfunction. The advanced stage is called Eisenmenger syndrome which forms a small percentage (1%) of all CHD patients. Therapies targeted on PAH symptoms are called primary therapy for PAH, but most CHD-PAH patients progress to advanced therapy which is directed at the PAH itself. In CHD-PAH, advanced therapies are extensively investigated for all three major pathways: endothelin-1 receptor antagonists such as bosentan, prostanoids such as epoprostenol and phosphodiesterase 5 inhibitors such as sildenafil. Endpoints in most trials were catheterization hemodynamics, World Health Organization functional class, six-minute walking distance and patient-focused outcomes, based on quality of life questionnaires and Borg dyspnea index. The BREATHE-5 and EARLY study were two important randomized controlled trials showing efficacy of bosentan at short follow-up. Moreover in patients with Eisenmenger syndrome, one recent survival retrospective study with majority of patients on bosentan showed strong survival benefit over conservative therapy. A diversity of prospective cohort and retrospective studies were performed but all with limited data, due to small numbers and heterogeneity of underlying CHD diagnoses. Further larger studies are needed to determine optimal treatment for adults with CHD-PAH. This review focuses on bosentan in CHD-PAH. In particular, we discuss outcome of various clinical trials and compare efficacy and safety of bosentan to other advanced therapies.Keywords: pulmonary arterial hypertension, bosentan, endothelin-1 receptor antagonist, congenital heart disease

Hadi AR Hadi, Alawi A Alsheikh-Ali, Wael AL Mahmeed, Jassim M Al SuwaidiInstitute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab EmiratesAbstract: Atrial fibrillation (AF) is the most common sustained arrhythmia and a ­challenging clinical problem encountered in daily clinical practice. There is an increasing body of evidence linking inflammation to a broad spectrum of cardiovascular conditions including AF. Historical evidence supports an association between AF and inflammation and is consistent with the association of AF with inflammatory conditions of the heart, such as myocarditis and pericarditis. AF has been associated with myocardial oxidative stress, and antioxidant agents have demonstrated antiarrhythmic benefit in humans. Increased plasma interleukin (IL)-6, C-reactive protein (CRP), and plasma viscosity support the existence of an inflammatory state among “typical” populations with chronic AF. These indexes of inflammation are related to the prothrombotic state and may be linked to the clinical characteristics of the patients (underlying vascular disease and comorbidities), rather than simply to the presence of AF itself. It has been suggested that inflammation may have a role in the development of atrial arrhythmias after cardiac surgery, and that a genetic predisposition to develop postoperative complications exists. Cytokines can have a prognostic significance; IL-6 levels, CRP, and other cytokines may have prognostic value in AF. Cytokine lowering therapies, statins, angiotensin converting enzyme inhibitors and other anti-inflammatory agents may have a role in the treatment of AF. The present article provides an overview of the evidence linking inflammatory cytokines to AF and their therapeutic and prognostic implications.Keywords: atrial fibrillation, inflammation, cytokines

Stephen Smith1, Douglas Lorenz2, James Peace3, Kimberly McLeod4, RS Crockett5, Roger Vogel4, and the Difluprednate ST601-004 Study Group1Eye Associates of Fort Myers, Fort Myers, Florida, USA; 2Nevada Eye and Ear, Henderson, Nevada, USA; 3United Medical Research, Inglewood, California, USA; 4Sirion Therapeutics, Inc., Tampa, Florida, USA; 5DATA, Inc., Bayou La Batre, Alabama, USA. Clinical trial registration number: NCT00616993Objective: To evaluate the efficacy and safety of twice-daily difluprednate ophthalmic ­emulsion 0.05% (Durezol®) versus placebo administered before surgery for managing inflammation and pain following cataract extraction.Methods: Eligible subjects (N = 121) were randomized 2:1 to topical treatment with 1 drop difluprednate or placebo administered twice daily for 16 days, followed by a 14-day ­tapering period. Dosing was initiated 24 hours before unilateral ocular surgery. Clinical signs of ­inflammation (anterior chamber [AC] cell and flare grade, bulbar conjunctival injection, ciliary injection, corneal edema, and chemosis), ocular pain/discomfort, intraocular pressure (IOP), and adverse events were assessed.Results: Clearing of inflammation on day 14 (primary endpoint), defined as an AC cell grade of 0 (≤5 cells) and a flare grade of 0 (complete absence), was achieved in a significantly greater percentage of subjects treated with difluprednate, compared with placebo (74.7% ­vs 42.5%; P = 0.0006). A significantly greater percentage of difluprednate-treated subjects were free of ocular pain/discomfort on day 14 than placebo-treated subjects (64.6% vs 30.0%; P = 0.0004). Three subjects (3.7%) in the difluprednate group had a clinically significant IOP rise (defined as ≥21 mmHg and a change from baseline ≥10 mmHg at same visit).Conclusions: Difluprednate, administered 2 times daily starting 24 hours before cataract ­surgery, was highly effective for managing ocular inflammation and relieving pain and discomfort postoperatively. Difluprednate was well tolerated and provides a convenient twice-daily option for managing postoperative ocular inflammation.Keywords: difluprednate, safety, efficacy, twice daily, postoperative ocular inflammation, corticosteroids