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Kosmos
Astronomia Astrofizyka
Inne

Kultura
Sztuka dawna i współczesna, muzea i kolekcje

Metoda
Metodologia nauk, Matematyka, Filozofia, Miary i wagi, Pomiary

Materia
Substancje, reakcje, energia
Fizyka, chemia i inżynieria materiałowa

Człowiek
Antropologia kulturowa Socjologia Psychologia Zdrowie i medycyna

Wizje
Przewidywania Kosmologia Religie Ideologia Polityka

Ziemia
Geologia, geofizyka, geochemia, środowisko przyrodnicze

Życie
Biologia, biologia molekularna i genetyka

Cyberprzestrzeń
Technologia cyberprzestrzeni, cyberkultura, media i komunikacja

Działalność
Wiadomości | Gospodarka, biznes, zarządzanie, ekonomia

Technologie
Budownictwo, energetyka, transport, wytwarzanie, technologie informacyjne

American Medical Journal

No illness gets cured without the patient’s adherence to the prescribed medicine (s). Reasons such as too many medicines, lack of health insurance coverage, high co-payment cost, loss of cognitive memory to take. are commonly noticed for non-adherence. In some illnesses, the patients who do not adhere to the prescribed medicines end up again in hospital. How should the pertinent data be analyzed to learn? Currently, there is no suitable methodology to scrutinize the data for a clear assessment about the significance of a reason. To fulfil such a need, this article develops and demonstrates a new underlying bivariate probability model for the data and a statistical methodology to extract pertinent information to check whether the non-adherent proportion of patients to medicine (s) is significant enough to come up with strict remedial policies. To start with, the case of too many prescribed medicines is examined. Then, the repeated hospitalization due to non-adherence is examined. The contents of this article could be easily extended to other reasons of non-adherence as well. In the presence of a reason, there might exist a number of non-adherent X and a number of adherent, Y patients. Both X and Y is observable in a sample of size n1 with the presence of a reason and in another random sample of size n2 with the absence of a reason. The total sample size is n = n1 + n2. Let 0<Φ<1 and 0<ρ<1 denote respectively the probability for a reason to exist in a patient and the probability for a patient to be non-adherent to the prescribed medicines. Of interest to the medical community is the trend of the sum, T = X+Y and Z = n-X-Y denoting respectively the total number of non-adherent and adherent patients irrespective of a reason. Hence, this article constructs a bivariate probability distribution for T and Z utilize it to explain several non-trivialities. To illustrate, non-adherence patients’ data in the literature are considered. Because the bivariate probability distribution is not seen in the literature, it is named as non-adherent bivariate distribution. Various statistical properties of the non-adherent bivariate distribution are identified and explained. An information based hypothesis testing procedure is devised to check whether an estimate of the parameter, ρ is significant. Two closely connected factors for the patients not adhering to the prescribed medicines are examined. The first is a precursor and it is that too many medicines are prescribed to take. In an illustration for the first reason, the probability for a patient not to adhere the medicines is estimated to be 0.78 which is statistically significant. The second is the post cursor and it is that the patients not-adhering to the medicines are more often hospitalized again. In an illustration of the second factor, the probability for the diabetic patients not to adhere the medicines is estimated to be 0.44 which is significant. The statistical power of accepting the true non-adherence probability by our methodology is excellent in both illustrations. A few comments are made about the future research work. Other reasons for the patients’ non-adherence might exist and they should also be examined. A regression type prediction model can be constructed if additional data on covariates are available. A principal component analysis might reveal clusters of reasons along with the grouping of illnesses if such multivariate data become available. The usual principal component analysis requires bivariate normally distributed data. For the data governed by the non-adherent bivariate distribution, a new principal component methodology needs to be devised and it will be done in a future research article. The contents of this article is the conceptual foundation for such future research work.

http://www.thescipub.com/abstract/10.3844/amjsp.2014.54.60 2014/07/18 - 23:57

Radiation resistant cancer stem cells are the main reason for treatment failure and tumor recurrence after cancer radiotherapy. Increasing biological evidences demonstrate that these cells possess the capacity to repair radiation induced DNA damage, protect themselves from radiation derived reactive oxygen species, survive and proliferate after several fractions of radiotherapy and finally, repopulate the heterogeneity of the tumor. Thus, targeting and eliminating these cells should be necessary to achieve cancer cure in radiotherapy. Three major approaches that specifically target radioresistant cancer stem cells have been recently investigated. First, inhibition of TGFβ, a major mediator of the tissue response to radiation, has been shown to induce radiosensitization of cancer stem cells by targeting the DNA damage response mechanism. Second, by preventing Notch activation during fractionated radiotherapy, cancer stem cells were depleted from their ability to repopulate the tumor after radiation. Finally, telomerase activity inhibitors have shown to specifically decrease the cancer stem cell population after radiotherapy. In the present review, we evaluate these radiosentitizing approaches and their possible effects when combined with fractionated radiotherapy as they promise to be a powerful tool in the battle against this cancer.

http://www.thescipub.com/abstract/10.3844/amjsp.2014.41.53 2014/07/17 - 05:59

Lactic acidosis is the most common cause of anion gap metabolic acidosis and is associated with high morbidity and mortality in hospitalized patients. The association between Hemophagocytic Lymphohistiocytosis (HLH) and lactic acidosis is still unclear. HLH causes cytokine overproduction which in turn induces lactic acidosis. There have been only few reports of type B lactic acidosis in HLH patients. There have been no studies addressing the outcome of cytokine removal for patients with HLH induced lactic acidosis. We reviewed literatures on HLH, focusing on its association with lactic acidosis and treatment options. This review demonstrates thatlactic acidosis in patients with HLH is under-recognized. Physicians should increase awareness of this association. In the setting of cytokine storm with multiorgan failure, cytokine removal with high blood flow, ultrafiltration rate and frequent membrane changes is a potential treatment option. More studies are urgently required to confirm this finding due to high morbidity and mortality of HLH.

http://www.thescipub.com/abstract/10.3844/amjsp.2014.37.40 2014/07/05 - 19:09

This case report discusses the history and management of a schizophrenic patient, a 18-year-old man, who had taken a massive overdose of clonazepam, abilify, depakote, zoloft and seroquel altogether. After discontinuation of these drugs and administration of cyproheptadine with IV fluids, he became hemo-dynamically stable. This case suggests that serotonin syndrome should be recognized promptly and complications need to be treated appropriately. Serotonin syndrome should be diagnosed surely to ensure the prompt initiation of the treatment including discontinuation of the precipitating drugs because the disease occasionally progresses rapidly to fatal condition. In addition, both the onset and resolution of symptoms are faster in serotonin syndrome.

http://www.thescipub.com/abstract/10.3844/amjsp.2014.33.36 2014/05/01 - 20:45

Percutaneous Coronary Interventional procedures (PCIs) are recognised as gold standard treatment for high risks patients with diffuse coronary atherosclerosis. Neurologic complications are one of the most dreaded procedural outcomes, stroke after PCI affects mainly elderly and high-risk patients (age more than 80 years and use of intra-aortic balloon pump), with longer times of the procedure and angiographic complications, such as dissection, abrupt closure and no reflow. We report two consecutive cases of posterior CVAs after percutaneous coronary procedures involving the ponto-mesencephalon and the cerebellum. Especially when risk factors are present, careful attention should be devoted to the preparation of the patient and to minimize catheter manipulation and exchanges.

http://www.thescipub.com/abstract/10.3844/amjsp.2014.28.32 2014/04/14 - 21:36

Paracetamol (PCM) overdose can cause nephrotoxicity with oxidative stress as one of the possible mechanisms mediating the event. However, Dehydroepiandrosterone (DHEA), the major secretory product of the human adrenal gland, has been shown to possess a multi-targeted antioxidant activity which is also effective against lipid peroxidation induced in various animal models and against various human disorders. In this study, the preventive effect of DHEA against PCM-induced nephrotoxicity was examined. Rats were divided into four groups containing 10 rats each, as follows: A control: Received normal saline, Vehicle treated: Received the vehicle (5% DMSO), PCM model (750 mg kg-1), PCM and DHEA treated: Received concomitant dose of PCM (750 mg kg-1) + DHEA (250 mg kg-1), respectively, for 4 consecutive weeks. All treatment were given orally to animals. Our results show that co-treatment of DHEA with PCM prevented the PCM-induced nephrotoxicity and oxidative impairments of the kidney, as evidenced by a significantly reduced (p<0.05) level of serum creatinine, urea and BUN with parallel significant increases in serum protein, Cr clearance and kidneys weights. Furthermore, DHEA was able to induce a significant increment (p<0.05) of renal levels of reduced Glutathione (GSH) and activities of Superoxide Dismutase (SOD) and Glutathione Peroxidise (GPx). An effect that was accompanied with a significant decrease in renal lipid peroxides levels (MDA). The nephroprotective effects of DHEA was confirmed by a reduced intensity of renal cellular damage, as evidenced by histological findings. In conclusion, DHEA at a daily dose of 250 mg kg-1 has a protective role against PCM-induced nephrotoxicity in rats and the process is probably mediated through its antioxidant properties.

http://www.thescipub.com/abstract/10.3844/amjsp.2014.16.27 2014/03/26 - 15:59

Prion diseases are associated with the accumulation of an abnormal isoformof cellular prion protein (PrPSc), which is the principal constituent of prions. Prions replicate in lymphoreticular tissues before neuroinvasion, suggesting that lymphoreticular biopsy samples may allow early diagnosis by detection of PrPSc. Creutzfeldt-Jakob Disease (CJD) is the most frequent prion disease in humans. Clinical diagnosis of sporadic (CJD) is based on the evaluation of rapidly progressive dementia, ataxia, myoclonus, changes on the electroencephalogram and other neurological signs. We report a problable (CJD) case in Santa Barbara surgical center, Rio de Janeiro, Brazil. From our clinical case, we decided to do a brief review about (CJD) researching at MedLine and Pubmed, using terms Creutzfeldt-Jakob disease and Prion diseases. A definite diagnosis, however, is confined to cases that have been evaluated neuropathlogically or by equivalent diagnostic techniques. The range in clinical expression of the disease is better appreciated and the existence of “atypical” cases of CJD is increasingly recognized. The clinical characteristics, laboratory findings, differential diagnosis, mechanisms of transmission and the actual therapeutic approach are discussed.

http://www.thescipub.com/abstract/10.3844/amjsp.2014.13.15 2014/03/14 - 10:04

Telemedicine the use of telecommunication and information technologies in order to provide clinical health care at a distance helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations. Although there were distant precursors to telemedicine, it is essentially a product of 20th century telecommunication and information technologies. These technologies permit communications between patient and medical staff with both convenience and fidelity, as well as the transmission of medical, imaging and health informatics data from one site to another. Early forms of telemedicine achieved with telephone and radio have been supplemented with video telephony, advanced diagnostic methods supported by distributed client/server applications and additionally with telemedical devices to support in-home care. There is a growing trend in the health domain to incorporate Smartphones and other wireless technologies to provide more efficient, cost effective and higher quality healthcare. With newer more sophisticated mobile devices for example, Smartphones this is an escalating practice. To date the use of mobile phone technology in the healthcare domain (mHealth) has been limited to uses such as disseminating information. However, mHealth is beginning to include software and data applications based on mobile devices and technologies. This movement is largely due to the advent of newer technologies associated with Smartphones. Some Smartphones can now be considered to be intelligent sensors with sensing capabilities such as Global Positioning System (GPS) location, proximity and accelerometers. This study examines the use of such technology in providing seamless mobile communications for telemedicine.

http://www.thescipub.com/abstract/10.3844/amjsp.2014.8.12 2014/02/13 - 21:13

Candidal Onychomycosis (COM) is a common nail disease which plays as sources pathogenic reservoir giving a rise to repeated candidiasis infections. This study aimed to evaluate PCR assays and phenotypic tests for identification of yeasts isolated from COM patients. The study included 100 clinically suspected patients of COM attending the main hospital and clinics in Al-Dewania province in the middle of Iraq during September 2011 to April 2012. One hundred yeast isolates were identified morphologically by CHROMagar medium. DNA was extracted from 14 representative’s isolates for accurate identification by PCR and fingerprinted by RAPD-PCR. Phenotypic examination of 100 yeasts isolates on CHROMagar revealed that these isolates were classified into 7 different species belonged to Candida form genus, PCR assay revealed that primer pair ITS1 and ITS4 was successfully amplified ITS1-5.8S-ITS2 rDNA region for 14 isolates of Candida spp. yielding a unique PCR products approximately 510-650bp in length. The results of RAPD-PCR assay showed that both primers (TAGGATCAGA and AGGTCACTGA) were genotyped 14 isolates of Candida into seven main genotypes; three of these genotypes had highly percentage of homologous (80-100%) among related isolates were studied in each Candida isolates, while the others four genotypes had 10-50% homologous. This study concluded that for accurate and prices identification must used PCR and fingerprinted by RAPD-PCR assays, the results of CHROMagar were correlated with gene expression for each Candida isolates, while the results of RAPD PCR assay were correlated with degrees similarity and difference of genotypes for Candida isolates under interest.

http://www.thescipub.com/abstract/10.3844/amjsp.2014.1.7 2014/01/01 - 10:43

The objective of the study was to analyze the vancomycin MIC distribution against bloodstream MRSA isolates for a period of 1 year in India. This retrospective study analyzed 71 blood stream MRSA strains isolated at a tertiary care hospital in India between January 2008 and December 2008. The vancomycin MIC was determined by broth microdilution method. Only one isolate per patient was analyzed. The range of vanocmycin MIC for the 71 isolates in this study was varied between 0.25-3 µg mL-1. Only 29 isolates had MIC less than 1 µg mL-1 and 17 isolates MIC were more than 2 µg mL-1. In this study the phenomenon of vancomycin MIC creep was noticed in more than 75% of MRSA bloodstream isolates. We suggest further in vivo studies to determine the clinical significance of this MIC creep.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.197.200 2013/12/21 - 09:31

Bisphenol A (BPA) is used to manufacture polycarbonate plastic products in resins lining metal cans, in dental sealants and in blends with other types of plastic products. In sharp contrast, there are many published studies that BPA has a wide range of significant adverse effects including structural and neurochemical changes throughout the brain associated with behavioral changes, such as hyperactivity, learning deficits and increased aggression in both males and females. So the aim of the present study was to investigate effect of BPA on learning and memory in passive avoidance learning model. Thirty six male Sprague Dawley rats weighing 180-260 g were used. The animals were divided into six groups: 1- control group (without any treatment) 2-sham group (received sesame oil the same volume as experimental, n = 6); 3-5 experimental (received BPA 5, 50, 100 and 150 mg kg-1 day, n = 24). BPA was administrated by oral intake by gavage for 15 days. Learning and memory were performed by shuttle-box. Data was analyzed by Kruskal-Wallis nonparametric test. The level of significance was considered P<0.05. Our data showed that BPA does not have a significant difference in time spent in light in doses of 5, 50 mg kg-1 day in learning and memory. BPA with dose of 100 and 150 mg kg-1 day showed a significant decrease in time spent in light relative to the control and sham in learning and memory. According to our results, BPA impaired learning and avoidance memory with high doses in the passive avoidance learning task.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.190.196 2013/12/10 - 17:52

Hypertension is a chronic physical condition with multifactorial causes. Although genetic factors have been associated to this pathological condition, characterization of the sequence patterns in the regulatory sites, for example, in 3’ or 5’ Untranslated Regions (UTR), remains to be explored. In particular, the 5’ UTR of genes associated with the regulation of blood pressure and oxidative stress are analyzed in this article. To gain insight into how certain DNA motifs are involved with high blood pressure, we decided to perform a study with sequences from genes reported as regulators of blood pressure and oxidative stress. 5’ UTR gene sequences were submitted to patterns recognition by the Multiple Em for Motif Elicitation (MEME) software. Afterward, the motifs obtained were searched for in the Transcription Element Search System (TESS) and Consite platforms, in order to identify the submitted sequence as element response of some transcription factor described previously. Three different motifs in each group of vasorelaxing-and vasocontractile-related gene sequences were detected. In the vasorelaxing group, motif lengths were 39 to 50 nucleotides and were located from -361 to -167 bp before the Open Reading Frame (ORF). In turn, motifs in vasocontractile group sequences were located from -619 to -570 nucleotides, with a length of from 18 to 40 nucleotides. Regarding the nucleic acid content in the motifs found, adenine was more prevalent in vasorelaxing-related sequences with 45% of the average frequency, whereas guanine on those vasocontractile-related sequences with 38%. Distinct motif sequences and variations of nucleotide content in the promoter region of vasorelaxing and vasocontractile-activity related genes were detected. These motifs of each group of genes, with a putative antagonistic role between them, might be a differential cis-regulatory elements of transcriptional machinery.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.184.189 2013/11/27 - 11:11

Abnormalities in the modulation of parasympathetic activity have been identified as a possible pathophysiological link with the association between decreases in heart rate recovery after exercise test. Hypothesis: To investigate if the application of different protocols of active recovery promotes difference in reducing Heart Rate (HR) in Post-Exercise (PE). This was a prospective, randomized trial of patients undergoing Exercise Testing (ET) and applied to two different protocols of active recovery. They were divided into G1 with recovery of 1.5 mph/2.5% and G2 40% of the speed and slope of the peak in the PE. Variables were evaluated pre-test and intrinsic to the TE. We compared the recovery of FC 1 and 2 min in the PE. Statistical analysis used the chi-square test, Student's t test and considered p<0.05. We analyzed 939 patients and 852 selected for randomization. Were allocated to G1 403 patients with mean age 47.86±14.31 years, 53.35% female and G2 with 449 patients with mean age 48.56±14.23 years and 51.7% were female. In the analysis of HR recovery of first (22.00 Vs. 23.57; p = 0.315) and second (36.17 Vs. 37.70, p = 0.06) minutes, G1 and G2 did not obtain differences. The use of different models of active recovery, applying fixed workload of 1.5 mph/2.5% slope or individually in 40% of the workload of the peak stress does not alter the recovery of HR in first or second minutes in the PE.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.179.183 2013/11/12 - 16:23

Alzeimer disease is a daunting nightmare to both the medical and families of the patients. Tireless efforts are made by the medical researchers to treat Alzheimer’s patients. The Alzhiemer patients’ data provides clues about its prognosis and they can be identifies when the data are analyzed and understood correctly. The data analysis is a first step in the path to breakthrough treatment. Towards this aim, this article introduces a new statistical distribution and calls it Down-Upsized Incidence Poisson Distribution (DUIPD). The properties of DUIPD are obtained and illustrated to interpret the patterns in the prognosis of two group of Alzheimer’s patients. In one group, the patients received a doseage of lecithin and other in the control group received placebo drug.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.150.159 2013/09/04 - 20:20

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder of women in their reproductive ages. Though PCOS is a complex, heterogeneous disorder, but there is strong evidence for its genetic predisposition. The aim was to study the association of Follicle Stimulating Hormone Receptor (FSHR) gene polymorphisms rs1394205, rs6165 and rs6166 in south Indian women with PCOS. The present case control study includes 97 women with PCOS and 101 healthy women without any history of infertility. Polymerase chain reaction and Restriction fragment length polymorphism based method were applied to identify the genotypes. Distribution of alleles and genotypes did not differ significantly between PCOS and controls (p-value: >0.05). Genotypic association analysis shows a significant association of rs6166 (G/G) genotype with PCOS in recessive gene model (P value: 0.04). Haplotype frequencies and their association analysis did not show any significant difference between PCOS and controls. No strong linkage is observed between rs6165 and rs6166 in the present study. Our study reveals significant association of FSHR gene polymorphism, rs6166 with PCOS in recessive gene model. When we observe the genotype frequencies, high frequency of heterozygotes in the population shows that rs6166 (G/A) in heterozygote condition is advantage to the population.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.160.167 2013/09/04 - 20:20

Medical malpractice litigation as a system in the U.S. serves multiple goals, including the promotion of safer medicine and the compensation of wrongfully injured patients. However, these aims are often at odds with systems-oriented strategies needed to promote patient safety. Additionally, there is widespread doubt of the actual fairness and efficiency of malpractice litigation. Regardless of the details surrounding major tort reform, to prevent malpractice claims physicians need to practice greater awareness of the evidence-based factors that place them at higher risk for a malpractice claim. Closed claims can be used as positive teaching tools that allow physicians to recognize for themselves important preventive strategies in the area of litigation. Internal medicine may not traditionally be thought of as a comparatively high-risk specialty field. In reality, however, an analysis of physicians facing a malpractice claim annually across all specialties shows that the field of internal medicine achieved greater proportions compared to specialty fields that are more often times considered higher-risk, such as emergency medicine and anesthesiology. This article aims to help the internal medicine physician in (1) analyzing the most frequent clinical events that have led to malpractice claims by using a few showcase examples and (2) introducing how these examples of closed claim cases can serve as a learning resource to reduce medical errors that most commonly lead to litigation and thus harms to both patient and provider.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.168.178 2013/09/04 - 20:20

For nearly half a century, the therapeutic options for the risk reduction of stroke in atrial fibrillation have been stagnant with vitamin K antagonists, such as warfarin, being the primary therapy. Although antiplatelet agents have been investigated over this time, they were never shown to reduce the risk of stroke at the level warfarin has. Considering the limited therapeutic options, the main decision facing clinicians was not determining which agent to use, but whether a patient was at high enough risk of stroke to benefit from anticoagulation. The CHADS2 and, more recently, the CHADSVASC risk assessment schemes have been shown to be a simple and predicable tool in determining an individual’s risk for stroke. Now, after nearly 50 years with limited alternatives, there has been a surge in therapies in the form of dabigatran, rivaroxaban and apixaban, which have been shown to be non-inferior and in some cases, superior to warfarin in their respective randomized controlled trials. This increase in available options is exciting but at the same time adds another layer of confusion to the process of selecting the appropriate agent for individual patients.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.143.149 2013/06/24 - 23:00

Barrett’s esophagus is the chief risk factor for esophageal adenocarcinoma. Reflux of gastric acid has long been related to the development of esophagitis and Barrett’s esophagus, but the role of duodenal contents is controversial. We review the literature on the role of duodenal contents in the development of esophagitis, Barrett’s esophagus and adenocarcinoma in addition to the role of acid suppressant therapy in the development or prevention of these changes. A computer-based search of the literature using the terms “Bilirubin, Barrett, Bile Reflux, duodeno-gastric reflux and oesophagus/esophagus” was performed. The role of bile and other constituents of duodenal refluxate were examined. Techniques for identifying non-acid reflux were also reviewed, as were the role of pH, medication and surgery in modulating disease severity. Complicated Barrett’s esophagus is associated with increased exposure to gastric and duodenal refluxate. Biological effect of bile acids depends on the conjugation status, the pH of the milieu and the pKa of bile acids. While Proton Pump Inhibitors reduce the levels of DGER, they also produce changes in gastric and lower esophageal pH that activate different bile acids at different pH levels resulting in unexpected injury. Conjugated bile acids are harmful in acidic environment while unconjugated bile acids are harmful at neutral pH environment. An overlap of toxicity among conjugated and unconjugated bile acids occurs between strongly acidic and neutral pH levels. Normalisation of gastric and duodenal refluxate should ideally be the goal of treatment.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.127.142 2013/06/10 - 11:13

A wide range of conditions can present with plural involvement. For this reason patients with pleural disorders may be seen by a number of different specialists. The most common pleural disorders include pleural effusion and pneumothorax. Pleural effusion and pneumothorax are defined as accumulation within the pleural space of fluid and air respectively. The most common disorders responsible for over 90% of pleural effusions include congestive heart failure, malignancy, infection and pulmonary embolism. The pneumothorax can be divided into primary spontaneous, secondary, iatrogenic or traumatic. This review article will discuss our current understanding behind the pathophysiology of pleural effusion. Common causes and less common conditions resulting in pleural effusion will be described. Investigations and management of patients with pleural dsiorders will also be discussed. In addition, recent advances in our understanding of etiology and management of pneumothorax will be covered. Investigations and management of pleural disorders require an understanding of the underlying pathology as well as the expertise in currently available interventional procedures. The main challenge remains to manage patients in accordance to the current guidelines, which is best achieved through specialist services. However, the knowledge related to pleural disorders remains of importance to many specialists.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.110.121 2013/06/10 - 11:13

After botulinum toxin was shown to help treat depression, I asked whether it can be therapeutic for anxiety disorders as well. In this brief letter, I go beyond pointing out my pioneering role in the suggesting of this idea and into highlighting some intuitive and counterintuitive aspects of this topic and some misconceptions. For example, if it is true that the effect of botulinum toxin occurs through the interruption of one’s ability to express, and as a result to perceive, sad emotions, then why is it not that common to report a loss of sad feelings after having botulinum toxin injected as a cosmetic in exactly the same way as applied to treat depression?

http://www.thescipub.com/abstract/10.3844/amjsp.2013.122.126 2013/06/10 - 11:13

Chronic Kidney Disease (CKD) is a growing epidemic in the United States. There are hormonal changes that develop long before the mineral changes in patients with CKD occur. Increased Parathyroid Hormone (PTH) levels first become evident when the estimated Glomerular Filtration Rate (eGFR) is below 60 mL/min/1.73m2. High serum phosphate stimulates the secretion of the Fibroblast Growth Factor 23 (FGF-23) predominantly by bone osteocytes. Recent finding shows that chronically elevated FGF-23 levels in CKD patients are important for the high rates of LVH and the high rates of mortality. Managing phosphorus disorders with phosphate binders and secondary hyperparathyroidism with vitamin D analog and calcimimetics may theoretically reduce cardiovascular morbidity and mortality. We still need more studies on managing phosphorus disorders with phosphate binders, secondary hyperparathyroidism with vitamin D analog and calcimimetics and the outcome data on mortality and fractures in CKD patients.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.105.109 2013/06/10 - 11:13

Cryptococcal Meningitis (CM) is a rare infection in immunocompetent patients. A kind of central nervous system infection caused by encapsulated yeast-like fungus Cryptococcus neoformans. A 59-year-old man presented to the Neurology Department of Nova Iguacu General Hospital, complaining has felt “muddled” recently and feeling diaphragmatic spasm without any apparent cause. In addition, at neurological examination, the patient was slightly confused and during the mini-mental state examination he scored less than 20 points, feeling “slowed down”, no cranial nerve dysfunction, “rigidity of gait as well as of hand movements, more pronounced on the right one, pyramidal signs bilaterally were more intensely noted on the left”. His MRI, lumbar puncture, fungal isolation and Nakin Ink were positive to Cryptococcosis while, in turn, HIV tests I and II were both negative. The treatment was started with Amphotericin B 50 mg IV, once a day, plus Dexamethashone. From our clinical case, we decided to do a brief review about Cryptococcoal Meningitis in immunocompetents and Cryptococcoma, researching at MedLine and Pubmed, using terms “Cryptococcal meningitis”, “Cryptococcal meningitis in immunocompetent” and “Cryptococcomas”. It is concluded that CM in immunocompetents is uncommon, but an important cause of non-acute meningitis, that should be included in the range of causes of preventable blindness. In this sense, this article purposes advertise clinicians and specialists, to recognize the clinical manifestation and diagnosis of cryptococcal meningitis in immunocompetents, trying to avoid a later diagnosis and the following complications.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.100.104 2013/06/10 - 11:13

Malaria remains a serious global public health problem and a leading cause of morbidity and mortality in sub Saharan Africa. In Zambia the disease is endemic with stable transmission, accounting for 40% of all out-patient attendances and is responsible for 20% deaths among children under five. Scaling up of scientifically proven high impact preventive, curative and supportive interventions and deploying the three-ones strategy: one coordinating mechanism; one implementation plan and one monitoring plan which is key for increased and successful public-private sector partner coordination, strengthening and mobilization. There has been marked impact in the reduction of the annual number of malaria deaths by over 60% and malaria cases by 66% (2000-2008), under-five malaria deaths by 41% (2006-2008), parasite prevalence among children under five from 22 to16% in 2010 and severe anemia rates in children by 56% (2006-2010). Intermittent presumptive treatment in pregnancy uptake has reached the RBM target at 86%. With these achievements, the country has surpassed targets set by: (i) the Abuja Declaration and (ii) the RBM of reducing the global malaria burden by 50% by 2010. The achievements can be attributed to increased advocacy, communication and behaviour change, efficient partnership coordination including strong community engagement, increased financial resources and evidence-based deployment of key technical interventions in accordance with the national malaria control programme policy and strategic direction. Maintaining the momentum and the gains is critical as the programme strives to achieve universal coverage of evidence-based and proven interventions. The country offers some unique models and experiences that could really benefit other programmes in the region. Community-level integrated entomological and active case surveillance, prompt effective treatment and sustained high levels of contemporary malaria prevention tools is pivotal to the long-term success of malaria control and future malaria elimination. However, there is great need for sustained, predictable, regular resources and broadening the partnership base. To ensure sustainability, Government needs to remain on the driving seat and committed to malaria control in terms of funding.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.91.99 2013/06/10 - 11:13

Human Immunodeficiency Virus (HIV)-Associated Nephropathy (HIVAN) is one of the most important renal complications found in HIV-infected individuals. Morbidity and mortality in this group of patients increases due to End-Stage Renal Disease (ESRD). Classic histological characteristics of HIVAN are collapsing Focal Segmental Glomerulosclerosis (FSGS), microcystic tubular dilation and interstitial inflammation and fibrosis. High prevalence of HIVAN among people of African descent can be explained by host genetic susceptibility, which is associated with several genes on human chromosome 22. HIV can infect renal epithelial cells via unconventional mechanisms and cause changes in multiple host cellular pathways, especially in renal tubular cells and podocytes. Accurate diagnosis of HIVAN relies mainly on renal biopsy. Antiretroviral therapy is the mainstay treatment for HIVAN and current standard guidelines recommend the initiation of Highly Active Antiretroviral Therapy (HAART) in all HIV-infected individuals with HIVAN, regardless of CD4 level. Other possible treatments for HIVAN including steroids, Angiotensin Converting Enzyme (ACE) inhibitors, renal replacement therapy and renal transplantation are reviewed in this chapter."

http://www.thescipub.com/abstract/10.3844/amjsp.2013.82.90 2013/06/10 - 11:13

Hemoglobin variants, ABO and Rhesus blood groups vary from one population to another. The study was designed to sample pregnant women population from Ayetoro community of Ogun state, Nigeria, for the purpose of updating information on the prevalence of abnormal hemoglobin variants, ABO and Rh blood groups and compare the results with previously published data. Hospital records of recruited pregnant women were sorted out for the determination of the prevalence of hemoglobin variants, ABO and Rh blood groups. Blood group O were the most prevalent (59.1%) followed by groups A (19.1%), B (17.1%) and AB (4.8%). Rhesus D antigen was positive in 97.1% and negative in 2.9% of the study population. Four genotypes; HbAA (70.5%), HbAS (18.1%), HbAC (10.5%) and HbCC (1.0%) were reported in this study. The occurrence of the hemoglobin variants and the different ABO blood groups varied significantly (p<0.05). The frequency of ABO and Rhesus blood groups from this study is consistent with reports from previous studies in Nigeria. The study helps in the formulation of genetic counseling policies to help prospective mothers make informed decisions before and after giving birth.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.78.81 2013/06/10 - 11:13

Advancing age is characterized by functional impairment of the many regulatory processes that provide integration between organs and therefore, may lead failure to maintain homeostasis under conditions of physiological stress. There are two main factors helping to identify the high risk for surgery. The first relates to the type of surgery and the second to the scope of cardiopulmonary functional capacity of the patient. There are major cardiovascular, respiratory, renal and musculoskeletal changes in elderly patients. Preoperative assessment of risk in elderly patients must consider patient factors, the surgical problem and the treatment options. Medical co-morbid conditions are common with age and may markedly increase the risks associated with surgical intervention. Postoperative care of elderly includes respiratory Care, renal function and fluid and electrolyte management, cardiovascular Care, management of pain and maintenance of function. In conclusion, health providers should pay attention to the quality of care in elderly patients because they are vulnerable surgical and anaesthetic stress. Minimizing perioperative risk in those patients requires thoughtful preoperative assessment of organ function and reserve, meticulous intraoperative management and postoperative care. Management of surgical elderly patients is both complex and different from younger patients. Assessment of the surgical problems and physiologic status of elderly persons must take into account the changes associated with advancing age, changes in the incidence, prevalence and natural history of certain disease processes; and the increased likelihood of multiple medical diagnoses and polypharmacy.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.63.77 2013/06/10 - 11:13

Alcohol consumption is a risk factor for non-communicable diseases such as cardiovascular diseases, liver cirrhosis and cancers. It has also been associated with risky sexual behaviors, hence, attributed as a factor in the increase of HIV incidence and prevalence. A cross sectional study was conducted using a modified World Health Organizations Global Non Communicable Diseases (NCD) Surveillance Initiative NCD-STEPs 1and 2. Multivariate logistic regression was used to examine the determinants of alcohol consumption. A total of 1627 individuals participated in the survey, of which 42.3% were males. Some 22.3% (36.2% of male and 12.1% of female; p<0.001) participants reported to have consumed alcohol during the 30 days preceding the survey. The factors considered to be associated with alcohol consumption were age, sex and smoking. Compared to respondents age 25-34 years, respondents of age 35-44 years were 38% (AOR = 1.38, 95%CI [1.11, 1.70]) more likely to report having consumed alcohol and those aged 45 years or older were 26% (AOR = 0.74, 95%CI [0.60, 0.93]) less likely to report having consumed alcohol. Female respondents were 47% (AOR = 0.53, 95%CI [0.46, 0.60]) less likely to report consuming alcohol compared to male respondents. Compared to respondents who reported smoking cigarettes, those who did not smoke cigarettes were 51% (AOR = 0.49, 95%CI [0.40, 0.59]) less likely to consume alcohol. The rate of alcohol consumption is high in this mining town. Factors identified in this study as associated with alcohol consumption, i.e., male sex, age, cigarette smoking, should be considered in designing interventions to curtail the level of alcohol consumption.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.6.11 2013/06/10 - 11:13

Despite the initial failures of ankle arthroplasty, the newer generations of total ankle replacement have shown good medium term results. Reasons stated for this change include a better overall understanding of ankle biomechanics; lessons learnt from hip and knee arthroplasty, improved ankle implant designs that better replicate the human anatomy and finally in the development of foot and ankle surgery as a sub-speciality with committed surgeons. Literature supports the use of total ankle replacement for advanced ankle arthritis in elderly patients with moderately active lifestyle but recommends counselling patients appropriately regarding reasonable expectations and complications. This review looks at the development of total ankle replacement, present indications; the surgical technique, the results from various centres and indicates the present position regarding the management of ankle arthritis.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.1.5 2013/06/10 - 11:13

During a treatment period of a cancer patient, the medical team ponders over a question: Is patient’s cancer recurrence significantly postponed by the medication, even if the illness is not completely cured? This question could be answered with data evidence if the data are analyzed with an appropriate model and a suitable methodology. A scanning of the literature reveals that no suitable technique now exists. Hence, there is a need to develop a new probability model and to formulate a statistical methodology. Both tasks are accomplished in this article to answer the above question. The Exponential Distribution (ED) is traditionally employed to portray the chance for a patient to survive beyond a given time, t>0. Because of its memory less property, the exponential distribution lacks an ability to answer whether the medication has significantly postponed the cancer recurrence for a patient. In essence, this memory less property assumes that a patient’s body functions with no memory. This notion of memory less is quite unreal with respect to cancer recurrence as it is contradictory to the medical belief of medicating a patient with an intention to stop or at least postpone cancer recurrence in a disease management. This article takes an approach by adding a prolonging parameter, ρ≥0 to the exponential distribution to represent the medication’s effect on the survival chance for a patient without a cancer recurrence. Because of the prolonging parameter, the probability structure of the exponential distribution gets altered and it is explicitly explained in the article. The altered exponential distribution is named Prolonged Survival Exponential Distribution (PSED). The properties of PSED are derived and then utilized to analyze patients’ cancer recurrence data. Also, likelihood ratio based statistical methodology based on PSED is derived and illustrated to address whether the medication has significantly postponed the cancer’s recurrence time in a particular patient. An analysis of recurrence times of three groups of sixteen bladder cancer patients was done. The first is the placebo group with seven patients. The second and third group consist respectively three and six patients receiving thiotepa and pyridoxine medication. The probability plots of their recurrence times confirm that the data do not follow an exponential distribution. The data analyses results reveal interesting statistical information about how effective the medication had been on each individual patient. Without the new model, PSED and the likelihood ratio testing methodology of this article, a patient specific interpretation is not possible. The medication worked in some but not all patients. The medication is thought to have not worked in a patient, when his/her estimate, ρ is closer to zero. However, on the average, the 2nd bladder cancer recurrence time is quicker in place group, next in pyridoxine group and much later in tholepin group. The new model, PSED and the likelihood ratio test of this article would be useful to analyze and interpret the probability pattern of recurrence times and whether the medication has significantly prolonged the next recurrence time of other cancers like melanoma, ulcer, ovarian. Also, the contents of this article have established a foundation to build a generalized regression methodology to identify predictors for increasing the survival time of cancer patients with more patients’ data.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.43.62 2013/03/27 - 21:10

Diabetes is associated with the development of premature cardiovascular disease. There have been many clinical trials of statin treatment conducted in patients with Coronary Heart Disease (CHD). Taking a closer look at the subset of those patients with diabetes mellitus puts no doubt on the beneficial effect of lowering cholesterol with statin in these patients. Earlier studies done dwell more on cholesterol reduction with statins in patients with CHD but without diabetes hence no strong supporting evidence was there to justify the use of statins in diabetic patients without cardiovascular disease. We search medline for studies on cholesterol reduction and cardiovascular risk reduction in diabetic patients. We found three secondary prevention trials (4S, CARE and LIPID); four primary prevention trials (ASCOT-LLA, CARDS, WOSCOPS and TexCaps); two mixed prevention trials (HPS and ASPEN); three trials (PROVE-IT, TNT and A to Z) that seek to evaluate whether intensive or moderate lipid lowering with statins will prevent cardiovascular risk and to what extent. Treatment decisions should be based on the reduction of absolute risk and not on the reduction in relative risk. Patients suffering from diabetes mellitus will incur a huge cost if they were to be commenced on statin from the day the diagnosis of diabetes was made. With the rising incidence of diabetes worldwide, statins should be targeted to those patients with diabetes mellitus who are most likely to benefit from it. Type 2 DM patients with metabolic syndrome or those with mild to moderate cardiovascular risk will benefit from statin therapy. Clinical benefits stand to be derived from statin therapy if moderate reduction of risk can be achieved in patients that are classified as having high cardiovascular risk. What this means is that all patients eligible to be enrolled in the HPS or CARDS study should be on statin treatment.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.36.42 2013/03/26 - 03:13

Recent studies suggest that epigenetic mechanisms are not only essential for the dynamic transcriptional regulation in embryonic and somatic stem cells, but are also actively involved in tumorigenesis: genes important for pluripotency are epigenetically regulated and aberrant epigenetic changes have been detected in virtually all human malignancies studied, including Hepatocellular Carcinoma (HCC). Infection with Hepatitis C Virus (HCV) is a major risk factor for the development of HCC. Despite the fact that HCV is a RNA virus without a DNA intermediate, recent studies demonstrate that HCV viral proteins may actively participate in epigenetic regulation of hepatic cancer stem cell phenotypes and induce HCC-specific epigenetic changes. Identification of host epigenetic alterations induced by HCV infection and epigenetic differences between hepatic cancer stem cells and the bulk non-tumorigenic cancer cells, may yield potential biomarkers for early detection, as well as therapeutic targets for HCV associated HCC."

http://www.thescipub.com/abstract/10.3844/amjsp.2013.21.35 2013/03/26 - 03:13

Currently, assessing superiority of a diagnostic test requires cumbersome calculations and confusing interpretations because of nonlinear Receiver Operating Characteristic Curve (ROC). To remedy these difficulties, this article prepares, provides an easier alternate geometric approach. That is, a simple but more effective visual approach with two complementary mosaic masonries are constructed with their properties, superimposed and utilized. First masonry is conditional on disease status. The second masonry is conditional on test outcomes. By superimposing both masonries and visualizing their overlap territory, our approach utilizes an angle, θ to assess superiority of a diagnostic test. A hypothesis testing procedure is also devised to compute the significance level of an estimated angle. The statistical power to accept a true angle is developed in the procedure. In the end, the concepts, properties and advantages of mosaic masonries are illustrated using medical and public health data sets."

http://www.thescipub.com/abstract/10.3844/amjsp.2013.12.20 2013/03/26 - 03:13

Alcohol consumption is a risk factor for non-communicable diseases such as cardiovascular diseases, liver cirrhosis and cancers. It has also been associated with risky sexual behaviors, hence, attributed as a factor in the increase of HIV incidence and prevalence. A cross sectional study was conducted using a modified World Health Organizations Global Non Communicable Diseases (NCD) Surveillance Initiative NCD-STEPs 1and 2. Multivariate logistic regression was used to examine the determinants of alcohol consumption. A total of 1627 individuals participated in the survey, of which 42.3% were males. Some 22.3% (36.2% of male and 12.1% of female; p<0.001) participants reported to have consumed alcohol during the 30 days preceding the survey. The factors considered to be associated with alcohol consumption were age, sex and smoking. Compared to respondents age 25-34 years, respondents of age 35-44 years were 38% (AOR = 1.38, 95%CI [1.11, 1.70]) more likely to report having consumed alcohol and those aged 45 years or older were 26% (AOR = 0.74, 95%CI [0.60, 0.93]) less likely to report having consumed alcohol. Female respondents were 47% (AOR = 0.53, 95%CI [0.46, 0.60]) less likely to report consuming alcohol compared to male respondents. Compared to respondents who reported smoking cigarettes, those who did not smoke cigarettes were 51% (AOR = 0.49, 95%CI [0.40, 0.59]) less likely to consume alcohol. The rate of alcohol consumption is high in this mining town. Factors identified in this study as associated with alcohol consumption, i.e., male sex, age, cigarette smoking, should be considered in designing interventions to curtail the level of alcohol consumption.

http://www.thescipub.com/abstract/10.3844/amjsp.2012.6.11 2013/03/26 - 03:13

Despite the initial failures of ankle arthroplasty, the newer generations of total ankle replacement have shown good medium term results. Reasons stated for this change include a better overall understanding of ankle biomechanics; lessons learnt from hip and knee arthroplasty, improved ankle implant designs that better replicate the human anatomy and finally in the development of foot and ankle surgery as a sub-speciality with committed surgeons. Literature supports the use of total ankle replacement for advanced ankle arthritis in elderly patients with moderately active lifestyle but recommends counselling patients appropriately regarding reasonable expectations and complications. This review looks at the development of total ankle replacement, present indications; the surgical technique, the results from various centres and indicates the present position regarding the management of ankle arthritis.

http://www.thescipub.com/abstract/10.3844/amjsp.2012.1.5 2013/03/26 - 03:13

Recent studies suggest that epigenetic mechanisms are not only essential for the dynamic transcriptional regulation in embryonic and somatic stem cells, but are also actively involved in tumorigenesis: genes important for pluripotency are epigenetically regulated and aberrant epigenetic changes have been detected in virtually all human malignancies studied, including Hepatocellular Carcinoma (HCC). Infection with Hepatitis C Virus (HCV) is a major risk factor for the development of HCC. Despite the fact that HCV is a RNA virus without a DNA intermediate, recent studies demonstrate that HCV viral proteins may actively participate in epigenetic regulation of hepatic cancer stem cell phenotypes and induce HCC-specific epigenetic changes. Identification of host epigenetic alterations induced by HCV infection and epigenetic differences between hepatic cancer stem cells and the bulk non-tumorigenic cancer cells, may yield potential biomarkers for early detection, as well as therapeutic targets for HCV associated HCC.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.275.289 2013/03/12 - 17:21

Currently, assessing superiority of a diagnostic test requires cumbersome calculations and confusing interpretations because of nonlinear Receiver Operating Characteristic Curve (ROC). To remedy these difficulties, this article prepares, provides an easier alternate geometric approach. That is, a simple but more effective visual approach with two complementary mosaic masonries are constructed with their properties, superimposed and utilized. First masonry is conditional on disease status. The second masonry is conditional on test outcomes. By superimposing both masonries and visualizing their overlap territory, our approach utilizes an angle, θ to assess superiority of a diagnostic test. A hypothesis testing procedure is also devised to compute the significance level of an estimated angle. The statistical power to accept a true angle is developed in the procedure. In the end, the concepts, properties and advantages of mosaic masonries are illustrated using medical and public health data sets.

http://www.thescipub.com/abstract/10.3844/amjsp.2013.266.274 2013/02/13 - 02:44

Alcohol consumption is a risk factor for non-communicable diseases such as cardiovascular diseases, liver cirrhosis and cancers. It has also been associated with risky sexual behaviors, hence, attributed as a factor in the increase of HIV incidence and prevalence. A cross sectional study was conducted using a modified World Health Organizations Global Non Communicable Diseases (NCD) Surveillance Initiative NCD-STEPs 1and 2. Multivariate logistic regression was used to examine the determinants of alcohol consumption. A total of 1627 individuals participated in the survey, of which 42.3% were males. Some 22.3% (36.2% of male and 12.1% of female; p<0.001) participants reported to have consumed alcohol during the 30 days preceding the survey. The factors considered to be associated with alcohol consumption were age, sex and smoking. Compared to respondents age 25-34 years, respondents of age 35-44 years were 38% (AOR = 1.38, 95%CI [1.11, 1.70]) more likely to report having consumed alcohol and those aged 45 years or older were 26% (AOR = 0.74, 95%CI [0.60, 0.93]) less likely to report having consumed alcohol. Female respondents were 47% (AOR = 0.53, 95%CI [0.46, 0.60]) less likely to report consuming alcohol compared to male respondents. Compared to respondents who reported smoking cigarettes, those who did not smoke cigarettes were 51% (AOR = 0.49, 95%CI [0.40, 0.59]) less likely to consume alcohol. The rate of alcohol consumption is high in this mining town. Factors identified in this study as associated with alcohol consumption, i.e., male sex, age, cigarette smoking, should be considered in designing interventions to curtail the level of alcohol consumption.

http://www.thescipub.com/abstract/10.3844/amjsp.2012.260.265 2013/01/30 - 09:51

Despite the initial failures of ankle arthroplasty, the newer generations of total ankle replacement have shown good medium term results. Reasons stated for this change include a better overall understanding of ankle biomechanics; lessons learnt from hip and knee arthroplasty, improved ankle implant designs that better replicate the human anatomy and finally in the development of foot and ankle surgery as a sub-speciality with committed surgeons. Literature supports the use of total ankle replacement for advanced ankle arthritis in elderly patients with moderately active lifestyle but recommends counselling patients appropriately regarding reasonable expectations and complications. This review looks at the development of total ankle replacement, present indications; the surgical technique, the results from various centres and indicates the present position regarding the management of ankle arthritis.

http://www.thescipub.com/abstract/10.3844/amjsp.2012.255.259 2013/01/17 - 16:08

Problem statement: Associations between serum levels of fetuin-A, C3 complement, calcium × phosphate product and calcification risk index and lipid profile in SLE patients were established. However, the mechanism of accelerated atherosclerosis accompanied with SLE remains elusive. We therefore turned to investigate the association between Fetuin-A, disease activity and accelerated atherosclerosis in patients with SLE. Approach: Serum blood samples were taken from 100 female SLE patients. All Patient samples were analyzed by ELISA for determination of Fetuin-A level. Calcium, Phosphate, C3 compelement, Lipid profile, Creatinine and urea were measured also in SLE patients compared with healthy control volunteers. Results: We found that Serum fetuin-A had been positively associated with carotid arterial stiffness, independent of known atherogenic factors in healthy subjects. Furthermore, Fetuin-A was correlated negatively with IMT, SLEDAI, CRI, CaxP product, Triglycerdies, VLDL and LDL. While it was correlated positively with C3 complement. Conclusion: Fetuin-A deficiency accompanied with increasing levels of calcium and phosphate gave an evidence that there was a key role of fetuin-A as a strong inhibitor of Cardio Vascular Calcification (CVC) by formation of a complex called (calciprotein) with calcium and phosphate in blood stream. So, Identification of biologic markers of disease activity associated with atherosclerosis may help to optimize therapy for this important manifestation of systemic autoimmune disease.

http://www.thescipub.com/abstract/10.3844/amjsp.2012.249.254 2012/09/15 - 10:51

Problem statement: Ramsay Hunt syndrome is characterized by peripheral facial palsy and eruptions in external ear reportedly due to the reactivation of latent varicela zoster virus in the sensory ganglia of facial nerve. Our purpose is to describe a case of this syndrome accompanied by the Neurology Service of Nova Iguacu General Hospital. Approach: A 60-year old female patient sought the emergency room due to a complaint because she was not able to close her left eye, followed by a drift of the labial fold to the right as well as a sensation of &#34burning eyes&#34 for the last three days. She also referred vertigo and bilateral hypoacusis, more intensely felt on the left side. Results: Physical examination showed a left facial palsy with a vesicular eruption in the left external auditory canal, ear lobe and neck on that side. Her taste sensation was decreased on the anterior 2/3 of the tongue, a negative rinne test, a positive weber test indicating a neurossensorial hearing loss, ataxia in walking, a Romberg sign and an abnormal fukuda pace test, however the CT scan was normal. Conclusion: The diagnosis is basically clinical, in turn, treatment is controversial. In addition to clinical findings, the diagnosis is confirmed by the presence of viral DNA in the involved tissue and vesicular exudate, as assessed by polymerase chain reaction. Ramsay Hunt syndrome involves severe dysfunction, with poorer facial nerve prognosis than in Bell’s palsy. Some studies suggest that treatment with prednisone and acyclovir may improve outcome, although a prospective randomised treatment trial remains to be undertaken.

http://www.thescipub.com/abstract/10.3844/amjsp.2012.237.239 2012/08/31 - 00:25