Extending the window for thrombolysis for treatment of acute ischaemic stroke during pregnancy: a review.

Historically, safety of intravenous recombinant tissue plasminogen activator (IV rt-PA) for the treatment of acute ischaemic stroke (AIS) is limited to use within 4.5 hours from symptom onset. Recent studies suggest the treatment window may be extended when patients have salvageable brain tissue on advanced neuroimaging. This paper describes a novel use of IV rt-PA for treatment of AIS in a pregnant patient within an extended-time window (>4.5 hours, and <9 hours) based on advanced neuroimaging with a favourable outcome. TWEETABLE ABSTRACT: Novel use of IV rt-PA for treatment of AIS in pregnancy within an extended-time window based on advanced imaging with a favourable outcome.

SPEXOR passive spinal exoskeleton decreases metabolic cost during symmetric repetitive lifting.

PURPOSE: Besides mechanical loading of the back, physiological strain is an important risk factor for low-back pain. Recently a passive exoskeleton (SPEXOR) has been developed to reduce loading on the low back. We aimed to assess the effect of this device on metabolic cost of repetitive lifting. To explain potential effects, we assessed kinematics, mechanical joint work, and back muscle activity. METHODS: We recruited ten male employees, working in the luggage handling department of an airline company and having ample experience with lifting tasks at work. Metabolic cost, kinematics, mechanical joint work and muscle activity were measured during a 5-min repetitive lifting task. Participants had to lift and lower a box of 10 kg from ankle height with and without the exoskeleton. RESULTS: Metabolic cost was significantly reduced by 18% when wearing the exoskeleton. Kinematics did not change significantly, while muscle activity decreased by up to 16%. The exoskeleton took over 18-25% of joint work at the hip and L5S1 joints. However, due to large variation in individual responses, we did not find a significant reduction of joint work around the individual joints. CONCLUSION: Wearing the SPEXOR exoskeleton decreased metabolic cost and might, therefore, reduce fatigue development and contribute to prevention of low-back pain during repetitive lifting tasks. Reduced metabolic cost can be explained by the exoskeleton substituting part of muscle work at the hip and L5S1 joints and consequently decreasing required back muscle activity.

Nd:YAG laser offers promising treatment option for familial glomuvenous malformation.

Although an uncommon entity, familial glomangiomatosis is often a source of significant discomfort to affected patients and impacts quality of life. Patients develop numerous painful vascular lesions, beginning in childhood. Because management strategies for this entity are sparsely reported in the literature, additional study is needed to establish best practice. We report positive results with the use of Nd:YAG laser in treating symptomatic lesions of familial glomuvenous malformation.

Percepciones de profesionales en enfermería sobre la violencia de pareja íntima contra la adolescente gestante / Perception of nursing professionals regarding intimate partner violence against pregnant teenagers / Percepções de profissionais de enfermagem sobre a violência do parceiro íntimo para a adolescente grávida

Se realizó un estudio cualitativo con el objetivo de describir las percepciones de profesionales en enfermería sobre la violencia\r\nde la pareja íntima contra adolescentes gestantes atendidas en el Hospital de Usaquén (Bogotá, Colombia). Este parte del papel\r\nque desempeña enfermería en la detección, prevención y atención de las gestantes víctimas de violencia de sus parejas y surge\r\nde una investigación anterior en ese centro de atención, que determinó que las gestantes más jóvenes son las más vulnerables.\r\nEl estudio se desarrolló mediante dos grupos focales, con participación de 14 enfermeras que laboran en el hospital. El análisis, de\r\ntipo fenomenológico, se realizó con apoyo del software Atlas ti 7. Entre los principales resultados se establece que, según la percepción de las enfermeras, la forma más frecuente de violencia de la pareja íntima contra la adolescente gestante es la psicológica, seguida del abandono y la violencia económica. En cuanto a las necesidades de detección resulta importante ampliar los tiempos de consulta, generar un ambiente de confianza, implementar protocolos de detección inicial y realizar tamizajes. En lo relativo a la prevención, se recomienda iniciar desde la infancia la formación en género y derechos, además de trabajar conjuntamente con la escuela. Para la atención, se considera imperioso el trabajo interdisciplinario. Como barreras se mencionan la negación de las gestantes a denunciar y la amenaza de sus parejas al equipo de enfermería ante la notificación, así como la falta de capacitación del personal de salud.

A qualitative study was conducted with the objective of describing the perceptions of nursing professionals regarding intimate partner violence (IPV) against pregnant adolescents attended at the Hospital de Usaquén (Bogotá, Colombia). This study is based on the role that nurses play in the detection, prevention and care of pregnant victims of violence from their partners and emerges from an earlier study in this center of attention that established that the youngest pregnant women are the most vulnerable. The study was developed through two focus groups, with the participation of 14 nurses that work at the hospital. A phenomenological analysis was carried out with the support of the Atlas ti 7 software. Among the main results, it is established that according to the perception of nurses, the most frequent form of violence form the intimate partner towards the pregnant adolescent is psychological, followed by abandonment and economic violence. Concerning the need for detection, it is considered important to extend consultation times, generate an atmosphere of trust, implement initial detection protocols, and perform screenings. In regard to prevention, it is recommended to initiate training in gender and rights from childhood, in addition to working together with the school. For the medical attention, interdisciplinary work is considered imperative. As barriers, mentioned were the refusal of the pregnant women to denounce, and the threats of their partners to the nursing staff after notification, as well as the lack of training of the medical personnel.

Um estudo qualitativo foi realizado com o objetivo de descrever a percepção de um grupo de enfermeiras sobre a violência por parceiro íntimo na gestação que afeta adolescentes gestantes atendidas no Hospital de Usaquén (Bogotá, Colômbia). Este estudo parte da importância da enfermagem na detecção, prevenção e cuidados de mulheres grávidas vítimas de violência por seus parceiros e é baseado em um estudo anterior em que o centro de atenção estabeleceu que as mulheres grávidas mais jovens são as mais vulneráveis. O estudo foi desenvolvido por meio de dois grupos de foco, com a participação de 14 enfermeiras vinculadas ao hospital. A análise, tipo fenomenológica, foi realizada com o apoio do software Atlas ti 7. Entre os principais resultados, define-se que, de acordo com a percepção das enfermeiras, a forma mais frequente de violência por parceiro íntimo é a psicológica, seguida do abandono e da violência econômica. No que diz respeito às necessidades de detecção é considerada importante para expandir o tempo de consulta, gerar um ambiente de confiança, implementar protocolos de detecção inicial e realizar triagens; no que diz respeito à prevenção, recomenda-se iniciar desde a infância a formação no domínio da igualdade entre os gêneros e direitos humanos, além de trabalhar em conjunto com a escola; já a atenção, é imperativa para o trabalho interdisciplinar. Como barreiras, foram mencionadas a negação por parte das gestantes em denunciar e a ameaça de seus parceiros à equipe de enfermagem, assim como a falta de capacitação dos profissionais de saúde.

A review on the dietary flavonoid kaempferol.

Epidemiological studies have revealed that a diet rich in plant-derived foods has a protective effect on human health. Identifying bioactive dietary constituents is an active area of scientific investigation that may lead to new drug discovery. Kaempferol (3,5,7-trihydroxy-2-(4-hydroxyphenyl)-4H-1-benzopyran-4-one) is a flavonoid found in many edible plants (e.g. tea, broccoli, cabbage, kale, beans, endive, leek, tomato, strawberries and grapes) and in plants or botanical products commonly used in traditional medicine (e.g. Ginkgo biloba, Tilia spp, Equisetum spp, Moringa oleifera, Sophora japonica and propolis). Some epidemiological studies have found a positive association between the consumption of foods containing kaempferol and a reduced risk of developing several disorders such as cancer and cardiovascular diseases. Numerous preclinical studies have shown that kaempferol and some glycosides of kaempferol have a wide range of pharmacological activities, including antioxidant, anti-inflammatory, antimicrobial, anticancer, cardioprotective, neuroprotective, antidiabetic, anti-osteoporotic, estrogenic/antiestrogenic, anxiolytic, analgesic and antiallergic activities. In this article, the distribution of kaempferol in the plant kingdom and its pharmacological properties are reviewed. The pharmacokinetics (e.g. oral bioavailability, metabolism, plasma levels) and safety of kaempferol are also analyzed. This information may help understand the health benefits of kaempferol-containing plants and may contribute to develop this flavonoid as a possible agent for the prevention and treatment of some diseases.

Bevacizumab para la degeneración macular relacionada a edad / Bevacizumab for age-related macular degenaration

Objetivo: Evaluar la eficacia de Bevacizumab en las neovascularizaciones coroideas subfoveales y yuxtafoveales de Degeneración Macular Relacionada a Edad (DMRE). Pacientes y Métodos: Serie intervencional sin control. Criterio de re-tratamiento basado en examen clínico con o sin angiofloresceinografía y OCT. Resultados: 44 ojos de 42 pacientes de DMRE recibieron la inyección intravítrea de bevacizumab 1.25mg y tuvieron seguimiento de 4-40 semanas, promedio 21.8 semanas. AV inicial fue entre 0.02 - 1.0, promedio 0.18 (log Mar 0.75) y AV final fue entre c/d - 1.0, promedio 0.25 (log Mar 0.58); que la diferencia resultó ser estadísticamente significativa (p<0.025). 26 (59 por ciento) ojos ganaron la AV al menos 1 línea de ETDRS, y dentro de los cuales 15 (34 por ciento) ojos ganaron 3 o más líneas de ETDRS. 24 (54 por ciento) ojos recibieron 2 o más inyecciones. 19 (43 por ciento) pacientes presentaron la DMRE cicatricial en su ojo contra lateral. Hubo un caso de leve hemovítrea como complicación. Conclusiones: Bevacizumab sería la terapia electiva para la DMRE exudativa en nuestro medio por su indiscutible eficacia, seguridad y bajo costo.

Objective: To study the efficacy of Bevacizumab for subfoveal or juxtafoveal choroidal neovascularization of Age-related Macular Degeneration (AMD). Patients and Methods: Interventional case series without control group. Re-treatment criteria was based on clinical examination with or without florescein angiography or OCT. Results: 44 eyes of 42 patients received intravitreal injection of bevacizumab 1.25mg. The mean follow up was 21.8 weeks, range 4-40 weeks. The mean initial VA was 0.18 (log Mar 0.75), range 0.02 - 1.0, and the mean final VA was 0.25 (log Mar 0.58), range finger count - 1.0. The difference between both VA was statistically significant (p<0.025). 26 (59 percent) eyes gained VA 1 line of ETDRS at least, and 15 (34 percent) eyes gained 3 or more lines of ETDRS. 24 (54 percent) eyes received 2 or more injections. 19 (43 percent) patients had disciform AMD in contra lateral eye. We had only one case of slight vitreal hemorrhage as complication. Conclusion: Bevacizumab would be the first line therapy for exudative AMD owing to its indisputable efficacy, security and low cost.