Multimedia information intervention and its benefits in partners of the head and neck cancer patients.

We aimed to investigate the levels of anxiety, depression, satisfaction with information provision and cancer-related knowledge in partners of head and neck cancer (HNC) patients receiving a Multimode Comprehensive Tailored Information Package (MCTIP). A non-randomised, controlled trial was conducted with partners of HNC patients recruited at two academic hospitals in Montreal. The Test participants received the MCTIP, while the Control participants received information in an ad hoc manner. All participants were evaluated using the Hospital Anxiety and Depression Scale (HADS), Satisfaction with Cancer Information Profile and a cancer knowledge questionnaire at baseline, and 3 and 6 months later. Data were analysed using descriptive statistics, t-test and chi-square test, and mixed model analysis to test the impact of the intervention. A total of 31 partners of HNC patients participated in this study and completed all the evaluations. The partners in the Test group experienced significantly lower levels of anxiety (P = 0.001) and depression (P = 0.003) symptoms and were more satisfied (P = 0.002) with cancer information provided than partners in the Control group. Providing tailored information seems to have positive outcomes regarding anxiety, depression, and satisfaction in partners of HNC patients. Larger randomised studies are warranted to validate these effects.

Survivorship care plans for breast cancer patients: understanding the quality of the available evidence.

AIM: The overall goal of the present study was to contribute to consistency in the provincial approach to survivorship care planning through knowledge synthesis and exchange. Our review focused on the research concerning the physical and emotional challenges of breast cancer (bca) patients and survivors and the effects of the interventions that have been used for lessening those challenges. METHODS: The psychosocial topics identified in bca survivorship care plans created by two different initiatives in our province provided the platform for our search criteria: quality of life (qol), sexual function, fatigue, and lifestyle behaviours. We conducted an umbrella review to retrieve the best possible evidence, and only reviews investigating the intended outcomes in bca survivors and having moderate-to-high methodologic quality scores were included. RESULTS: Of 486 reports retrieved, 51 reviews met the inclusion criteria and form part of the synthesis. Our results indicate that bca patients and survivors experience numerous physical and emotional challenges and that interventions such as physical activity, psychoeducation, yoga, and mindfulness-based stress reduction are beneficial in alleviating those challenges. CONCLUSIONS: Our study findings support the existing survivorship care plans in our province with respect to the physical and emotional challenges that bca survivors often face. However, the literature concerning cancer risks specific to bca survivors is scant. Although systematic reviews are considered to be the "gold standard" in knowledge synthesis, our findings suggest that much remains to be done in the area of synthesis research to better guide practice in cancer survivorship.

Survivorship care plans for people with colorectal cancer: do they reflect the research evidence?

AIM: In the present study, we synthesized the published literature about the psychosocial aspects of colorectal cancer (crc) survivorship to support an update of the evidentiary base of the survivorship care plans (scps) created in our jurisdiction. METHODS: The psychosocial topics identified in the crc scps created by two different initiatives in our province were used as search criteria: quality of life (qol), sexual function, fatigue, and lifestyle behaviors. An umbrella review was conducted to retrieve the best possible evidence. Only reviews that investigated the intended outcomes in crc survivors and those with moderate-to-high methodologic quality scores were included. RESULTS: Of 462 retrieved reports, eight reviews met the inclusion criteria for the synthesis. Of those eight, six investigated the challenges of crc survivors and two investigated the effect of physical activity on survivor well-being. Our results indicate that emotional and physical challenges are common in crc survivors and that physical activity is associated with clinically important benefits for the fatigue and physical functioning of crc survivors. CONCLUSIONS: Our study findings update the evidence and indicate that existing scps in our province concerning the physical and emotional challenges of crc survivors reflect the evidence at the time of their issue. However, the literature concerning cancer risks specific to crc survivors is lacking. Although systematic reviews are considered to be the "gold standard" in knowledge synthesis, our findings suggest that much remains to be done in the area of synthesis research to better guide practice in cancer survivorship.

Early Childhood Caries and Dental Care Utilization in Mangalore, India: Parents' Perceptions.

BACKGROUND: Parents often underuse dental care services for their children with early childhood caries (ECC), resulting in a high burden of untreated dental caries. AIM: To describe parental perceptions and challenges in dental care utilization for their children with ECC. DESIGN: A descriptive qualitative study was conducted with parents of children with ECC seeking dental care in Mangalore, India. Data were collected through focus group discussions using an interview guide. Manual line-by-line coding and content analysis methods were used for data analysis. RESULTS: Three categories were generated from data obtained through 5 focus groups of 27 participants: dental care visiting patterns, the significance of dental visits, and challenges to dental care utilization. Parents would only visit the dentist when they perceived their children's tooth problems. The challenges faced include time constraints, misinformation, lack of awareness and motivation, costs, fear, and anxiety of the children and the parents themselves. Parents perceived improvements in the awareness of their children's oral health and quality of life after dental visits. CONCLUSION: Attending dental services to treat their children's tooth problems was the primary way of attaining awareness about prevention among the parents of children with ECC. Increased oral health awareness and improved quality of life can motivate parents to seek further dental care for their children. Collaboration with multidisciplinary stakeholders is required to improve oral health awareness among parents of children with ECC. KNOWLEDGE TRANSFER STATEMENT: The study's results will help plan targeted preventive programs for children with ECC. The study suggests dental care utilization by children with ECC is based on parental perceptions of their children's tooth problems. It outlines the challenges that affect dental visits of children with ECC and the role of multidisciplinary stakeholders. Improved oral health awareness and quality of life following dental treatment can facilitate further dental visits.

Early Feeding and Weaning Practices of Indian Children with Early Childhood Caries: A Qualitative Exploration.

OBJECTIVE: To describe the early feeding, weaning, and oral hygiene practices of children with early childhood caries (ECC), their parents' knowledge and attitudes regarding infant feeding, and the feeding-related challenges faced by the parents. METHODS: This descriptive qualitative study involved parents of children with ECC who sought dental treatment at an academic dental college in India. Data were collected though focus groups conducted with the 27 parents of children with ECC, using a focus group discussion guide. Data were analyzed using the content analysis method. RESULTS: Community norms, such as learning from the older women in the families or neighborhoods, guided the feeding method, duration of feeding, and weaning. Breastfeeding or bottle-feeding at bedtime beyond 12 mo of age and feeding sugary drinks during weaning were standard practices, despite knowing the risk for dental caries. Parents faced multiple challenges regarding weaning and were unaware of the significance of infant oral hygiene practices. CONCLUSION: In children with ECC, infant feeding practices included prolonged breastfeeding or bottle-feeding beyond the required age, feeding at bedtime, and feeding sugary drinks. Although the parents knew that these feeding habits could increase the risk for caries, they lacked the self-efficacy to translate their knowledge into action during weaning. Also, they lacked awareness regarding infant oral hygiene practices. KNOWLEDGE TRANSFER STATEMENT: The study provides information on the feeding habits of infants that can increase the risk for caries, the challenges faced by the parents of these children in altering these risky habits, and their lack of knowledge on infant oral hygiene practices. Policy/decision makers can advocate for pediatricians and pediatric dentists to incorporate anticipatory guidance or motivational interviewing techniques to tailor the preventive program for ECC for Indian children.

Identification of a high affinity nucleocapsid protein binding element within the Moloney murine leukemia virus Psi-RNA packaging signal: implications for genome recognition.

Murine leukemia virus (MLV) is currently the most widely used gene delivery system in gene therapy trials. The simple retrovirus packages two copies of its RNA genome by a mechanism that involves interactions between the nucleocapsid (NC) domain of a virally-encoded Gag polyprotein and a segment of the RNA genome located just upstream of the Gag initiation codon, known as the Psi-site. Previous studies indicated that the MLV Psi-site contains three stem loops (SLB-SLD), and that stem loops SLC and SLD play prominent roles in packaging. We have developed a method for the preparation and purification of large quantities of recombinant Moloney MLV NC protein, and have studied its interactions with a series of oligoribonucleotides that contain one or more of the Psi-RNA stem loops. At RNA concentrations above approximately 0.3 mM, isolated stem loop SLB forms a duplex and stem loops SL-C and SL-D form kissing complexes, as expected from previous studies. However, neither the monomeric nor the dimeric forms of these isolated stem loops binds NC with significant affinity. Longer constructs containing two stem loops (SL-BC and SL-CD) also exhibit low affinities for NC. However, NC binds with high affinity and stoichiometrically to both the monomeric and dimeric forms of an RNA construct that contains all three stem loops (SL-BCD; K(d)=132(+/-55) nM). Titration of SL-BCD with NC also shifts monomer-dimer equilibrium toward the dimer. Mutagenesis experiments demonstrate that the conserved GACG tetraloops of stem loops C and D do not influence the monomer-dimer equilibrium of SL-BCD, that the tetraloop of stem loop B does not participate directly in NC binding, and that the tetraloops of stem loops C and D probably also do not bind to NC. These surprising results differ considerably from those observed for HIV-1, where NC binds to individual stem loops with high affinity via interactions with exposed residues of the tetraloops. The present results indicate that MLV NC binds to a pocket or surface that only exists in the presence of all three stem loops.

Effect of metabolic acidosis upon sleep apnea.

The effects of metabolic acidosis upon the pattern of apnea during sleep were assessed in ten sleep apnea patients. Four had pure obstructive apnea, two pure central apnea, and four had mixed apnea. Acidosis was induced with acetazolamide. Acid-base shifts had little effect in pure obstructive and pure central apnea, but had a significant effect in mixed apnea. In two of the mixed apneic patients, metabolic acidosis converted predominantly central apnea into nearly pure obstructive apnea, prolonging apneic periods and worsening hypoxemia. A suggested explanation for this is the greater stimulating effect of acidosis upon the lower bellows muscles than upon the muscles which act to maintain patency of the upper airways. The observation that some patients with mixed sleep apnea appear to have central apnea while relatively alkalotic and obstructive apnea while acidotic emphasizes the need for more careful and detailed characterization of apneic disorders with respect to their responses to body states and therapeutic agents.

Recommended precautions when using low-osmolality or nonionic contrast agents with vasodilators.

Low-osmolality contrast agents were tested for potential chemical incompatibility with vasodilators commonly used in angiography. A mixture of Hexabrix and papaverine produced a white crystalline precipitate. Hexabrix and tolazoline exhibited transient immiscibility. Injection of a flush solution between vasodilator and contrast agent is recommended as a precaution.

Vitamin D deficiency and low osteocalcin concentrations in anorexia nervosa.

The calcium, vitamin D, and osteocalcin concentrations were investigated in 17 patients with anorexia nervosa. Serum 25-hydroxyvitamin D (25 OHD) concentrations below normal were observed in 15 (88%); only two patients has serum 1,25 dihydroxycholecalciferol (1,25(OH)2D) concentrations below normal. Serum parathyroid hormone (PTH) concentration was also normal in all except these two patients. Serum osteocalcin concentration was below normal in seven of 14 patients. Although a low concentration of serum 25 OHD is common in patients with anorexia nervosa in the United Kingdom, 1,25(OH)2D concentrations are usually normal. Hypovitaminosis D with secondary hyperparathyroidism is relatively uncommon. The subnormal osteocalcin concentrations observed in these patients probably reflect diminished osteoblastic activity, which may contribute to their osteopenia.

Diminished [3H] ouabain binding and 86Rb influx by leukocytes in anorexia nervosa.

Leukocyte Na-K ATPase was assessed in ten patients with anorexia nervosa. The indices of Na-K ATPase measured were 86Rb influx and [3H]-ouabain binding. Both 86Rb influx and [3H]-ouabain binding were significantly lower in patients with anorexia nervosa than in controls. Following weight gain (4.1 to 11.9 kg) in seven patients both 86Rb influx and [3H]-ouabain binding increased in each patient to levels similar to those in controls, although the patients still remained underweight. Acute oral glucose challenge (75 g) also resulted in an increase in 86Rb influx and [3H]-ouabain binding in each of the eight patients tested. There was a significant correlation between 86Rb influx and [3H]-ouabain binding. We conclude that the leukocytes of patients with anorexia nervosa have a significantly diminished number of Na-K ATPase units with a parallel decrease in 86Rb influx. Weight gain and acute glucose challenge result in an increase in both indices of Na-K ATPase. Nutrition appears to play an important role in the modulation of this enzyme.

Combined radiological and surgical management of arteriovenous malformation of the lung.

Multiple, bilateral arteriovenous malformations (AVMs) of the lung are diagnostically and therapeutically challenging. In staged procedures over seven days, a 19-year-old woman underwent blocking of the feeding artery to six moderate-sized AVMs in the left lower lobe, embolization of three more AVMs in the left lower lobe, and resection of a large AVM in the right lower lobe through a right-sided thoracotomy. These procedures preserved maximal lung tissue, and one year later the patient is essentially symptom free.

Economic aspects of an epidemic of haemorrhagic conjunctivitis in a rural community.

The estimated economic loss due to an epidemic of acute haemorrhagic conjunctivitis in 1981 in a rural community of Goa studied by house-to-house survey of 7230 families is reported. Thirty-five per cent of families were affected and in 62% of these families more than three persons developed conjunctivitis. The affected were forced to be absent from work resulting in a reduction of the work force (loss of 7735 man days) and loss of income (Rs 1,33,300). The type of treatment followed and estimates of treatment cost are described. The economic consequences to the country of this widespread epidemic are described.

Serum immunoreactive trypsin in tropical pancreatic diabetes syndrome.

Fifteen patients with tropical pancreatic diabetes syndrome (TPDS), 16 insulin-dependent diabetics (IDD), 27 non-insulin-dependent diabetics (NIDD) and 14 normal subjects, all from India, were investigated for markers of beta-cell (C-peptide) and exocrine (immunoreactive trypsin; IRT) reserve. IRT and C-peptide concentrations were the lowest in TPDS, lower than normal in IDD, and not significantly different from normal in NIDDs. There was a highly significant correlation (rs = 0.93; P less than 0.0001) between IRT and C-peptide (measured in 50% of patients and controls) concentrations when all diabetic groups were combined. Such a correlation was absent when TPDS patients were considered in isolation, largely because of the markedly low IRT concentration. Fourteen of 15 patients (93%) with TPDS had subnormal IRT concentrations, of which 11 had IRT values of less than 50 micrograms/L. These IRT values are similar to those previously reported in cystic fibrosis. Only 6 of 16 IDDs (38%) had subnormal IRT concentrations, of which only one was below 50 micrograms/L. These data suggest that exocrine pancreatic reserve is markedly diminished in TPDS and that a subnormal IRT concentration may be a useful biochemical marker for this form of diabetes.

The application of selective ROE experiments to study solution structures of cyclomaltooligosacharide derivatives and complexes.

Selective one-dimensional ROE experiments were applied to study the host-guest interactions of cyclomaltohexaose with p-nitrophenol and the solution structure of 3A-(4-methylamino-3-nitrobenzyl)-cyclomaltoheptaose. The line selective excitation of the aromatic signals of p-nitrophenol gave intense ROE enhancements on the cyclomaltohexaose multiplets (H3 and H5), indicating deep complexation inside the cavity. The results on 3A-(4-methylamino-3-nitrobenzyl)-cyclomaltopheptose showed that the aromatic moiety covers the wider base of the cyclomaltoheptaose cone. The rotational correlation time for this compound was calculated to be 2.9 x 10-(-10)s using carbon-13 spin-lattice relaxation data. Quantitative analysis of the measured enhancements was performed and proton-proton distances were obtained between the aromatic and cyclomaltoheptoase protons as well as interglycosidic distances inside the cyclomaltoheptaose moiety.

Migration of a ventriculoperitoneal shunt into the pulmonary artery.

Ventriculoperitoneal (VP) shunts have been reported to migrate into a number of unusual locations within the abdomen, chest, and pelvis. We report a case in which a documented, correctly placed VP shunt subsequently migrated to an intravascular location. This intravascular migration led to malposition of the shunt tubing within the pulmonary artery. Attempts to remove the catheter via a postauricular incision were complicated by arrhythmias induced by traction on the shunt tubing. Eventual removal of the shunt was accomplished in stages, through the use of an intravascular, radiographically guided snare, introduced through the femoral vein.

Further evidence for the reliability and validity of the Modified Dental Anxiety Scale.

AIM: To gain further evidence of the psychometric properties of the Modified Dental Anxiety Scale. SETTING: Dental admission clinics. DESIGN: Consecutive sampling, cross-sectional survey. PARTICIPANTS: Patients (n = 800) in four cities (Belfast, Northern Ireland; Helsinki, Finland; Jyväskylä, Finland and Dubai, UAE). METHODS: Questionnaire booklet handed to patients, attending clinics, for completion following an invitation by the researcher to be included in the study. MEASURES: Modified Dental Anxiety Scale (MDAS), together with further questions concerning dental attendance and nervousness about dental procedures. RESULTS: Overall 9.3 per cent of patients indicated high dental anxiety. MDAS showed high levels of internal consistency, and good construct validity. The relationship of dental anxiety with age was similar to previous reports and showed lowered anxiety levels in older patients. CONCLUSION: Data from three countries has supported the psychometric properties of this modified and brief dental anxiety scale.

Imprint cytology in the diagnosis of breast tumor.

Fifty breast lumps seen and operated on at the Goa Medical College Hospital over a one year period form the material for this study. The cases were at first diagnosed clinically. At operation a naked eye assessment of the malignancy of the excised breast lump was made. Slide imprints for cytodiagnosis were made and finally the excised mass sent for paraffin section study. A rapid diagnosis of these 50 surgically removed breast lumps was thus made by naked eye examination and imprint cytodiagnosis and the results were compared with routine paraffin section diagnosis which is considered the final diagnosis. An analysis of the results show that naked eye examination of the excised breast lump distinguished between malignant and non-malignant lumps correctly in 96% of cases, rapid imprint cytodiagnosis was correct in 98% of cases, clinical diagnosis in 96% of cases and aspiration cytodiagnosis in all cases. Naked eye examination of the mass prior to imprinting would help to decide the correct pressure to be used to avoid false results.

In vitro studies on peroxidative changes leading to hemolysis of erythrocytes infested with malarial parasite Plasmodium vivax.

Blood erythrocytes of 25 confirrhed malarial patients infested with P. vivax were analyzed for peroxidation and hemolysis and results compared with 10 uninfected normal control samples. Results indicated significant increase in peroxide formation measured as malondialdehyde, both in presence and absence of H2O2, in parasite infested erythrocytes. These changes induced hemolysis of infected erythrocytes which was increased manifold in presence of H2O2 and could probably be the reason for extensive anemia reported in malaria.

Studies on the antiperoxide and antihaemolytic action of polyamines using human erythrocytes.

Blood RBC's were used to study the role of polyamines, putrescine, spermidine and spermine individually as antioxidants against the peroxidative action of H(2)O(2) which leads to haemolysis of erythrocytes. Results indicated that putrescine did not act as antioxidant at all concentrations used in our studies. However, spermidine and spermine suppressed peroxidative changes in RBC's due to the action of H(2)O(2) and this suppression was greater with higher concentration of these individual polyamines used, separately. Further, all the three polyamines decreased haemolysis of erythrocytes at all concentrations studied. The action of putrescine to suppress haemolysis of RBC's without showing antioxidant property hypothetically suggests that these properties of respective polyamines may have independent mechanism of action.

Enhancement of myeloperoxidase activity in WBCS in oral cancer patients treated with Granulocyte Macrophage Colony Stimulating Factor (GM-CSF)-A pilot study.

In a pilot study with five oral cancer patients undergoing radiotherapy (RT) three were given Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) as a protective agent to reduce the mucosal inflammation during radiotherapy. The myeloperoxidase (MPO) enzyme activity in WBC was quantitated. The three patients showed a significant increase in the MPO activity when compared with two untreated controls indicating the efficacy of GM-CSF as a protective agent. It is suggested that further detailed studies with larger number of patients would be useful.