RESUMO
Close liaison with ICU-trained dietitians and early initiation of nutrition is a fundamental principle of care of critically ill patients- this should be done while monitoring closely for refeeding syndrome. Enteral nutrition delivered by volumetric pumps should be used where possible, though parenteral nutrition should be started early in patients with high nutritional risk factors. Malnutrition and loss of muscle mass are common in patients who are admitted to ICUs and are prognostic for patient-centred outcomes including complications and mortality. Obesity is part of that story, and isocaloric and high-protein provision of nutrition is important in this group of patients who comprise a growing proportion of people treated. Assessing protein stores and appropriate dosing is, however, challenging in all groups of patients. It would be beneficial to develop strategies to reduce muscle wasting as well; various strategies including amino acid supplementation, ketogenic nutrition and exercise have been trialled, but the quality of data has been inadequate to address this phenomenon. Nutritional targets are rarely achieved in practice, and all ICUs should incorporate clear guidelines to help address this. These should include local nutritional and fasting guidelines and for the management of feed intolerance, early access to post-pyloric feeding and a multidisciplinary framework to support the importance of nutritional education.
Assuntos
Estado Terminal , Desnutrição , Humanos , Estado Terminal/terapia , Estado Nutricional , Desnutrição/terapia , Nutrição Enteral , Unidades de Terapia Intensiva , Cuidados CríticosRESUMO
Treatment of cancer-related symptoms represents a major challenge for physicians. The purpose of this pilot study was to determine whether a brief bedside visual art intervention (BVAI) facilitated by art educators improves mood, reduces pain and anxiety in patients with haematological malignancies. Thirty-one patients (21 women and 10 men) were invited to participate in a BVAI where the goal of the session was to teach art technique for ~30 min. Primary outcome measures included the change in visual analog scale, the State-Trait Anxiety Inventory and the Positive and Negative Affect Schedule scale, from baseline prior to and immediately post-BVAI. Total of 21 patients (19 women and two men) participated. A significant improvement in positive mood and pain scores (p = .003 and p = .017 respectively) as well as a decrease in negative mood and anxiety (p = .016 and p = .001 respectively) was observed. Patients perceived BVAI as overall positive (95%) and wished to participate in future art-based interventions (85%). This accessible experience, provided by artists within the community, may be considered as an adjunct to conventional treatments in patients with cancer-related mood symptoms and pain, and future studies with balanced gender participation may support the generalisability of these findings.
Assuntos
Afeto , Ansiedade/terapia , Arteterapia/métodos , Dor do Câncer/terapia , Neoplasias Hematológicas/terapia , Adulto , Idoso , Ansiedade/psicologia , Dor do Câncer/psicologia , Feminino , Neoplasias Hematológicas/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Adulto JovemRESUMO
Populations of Plutella xylostella, extending over 3800 km in southern Australia, show no genetic structure as assessed by microsatellite markers; yet outbreaks of pyrethroid resistance occur sporadically in cropping areas. Since mutations in the para voltage-gated sodium channel gene have been implicated in pyrethroid resistance, we looked for DNA sequence variation at this target among Australian moths. We found two resistance mutations previously reported for this species (L1014F and T929I), as well as a novel substitution (F1020S). Of the eight possible haplotypes formed by combinations of these three biallelic polymorphisms, only four were found in Australian populations: the wild-type allele (w), the kdr mutation allele (kdr) with only L1014F, the super-kdr-like combination of L1014F and T929I (skdrl), and the crashdown allele with only F1020S (cdr). Comparison of genotype frequencies among survivors of permethrin assays with those from untreated controls identified three resistant genotypes: skdrl homozygotes, cdr homozygotes and the corresponding heterozygote, cdr/skrdl - the heterozygote being at least as resistant as either homozygote. Spatial heterogeneity of allele frequencies was conspicuous, both across the continent and among local collections, consistent with reported spatial heterogeneity of pyrethroid resistance. Further, high resistance samples were sometimes associated with high frequency of cdr, sometimes high frequency of skdrl, or sometimes with a high combined cdr+skdrl frequency. The skdrl and cdr alleles explain a high proportion of the Australia-wide resistance variation. These data add to evidence that nerve insensitivity by mutations in the para-sodium channel gene is a common pyrethroid resistance mechanism in P. xylostella.
Assuntos
Inseticidas , Mariposas/genética , Piretrinas , Canais de Sódio/genética , Animais , Austrália , Sequência de Bases , Genótipo , Proteínas de Insetos/genética , Resistência a Inseticidas/genética , Dados de Sequência Molecular , Mutação PuntualRESUMO
Platelet activation and thrombin formation are integral in the pathophysiology of acute coronary syndrome. Currently available pharmacotherapies inhibit the cascade of platelet aggregation and activation, and prevent thrombin formation to limit platelet-fibrin complex formation, thus maintaining coronary patency and ultimately improving clinical outcomes. This is a rapidly evolving field with next-generation antithrombotic combinations aimed at achieving the "Holy Grail" of improved anti-ischemic efficacy whilst minimizing bleeding risk. Our review article focuses on the use of antithrombotic agents for the contemporary management of patients with ACS.
Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Anticoagulantes/uso terapêutico , Humanos , Ativação Plaquetária , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Antagonistas do Receptor Purinérgico P2Y/uso terapêuticoRESUMO
A cross sectional survey on pattern and perception of herbal use among medical patients in Penang Hospital was conducted. Among 250 patients surveyed, 67.9% were using herbal medicine and conventional medicine concomitantly. A majority of the patients used herbs for health maintenance (51.3%) purpose. More than 90% of herbal users did not disclose herbal use to their physician and "Doctor never asked" was the major reason given (54.2%). The Chinese reported the highest rate of herbal use but was least likely to disclose. These findings are important for health professionals to ensure medication safety and recognise potential drug herb interaction.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Medicina Herbária , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fitoterapia/estatística & dados numéricos , Preparações de Plantas/uso terapêutico , Plantas Medicinais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Interações Ervas-Drogas , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Preparações Farmacêuticas , Inquéritos e QuestionáriosRESUMO
Myelodysplastic syndrome (MDS) is characterized by ineffective hematopoiesis with resultant cytopenias. Increased apoptosis and aberrantly functioning progenitors are thought to contribute to this phenotype. As is the case for other malignancies, overcoming apoptosis is believed to be important in progression toward acute myeloid leukemia (AML). Using the NUP98-HOXD13 (NHD13) transgenic mouse model of MDS, we previously reported that overexpression of the anti-apoptotic protein BCL2, blocked apoptosis and improved cytopenias, paradoxically, delaying leukemic progression. To further understand this surprising result, we examined the role of p53 and its pro-apoptotic effectors, PUMA and NOXA in NHD13 mice. The absence of p53 or PUMA but not NOXA reduced apoptosis and expanded the numbers of MDS-repopulating cells. Despite a similar effect on apoptosis and cell numbers, the absence of p53 and PUMA had diametrically opposed effects on progression to AML: absence of p53 accelerated leukemic progression, while absence of PUMA significantly delayed progression. This may be explained in part by differences in cellular responses to DNA damage. The absence of p53 led to higher levels of γ-H2AX (indicative of persistent DNA lesions) while PUMA-deficient NHD13 progenitors resolved DNA lesions in a manner comparable to wild-type cells. These results suggest that targeting PUMA may improve the cytopenias of MDS without a detrimental effect on leukemic progression thus warranting further investigation.
Assuntos
Proteínas Reguladoras de Apoptose/metabolismo , Apoptose , Síndromes Mielodisplásicas/patologia , Proteínas Supressoras de Tumor/metabolismo , Animais , Proteínas Reguladoras de Apoptose/genética , Transplante de Medula Óssea , Dano ao DNA , Modelos Animais de Doenças , Progressão da Doença , Células-Tronco Hematopoéticas/citologia , Células-Tronco Hematopoéticas/metabolismo , Humanos , Estimativa de Kaplan-Meier , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/patologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Transgênicos , Síndromes Mielodisplásicas/metabolismo , Síndromes Mielodisplásicas/mortalidade , Proteínas de Fusão Oncogênica/genética , Fenótipo , Proteínas Proto-Oncogênicas c-bcl-2/genética , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Proteína Supressora de Tumor p53/deficiência , Proteína Supressora de Tumor p53/genética , Proteína Supressora de Tumor p53/metabolismo , Proteínas Supressoras de Tumor/genéticaRESUMO
BACKGROUND: Therapeutic options for management of diabetic gastroparesis are limited. Failure to maintain upregulation of heme oxygenase (HO1) leads to loss of interstitial cells of Cajal and delayed gastric emptying (GE) in non-obese diabetic mice. Our hypothesis was that hemin upregulation of HO1 would restore normal GE in humans with gastroparesis. AIMS: To compare effects of hemin and placebo infusions on HO1 activity and protein, GE, autonomic function, and gastrointestinal symptoms in diabetic gastroparesis. METHODS: In a single-center, double-blind, placebo-controlled, randomized clinical trial, we compared intravenous hemin, prepared in albumin, or albumin alone (placebo) in 20 patients, aged 41 ± 5 (SEM) years with diabetic gastroparesis. After infusions on days 1, 3, and 7, weekly infusions were administered for 7 additional weeks. Assessments included blood tests for HO1 protein and enzyme activity levels, GE with 13 C-spirulina breath test, autonomic functions (baseline and end), and gastrointestinal symptoms every 2 weeks. KEY RESULTS: Nine of 11 patients randomized to hemin completed all study procedures. Compared to placebo, hemin increased HO1 protein on days 3 (p = 0.0002) and 7 (p = 0.008) and HO1 activity on day 3 (p = 0.0003) but not after. Gastric emptying, autonomic functions, and symptoms did not differ significantly in the hemin group relative to placebo. CONCLUSIONS & INFERENCES: Hemin failed to sustain increased HO1 levels beyond a week and did not improve GE or symptoms in diabetic gastroparesis. Further studies are necessary to ascertain whether more frequent hemin infusions or other drugs would have a more sustained effect on HO1 and improve GE.
Assuntos
Diabetes Mellitus/sangue , Esvaziamento Gástrico/efeitos dos fármacos , Gastroparesia/sangue , Heme Oxigenase-1/sangue , Hemina/administração & dosagem , Adulto , Idoso , Diabetes Mellitus/tratamento farmacológico , Método Duplo-Cego , Feminino , Esvaziamento Gástrico/fisiologia , Gastroparesia/tratamento farmacológico , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
Mutations in the DYNAMIN2 (DNM2) gene are frequently detected in human acute T-cell lymphoblastic leukemia (T-ALL), although the mechanisms linking these mutations to disease pathogenesis remain unknown. Using an ENU-based forward genetic screen for mice with erythroid phenotypes, we identified a heterozygous mouse line carrying a mutation in the GTPase domain of Dnm2 (Dnm2V265G) that induced a microcytic anemia. In vitro assays using the V265G mutant demonstrated loss of GTPase activity and impaired endocytosis that was comparable to other DNM2 mutants identified in human T-ALL. To determine the effects of DNM2 mutations in T-ALL, we bred the Dnm2V265G mice with the Lmo2 transgenic mouse model of T-ALL. Heterozygous Dnm2 mutants lacking the Lmo2 transgene displayed normal T-cell development, and did not develop T-ALL. In contrast, compound heterozygotes displayed an accelerated onset of T-ALL compared with mice carrying the Lmo2 oncogene alone. The leukemias from these mice exhibited a more immature immunophenotype and an expansion in leukemic stem cell numbers. Mechanistically, the Dnm2 mutation impaired clathrin-mediated endocytosis of the interleukin (IL)-7 receptor resulting in increased receptor density on the surface of leukemic stem cells. These findings suggest that DNM2 mutations cooperate with T-cell oncogenes by enhancing IL-7 signalling.
Assuntos
Dinamina II/genética , Interleucina-7/metabolismo , Leucemia de Células T/etiologia , Mutação , Proteínas Adaptadoras de Transdução de Sinal/genética , Animais , Endocitose/genética , GTP Fosfo-Hidrolases/metabolismo , Humanos , Proteínas com Domínio LIM/genética , Leucemia de Células T/genética , Leucemia de Células T/metabolismo , Camundongos , Oncogenes , Transdução de SinaisRESUMO
ST elevation in lead III > II has a higher sensitivity than lead V4R in diagnosing right ventricular myocardial infarction. Lead III > II is also predictive of in-hospital mortality.
Assuntos
Eletrocardiografia , Infarto do Miocárdio/diagnóstico , Disfunção Ventricular Direita/diagnóstico , Idoso , Distribuição de Qui-Quadrado , Feminino , Mortalidade Hospitalar , Humanos , Funções Verossimilhança , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Disfunção Ventricular Direita/mortalidadeRESUMO
Isolated right ventricular ischemia in combination with myocardial infarction (MI) is uncommon, accounting for fewer than 3% of all MI cases. A young man who presented with acute right ventricular ischemia from occlusion of a codominant right coronary artery proximal to an acute marginal branch is presented. His presenting electrocardiogram (ECG) showed ST segment elevation in V1 to V4 mimicking acute anterior MI. ECG criteria for isolated right ventricular ischemia are discussed.
Assuntos
Doença das Coronárias/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico , Isquemia Miocárdica/diagnóstico , Disfunção Ventricular Direita/diagnóstico , Doença Aguda , Adulto , Angioplastia Coronária com Balão , Angiografia Coronária , Doença das Coronárias/cirurgia , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Masculino , Fatores de Risco , Resultado do TratamentoRESUMO
Commutation signaling is a bandwidth expanding modulation scheme that is robust to multipath induced intersymbol interference making it suitable for wireless digital communications. By using multipath diversity combining, commutation signaling exploits the time diversity that is inherent in a multipath propagation environment. This paper considers a surface acoustic wave (SAW) implementation of a commutation signaling modem for broadband indoor wireless communication. The modem employs differential encoding and a form of direct sequence spread spectrum modulation with the following specifications: data rate 40 Mb/sec, chip rate 200 MHz, and IF frequency 1 GHz. The differential coherent detector is a key element of a low cost, low complexity commutation signaling modem. A commutation signaling differential coherent detector has been implemented using SAW and RF integrated circuit (RF IC) technologies. The SAW devices have been fabricated on 1280-rotated Y-cut, X-propagating lithium niobate using approximately 1 micron line widths. RF IC technology Is used to implement the high-speed bilinear multipliers needed for differential coherent detection as well as the low-impedance buffers used to drive these multipliers.
RESUMO
Ogston's (1958) fiber model based on Poisson's distribution function gives the average number of fibers making contact and no contact inside a sphere of radius r. The probability of penetration of spherical particles within a fibrous network was derived from the moment generating function [Formula: see text] A is the number of particles that intrude into a sphere of radious r. alpha(mu) is the probability that a particle, whose center is mu units away from the origin, intrudes into a sphere of radius r. A has a Poisson distribution with a mean value E(A) = 4pinualpha(mu)mu(2)dmu. The theoretical derivation of the distribution function of A gives Ogston's fiber model.