The Comparison of Strattice and SurgiMend in Acellular Dermal Matrix-Assisted, Implant-Based Immediate Breast Reconstruction.

BACKGROUND: Strattice (porcine derivative) and SurgiMend (bovine derivative) are the two most common acellular dermal matrices used in breast reconstruction in the United Kingdom. This retrospective study compared clinical outcomes in immediate implant-based breast reconstruction patients. METHODS: The study, conducted across three hospitals, included all patients who underwent immediate implant-based breast reconstruction using Strattice and SurgiMend. The primary outcome measure was implant loss rate. Secondary outcome measures included acellular dermal matrix loss rate, seroma formation, and minor and major complication rates. Intergroup comparison was performed. RESULTS: Eighty-two patients (Strattice, n = 45; SurgiMend, n = 37) underwent 97 immediate implant-based breast reconstructions (Strattice, n = 54; SurgiMend, n = 43). There were no differences between groups for age, comorbidities, specimen weight, or implant volume. Drains were used in all Strattice and 36 (84 percent) SurgiMend cases. The implant loss rate was higher for Strattice (n = 10, 20 percent) compared with SurgiMend (n = 3, 7 percent) but failed to reach statistical significance (chi-square test, p = 0.077). The acellular dermal matrix loss rate was significantly higher (Fisher's exact test, p = 0.014) in the Strattice group (n = 7, 14 percent), with no acellular dermal matrix loss with SurgiMend. The reoperation rate was also significantly higher (chi-square test, p = 0.002) in the Strattice group (n = 17, 33 percent, versus n = 3, 7 percent). The incidence of red breast was significantly higher (chi-square test, p = 0.022) in the SurgiMend group (n = 9, 21 percent, versus n = 3, 6 percent). Seroma, wound problems, and infection rates were similar. CONCLUSIONS: Clinical outcomes, including implant loss, acellular dermal matrix loss, and reoperation rates, are significantly better when using SurgiMend in immediate implant-based breast reconstruction compared with Strattice. An appropriately powered randomized trial is needed to provide further information. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

L-cysteine protected copper nanoparticles as colorimetric sensor for mercuric ions.

This report demonstrates a novel, simple and efficient protocol for the synthesis of copper nanoparticles in aqueous solution using L-cysteine as capping or protecting agent. UV-visible (UV-vis) spectroscopy was employed to monitor the LSPR band of L-cysteine functionalized copper nanoparticles (Cyst-Cu NPs) based on optimizing various reaction parameters. Fourier Transform Infrared (FTIR) spectroscopy provided information about the surface interaction between L-cysteine and Cu NPs. Transmission Electron Microscopy (TEM) confirmed the formation of fine spherical, uniformly distributed Cyst-Cu NPs with average size of 34 ± 2.1 nm. X-ray diffractometry (XRD) illustrated the formation of pure metallic phase crystalline Cyst-Cu NPs. As prepared Cyst-Cu NPs were tested as colorimetric sensor for determining mercuric (Hg(2+)) ions in an aqueous system. Cyst-Cu NPs demonstrated very sensitive and selective colorimetric detection of Hg(2+) ions in the range of 0.5 × 10(-6)-3.5 × 10(-6) mol L(-1) based on decrease in LSPR intensity as monitored by a UV-vis spectrophotometer. The developed sensor is simple, economic compared to those based on precious metal nanoparticles and sensitive to detect Hg(2+) ions with detection limit down to 4.3 × 10(-8) mol L(-1). The sensor developed in this work has a high potential for rapid and on-site detection of Hg(2+) ions. The sensor was successfully applied for assessment of Hg(2+) ions in real water samples collected from various locations of the Sindh River.

Inappropriate prescribing in patients accessing specialist palliative day care services.

BACKGROUND: For patients accessing specialist palliative care day services, medication is prescribed routinely to manage acute symptoms, treat long-term conditions or prevent adverse events associated with these conditions. As such, the pharmacotherapeutic burden for these patients is high and polypharmacy is common. Consequently, the risk of these patients developing drug-related toxicities through drug­drug interactions is exacerbated. Medication use in this group should, therefore, be evaluated regularly to align with achievable therapeutic outcomes considering remaining life expectancy. OBJECTIVE: To (1) assess the prevalence of inappropriate medication use; (2) identify potential drug­drug interactions; and, (3) determine how many potential drug­ drug interactions could be prevented by discontinuing inappropriate medication. SETTING: A specialist tertiary care palliative care centre in Northern England serving a population of 330,000. MAIN OUTCOME MEASURE: Prescribing of inappropriate medication. METHOD: Medication histories for patients accessing a specialist palliative day care centre were established and a modified Delphi method was used to reach consensus of medication appropriateness. The Delphi method utilized a framework considering the following factors: remaining life expectancy of the patient, time until benefit of the treatment, goals of care and treatment targets. Potential drug interactions were established using drug interaction recognition software and categorised by their ability to cause harm. RESULTS: A total number of 132 patients were assessed during the study period who were prescribed 1,532 (mean = 12/patient) medications; 238 (16 %) were considered inappropriate in the context of limited life expectancy. The most common class of medications considered inappropriate were the statins, observed in 35 (27 %) patients. A total of 267 potential drug­drug interactions were identified; 112 were clinically significant and 155 were not considered clinically significant. Discontinuation of inappropriate medication would reduce the total number of medications taken to 1,294 (mean = 10/patient) and prevent 31 clinically significant potential drug­drug interactions. CONCLUSION: Patients accessing specialist palliative day care services take many inappropriate medications. These medications not only increase the pharmacotherapeutic burden for the patient but they also contribute to potential drug­drug interactions. These patients should have their medication reviewed in the context of life limiting illness aligned with achievable therapeutic outcomes.

A once-a-day dosage form for the delivery of insulin through the nasal route: in vitro assessment and in vivo evaluation.

An in situ thermogelling, mucoadhesive formulation based on N-trimethyl chitosan chloride has been evaluated for its potential to affect the transmucosal delivery of insulin via the nasal route. In vitro studies at a physiologically relevant temperature (ca. 35 °C) have shown that the formulation releases most of its insulin load (ca. 70%) in a non-Fickian manner during the timescale over which the sol-to-gel transition (ca. 8 min) takes place, and also that, once gelation is complete, the release of the remainder of the therapeutic content follows first order kinetics over at least sixty minutes. Investigations on the effects of the application of the same formulation to a modelled nasal mucosa (Calu-3 cell monolayer) have indicated the capability of the formulation to induce the transient opening of tight junctions. Cytotoxic investigations have shown that the formulation exhibits negligible detrimental effects to the integrity of these monolayers. The in vivo potential of the nasal formulation to act as a once-a-day dosage form for the intranasal delivery of insulin has been demonstrated in a diabetic-rat model.

Thermosensitive hydrogels for nasal drug delivery: the formulation and characterisation of systems based on N-trimethyl chitosan chloride.

Towards the development of a thermosensitive drug-delivery vehicle for nasal delivery, a systematic series of N-trimethyl chitosan chloride polymers, synthesised from chitosans of three different average molecular weights, have been co-formulated into a hydrogel with poly(ethylene glycol) and glycerophosphate. Rheological evaluations have shown that hydrogels derived from N-trimethyl chitosan with a low degree of quaternisation and high or medium average molecular weight exhibit relatively short sol-gel transition times at physiologically relevant temperatures. Also, the same hydrogels display good water-holding capacity and strong mucoadhesive potential, and their mixtures with mucus exhibit rheological synergy. An aqueous hydrogel formulation, derived from N-trimethyl chitosan of medium average molecular weight and low degree of quaternisation, appears particularly promising in that it exhibits most favourable rheological and mucoadhesive behaviour and a sol-gel transition that occurs at 32.5°C within 7 min.

Successful medical management of emphysematous gastritis with concomitant portal venous air: a case report.

INTRODUCTION: The causes of diffuse abdominal pain following pelvic surgery are numerous. We present a rare case of acute abdominal pain in a woman in the post-partum period. CASE PRESENTATION: A 25-year-old Caucasian woman with neurofibromatosis type 1 presented to our hospital with diffuse abdominal pain immediately after a cesarean section. The patient was acutely ill and toxic with a fever of 38.8 degrees C, a pulse of 120 beats per minute and a distended abdomen with absent bowel sounds. A computed tomography scan showed air in the wall of the stomach and portal venous system. The patient was successfully treated with intravenous antibiotics, bowel rest and total parenteral nutrition. CONCLUSION: It is rare for a case of emphysematous gastritis associated with portal venous air to be treated successfully without surgery. To the best of our knowledge, to date there has been no reported association of emphysematous gastritis with neurofibromatosis.

Disrrafismo espinal / Spinal dysrraphism

El término "Disrrafismo" expresa cierre defectuoso del tubo neural en la primeras 2 a 3 semanas del estadío embrionario, debido a múltiples factores genéticos que pueden involucrar antecedentes familiares, elementos ambientales o nutricionales en su etiología. Se hace necesario una actualización de dichas patologías, su repercusión clínica y las técnicas quirúrgicas a emplearse para preservar o mejorar el daño neural establecido. De igual manera, hacer conciencia que éstas afecciones implican un equipo multidisciplinario que logre una mejor calidad de vida al paciente y apoyo a sus familiares para salir adelante en ésta dificil tarea. Se revisa el estado actual del disrrafismo en el Hospital Escuela de Tegucigalpa, Honduras

Neurocisticercosis pediatrica: Caracteristicas clínicas en Honduras / Pediatric neurocysticercosis: clinical features in Honduras

Se presenta una investigación clínica de neurocisticercosis en el Hospital Escuela de Honduras, que comprende los periodos entre enero 1978 y diciembre 1992, que corresponde a 304 casos (100 por ciento) de los cuales 44(14.47 por ciento) son de edad pediátrica (0-20 años) y todos de ubicación cerebral parenquimatosa, cuyo cuadro clínico predominante fue hipertensión intracraneana y convulsiones. Los síntomas sobresalientes fueron: vómitos 39 casos (88.64 por ciento), convulsiones 37(84.09 por ciento) y cefalea 33(75 por ciento); el signo mas destacado fue papilema en 21 casos(47.72 por ciento) y como síntomas asociado hiporexia en 14 casos (31.81 por ceinto). No se observó predominancia en sexo y la edad de más afectación fue de 8 a 20 años con 36 casos (81.86 por ciento). El método radiológico que más ayudo al diagnóstico fue la tomografía cerebral, que definio cinco imágenes diferentes de la enfermedad: 1) fases de calificaciones parenquimatosas, 2) fase de edema difuso, 3) fase granulomatosa, 4) fase hidrocefálica y 5) fase pseudotumoral. Se comprueba la ayuda de la prueba de Elisa para confirmar el diagnostico. La terapéutica incluyó el uso de albendazole, anticomiciales y esteroides solos o asociados. No se encontró ningun caso espinal y se concluye que la neurocisticercosis en pediatría es de evolución benigna y de buen pronóstico, ya que no hubo mortalidad.