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BACKGROUND: This study presents the pattern of respiratory effects seen among residents chronically exposed to gas flaring in some communities in the Niger Delta Region, Nigeria. The other health challenges associated with this chronic exposure to gas were also evaluated in the study. METHODS: A total of three hundred and eighty-six 386 adult residents in Ibeno, Niger Delta Region who have been residents for at least two years. Four hundred and fourteen (414) age, sex, and height-matched control unexposed residents in Etinan were recruited for a cross-sectional survey study comparing their respiratory symptoms and other related health challenges. Past and current smokers were excluded from the study in both groups. The study was conducted using a questionnaire as the investigative tool. Both descriptive and inferential statistics were used to analyze the data. RESULTS: Most of the respondents in both exposed and control communities were aged 18-30 years, with a height range of 161-170 cm. Both exposed and control subjects experienced similar symptoms suggestive of respiratory disorders, however, the prevalence was significantly higher among exposed subjects than controls: Cough 57(14.8%) vs. 39(10.1%); breathlessness 58(15%) vs. 28(7.3); wheezing 22(5.7) vs. 12(3.1). The respondents from the exposed community were mostly traders and fishermen while the controls were predominantly farmers. CONCLUSION: There is substantial evidence from the data presented that prolonged exposure to air pollution from gas flaring has significant respiratory and other health implications on residents in these communities reflected as increased frequency of symptoms of cough, chest pain, difficulty in breathing, wheezing, chest tightness, Skin and eye irritation. There is therefore an urgent need for intensified efforts and commitment by the government to speed up the implementation of policies regarding the reduction of flaring of natural gas associated with oil production and the adoption of measures to mitigate the effect of the exposure on human health.
CONTEXTE: Cette étude présente les effets respiratoires observés chez les résidents chroniquement exposés au torchage de gaz dans certaines communautés de la région du delta du Niger, au Nigeria. Les autres problèmes de santé associés à cette exposition chronique au gaz ont également été évalués dans cette étude. MÉTHODES: Un total de 386 résidents adultes d'Ibeno, dans la région du delta du Niger, ayant résidé pendant au moins deux ans, ont été inclus dans l'étude. Quatre cent quatorze (414) résidents non exposés, appariés en fonction de l'âge, du sexe et de la taille, à Etinan ont été recrutés pour une étude transversale comparant leurs symptômes respiratoires et d'autres problèmes de santé associés. Les fumeurs passés et actuels ont été exclus de l'étude dans les deux groupes. L'étude a été menée à l'aide d'un questionnaire comme outil d'investigation. Des statistiques descriptives et inférentielles ont été utilisées pour analyser les données. RÉSULTATS: La plupart des répondants dans les communautés exposées et témoins avaient entre 18 et 30 ans, avec une taille allant de 161 à 170 cm. Les sujets exposés et témoins ont présenté des symptômes similaires suggérant des troubles respiratoires, cependant, la prévalence était significativement plus élevée chez les sujets exposés que chez les témoins : Toux - 57 (14,8 %) contre 39 (10,1 %) ; essoufflement 58 (15 %) contre 28 (7,3 %) ; sifflement 22 (5,7 %) contre 12 (3,1 %). Les répondants de la communauté exposée étaient principalement des commerçants et des pêcheurs, tandis que les témoins étaient principalement des agriculteurs. CONCLUSION: Les données présentées fournissent des preuves substantielles que l'exposition prolongée à la pollution de l'air due au torchage de gaz a des implications respiratoires et autres sur la santé des résidents de ces communautés, se traduisant par une fréquence accrue des symptômes de toux, douleur thoracique, difficulté à respirer, sifflement, oppression thoracique, irritation de la peau et des yeux. Il est donc urgent d'intensifier les efforts et l'engagement du gouvernement pour accélérer la mise en Åuvre des politiques visant à réduire le torchage du gaz naturel associé à la production de pétrole et à adopter des mesures pour atténuer les effets de l'exposition sur la santé humaine. MOTS CLÉS: Effet respiratoire, Exposition chronique, Torchage de gaz, Delta du Niger.
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Exposição Ambiental , Humanos , Nigéria/epidemiologia , Masculino , Adulto , Feminino , Estudos Transversais , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Exposição Ambiental/efeitos adversos , Prevalência , Doenças Respiratórias/epidemiologia , Inquéritos e Questionários , Sons Respiratórios/etiologia , Tosse/epidemiologia , Estudos de Casos e ControlesRESUMO
BACKGROUND: Bronchiectasis is often considered an orphan disease in developed societies. This may not be the case with low-income countries. Currently there is a paucity of data on the pattern and presentation of this condition in Nigeria. OBJECTIVE: This study was undertaken to determine the frequency and pattern of presentation of bronchiectasis in a tertiary healthcare facility in Uyo, South-South, Nigeria. METHODS: We carried out a three-year prospective study of adult patients aged between 15-85 years diagnosed with bronchiectasis in the University of Uyo Teaching Hospital in Uyo, Nigeria between 2016 and 2019. RESULTS: Eighty-two patients were identified from the clinic register. Out of these, 76 were recruited into the study; made up of 44(57.9%) males and 32 (42.1%) females. The average age of the patients was 49.7 ± 14.1 years. Sixteen (21.1%) of the patients were HIV positive. Forty-four (57.9%) patients had previously been treated for pulmonary tuberculosis. Majority of the patients; 72 (94.7%) had chronic productive cough. Sixty-four (84.2%) had at least one episode of exacerbation within the last 12 months while 36(47.4%) had a severe exacerbation requiring hospitalisation. Hospitalisation was associated with several factors with the strongest contributor being the presence of respiratory distress on physical examination (OR 15.4 p= 0.002). CONCLUSION: Bronchiectasis is not an uncommon disease amongst our patients. A previous history of pulmonary tuberculosis is the commonest associated predisposing medical condition. There is a high rate of exacerbation among these patients with respiratory distress as the strongest predictor of hospitalisation.
CONTEXTE: La bronchectasie est souvent considérée comme une maladie orpheline dans les sociétés développées.Ce n'est peut-être pas le cas dans pays à faible revenu. Actuellement, il y a une pénurie de données sur les caractéristiques et la présentation de cette maladie au Nigeria. OBJECTIF: Cette étude a été entreprise pour déterminer la fréquence et le mode de présentation de la bronchectasie dans un établissement de soins tertiaires à Uyo, dans le sud-sud du Nigeria. MÉTHODES: Nous avons mené une étude prospective sur trois ans auprès de patients adultes âgés de 15 à 85 ans chez qui on a diagnostiqué une bronchectasie dans l'hôpital universitaire d'Uyo, à Uyo, entre 2016 et 2019. Uyo, au Nigeria, entre 2016 et 2019. RÉSULTATS: Quatre-vingt-deux patients ont été identifiés à partir du registre de la clinique registre. Parmi ceux-ci, 76 ont été recrutés dans l'étude ; composés de 44 (57,9 %) hommes et 32 (42,1 %) femmes. L'âge moyen des patients était de 49,7 ± 14,1 ans. Seize (21,1 %) des patients étaient séropositifs. Quarante-quatre (57,9 %) patients avaient déjà été traités pour une tuberculose pulmonaire.La majorité des patients ; 72 (94,7%) avaient une toux productive chronique. Soixante-quatre (84,2 %) ont eu au moins un épisode d'exacerbation au cours des 12 derniers mois, tandis que 36 (47,4 %) ont eu une exacerbation sévère nécessitant une hospitalisation. L'hospitalisation était associée à plusieurs facteurs, le facteur le plus important étant la présence d'une présence d'une détresse respiratoire à l'examen physique (OR 15.4 p= 0.002). CONCLUSION: La bronchectasie n'est pas une maladie rare parmi nos patients. Un antécédent de tuberculose pulmonaire est l'état médical prédisposant le plus fréquent.ll existe un taux élevé d'exacerbation chez ces patients, la détresse respiratoire étant le facteur prédictif le plus fort d'hospitalisation. MOTS CLÉS: Étiologie, Caractéristiques cliniques, Bronchiectasie, Exacerbation, Hospitalisation.
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Bronquiectasia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/diagnóstico , Bronquiectasia/epidemiologia , Bronquiectasia/etiologia , Tosse/epidemiologia , Tosse/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Prospectivos , Centros de Atenção Terciária , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a global pandemic. Older people and those with poorly controlled co-morbidities have higher risk of mortality. This study was conducted to highlight the clinical features, challenges of management and outcome for the patients we have seen in our centre over the past one year. METHODS: This was a retrospective cross-sectional study involving all patients admitted in the COVID-19 Isolation unit of University of Uyo Teaching Hospital (UUTH) from June, 2020-May, 2021. Clinical and laboratory information were obtained from the patient case notes. Ethical clearance for the conduct of the study was obtained from the Ethics committee, UUTH, Uyo. Data was analysed with STATA version 13. RESULTS: Thirty-three (37.9%) patients were COVID-19 PCR positive. The mean ± SD age of COVID-19 PCR positive patients was 57.3 ± 13.4 years with majority (69.7%) being above 50 years. There was a male preponderance (75%). Eleven (34.4%) patients died while 21(65.6%) were discharged. The highest co-morbidity associated with COVID-19 mortality was diabetes mellitus (7 out of 11; 63.6%). There was a poor uptake of supportive investigations for the management of COVID-19 patients. A raised body temperature (P=0.0006), a low SPO2 (0.00004), high respiratory rate (0.0009) on admission and shorter duration of admission (0.0002), were associated with mortality. CONCLUSION: The presence of co-morbidities, fever, low SPO2 and high respiratory rates on admission are associated with increased mortality from COVID-19 disease. A paucity of supportive investigations was a major challenge to COVID-19 management. We therefore recommend the strengthening of our laboratory capacity.
CONTEXTE ET OBJECTIFS: La maladie de coronavirus 2019 (COVID-19) est une pandémie mondiale. Les personnes âgées et celles qui présentent des comorbidités mal contrôlées ont un risque de mortalité plus élevé. Cette étude a été menée pour mettre en évidence les caractéristiques cliniques, les défis de la gestion et le résultat des patients que nous avons vus dans notre centre au cours de la dernière année. MÉTHODES: Il s'agissait d'une étude transversale rétrospective impliquant tous les patients admis dans l'unité d'isolement COVID- 19 de l'University of Uyo Teaching Hospital (UUTH) de juin 2020 à mai 2021. Les informations cliniques et de laboratoire ont été obtenues à partir des notes de cas des patients. L'autorisation éthique pour la réalisation de l'étude a été obtenue auprès du comité d'éthique de l'UUTH, Uyo. Les données ont été analysées avec STATA version 13. RÉSULTATS: Trente-trois (37,9%) patients étaient positifs à la PCR COVID-19. L'âge moyen ± SD des patients positifs au COVID-19 PCR était de 57,3 ± 13,4 ans, la majorité (69,7%) ayant plus de 50 ans. Il y avait une prépondérance masculine (75 %). Onze (34,4 %) patients sont décédés et 21 (65,6 %) sont sortis de l'hôpital. La comorbidité la plus importante associée à la mortalité de COVID-19 était le diabète miletus (7 sur 11 : 63 : 6 %). Les investigations de soutien pour la gestion des patients COVID-19 ont été peu utilisées. Une température corporelle élevée (P=0,0006), une faible SPO2 (0,00004), une fréquence respiratoire élevée (0,0009) à l'admission et une durée d'admission plus courte (0,0002) étaient associées à la mortalité. CONCLUSION: La présence de comorbidités, de fièvre, d'une faible SPO2 et d'une fréquence respiratoire élevée à l'admission est associée à une mortalité accrue de la maladie de COVID-19. Le manque d'investigations de soutien a été un défi majeur pour la gestion de la maladie COVID-19. Nous recommandons donc le renforcement de la capacité de nos laboratoires. Mots clés: COVID-19, défis, gestion des cas, Nigeria.
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COVID-19 , Humanos , Masculino , Idoso , Adulto , Pessoa de Meia-Idade , COVID-19/epidemiologia , COVID-19/terapia , Administração de Caso , Estudos Retrospectivos , Estudos Transversais , Hospitais de Ensino , FebreRESUMO
The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.
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COVID-19 , Síndrome de COVID-19 Pós-Aguda , HumanosRESUMO
BACKGROUND: Bronchiectasis is characterized by chronic symptoms and impaired physical activity. Anxiety and depression usually complicate chronic illness. Thus, underdiagnosis of psychological distress in bronchiectasis may lead to increased morbidity and mortality. AIMS: The aim of this study is to evaluate the impact of physical illness on psychological distress and its association with health-related quality of life (HRQOL). SUBJECTS AND METHODS: This is a cross-sectional study of adults with bronchiectasis. Patients completed a study questionnaire, the hospital anxiety and depression scale and the World Health Organization quality of life brief (WHOQOL-BREF) questionnaire. Physical examination was conducted on all participants. RESULTS: 103 patients were recruited for this study: 54 males (52.4%) and 49 females (47.6%). The average age of the patients was 49.12 ± 14.37 years. The most common predisposing factor for bronchiectasis amongst the patients was previous pulmonary tuberculosis (51 patients, 49.5%). Chronic productive cough, which was reported by 98 of the subjects (95.15%), was the most common symptom. 89 subjects (86.41%) reported episodes of shortness of breath, 82 (79.61%) reported at least one episode of exacerbation, while 52 subjects (50.49%) were hospitalized for bronchiectasis in the previous 12 months. 23 subjects (22.3%) had anxiety and 32 (31.1%) had depression. Anxiety and depression were significantly associated with indicators of severe disease. The subjects recorded low HRQOL scores across all domains. Psychological distress displayed a significant negative association with all the quality-of-life domains except between anxiety and social interaction. CONCLUSION: Symptoms of depression and anxiety are common among patients with bronchiectasis and these symptoms have a negative impact on HRQOL.
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Bronquiectasia , Angústia Psicológica , Adulto , Ansiedade/epidemiologia , Bronquiectasia/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Phosphorylcholine (PC) is an important pro-inflammatory damage-associated molecular pattern. Previous data have shown that natural IgM anti-PC protects against cardiovascular disease. We aimed to develop a monoclonal PC IgG antibody with anti-inflammatory and anti-atherosclerotic properties. METHODS: Using various techniques PC antibodies were validated and optimized. In vivo testing was performed in a femoral artery cuff model in ApoE3*Leiden mice. Safety studies are performed in rats and cynomolgus monkeys. RESULTS: A chimeric anti-PC (PC-mAb(T15), consisting of a human IgG1 Fc and a mouse T15/E06 Fab) was produced, and this was shown to bind specifically to epitopes in human atherosclerotic tissues. The cuff model results in rapid induction of inflammatory genes and altered expression of genes associated with ER stress and choline metabolism in the lesions. Treatment with PC-mAb(T15) reduced accelerated atherosclerosis via reduced expression of endoplasmic reticulum stress markers and CCL2 production. Recombinant anti-PC Fab fragments were identified by phage display and cloned into fully human IgG1 backbones creating a human monoclonal IgG1 anti-PC (PC-mAbs) that specifically bind PC, apoptotic cells and oxLDL. Based on preventing macrophage oxLDL uptake and CCL2 production, four monoclonal PC-mAbs were selected, which to various extent reduced vascular inflammation and lesion development. Additional optimization and validation of two PC-mAb antibodies resulted in selection of PC-mAb X19-A05, which inhibited accelerated atherosclerosis. Clinical grade production of this antibody (ATH3G10) significantly attenuated vascular inflammation and accelerated atherosclerosis and was tolerated in safety studies in rats and cynomolgus monkeys. CONCLUSIONS: Chimeric anti-PCs can prevent accelerated atherosclerosis by inhibiting vascular inflammation directly and through reduced macrophage oxLDL uptake resulting in decreased lesions. PC-mAb represents a novel strategy for cardiovascular disease prevention.
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Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/terapia , Imunoglobulina G/imunologia , Fosforilcolina/imunologia , Animais , Anticorpos Monoclonais/toxicidade , Aterosclerose/prevenção & controle , Quimera , LDL-Colesterol/antagonistas & inibidores , LDL-Colesterol/metabolismo , Colina/metabolismo , Modelos Animais de Doenças , Feminino , Macaca fascicularis , Macrófagos/metabolismo , Masculino , Camundongos Endogâmicos C57BL , Oxirredução , RatosRESUMO
OBJECTIVES: Micro-elimination of hepatitis C virus (HCV) in people living with HIV (PLHIV) and co-infected with HCV has been proposed as a key contribution to the overall goal of HCV elimination. While other studies have examined micro-elimination in HIV-treated cohorts, few have considered HCV micro-elimination among those not treated for HIV or at a national level. METHODS: Through data linkage of national and sentinel surveillance data, we examined the extent of HCV testing, diagnosis and treatment among a cohort of PLHIV in Scotland identified through the national database of HIV-diagnosed individuals, up to the end of 2017. RESULTS: Of 5018 PLHIV, an estimated 797 (15%) had never been tested for HCV and 70 (9%) of these had undiagnosed chronic HCV. The odds of never having been tested for HCV were the highest in those not on HIV treatment [adjusted odds ratio (aOR) = 7.21, 95% confidence interval (CI): 5.15-10.10). Overall HCV antibody positivity was 11%, and it was at its highest among people who inject drugs (49%). Most of those with chronic HCV (91%) had attended an HCV treatment clinic but only half had been successfully treated (54% for those on HIV treatment, 12% for those not) by the end of 2017. The odds of never having been treated for HCV were the highest in those not on HIV treatment (aOR = 3.60, 95% CI: 1.59-8.15). CONCLUSIONS: Our data demonstrate that micro-elimination of HCV in PLHIV is achievable but progress will require increased effort to engage and treat those co-infected, including those not being treated for their HIV.
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Infecções por HIV , Hepatite C Crônica , Hepatite C , Abuso de Substâncias por Via Intravenosa , Antivirais/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Hepacivirus , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Humanos , Armazenamento e Recuperação da InformaçãoRESUMO
Exposome factors that lead to stressed skin can be defined as any disturbance to homeostasis from environmental (meteorological factors, solar radiation, pollution or tobacco smoke) and/or internal exposure (unhealthy diet, hormonal variations, lack of sleep, psychosocial stress). The clinical and biological impact of chronic exposome effects on skin functions has been extensively reviewed, whereas there is a paucity of information on the impact of short-term acute exposure. Acute stress, which would typically last minutes to hours (and generally no more than a week), provokes a transient but robust neuroendocrine-immune and tissue remodelling response in the skin and can alter the skin barrier. Firstly, we provide an overview of the biological effects of various acute stressors on six key skin functions, namely the skin physical barrier, pigmentation, defences (antioxidant, immune cell-mediated, microbial and microbiome maintenance), structure (extracellular matrix and appendages), neuroendocrine and thermoregulation functions. Secondly, we describe the biological and clinical effects on adult skin from individual exposome factors that elicit an acute stress response and their consequences in skin health maintenance. Clinical manifestations of acutely stressed skin may include dry skin that might accentuate fine lines, oily skin, sensitive skin, pruritus, erythema, pale skin, sweating, oedema and flares of inflammatory skin conditions such as acne, rosacea, atopic dermatitis, pigmentation disorders and skin superinfection such as viral reactivation. Acute stresses can also induce scalp sensitivity, telogen effluvium and worsen alopecia.
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Dermatite Atópica , Expossoma , Adulto , Agressão , Exposição Ambiental , Humanos , PeleRESUMO
An overview of various approaches to synthesize gold nanoparticles (AuNPs) bearing one single chemically addressable unit and their diverse fields of application is presented. This comprehensive review not only describes the strategies pursued to obtain monofunctionalized AuNPs, but also reports their behavior as 'massive' molecules in wet chemical protocols and the scope of their applications. The latter reaches from site-specific labels in biomolecules over mechanical barriers in superstructures to building blocks in hybrid nano-architectures. The complementing physical properties of AuNPs combined with precise chemical control of their attachment makes these objects promising building blocks for numerous proof-of-concept experiments and applications.
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The size of a ΔK=0 M1 excitation strength has been determined for the first time in a predominantly axially deformed even-even nucleus. It has been obtained from the observation of a rare K-mixing situation between two close-lying J^{π}=1^{+} states of the nucleus ^{164}Dy with components characterized by intrinsic projection quantum numbers K=0 and K=1. Nuclear resonance fluorescence induced by quasimonochromatic linearly polarized γ-ray beams provided evidence for K mixing of the 1^{+} states at 3159.1(3) and 3173.6(3) keV in excitation energy from their γ-decay branching ratios into the ground-state band. The ΔK=0 transition strength of B(M1;0_{1}^{+}â1_{K=0}^{+})=0.008(1)µ_{N}^{2} was inferred from a mixing analysis of their M1 transition rates into the ground-state band. It is in agreement with predictions from the quasiparticle phonon nuclear model. This determination represents first experimental information on the M1 excitation strength of a nuclear quantum state with a negative R-symmetry quantum number.
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The ^{80}Ge structure was investigated in a high-statistics ß-decay experiment of ^{80}Ga using the GRIFFIN spectrometer at TRIUMF-ISAC through γ, ß-e, e-γ, and γ-γ spectroscopy. No evidence was found for the recently reported 0_{2}^{+} 639-keV level suggested as evidence for low-energy shape coexistence in ^{80}Ge. Large-scale shell model calculations performed in ^{78,80,82}Ge place the 0_{2}^{+} level in ^{80}Ge at 2 MeV. The new experimental evidence combined with shell model predictions indicate that low-energy shape coexistence is not present in ^{80}Ge.
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In this work, we investigate the influence of channel structure and fluid rheology on non-inertial migration of non-Brownian polystyrene beads. Particle migration in this regime can be found in biomedical, chemical, environmental and geological applications. However, the effect of fluid rheology on particle migration in porous media remains to be clearly understood. Here, we isolate the effects of elasticity and shear thinning by comparing a Newtonian fluid, a purely elastic (Boger) fluid, and a shear-thinning elastic fluid. To mimic the complexity of geometries in real-world application, a random porous structure is created through a disordered arrangement of cylindrical pillars in the microchannel. Experiments are repeated in an empty channel and in channels with an ordered arrangement of pillars, and the similarities and differences in the observed particle focusing are analyzed. It is found that elasticity drives the particles away from the channel walls in an empty microchannel. Notably, particle focusing is unaffected by curved streamlines in an ordered porous microchannel and particles stay away from pillars in elastic fluids. Shear-thinning is found to reduce the effect of focusing and a broader region of particle concentration is observed. It is also noteworthy that the rheological characteristics of the fluid are not important for the particle distribution in a randomly arranged pillared microchannel and particles have a uniform distribution for all suspending fluids. Moreover, discussion on the current discrepancy in the literature about the equilibrium positions of the particles in a channel is extended by analyzing the results obtained in the current experiments.
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BACKGROUND: Cognitive Bias Modification (CBM) has been used successfully as a computer-based intervention in disorders such as anxiety. However, CBM to modify interpretations of ambiguous information relevant to paranoia has not yet been tested. We conducted a qualitative investigation of a novel intervention called CBM for paranoia (CBM-pa) to examine its acceptability in patients with psychosis. METHODS: Eight participants with psychosis who completed CBM-pa were identified by purposive sampling and invited for a semi-structured interview to explore the facilitators and barriers to participation, optimum form of delivery, perceived usefulness of CBM-pa and their opinions on applying CBM-pa as a computerised intervention. The interviews were transcribed and analysed using thematic analysis by researchers working in collaboration with service users. RESULTS: Themes emerged relating to participants' perception about delivery, engagement, programme understanding, factors influencing experience, perceived impact and application of CBM-pa. CBM-pa was regarded as easy, straightforward and enjoyable. It was well-accepted among those we interviewed, who understood the procedure as a psychological intervention. Patients reported that it increased their capacity for adopting alternative interpretations of emotionally ambiguous scenarios. Although participants all agreed on the test-like nature of the current CBM-pa format, they considered that taking part in sessions had improved their overall wellbeing. Most of them valued the computer-based interface of CBM-pa but favoured the idea of combining CBM-pa with some form of human interaction. CONCLUSIONS: CBM-pa is an acceptable intervention that was well-received by our sample of patients with paranoia. The current findings reflect positively on the acceptability and experience of CBM-pa in the target population. Patient opinion supports further development and testing of CBM-pa as a possible adjunct treatment for paranoia. TRIAL REGISTRATION: Current Controlled Trials ISRCTN: 90749868 . Retrospectively registered on 12 May 2016.
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Terapia Cognitivo-Comportamental/métodos , Transtornos Paranoides/terapia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Transtornos Psicóticos/terapia , Adulto , Feminino , Humanos , Masculino , Transtornos Paranoides/psicologia , Transtornos Psicóticos/psicologia , Pesquisa Qualitativa , Interface Usuário-ComputadorRESUMO
Because hermatypic species use symbiotic algal photosynthesis, most of the literature in this field focuses on this autotrophic mode and very little research has studied the morphology of the coral's digestive system or the digestion process of particulate food. Using histology and histochemestry, our research reveals that Stylophora pistillata's digestive system is concentrated at the corals' peristome, actinopharynx and mesenterial filaments (MF). We used in-situ hybridization (ISH) of the RNA transcript of the gene that codes for the S. pistillata digestive enzyme, chymotrypsinogen, to shed light on the functionality of the digestive system. Both the histochemistry and the ISH pointed to the MF being specialized digestive organs, equipped with large numbers of acidophilic and basophilic granular gland cells, as well as acidophilic non-granular gland cells, some of which produce chymotrypsinogen. We identified two types of MF: short, trilobed MF and unilobed, long and convoluted MF. Each S. pistillata polyp harbors two long convoluted MF and 10 short MF. While the short MF have neither secreting nor stinging cells, each of the convoluted MF display gradual cytological changes along their longitudinal axis, alternating between stinging and secreting cells and three distinctive types of secretory cells. These observations indicate the important digestive role of the long convoluted MF. They also indicate the existence of novel feeding compartments in the gastric cavity of the polyp, primarily in the nutritionally active peristome, in the actinopharynx and in three regions of the MF that differ from each other in their cellular components, general morphology and chymotrypsinogen excretion.
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Antozoários/anatomia & histologia , Sistema Digestório/anatomia & histologia , Sequência de Aminoácidos , Animais , Quimotripsinogênio/química , Quimotripsinogênio/metabolismo , Sistema Digestório/citologia , Hibridização In Situ , Alinhamento de SequênciaRESUMO
We investigate creeping viscoelastic fluid flow through two-dimensional porous media consisting of random arrangements of monodisperse and bidisperse cylinders, using our finite volume-immersed boundary method introduced in S. De, et al., J. Non-Newtonian Fluid Mech., 2016, 232, 67-76. The viscoelastic fluid is modeled with a FENE-P model. The simulations show an increased flow resistance with increase in flow rate, even though the bulk response of the fluid to shear flow is shear thinning. We show that if the square root of the permeability is chosen as the characteristic length scale in the determination of the dimensionless Deborah number (De), then all flow resistance curves collapse to a single master curve, irrespective of the pore geometry. Our study reveals how viscoelastic stresses and flow topologies (rotation, shear and extension) are distributed through the porous media, and how they evolve with increasing De. We correlate the local viscoelastic first normal stress differences with the local flow topology and show that the largest normal stress differences are located in shear flow dominated regions and not in extensional flow dominated regions at higher viscoelasticity. The study shows that normal stress differences in shear flow regions may play a crucial role in the increase of flow resistance for viscoelastic flow through such porous media.
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AIM: Anastomotic leakage (AL) following abdominal surgery is a critical determinant of postoperative recovery, of which the aetiology is largely unknown. Interestingly, interventions aimed at reducing the inflammatory response and postoperative ileus (POI) have an unexpected effect on AL. The aim of this study was to investigate the relation of POI with inflammation and AL after colorectal resection. METHOD: A post hoc analysis of a prospective randomized controlled trial in which patients underwent a colorectal resection was performed. Patients undergoing a colorectal resection were stratified into having or not having POI. The incidence of AL and other clinical parameters was registered prospectively. Intestinal fatty acid binding protein (I-FABP, a marker for tissue damage) and the inflammatory response in plasma and colon tissue were determined. RESULTS: AL was present in nine of 43 patients in the POI group, and in one of 65 in the group without POI (P < 0.001). There was a significant association between POI and AL (OR 12.57, 95% CI: 2.73-120.65; P = 0.0005). Patients with POI had significantly higher plasma levels of soluble tumour necrosis factor receptor 1 (TNFRSF1A) at 4 h postoperatively (0.89 ng/l, interquartile range 0.56) than patients without POI (0.80 ng/l, interquartile range 0.37; P = 0.04) and higher plasma levels of C-reactive protein on the second day postoperatively (234 ± 77 vs 163 ± 86 mg/l; P = 0.001). Patients who developed AL had significantly higher plasma levels of I-FABP compared with patients without AL at 24 h after onset of surgery. CONCLUSION: POI is associated with a higher prevalence of AL and an increased inflammatory response.
Assuntos
Fístula Anastomótica/etiologia , Colectomia/efeitos adversos , Doenças do Colo/etiologia , Íleus/etiologia , Complicações Pós-Operatórias , Idoso , Fístula Anastomótica/sangue , Fístula Anastomótica/epidemiologia , Proteína C-Reativa/análise , Doenças do Colo/sangue , Doenças do Colo/epidemiologia , Neoplasias Colorretais/cirurgia , Proteínas de Ligação a Ácido Graxo/análise , Feminino , Humanos , Íleus/sangue , Íleus/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
A major problem in chronic heart failure is the inability of hypertrophied cardiomyocytes to maintain the required power output. A Hill-type oxygen diffusion model predicts that oxygen supply is limiting in hypertrophied cardiomyocytes at maximal rates of oxygen consumption and that this limitation can be reduced by increasing the myoglobin (Mb) concentration. We explored how cardiac hypertrophy, oxidative capacity, and Mb expression in right ventricular cardiomyocytes are regulated at the transcriptional and translational levels in an early stage of experimental pulmonary hypertension, in order to identify targets to improve the oxygen supply/demand ratio. Male Wistar rats were injected with monocrotaline to induce pulmonary hypertension (PH) and right ventricular heart failure. The messenger RNA (mRNA) expression levels per nucleus of growth factors insulin-like growth factor-1Ea (IGF-1Ea) and mechano growth factor (MGF) were higher in PH than in healthy controls, consistent with a doubling in cardiomyocyte cross-sectional area (CSA). Succinate dehydrogenase (SDH) activity was unaltered, indicating that oxidative capacity per cell increased. Although the Mb protein concentration was unchanged, Mb mRNA concentration was reduced. However, total RNA per nucleus was about threefold higher in PH rats versus controls, and Mb mRNA content expressed per nucleus was similar in the two groups. The increase in oxidative capacity without an increase in oxygen supply via Mb-facilitated diffusion caused a doubling of the critical extracellular oxygen tension required to prevent hypoxia (PO2crit). We conclude that Mb mRNA expression is not increased during pressure overload-induced right ventricular hypertrophy and that the increase in myoglobin content per myocyte is likely due to increased translation. We conclude that increasing Mb mRNA expression may be beneficial in the treatment of experimental PH.
Assuntos
Cardiomegalia/metabolismo , Hipertensão Pulmonar/metabolismo , Miócitos Cardíacos/metabolismo , Mioglobina/metabolismo , Animais , Cardiomegalia/etiologia , Células Cultivadas , Ventrículos do Coração/metabolismo , Hipertensão Pulmonar/complicações , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Miócitos Cardíacos/patologia , Mioglobina/genética , Oxigênio/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos , Ratos Wistar , Succinato Desidrogenase/metabolismoRESUMO
The expert panel on diabetic foot infection (DFI) of the International Working Group on the Diabetic Foot conducted a systematic review seeking all published reports relating to any type of treatment for infection of the foot in persons with diabetes published as of 30 June 2014. This review, conducted with both PubMed and EMBASE, was used to update an earlier one undertaken on 30 June 2010 using the same search string. Eligible publications included those that had outcome measures reported for both a treated and a control population that were managed either at the same time, or as part of a before-and-after case design. We did not include studies that contained only information related to definition or diagnosis, but not treatment, of DFI. The current search identified just seven new articles meeting our criteria that were published since the 33 identified with the previous search, making a total of 40 articles from the world literature. The identified articles included 37 randomised controlled trials (RCTs) and three cohort studies with concurrent controls, and included studies on the use of surgical procedures, topical antiseptics, negative pressure wound therapy and hyperbaric oxygen. Among the studies were 15 RCTs that compared outcomes of treatment with new antibiotic preparations compared with a conventional therapy in the management of skin and soft tissue infection. In addition, 10 RCTs and 1 cohort study compared different treatments for osteomyelitis in the diabetic foot. Results of comparisons of different antibiotic regimens generally demonstrated that newly introduced antibiotic regimens appeared to be as effective as conventional therapy (and also more cost-effective in one study), but one study failed to demonstrate non-inferiority of a new antibiotic compared with that of a standard agent. Overall, the available literature was both limited in both the number of studies and the quality of their design. Thus, our systematic review revealed little evidence upon which to make recommendations for treatment of DFIs. There is a great need for further well-designed trials that will provide robust data upon which to make decisions about the most appropriate treatment of both skin and soft tissue infection and osteomyelitis in diabetic patients.
Assuntos
Anti-Infecciosos/uso terapêutico , Pé Diabético/terapia , Medicina Baseada em Evidências , Medicina de Precisão , Dermatopatias Infecciosas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos Locais/efeitos adversos , Anti-Infecciosos Locais/uso terapêutico , Terapia Combinada/efeitos adversos , Pé Diabético/complicações , Pé Diabético/microbiologia , Quimioterapia Combinada/efeitos adversos , Humanos , Osteomielite/complicações , Osteomielite/microbiologia , Osteomielite/prevenção & controle , Osteomielite/terapia , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/microbiologia , Dermatopatias Infecciosas/terapia , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/terapiaRESUMO
BACKGROUND: Appraisals are suggested to play a determining role in the clinical outcome of psychotic experiences (PEs). We used experimental tasks that mimic PEs to investigate appraisals in individuals with PEs with and without a 'need-for-clinical-care', and psychosis patients whose symptoms have remitted. We predicted that patients would appraise the tasks as threatening regardless of current symptom level, while non-clinical and control groups would appraise them as non-threatening. METHOD: Appraisals following three anomalous experiences-inducing tasks [Telepath, Cards task, Virtual acoustic space paradigm (VASP)] were examined in 71 individuals: symptomatic (n = 18) and remitted (n = 16) psychosis patients; non-clinical group with PEs (n = 16); controls without PEs (n = 21). RESULTS: As predicted, symptomatic patients endorsed more threatening appraisals for all tasks than non-clinical and control groups, who did not differ from each other. However, remitted patients were less likely to endorse threatening appraisals of the Cards and Telepath than their symptomatic counterparts, although they did not differ in global ratings of how striking, threatening and distressing they found the tasks. Moreover, remitted participants endorsed more threatening appraisals of the Telepath and VASP than non-clinical participants, and of the VASP than controls. Remitted participants also rated all three tasks as globally more threatening than the non-clinical group and controls. CONCLUSIONS: Clinical outcome may not necessarily be driven by the presence of symptoms, with threatening appraisals of PEs representing a key factor. The remitted group's intermediate appraisal scores imply that the relationship between appraisal and clinical outcome is not straightforward, and potential mediating factors need to be determined.
Assuntos
Cognição , Avaliação das Necessidades , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Testes Psicológicos , Inquéritos e Questionários , Adulto JovemRESUMO
The purpose of this investigation was to evaluate the diversity of bacteria in diabetic foot osteomyelitis using a 16S rRNA sequencing approach and to compare the results with conventional culture techniques. In this prospective observational study, we obtained 34 bone samples from patients admitted to our hospital with a moderate-severe diabetic foot infection. We analysed the distribution of the 16S rRNA gene sequences in the bone samples, using an Illumina MiSeq Personal Sequencer. We compared the genera that were detected with the cultured pathogens in the bone samples with conventional techniques. In the 23 samples that had positive results with both techniques, Staphylococcus, Corynebacterium, Streptococcus and Propionibacterium spp. were detected in 20, 18, 13 and 11 samples, respectively. Significantly more anaerobes were detected with 16S rRNA sequencing compared to conventional techniques (86.9 % vs. 23.1 %, p = 0.001) and more Gram-positive bacilli were present (78.3 % vs. 3.8 %, p < 0.001). Staphylococcus spp. were identified in all of the sequenced bone samples that were negative with conventional techniques. Mixed genera were present in 83.3 % (5 of 6) of the negative samples. Anaerobic and fastidious organisms may play a more significant role in osteomyelitis than previously reported. Further studies with larger populations are needed in order to fully understand the clinical importance of the microbial diversity of diabetic foot osteomyelitis.