RESUMO
OBJECTIVE: To examine the relationship between anti-Müllerian hormone (AMH) and the severity of the phenotype of patients with polycystic ovary syndrome (PCOS) and whether AMH can act as a diagnostic marker for PCOS? DESIGN: A prospective diagnostic utility study of AMH as a marker of PCOS. PATIENTS: A consecutive series of women presenting to a tertiary infertility clinic (n = 164) plus a second series of women prepared for assisted conception treatments (n = 89) recruited between June 2012 and May 2013. MEASUREMENTS: Polycystic ovary syndrome was diagnosed using the Rotterdam criteria. AMH was measured using the Generation II assay (Beckman Coulter). The diagnostic utility of AMH was established using receiver operator characteristic (ROC) curves. Cut-off values for the individual features of PCOS are proposed. RESULTS: There was a significant difference in serum AMH concentration in women with normal ovaries (13·2 pmol/l), polycystic ovary morphology (PCOM) alone (37·8 pmol/l) and PCOS (53·2 pmol/l). Follicle number, increasing cycle length and evidence of hyperandrogenism were all independently associated with serum AMH concentration (P < 0·01). AMH was significantly affected by the different phenotypic presentations of PCOS with those with all components (PCOM, HA and OA) having the highest mean value [72·7 pmol/l (P < 0·01)]. CONCLUSIONS: Serum AMH has the capacity to act as a diagnostic test for PCOS. Moreover, since its value rises with the more marked phenotypes, different cut-off values need to be used to differentiate those patients with polycystic ovarian morphology (PCOM), hyperandrogenism (HA) and oligoanovulation (OA).
Assuntos
Hormônio Antimülleriano/sangue , Síndrome do Ovário Policístico/diagnóstico , Adulto , Anovulação/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Hiperandrogenismo/diagnóstico , Síndrome do Ovário Policístico/sangue , Curva ROC , Índice de Gravidade de Doença , Adulto JovemRESUMO
OBJECTIVE: To report our experience of diagnosis, investigation and management in patients who had undergone laryngectomy secondary to previous squamous cell carcinoma, who were subsequently infected with severe acute respiratory syndrome coronavirus-2 during the coronavirus disease 2019 pandemic. CASE REPORTS: Four post-laryngectomy patients with laboratory-proven severe acute respiratory syndrome coronavirus-2 infection were admitted to our institution from 1 March to 1 May 2020. All patients displayed symptoms of coronavirus disease 2019 and underwent investigations, including swab and serum sampling, and chest X-ray where indicated. All were managed conservatively on dedicated coronavirus disease 2019 wards and were discharged without the requirement of higher level care. CONCLUSION: It is hypothesised that laryngectomy may offer a protective effect against severe or critical disease in severe acute respiratory syndrome coronavirus-2 infection. We hope sharing our experience will aid all practitioners in the management of this, often intimidating, cohort of patients.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Infecções por Coronavirus/diagnóstico , Neoplasias Laríngeas/patologia , Laringectomia/efeitos adversos , Pneumonia Viral/diagnóstico , Idoso , Betacoronavirus/isolamento & purificação , COVID-19 , Tratamento Conservador/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Feminino , Humanos , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Complicações Pós-Operatórias/virologia , SARS-CoV-2 , Resultado do TratamentoRESUMO
BACKGROUND: Fibre-optic nasoendoscopy and fibre-optic laryngoscopy are high-risk procedures in the coronavirus disease 2019 era, as they are potential aerosol-generating procedures. Barrier protection remains key to preventing transmission. METHODS: A device was developed that patients can wear to reduce potential aerosol contamination of the surroundings. CONCLUSION: This device is simple, reproducible, easy to use, economical and well-tolerated. Full personal protection equipment should additionally be worn by the operator.
Assuntos
Líquidos Corporais/virologia , Infecções por Coronavirus/transmissão , Endoscopia/efeitos adversos , Laringoscopia/normas , Equipamento de Proteção Individual/virologia , Pneumonia Viral/transmissão , Aerossóis , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Transmissão de Doença Infecciosa/prevenção & controle , Endoscopia/normas , Desenho de Equipamento , Humanos , Nariz/diagnóstico por imagem , Otorrinolaringologistas/estatística & dados numéricos , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , SARS-CoV-2 , Inquéritos e QuestionáriosAssuntos
Segurança do Paciente , Complicações Pós-Operatórias/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Gestão da Segurança/métodos , Traqueostomia/normas , Adulto , Criança , Humanos , Incidência , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Reino Unido/epidemiologiaRESUMO
Non-invasive mucosal sampling (nasosorption and nasal curettage) was used following nasal allergen challenge with grass pollen in subjects with allergic rhinitis, in order to define the molecular basis of the late allergic reaction (LAR). It was found that the nasal LAR to grass pollen involves parallel changes in pathways of type 2 inflammation (IL-4, IL-5 and IL-13), inflammasome-related (IL-1ß), and complement and circadian-associated genes. A grass pollen nasal spray was given to subjects with hay fever followed by serial sampling, in which cytokines and chemokines were measured in absorbed nasal mucosal lining fluid, and global gene expression (transcriptomics) assessed in nasal mucosal curettage samples. Twelve of 19 subjects responded with elevations in interleukin (IL)-5, IL-13, IL-1ß and MIP-1ß/CCL4 protein levels in the late phase. In addition, in these individuals whole-genome expression profiling showed upregulation of type 2 inflammation involving eosinophils and IL-4, IL-5 and IL-13; neutrophil recruitment with IL-1α and IL-1ß; the alternative pathway of complement (factor P and C5aR); and prominent effects on circadian-associated transcription regulators. Baseline IL-33 mRNA strongly correlated with these late-phase responses, whereas a single oral dose of prednisone dose-dependently reversed most nasal allergen challenge-induced cytokine and transcript responses. This study shows that the LAR to grass pollen involves a range of inflammatory pathways and suggests potential new biomarkers and therapeutic targets. Furthermore, the marked variation in mucosal inflammatory events between different patients suggests that in the future precision mucosal sampling may enable rational specific therapy.
Assuntos
Proteínas do Sistema Complemento/metabolismo , Hipersensibilidade/imunologia , Inflamassomos/metabolismo , Mucosa Nasal/imunologia , Células Th2/imunologia , Adulto , Alérgenos/imunologia , Antígenos de Plantas/imunologia , Feminino , Humanos , Hipersensibilidade/dietoterapia , Hipersensibilidade/tratamento farmacológico , Hipersensibilidade Tardia , Interleucina-13/metabolismo , Interleucina-1beta/metabolismo , Interleucina-5/metabolismo , Masculino , Pessoa de Meia-Idade , Poaceae/imunologia , Pólen/imunologia , Prednisona/uso terapêutico , Adulto JovemRESUMO
The objectives of this study were to determine (1) the rates of complications, admissions to hospital and requirements for further surgery in patients fitted with tracheoesophageal fistula speech valves, and (2) whether any factors were predictive of complications. A case note review was undertaken of all patients undergoing a laryngectomy at Gartnavel General and Stobhill Hospitals over a 10-year period. One hundred patients were identified. Forty-five patients had complications from their valves, most commonly granulation tissue formation. Thirty-five had a least one admission related to complications and 34 required further surgery. Sixty-seven were vocalizing with the valve. Radiotherapy and valve type were not statistically significant in predicting complications in this study. Primary puncture was associated with a higher rate of complications, although the numbers undergoing secondary puncture were small.
Assuntos
Neoplasias Laríngeas/cirurgia , Laringe Artificial , Implantação de Prótese/métodos , Voz Alaríngea , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Terapia Combinada , Feminino , Granuloma , Humanos , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/reabilitação , Laringectomia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Three sorptive media, blast furnace slag, cement clinker, and gravel were investigated for their capacity to remove phosphorus in a subsurface flow constructed treatment wetland post-treatment filter. Three filters were designed: two containing a mixture of either slag and gravel or clinker and gravel, and one with gravel only as the control filter. They were installed as a demonstration polishing treatment step to a constructed treatment wetland treating residential wastewater collected from 137 mobile home units at the Sunny Creek Estates Mobile Home Park. The filters were commissioned during the summer of the field season, with the data gathering taking place over a period of one year. The slag filter consistently had the lowest outflow dissolved phosphorus concentrations (0.27 +/- 0.08 mg l(-1), n=21), whereas the clinker filter had the highest outflow dissolved phosphorus concentrations (0.72 +/- 0.20 mg l(-1), n=23). The clinker filter performed well below expectations based on previous laboratory investigations, possibly due to lower pH conditions encountered in the field study. All of the filters maintained relatively constant outflow concentrations of phosphorus below 1 mg l(-1), despite varying input conditions and environmental factors such as temperature and phosphorus loading, and the occurrence of net export of phosphorus from the wetland. Net export of phosphorus from the filters occurred in the winter months, which was attributed to the decrease in input phosphorus concentrations below the maintained outflow concentrations (leading to phosphorus desorption), rather than cold temperatures or failure of the filter. Although the exact mechanisms of phosphorus removal are still under investigation, the results from this field study allowed for recommendations to be made for improving phosphorus removal at the Sunny Creek Estates constructed treatment wetland, in addition to providing valuable information for new and existing constructed treatment wetlands in cold climate areas.
Assuntos
Fósforo/química , Eliminação de Resíduos Líquidos , Purificação da Água , Áreas Alagadas , Adsorção , Clima Frio , Desenho de Equipamento , Eutrofização , Filtração , Eliminação de Resíduos Líquidos/instrumentação , Eliminação de Resíduos Líquidos/métodos , Purificação da Água/instrumentação , Purificação da Água/métodosRESUMO
CONCLUSION: The average SNOT 22 score should be calculated locally and be used as a reference when managing patients with nasal symptoms. OBJECTIVE: To calculate the average Sino Nasal Outcome Test (SNOT) 22 score across Lanarkshire and to compare it with similar studies. METHODOLOGY: Prospective data collection in which SNOT 22 forms were filled by the Lanarkshire population who had no history of sinonasal disease. Participants included patient attendants and hospital staff across multiple hospital sites in NHS Lanarkshire. All patients with hay fever, previous nasal surgeries, or any history of use of topical steroid sprays were excluded from the study. RESULTS: This study included 118 participants, out of which three had to be excluded due to unclear data entry. The total number for SNOT forms included for analysis was 115. This included 85 females and 29 males, while one form remained unanswered. The mean age was 49 (range = 15-81) years. The mean SNOT 22 score was 18 (range = 0-89).
Assuntos
Rinite/diagnóstico , Sinusite/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Rinite/complicações , Sinusite/complicações , Fatores Socioeconômicos , Inquéritos e Questionários , Reino Unido , Adulto JovemRESUMO
Sudden intense sensory stimuli elicit a cascade of involuntary responses, including a short-latency skeletal muscular response ('eyeblink startle response') and longer-latency autonomic responses. These responses are enhanced when subjects anticipate an aversive event compared to periods when subjects are resting ('fear potentiation'). It has been reported previously that the anxiolytic diazepam can suppress fear-potentiation of the eyeblink startle response in human volunteers. The present experiment aimed to confirm and extend these observations by examining the effect of another benzodiazepine, lorazepam, on the eyeblink and skin conductance components of the acoustic startle, and on fear-potentiation of these responses. Eighteen male volunteers participated in three weekly sessions in which they received oral treatment with placebo, lorazepam (1 mg) and lorazepam (2 mg), according to a balanced three-period, crossover, double-blind design. Two hours after ingestion of the treatments, electromyographic responses of the orbicularis oculi muscle and skin conductance responses were evoked by sound pulses during alternating periods in which the threat of an electric shock (electrodes attached to the subject's wrist) was present (THREAT) and absent (SAFE). The THREAT condition was associated with significant increase in the amplitude of the electromyographic (EMG) and skin conductance responses; there were also increases in baseline skin conductance, the number and amplitude of 'spontaneous' skin conductance fluctuations and self-rated anxiety. Lorazepam attenuated the effect of THREAT on self-rated anxiety and on the amplitude of the EMG response, but had no significant effect on fear-potentiation of the skin conductance responses. These results extend previous findings of the effect of diazepam on the fear-potentiated eyeblink startle response to lorazepam, and suggest that fear-potentiation of the later autonomic component of the startle response may be less sensitive to benzodiazepines than the fear-potentiated eyeblink response and self-rated anxiety.
Assuntos
Medo/psicologia , Hipnóticos e Sedativos/farmacologia , Lorazepam/farmacologia , Reflexo de Sobressalto/efeitos dos fármacos , Estimulação Acústica , Adolescente , Adulto , Ansiedade/psicologia , Piscadela/efeitos dos fármacos , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Eletromiografia/efeitos dos fármacos , Eletrochoque , Fusão Flicker/efeitos dos fármacos , Resposta Galvânica da Pele/efeitos dos fármacos , Humanos , MasculinoRESUMO
Acute auricular haematoma is a common problem in rugby players and can be difficult to treat due to re-accumulation of the fluid and can subsequently cause the unsightly cauliflower ear. We present a case of auricular haematoma affecting the central part of the pinna in a professional rugby player. This was treated successfully by aspiration and the use of silicone splints which allowed the player to continue training and competing.
Assuntos
Deformidades Adquiridas da Orelha/prevenção & controle , Dispositivos de Proteção das Orelhas , Orelha Externa/lesões , Futebol Americano/lesões , Hematoma/prevenção & controle , Elastômeros de Silicone/uso terapêutico , Adulto , Deformidades Adquiridas da Orelha/etiologia , Hematoma/etiologia , Humanos , Masculino , Prevenção SecundáriaAssuntos
Bioquímica , Enzimas , Sequência de Aminoácidos , Bacteriófagos/enzimologia , Fenômenos Bioquímicos , Quimotripsina , Ovos , Eletroforese , Frutose-Bifosfato Aldolase/análise , Gliceraldeído-3-Fosfato Desidrogenases/análise , Biologia Molecular , Muramidase , Proteínas Musculares/análise , Elastase Pancreática , Peptídeos/análise , Ribonucleases , Tripsina , Reino Unido , Difração de Raios XAssuntos
Microbiologia , Academias e Institutos , Engenharia Biomédica , Fenômenos Químicos , Físico-Química , Colífagos , Técnicas de Cultura , DNA Bacteriano , Diploide , Condutividade Elétrica , Eucariotos , Fermentação , Cooperação Internacional , Métodos , Neisseria gonorrhoeae/isolamento & purificação , Pressão , Pesquisa , Suécia , Toxinas BiológicasRESUMO
The effect of a 15% reduction in maternal nutrition for the first 70 days of gestation on cardiovascular and hypothalamic-pituitary-adrenal (HPA) axis responses to administration of corticotropin releasing hormone (CRH) + arginine vasopressin (AVP) was studied at 128 +/- 0.7 days gestation in fetal sheep and postnatally, at 85 +/- 4.5 days in young lambs. The effect on the fetal cardiovascular response to acute hypoxaemia was also examined. Under basal conditions, fetal heart rate (FHR) was reduced (P < 0.05) and basal femoral artery vascular resistance (FVR) was increased (P < 0.05) in fetuses of dietary-restricted (R) ewes compared with controls (C). Fetal mean arterial pressure (MAP) was similar in both groups. Femoral artery vascular resistance was also greater during hypoxaemia in R fetuses compared with C fetuses (P < 0.05), suggesting that chemoreflex mechanisms were augmented in the R group. The fetal ACTH response to CRH + AVP was similar in both groups. However, cortisol responses to CRH + AVP were smaller in R fetuses compared with C fetuses (P<0.05). Postnatally, basal MAP (P < 0.05), and ACTH (P < 0.01) and cortisol (P < 0.001) responses were greater in R lambs compared with C lambs. It was concluded that modest maternal undernutrition during pregnancy alters development of the cardiovascular system, producing elevated blood pressure in postnatal life. Development of the HPA axis is also altered, with reduced activity during fetal life, but increased activity postnatally. The data suggest that the HPA axis may play a role in mediating the elevation of MAP in R lambs.
Assuntos
Sistema Cardiovascular/embriologia , Privação de Alimentos/fisiologia , Sistema Hipotálamo-Hipofisário/embriologia , Sistema Hipófise-Suprarrenal/embriologia , Hormônio Adrenocorticotrópico/sangue , Animais , Animais Recém-Nascidos , Arginina Vasopressina/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Sistema Cardiovascular/crescimento & desenvolvimento , Hormônio Liberador da Corticotropina/administração & dosagem , Desenvolvimento Embrionário e Fetal , Feminino , Feto/efeitos dos fármacos , Feto/fisiologia , Idade Gestacional , Frequência Cardíaca/efeitos dos fármacos , Hidrocortisona/sangue , Sistema Hipotálamo-Hipofisário/crescimento & desenvolvimento , Troca Materno-Fetal , Sistema Hipófise-Suprarrenal/crescimento & desenvolvimento , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Ovinos , Resistência Vascular/efeitos dos fármacosRESUMO
BACKGROUND: Tracheostomies are a common procedure within the specialties of otolaryngology and intensive care. The ENT department at Monklands Hospital has developed the position of tracheostomy clinical nurse specialist to improve the management of tracheostomy patients. There is evidence to support the development of a multidisciplinary team for the management of tracheostomy patients following intensive care unit treatment; however, the creation of a specific tracheostomy clinical nurse specialist position has not been widely endorsed in the literature. OBJECTIVE: This paper describes the role of the tracheostomy clinical nurse specialist, advocating this position within the multidisciplinary team.
Assuntos
Enfermeiros Clínicos , Equipe de Assistência ao Paciente , Traqueostomia/enfermagem , Humanos , Unidades de Terapia Intensiva/organização & administração , Papel do Profissional de EnfermagemRESUMO
The alertness-promoting effect of MK-0249 (10 or 50 mg), a histamine subtype-3 receptor (HRH3) inverse agonist (IA), was evaluated in the stimulant reference sleep deprivation model (SRSDM) using a double-blind, double-dummy, placebo- and modafinil- (200 mg) controlled, four-period crossover design in 24 healthy young men. The two primary hypotheses were related to sleep latency (first appearance of one epoch of stage 2, 3, or 4 or REM sleep, as detected using polysomnography (PSG)) at 8:00 AM on day 2. Statistically significant increases in sleep latency were observed in association with the use of modafinil 200 mg (9.07 min; P < 0.0001), MK-0249 50 mg (5.17 min; P = 0.008), and MK-0249 10 mg (5.45 min; P = 0.005) at the maintenance of wakefulness test (MWT) at 8:00 AM. Sleep latency was higher when averaged over all MWT time points (P < 0.0001 for modafinil and for both doses of MK-0249). The alertness-promoting effect with the use of MK-0249 in the SRSDM suggests that HRH3 IAs may be effective in disorders involving excessive somnolence.