Recognition of pulmonary hypertension in the rheumatology community: lessons from a Quality Enhancement Research Initiative.

OBJECTIVES: The aim of this study was to utilise the Quality Enhancement Research Initiative in Systemic Sclerosis (QuERI-SSc) to measure and reduce a perceived gap in the diagnosis of pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc). METHODS: Rheumatologists enrolled patients with SSc (aged ≥ 18 years) and provided data on a panel of diagnostic tests over 3 years. Pulmonary function testing, echocardiography, 6-minute walk distance, N-terminal pro-brain natriuretic peptide assays, high-resolution computed tomography of the lungs, and ventilation/perfusion scan plus right heart catheterisation (RHC; when appropriate) were emphasised. Exclusion criteria included previously documented PAH, interstitial lung disease, and SSc overlapping with other connective tissue disease. RESULTS: Participating rheumatologists enrolled 207 patients with SSc (90% female; 80% white), with a median age of 57 years and median disease duration of 5 years. A total of 82% of patients were classified as New York Heart Association functional class I and II; of these patients, 177 had an echocardiogram at enrolment and 191 at any time during the study. Of those who met study-specified criteria for RHC at enrolment, only 3 of 7 patients underwent RHC. CONCLUSIONS: The screening algorithm was successful in identifying patients with mild impairment. Although specific tools were recommended for screening PAH in patients with SSc, results indicate that significant diagnostic care gaps still exist in the general rheumatology community. Better understanding and adherence to guidelines could improve the care and, ideally, outcomes of these high-risk patients.

Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients.

BACKGROUND: Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol. METHODS: A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine) are active members and are affiliated with various hospitals in the Philippines. Data collectors will be identified and trained in the audit process. A pilot audit will be conducted to test the feasibility of the audit protocol, and refinements to the protocol will be undertaken as necessary. The comprehensive audit process will take place for a period of 3 months. Data will be encoded using MS Excel(®). Data will be reported as means and percentages as appropriate. Subgroup analysis will be undertaken to look into differences and variability of stroke patient descriptors and rehabilitation activities. CONCLUSION: This audit study is an ambitious project, but given the "need" to conduct the audit to identify "gaps" in current practice, and the value it can bring to serve as a platform for implementation of evidence-based stroke management in the Philippines to achieve best patient and health outcomes, the audit team is more than ready to take up the challenge.

A novel schiff base zinc coordination compound inhibits proliferation and induces apoptosis of human osteosarcoma cells / 华中科技大学学报（医学）（英德文版）

Various kinds of schiff base metal complexes have been proven to induce apoptosis of tumor cells. However, it remains largely unknown whether schiff base zinc complexes induce apoptosis in human cancer cells. Here, we synthesized a novel schiff base zinc coordination compound (SBZCC) and investigated its effects on the growth, proliferation and apoptosis of human osteosarcoma MG-63 cells. A novel SBZCC was synthesized by chemical processes and used to treat MG-63 cells. The cell viability was determined by CCK-8 assay. The cell cycle progression, mitochondrial membrane potential and apoptotic cells were analyzed by flow cytometry. The apoptosis-related proteins levels were determined by immunoblotting. Treatment of MG-63 cells with SBZCC resulted in inhibition of cell proliferation and cell cycle arrest at G1 phase. Moreover, SBZCC significantly reduced the mitochondrial membrane potential and induced apoptosis, accompanied with increased Bax/Bcl-2 and FlasL/Fas expression as well as caspase-3/8/9 cleavage. Our results demonstrated that the synthesized novel SBZCC could inhibit the proliferation and induce apoptosis of MG-63 cells via activating both the mitochondrial and cell death receptor apoptosis pathways, suggesting that SBZCC is a promising agent for the development as anticancer drugs.

A prevalence study of pathologic gambling among substance-related disorder patients admitted at the medical city using the south oaks gambling screen

Objectives: To determine the prevalence of pathologic gambling among substance-related disorder patients admitted at The Medical City Psychiatric Unit and describe the demographic characteristics of identified pathologic gamblers. Methods: Patients admitted under the pyschiatry service of The Medical City from June 2003 to March 2004 who fulfilled the DSM-IV TR diagnostic criteria for Substance-Related disorders were included in this study. The South Oaks Gambling Screen (SOGS), a validated and reliable instrument for screening populations with gambling problems was administered to determine the presence of pathologic gambling. Demographic data was also collected from patients. Results: Fifty one patients were eligible for the study but only 49 participated in the study since 2 did not give their consent. Eleven patients (22.45%) were identified as probable pathologic gamblers (PPG) and 21 patients (42.86%) were considered problem gamblers (PG). Majority of the PPG were male, ?40 years of age, received some college education, abused methamphetamine, and had a family history of gambling problems. Conclusion: There was a high prevalence of pathologic gambling among patients with substance-related disorders. Thus, it is recommended that assessment of gambling problems should be part of the initial psychiatric evaluation of substance-related disorder patients. Further local research on this topic should also be conducted to validate results of this study.

A study on the acute anti-ulcer effects of narra (Pterocarpus Indicus Will.) on indomethacin-induced gastric ulcers in male albino rats (Rattus rattus)

Gastric, duodenal and peptic ulcers are collectively ranked as one of the causes of deaths in the country. Management of these diseases comes at a high cost. The researchers explored the use of indigenous narra (Pterocarpus indicus Will.) as a low cost alternative to other expensive medications. This study aimed to determine the presence and degree of ulcerations in Indomethacin-induced gastric ulcers in male albino rats after treatment with either narra leaf decoction or sucralfate. It also aimed to compare the anti-ulcer effects of different dosages of narra leaf decoction with that of sucralfateTwenty-five male rats weighting 115-200 grams were randomly divided into five groups. Gastric ulcers were induced by orally administering 30 mg/kg body weight (BW) of Indomethacin in all rats. Treatments were divided as follows: Negative control (NSS)-10 mg/kg BW normal saline solution; positive control (SUC)-1 g/kg BW sucralfate; Narra group 1 (N1)-3.94 g/kg BW narra leaf decoction; Narra group 2 (N2)-9.89 g/kg BW narra leaf decoction; and, Narra group 3 (N3)-24.84 g/kg BW narra leaf decoction. All treatments were administered using oral gavage and were repeated at intervals of 24 hours for three days. Six hours after the last administration of treatment, the rats were sacrificed and their stomachs excised. Gross analysis was done using the Bests Ulcer Staging Index while histopathological analysis was performed according to the presence and degree of ulcers and hemorrhage. Results were analyzed using Kruskal- Wallis Test for one-way ANOVAOn gross analysis, ulcers and hemorrhages were seen in some of the rat stomachs but the difference in the effects of the treatments on the different groups was not statistically significant. On histopathological analysis, ulcers and hemorrhages were evident in the NSS group but were not noted in the SUC group. The difference between the SUC and NSS groups was statistically significant. Histopathologic studies also showed the following: 2/5 rats had ulcers in Narra group 1; 2/5 in Narra group 2; and, none in Narra group 3 (but all of these rats died before the end of the experiment). However, histopathological differences among the treatment groups were not statistically significantThese findings suggest that narra may have anti-ulcer effects. It is recommended that a dosage higher than 24.84 g/kg BW (the highest narra dosage administered for three days in this experiment) be used in further experiments. The duration of exposure to the drug should also be lengthened. (Author)