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Sample records for bla clinical review

  1. Co-occurrence of blaNDM-1 with blaOXA-23 or blaOXA-58 in clinical multidrug-resistant Acinetobacter baumannii isolates in Algeria.

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    Ramoul, Abir; Loucif, Lotfi; Bakour, Sofiane; Amiri, Sabrina; Dekhil, Mazouz; Rolain, Jean-Marc

    2016-09-01

    The aim of this study was to characterise the mechanisms of carbapenem resistance in Acinetobacter baumannii strains isolated in an Algerian hospital. A total of 43 imipenem-resistant A. baumannii clinical isolates collected between 2010 and 2013 were identified using API 20NE and were confirmed by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS). Antibiotic susceptibility testing was performed by the disk diffusion and Etest methods. Carbapenemase activity was detected using microbiological tests and PCR. Genetic transfer of the blaNDM-1 gene was performed by conjugation using sodium azide-resistant Escherichia coli J53 as recipient strain. Clonal relationships were studied by multilocus sequence typing (MLST) using partial sequences of the csuE and blaOXA-51 genes. All 43 A. baumannii isolates were resistant to imipenem with high minimum inhibitory concentrations (MICs) (>32μg/mL). The strains harboured blaOXA-23, blaNDM-1, blaOXA-58 and/or blaOXA-24 genes. Co-existence of blaNDM-1 and blaOXA-23 or blaOXA-58 was detected in two isolates and one isolate, respectively. NDM-1 plasmid transfer to E. coli J53 was successful only for one of the three strains harbouring both blaNDM-1 and blaOXA-23 or blaOXA-58. The phylogenetic tree obtained from concatenation of the partial sequences of csuE and blaOXA-51 showed that there was no genetic relationship between the isolates and the blaNDM-1 resistance gene. Here we report for the first time the co-occurrence of blaNDM-1 along with blaOXA-23 or blaOXA-58 in recent clinical isolates of A. baumannii from Northeast Algeria. These findings re-emphasise the dissemination and rapid spread of blaNDM-1 carbapenemase genes in multidrug-resistant clinical A. baumannii isolates in Algeria.

  2. The Frequency of blaVIM, blaIMP, blaKPC and blaNDM Carbapenemase Genes in Clinical Isolates of Klebsiella Pneumoniae in Kermanshah Medical Centers

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    A Zare

    2015-11-01

    Full Text Available Background: Carbapenemase genes have been spread among strains of Klebsiella pneumoniae that make them resistant to carbapenems. Hence, the present study aimed to study the prevalence of carbapenmase genes within K. pneumoniae isolates in Kermanshah medical centers. Methods: Sixty isolates of K. pneumoniae were collected and identified using API kit. Then, antibiotic susceptibility of isolates was determined using a disk diffusion method. The carbapenems-resistant isolates were screened for carbapenemases production using the Modified Hodge Test (MHT. The carbapenemase genes of blaVIM, blaIMP, KPC and blaNDM were detected by PCR test . Results: Out of 60 isolates, 4 isolates were resistant to carbapenem antibiotics, but only one isolate was demonstrated to be positive for carbapenemases by MHT phenotypic testing. The gene of blaVIM was detected in three isolates by PCR, though other genes were not found in the isolates. Within the isolates, 6.67% and 100% were resistant to carbapenem and ampicillin, respectively. Conclusion: The study findings revealed that dissemination rate of carbapenemase genes was not reported to be high among isolates of K. pneumoniae in Kermanshah. Only blaVIM gene was probably more frequent than other tested genes. Since most isolates examined in this study were susceptible to carbapenem antibiotics, these antibiotics are still regarded as effective drugs against infections caused by K. pneumoniae.

  3. Coexistence of blaNDM-1 、blaKPC-2 、blaDHA-1 、blaTEM-1 and blaOXA-1 genes in a clinical ST11 Klebsiella pneumoniae isolate in chi-na%首例同时携带 blaNDM-1、blaKPC-2、blaDHA-1、blaTEM-1和 blaOXA-1基因的 ST11肺炎克雷伯菌临床株

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    油丽萍; 陈爱文; 秦萍; 徐茶; 赵辉; 吴春梅; 朱元祺

    2015-01-01

    Objective To explore the molecular mechanism of the clinical carbapenem-resistant Klebsiella pneumon-iae isolates.Methods The strains identification and antibiotic susceptibilities were performed by VITEK-2 compact system.The genes of AmpC,ESBLs,MBL and KPCβ-lactamases were screened by specific PCR.And genotypes were confirmed by DNA sequencing.PFGE and multilocus sequence typing (MLST)were performed.Results 5 Klebsiella pneumoniae isolates were resistant to all antibiotics tested.Genotyping(PFGE)clustered 5 K .pneumoniae isolates into a single clonal type and MLST assigned them to sequence type 11.The blaKPC-2 ,baTEM-1 ,blaCTXG 9 and rmtB genes were present in four isolates.And Molecular testing verified the presence of blaNDM-1 ,blaKPC-2 ,blaDHA-1 ,blaTEM-1 and blaOXA-1 genes in a Klebsiella pneumoniae isolate.Conclusion To our knowledge,this is first report of coexistence of blaNDM-1 , blaKPC-2 ,blaDHA-1 ,blaTEM-1 and blaOXA-1 genes in a clinical Klebsiella pneumonia isolate.It may herald the emergence of a new pattern of drug resistance.Surveillance of metallo-β-lactamases in enterobacteriaceae is urgently needed to control and prevent the spread of these isolates.%目的:探讨产碳青霉烯酶肺炎克雷伯菌的耐药机制,为医院感染控制提供依据。方法法国 VITEK-2 Compact 对细菌进行鉴定和药敏试验;改良 Hodge 试验初筛肺炎克雷伯菌是否产碳青霉烯酶;多重 PCR 对菌株进行β-内酰胺类耐药基因和16S rRNA 甲基化酶基因的检测,测序确认基因型;多位点序列分型和脉冲场凝胶电泳实验进行细菌的同源性分析。结果5株肺炎克雷伯菌多位点序列分型是 ST11型,其中4株都同时携带有 blaKPC-2、blaTEM-1、blaCTXG 9和16S rRNA 甲基化酶 rmtB 基因,另外1株(HD03)肺炎克雷伯菌同时携带 blaNDM-1、blaKPC-2、blaDHA-1、blaTEM-1和 blaOXA-1基因。脉冲场凝胶电泳显示,除了 HD04菌株多一条带外,其余带型5株菌完

  4. Outbreak Caused by blaOXA-72-Producing Acinetobacter baumannii ST417 Detected in Clinical and Environmental Isolates.

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    Tamayo-Legorreta, Elsa; Turrubiartes-Martínez, Edgar; Garza-Ramos, Ulises; Niño-Moreno, Perla; Barrios, Humberto; Sánchez-Pérez, Alejandro; Reyna-Flores, Fernando; Tovar-Oviedo, Juana; Magaña-Aquino, Martin; Cevallos, Miguel Angel; Silva-Sanchez, Jesus

    2016-03-01

    We characterized an outbreak of imipenem-resistant Acinetobacter baumannii with clinical and environmental isolates from a tertiary care hospital in San Luis Potosi, Mexico. During a 4-month period, a total of 32 nonrepetitive imipenem-resistant clinical isolates of A. baumannii were collected. All isolates were susceptible to colistin and tigecycline and resistant to cefepime, ceftazidime, ceftriaxone, imipenem, and meropenem. Genotyping by pulsed-field gel electrophoresis showed a major clone (A). Multilocus sequence type (MLST) analysis was performed, revealing sequence type (ST) 417 (ST417) and 208 (ST208). The blaIMP-, blaVIM-, blaGIM-, blaSIM-, blaNDM-type, and blaOXA-type (blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, and blaOXA-58-like) genes were screened and showed that the blaOXA-51-like and blaOXA-24-like genes were present in all isolates. Sequencing and southern hybridization were performed, confirming the presence of the blaOXA-72 gene and its plasmid-borne nature. In addition, the blaOXA-72-XerC/XerD-like association was identified. These findings indicate that a clonal spread of blaOXA-72-producing A. baumannii ST417 had occurred throughout the hospital. The ST417 corresponded with a previous ST described in the United States.

  5. Co-Carriage of blaKPC-2 and blaNDM-1 in Clinical Isolates of Pseudomonas aeruginosa Associated with Hospital Infections from India.

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    Deepjyoti Paul

    Full Text Available Global spread of KPC poses to be a serious threat complicating treatment options in hospital settings. The present study investigates the genetic environment of blaKPC-2 among clinical isolates of Pseudomonas aeruginosa from a tertiary referral hospital of India. The study isolates were collected from different wards and clinics of Silchar Medical College and Hospital, India, from 2012-2013. The presence of blaKPC was confirmed by genotypic characterization followed by sequencing. Cloning of the blaKPC-2 gene was performed and the genetic environment of this gene was characterized as well. Transferability of the resistance gene was determined by transformation assay and Southern hybridization. Additionally, restriction mapping was also carried out. Two isolates of P. aeruginosa were found to harbor blaKPC-2, were resistant towards aminoglycosides, quinolone and β-lactam-β-lactamase inhibitor combination. In both the isolates, the resistance determinant was associated with class 1 integron and horizontally transferable. Both the isolates were co-harboring blaNDM-1. The first detection of this integron mediated blaKPC-2 coexisting with blaNDM-1 in P. aeruginosa from India is worrisome, and further investigation is required to track the gene cassette mediated blaKPC-2 in terms of infection control and to prevent the spread of this gene in hospitals as well as in the community.

  6. Molecular detection of metallo-β-lactamase genes, blaIMP-1, blaVIM-2 and blaSPM-1 in imipenem resistant Pseudomonas aeruginosa isolated from clinical specimens in teaching hospitals of Ahvaz, Iran

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    Mojtaba Moosavian

    2015-10-01

    Full Text Available Background and Objectives: Carbapenem resistant Pseudomonas aeruginosa is a serious cause of nosocomial infections.The main purpose of the study is to determine the prevalence rate of imipenem resistant Pseudomonas aeruginosa carryingmetallo- beta- lactamase (MBL genes.Material and Methods: 236 Pseudomonas aeruginosa isolates were collected from teaching hospitals of Ahvaz Universityof Medical Sciences during a period of 9 months in 2012. These strains were identified using conventional microbiologicaltests. The susceptibility of isolates to antibiotics were assessed using disk diffusion test. The IMP-EDTA combination diskphenotypic test was performed for detection of MBL producing strains. Finally, polymerase chain reaction (PCR wasperformed to detect MBL genes, blaIMP-1, blaVIM-2 and blaSPM-1 in imipenem resistant strains.Results: Out of 236 examined isolates, 122 isolates (51.4% were resistant to imipenem. The IMP-EDTA combination testshowed that among 122 imipenem resistant strains, 110 strains (90% were phenotipically MBL producers. Additionally, theresults of PCR method showed that 2 strains (1.6% and 67strains (55% of imipenem resistant Pseudomonas aeruginosaisolates contained blaVIM-2 and blaIMP-1 genes respectively. No SPM-1gene was found in the examined samples.Conclusion: Resistance of P. aeruginosa isolates to imipenem due to MBL enzymes is increasing in Ahavaz. Becauseof clinical significance of this kind of resistance, rapid detection of MBL producing strains and followed by appropriatetreatment is necessary to prevent the spreading of these organisms.

  7. Genetic characteristics of blaNDM-1-positive plasmid in Citrobacter freundii isolate separated from a clinical infectious patient.

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    Du, Xiao-Xing; Wang, Jian-Feng; Fu, Ying; Zhao, Feng; Chen, Yan; Wang, Hai-Ping; Yu, Yun-Song

    2013-09-01

    This study reports an infectious case involving an (NDM-1)-producing Citrobacter freundii and further explored the potential threat of the bla(NDM-1) gene by analysing the characteristics of the (NDM-1)-encoding plasmid sequence. A bla(NDM-1)-positive C. freundii with high resistance to carbapenems was separated from a clinical patient suffering from a urinary tract infection. S1 nuclease-based plasmid analysis followed by Southern blot hybridization, a conjugation experiment and electrotransformation confirmed that the bla(NDM-1) gene was located on a plasmid. High-throughput sequencing of the bla(NDM-1)-positive plasmid (pCFNDM-CN) showed that it was a 54 kb IncX-type plasmid and contained a backbone region and a variable region with two β-lactamase genes (bla(NDM-1) and bla(SHV-12)). The NDM-1 composite transposon in the variable region was surrounded by IS26 and IS5-truncated ISAba125, and shared a high sequence similarity to the bla(NDM-1) surrounding structure in Acinetobacter spp. Our research suggested that the NDM-1 composite transposon might play an essential role in mobilization of the bla(NDM-1) gene from Acinetobacter spp. to Enterobacteriaceae.

  8. Evaluation of LAMP assay using phenotypic tests and conventional PCR for detection of blaNDM-1 and blaKPC genes among carbapenem-resistant clinical Gram-negative isolates.

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    Solanki, Rachana; Vanjari, Lavanya; Ede, Nagapriyanka; Gungi, Akhila; Soory, Amarendranath; Vemu, Lakshmi

    2013-10-01

    Carbapenem-resistant pathogens cause infections associated with significant morbidity and mortality. This study evaluates the use of the loop-mediated isothermal amplification (LAMP) assay for rapid and cost-effective detection of bla(NDM-1) and bla(KPC) genes among carbapenem-resistant Gram-negative bacteria in comparison with conventional PCR and existing phenotypic methods. A total of 60 carbapenem-resistant clinical isolates [Escherichia coli (15), Klebsiella pneumoniae (22), Acinetobacter baumannii (23)] were screened for the presence of carbapenemases (bla(KPC) and bla(NDM-1)) using phenotypic methods such as the modified Hodge test (MHT) and combined disc test (CDT) and molecular methods such as conventional PCR and LAMP assay. In all, 47/60 isolates (78.3%) were MHT positive while 48 isolates were positive by CDT [46.6% positive with EDTA, 30% with 3' aminophenylboronic acid (APB) plus EDTA and 1.6% with APB alone]. Isolates showing CDT positivity with EDTA or APB contained bla(NDM-1) and bla(KPC) genes, respectively. bla(NDM-1) was present as a lone gene in 28 isolates (46.7%) and present together with the bla(KPC) gene in 19 isolates (31.7%). Only one E. coli isolate had a lone bla(KPC) gene. The LAMP assay detected either or both bla(NDM-1) and bla(KPC) genes in four isolates that were missed by conventional PCR. Neither gene could be detected in 12 (20%) isolates. The LAMP assay has greater sensitivity, specificity and rapidity compared to the phenotypic methods and PCR for the detection of bla(NDM-1) and bla(KPC). With a turnaround time of only 2-3 h, the LAMP assay can be considered a point-of-care assay.

  9. Distribution of allelic variants of the chromosomal gene bla OXA-114-like in Achromobacter xylosoxidans clinical isolates.

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    Traglia, German Matías; Almuzara, Marisa; Merkier, Andrea Karina; Papalia, Mariana; Galanternik, Laura; Radice, Marcela; Vay, Carlos; Centrón, Daniela; Ramírez, María Soledad

    2013-11-01

    Achromobacter xylosoxidans is increasingly being documented in cystic fibrosis patients. The bla(OXA-114) gene has been recognized as a naturally occurring chromosomal gene, exhibiting different allelic variants. In the population under study, the bla(OXA-114)-like gene was found in 19/19 non-epidemiological-related clinical isolates of A. xylosoxidans with ten different alleles including 1 novel OXA-114 variant.

  10. Ultrastructural Changes in Clinical and Microbiota Isolates of Klebsiella pneumoniae Carriers of Genes bla SHV, bla TEM, bla CTX-M, or bla KPC When Subject to β-Lactam Antibiotics.

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    Veras, Dyana Leal; Lopes, Ana Catarina de Souza; da Silva, Grasielle Vaz; Gonçalves, Gabriel Gazzoni Araújo; de Freitas, Catarina Fernandes; de Lima, Fernanda Cristina Gomes; Maciel, Maria Amélia Vieira; Feitosa, Ana Paula Sampaio; Alves, Luiz Carlos; Brayner, Fábio André

    2015-01-01

    The aim of this study was to characterize the ultrastructural effects caused by β-lactam antibiotics in Klebsiella pneumoniae isolates. Three K. pneumoniae clinical isolates were selected for the study with resistance profiles for third-generation cephalosporins, aztreonam, and/or imipenem and with different resistance genes for extended-spectrum β-lactamases (ESBL) or Klebsiella pneumoniae carbapenemase (KPC). Two K. pneumoniae isolates obtained from the microbiota, which were both resistant to amoxicillin and ampicillin, were also analyzed. In accordance with the susceptibility profile, the clinical isolates were subjected to subminimum inhibitory concentrations (sub-MICs) of cefotaxime, ceftazidime, aztreonam, and imipenem and the isolates from the microbiota to ampicillin and amoxicillin, for analysis by means of scanning and transmission electron microscopy. The K. pneumoniae isolates showed different morphological and ultrastructural changes after subjection to β-lactams tested at different concentrations, such as cell filamentation, loss of cytoplasmic material, and deformation of dividing septa. Our results demonstrate that K. pneumoniae isolates harboring different genes that encode for β-lactamases show cell alterations when subjected to different β-lactam antibiotics, thus suggesting that they possess residual activity in vitro, despite the phenotypic resistance presented in the isolates analyzed.

  11. Characterization of IncA/C conjugative plasmid harboring bla TEM-52 and bla CTX-M-15 extended-spectrum β-lactamases in clinical isolates of Escherichia coli in Tunisia.

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    Chouchani, C; El Salabi, A; Marrakchi, R; Ferchichi, L; Walsh, T R

    2012-06-01

    To characterize the extended-spectrum β-lactamases (ESBLs) as well as their genetic environment in different isolates of Escherichia coli from patients with repeated urinary tract infections, large multidrug resistance (MDR) plasmids have been found. Definitive evidence for the presence of an A/C incompatibility complex (IncA/C) plasmid in the MDR isolates was provided by the probing of plasmids extracted from the clinical isolates. Conjugation experiments showed that bla genes were transferred by conjugation from the ten E. coli clinical isolates to E. coli XL1-Blue recipient. A comparative restriction fragment length polymorphism (RFLP) analysis of these plasmids showed that they are genetically similar, while the overall similarity of these plasmids supports the likelihood of recent movements among these E. coli isolates. Polymerase chain reaction (PCR) amplification and sequencing of the amplicons showed that the IncA/C plasmids harbor two ESBLs, identified as TEM-52 and CTX-M-15. Analysis of the plasmid DNA surrounding the bla (CTX-M-15) gene in the clinical isolates under study revealed a partially truncated fragment of ISEcp1 tnpA transposase. This result indicates the variety of genetic events that have enabled associations between ISEcp1 sequences and bla (CTX-M-15) genes in these clinical isolates.

  12. Draft Genome Sequences of Pandrug-Resistant Serratia marcescens Clinical Isolates Harboring blaNDM-1

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    Yao, Yancheng; Falgenhauer, Linda; Kempf, Volkhard A. J.; Hogardt, Michael; Göttig, Stephan; Imirzalioglu, Can

    2017-01-01

    ABSTRACT The draft genome sequences of two clonal, pandrug-resistant Serratia marcescens clinical isolates were determined. The resistance phenotype was plasmid driven, as 14 of 17 resistance genes were present on large IncFIB(K), IncHI2, and IncA/C2 plasmids indicating a large pool of transmissible antibiotic resistance genes. PMID:28104656

  13. Multiplex PCR amplification assay for the detection of blaSHV, blaTEM and blaCTX-M genes in Enterobacteriaceae.

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    Monstein, H-J; Ostholm-Balkhed, A; Nilsson, M V; Nilsson, M; Dornbusch, K; Nilsson, L E

    2007-12-01

    Extended-spectrum beta-lactamases (ESBLs) are often mediated by (bla-)SHV, (bla)TEM and (bla)CTX-M genes in Enterobacteriaceae and other Gram-negative bacteria. Numerous molecular typing methods, including PCR-based assays, have been developed for their identification. To reduce the number of PCR amplifications needed we have developed a multiplex PCR assay which detects and discriminates between (bla-)SHV, (bla)TEM and (bla)CTX-M PCR amplicons of 747, 445 and 593 bp, respectively. This multiplex PCR assay allowed the identification of (bla-)SHV, (bla)TEM and (bla)CTX-M genes in a series of clinical isolates of Enterobacteriaceae with previously characterised ESBL phenotype. The presence of (bla)SHV, (bla)TEM and (bla)CTX-M genes was confirmed by partial DNA sequence analysis. Apparently, the universal well-established CTX-M primer pair used here to reveal plasmid-encoded (bla)CTX-M genes would also amplify the chromosomally located K-1 enzyme gene in all Klebsiella oxytoca strains included in the study.

  14. First characterisation of plasmid-mediated quinolone resistance-qnrS1 co-expressed bla CTX-M-15 and bla DHA-1 genes in clinical strain of Morganella morganii recovered from a Tunisian Intensive Care Unit

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    S Mahrouki

    2012-01-01

    Full Text Available Purpose: Aim of this study was to show the emergence of the qnr genes among fluoroquinolone-resistant, AMPC and ESBL (extended-spectrum-beta-lactamase co-producing Morganella morganii isolate. Materials and Methods: A multi resistant Morganella morganii SM12012 isolate was recovered from pus from a patient hospitalized in the intensive care unit at the Military hospital, Tunisia. Antibiotic susceptibility was tested with the agar disk diffusion method according to Clinical and Laboratory Standards Institute guidelines. ESBLs were detected using a standard double-disk synergy test. The characterization of beta-lactamases and associated resistance genes were performed by isoelectric focusing, polymerase chain reaction and nucleotide sequencing. Results: The antimicrobial susceptibility testing showed the high resistance to penicillins, cephalosporins (MICs: 64-512 μg/ml and fluoroquinolones (MICs: 32-512 μg/ml. But M. morganii SM12012 isolate remained susceptible to carbapenems (MICs: 4-<0.25 μg/ml. The double-disk synergy test confirmed the phenotype of extended-spectrum β-lactamases (ESBLs. Three identical β-lactamases with pI values of 6.5, 7.8 and superior to 8.6 were detected after isoelectric focusing analysis. These β-lactamases genes can be successfully transferred by the conjugative plasmid. Molecular analysis demonstrated the co-production of bla DHA-1, bla CTX-M-15 and qnrS1 genes on the same plasmid. The detection of an associated chromosomal quinolone resistance revealed the presence of a parC mutation at codon 80 (Ser80-lle80. Conclusion: This is the first report in Tunisia of nosocomial infection due to the production of CTX-M-15 and DHA-1 β-lactamases in M. morganii isolate with the association of quinolone plasmid resistance. The incidence of these strains invites continuous monitoring of such multidrug-resistant strains and the further study of their epidemiologic evolution.

  15. Diversity of the Genetic Environment of the blaKPC-2 Gene Among Klebsiella pneumoniae Clinical Isolates in a Chinese Hospital.

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    Wang, Lian-Hui; Wei, Dan-Dan; Wan, La-Gen; Yu, Yang; Deng, Qiong; Liu, Yang

    2016-01-01

    KPC-producing Klebsiella pneumoniae (KPC-Kp) has been frequently reported worldwide and constitutes a major healthcare threat, given their extensively drug-resistant phenotypes. In this study, we report the characterization of the genetic environment of blaKPC-2 gene in KPC-Kp clinical strains from China belonging to diverse genotypes. Thirty-five nonduplicated KPC-Kp isolates collected in a Chinese hospital during 2012 were analyzed. All were multidrug resistant due to the presence of other resistance determinants, including metallo-β-lactamases (IMP-4, NDM-1), extended-spectrum β-lactamases (CTX-M-14, -15, -3, -10, and SHV-12), 16S rRNA methylases (armA and rmtB), and plasmid-mediated quinolone resistance determinants [qnrA, B, S, aac(6')-Ib-cr]. Using pulsed-field gel electrophoresis (PFGE), the 35 isolates were grouped into 12 clusters that were further identified as 15 sequence types (STs) by multilocus sequence typing. ST11 K. pneumoniae was the predominant clone attributed to the outbreak. blaKPC-2 was carried in plasmids of various sizes and incompatibility types. The genetic environment analysis, based on genetic structure in the plasmid pKP048, revealed five distinct platforms: the most prevalent structure was the continual occurrence in diverse STs (ST11, ST258, ST340, ST395, ST437, and ST494), harboring plasmid of blaKPC-2 in a genetic environment flanked by ISKpn8 and ISKpn6 like. This study highlights the continued evolution of the genetic environment of the blaKPC-2 gene in our hospital and movement to multiple plasmid backbones that results in acquisition by multiple clones of K. pneumoniae.

  16. Draft Genome Sequence of a Colistin-Resistant Klebsiella pneumoniae Clinical Strain Carrying the blaNDM-1 Carbapenemase Gene

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    Yao, Zhihong; Feng, Yu; Lin, Ji

    2017-01-01

    ABSTRACT Klebsiella pneumoniae strain WCHKP1845, recovered from the sputum of a patient with pneumonia, was resistant to colistin and carried the carbapenemase gene blaNDM-1. Here, we report its 5.4-Mb draft genome sequence, comprising 140 contigs with an average 57.33% G+C content. The genome contains 5,118 coding sequences and 88 tRNA genes. PMID:28209835

  17. Detection of P. aeruginosa harboring bla CTX-M-2, bla GES-1 and bla GES-5, bla IMP-1 and bla SPM-1 causing infections in Brazilian tertiary-care hospital

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    Polotto Milena

    2012-08-01

    Full Text Available Abstract Background Nosocomial infections caused by Pseudomonas aeruginosa presenting resistance to beta-lactam drugs are one of the most challenging targets for antimicrobial therapy, leading to substantial increase in mortality rates in hospitals worldwide. In this context, P. aeruginosa harboring acquired mechanisms of resistance, such as production of metallo-beta-lactamase (MBLs and extended-spectrum beta-lactamases (ESBLs have the highest clinical impact. Hence, this study was designed to investigate the presence of genes codifying for MBLs and ESBLs among carbapenem resistant P. aeruginosa isolated in a Brazilian 720-bed teaching tertiary care hospital. Methods Fifty-six carbapenem-resistant P. aeruginosa strains were evaluated for the presence of MBL and ESBL genes. Strains presenting MBL and/or ESBL genes were submitted to pulsed-field gel electrophoresis for genetic similarity evaluation. Results Despite the carbapenem resistance, genes for MBLs (blaSPM-1 or blaIMP-1 were detected in only 26.7% of isolates. Genes encoding ESBLs were detected in 23.2% of isolates. The blaCTX-M-2 was the most prevalent ESBL gene (19.6%, followed by blaGES-1 and blaGES-5 detected in one isolate each. In all isolates presenting MBL phenotype by double-disc synergy test (DDST, the blaSPM-1 or blaIMP-1 genes were detected. In addition, blaIMP-1 was also detected in three isolates which did not display any MBL phenotype. These isolates also presented the blaCTX-M-2 gene. The co-existence of blaCTX-M-2 with blaIMP-1 is presently reported for the first time, as like as co-existence of blaGES-1 with blaIMP-1. Conclusions In this study MBLs production was not the major mechanism of resistance to carbapenems, suggesting the occurrence of multidrug efflux pumps, reduction in porin channels and production of other beta-lactamases. The detection of blaCTX-M-2,blaGES-1 and blaGES-5 reflects the recent emergence of ESBLs among antimicrobial resistant P. aeruginosa and

  18. The Clinical Isolate Pseudomonas aeruginosa MMA83 Carries Two Copies of the blaNDM-1 Gene in a Novel Genetic Context

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    Jovčić, Branko; Lepsanović, Zorica; Begović, Jelena; Rakonjac, Bojan; Perovanović, Jelena; Topisirović, Ljubiša; Kojić, Milan

    2013-01-01

    The genetic context of the blaNDM-1 gene in the genome of Pseudomonas aeruginosa MMA83 was investigated. Sequencing of the cosmid selected for the blaNDM-1 gene revealed the presence of two blaNDM-1 copies in the genome of P. aeruginosa MMA83 in a unique genetic environment. Additionally, mating assays, DNA-DNA hybridization, and an S1 nuclease assay strongly suggest that the blaNDM-1 gene in P. aeruginosa MMA83 is chromosome borne.

  19. Detection of Ampicillin Resistance Genes (bla in Clinical Isolates of Escherichia coli with Polymerase Chain Reaction Method

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    Tiana Milanda

    2014-09-01

    Full Text Available Escherichia coli is a rod negative Gram which could be pathogenic, if its value increases or located in outer gastrointestinal tract. Pathogenic E. coli will produce enterotoxin which will cause diarrhoea or infection in urine tract. Ampicilin was one of particular antibiotics to overcome infection. Ampicilin nowadays is no longer used as primary medicine, because of its resistance case. The aim of this research is to detect the presence of gene which is responsible to ampicilin resistant E. coli. We used isolated midstream urine from cystitis object in Hasan Sadikin Hospital (RSHS as samples. Polymerase Chain Reaction (PCR method (colony-PCR and DNA-PCR were done to invenstigate the antibiotic resistency. Based on the result of antibiotic susceptibility testing to ampicillin, E. coli samples were resistant to ampicilin. Elektroforegram products of colony-PCR and DNA-PCR showed that the resistance case of ampicilin caused by bla gene (199 bp. Selective and rational antibiotic treatment is required to prevent ampicillin resistance in patients with symptoms

  20. Imipenem-resistant Acinetobacter baumannii carrying the ISAba1-bla OXA-23, 51 and ISAba1-bla ADC-7 genes in Monteria, Colombia

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    Pedro Martínez

    2012-12-01

    Full Text Available The purpose of this study was to identify the genes coding for resistance to ceftazidime and imipenem and describe the molecular epidemiology of A. baumannii strains isolated from a clinical center in Colombia. Twenty isolates of imipenem-resistant A. baumannii from an equal number of patients with nosocomial infections were obtained. Primers were used to amplify genes bla IMP, bla VIM, bla OXA-23, bla OXA-24, bla OXA-58, bla OXA-51 and bla ADC-7. To detect insertion sequences ISAba1/bla OXA-23, ISAba1/bla OXA-51 and ISAba1/bla ADC-7, mapping by PCR using combinations of reverse primers ISAba1 and reverse primers of bla OXA-23, bla OXA-51 and bla ADC-7 were used. The amplification products were purified and cloned into PCR 2.1-TOPO vector and transformed into chemically competent Escherichia coli TOP10. These amplicons were then sequenced. PFGE was performed on DNA of A. baumannii isolates digested with ApaI. Results. The DNA profiles obtained included 9 clusters with, four 2-7 isolates per profile, and 5 single-isolate profiles. Of the 20 isolates resistant to imipenem, 15 carried bla OXA-23 gene, 4 contained ISAba1 upstream of bla OXA-51 gene, and 6 contained ISAba1 upstream of bla OXA-23 gene. Eighteen of these isolates carried the bla ADC-7 gene, with 9 of the isolates having ISAba1 located upstream of this gene. This is the first report of the ISAba1 /ADC-7 associated with OXAs genes in A. baumannii isolates from Colombia.

  1. Characterization of a novel Klebsiella pneumoniae sequence type 476 carrying both bla KPC-2 and bla IMP-4.

    Science.gov (United States)

    Wang, Y; Cao, W; Zhu, X; Chen, Z; Li, L; Zhang, B; Wang, B; Tian, L; Wang, F; Liu, C; Sun, Z

    2012-08-01

    Carbapenemase-producing Klebsiella pneumoniae has recently spread rapidly throughout China. In this study, we characterized a carbapenem-resistant K. pneumoniae isolate that produced both KPC-2 and IMP-4 type carbapenemases. A clinical isolate of K. pneumoniae, resistant to both meropenem and imipenem, was recovered from a urine sample. Antibiotic susceptibility was determined using the broth microdilution method and Etest (bioMérieux, France). Pulsed-field gel electrophoresis and multilocus sequence typing (MLST) were used for gene type analysis. bla (KPC) and the encoding genes of ESBLs and plasmid-mediated AmpC enzymes were polymerase chain reaction (PCR) amplified and sequenced. Plasmids were analyzed by transformation, enzyme restriction and Southern blot. PCR analysis revealed that the isolate was simultaneously carrying bla (KPC-2), bla (IMP-4), bla (TEM-1), and bla (OKP-B) genes. MLST assigned the isolate to a novel sequence type, ST476. bla (KPC-2)-harbouring plasmids of the isolate and comparative strains had similar EcoRI and HindIII restriction maps, while IMP-4-harbouring plasmids had variable HindIII restriction maps. Coexistence of bla (KPC-2) and bla (IMP-4) was probably due to bla (IMP-4)-harbouring plasmid transmission into KPC-2-producing K. pneumoniae (ST476). The concomitant presence of these genes is alarming and poses both therapeutic and infection control problems.

  2. Identification of blaOXA-51, blaOXA-58, blaDIM-1 and blaVIM carbapenemase genes in hospital enterobacteriaceae isolates from Sierra Leone

    Science.gov (United States)

    We describe the results of a molecular epidemiological survey of 15 carbapenemase-encoding genes from a recent collection of clinical isolates. The most salient findings revealed that (i) 60% of the isolates harbored multiple carbapenemase genes, (ii) the blaDIM-1 gene that has only been reported in...

  3. Clinical Specimen-Direct LAMP: A Useful Tool for the Surveillance of blaOXA-23-Positive Carbapenem-Resistant Acinetobacter baumannii.

    Science.gov (United States)

    Yamamoto, Norihisa; Hamaguchi, Shigeto; Akeda, Yukihiro; Santanirand, Pitak; Kerdsin, Anusak; Seki, Masafumi; Ishii, Yoshikazu; Paveenkittiporn, Wantana; Bonomo, Robert A; Oishi, Kazunori; Malathum, Kumthorn; Tomono, Kazunori

    2015-01-01

    Healthcare-associated infections are a leading cause of morbidity and mortality worldwide. Treatment is increasingly complicated by the escalating incidence of antimicrobial resistance. Among drug-resistant pathogens, carbapenem-resistant Acinetobacter baumannii (CRAb) is of increasing concern because of the limited applicable therapies and its expanding global distribution in developed countries and newly industrialized countries. Therefore, a rapid detection method that can be used even in resource-poor countries is urgently required to control this global public health threat. Conventional techniques, such as bacterial culture and polymerase chain reaction (PCR), are insufficient to combat this threat because they are time-consuming and laborious. In this study, we developed a loop-mediated isothermal amplification (LAMP) method for detecting blaOXA-23-positive CRAb, the most prevalent form of CRAb in Asia, especially in Thailand, and confirmed its efficacy as a surveillance tool in a clinical setting. Clinical samples of sputum and rectal swabs were collected from patients in a hospital in Bangkok and used for LAMP assays. After boiling and centrifugation, the supernatants were used directly in the assay. In parallel, a culture method was used for comparison purposes to evaluate the specificity and sensitivity of LAMP. As a first step, a total of 120 sputum samples were collected. The sensitivity of LAMP was 88.6% (39/44), and its specificity was 92.1% (70/76) using the culture method as the "gold standard". When surveillance samples including sputum and rectal swabs were analyzed with the LAMP assay, its sensitivity was 100.0%. This method enables the direct analysis of clinical specimens and provides results within 40 minutes of sample collection, making it a useful tool for surveillance even in resource-poor countries.

  4. Clinical Specimen-Direct LAMP: A Useful Tool for the Surveillance of blaOXA-23-Positive Carbapenem-Resistant Acinetobacter baumannii.

    Directory of Open Access Journals (Sweden)

    Norihisa Yamamoto

    Full Text Available Healthcare-associated infections are a leading cause of morbidity and mortality worldwide. Treatment is increasingly complicated by the escalating incidence of antimicrobial resistance. Among drug-resistant pathogens, carbapenem-resistant Acinetobacter baumannii (CRAb is of increasing concern because of the limited applicable therapies and its expanding global distribution in developed countries and newly industrialized countries. Therefore, a rapid detection method that can be used even in resource-poor countries is urgently required to control this global public health threat. Conventional techniques, such as bacterial culture and polymerase chain reaction (PCR, are insufficient to combat this threat because they are time-consuming and laborious. In this study, we developed a loop-mediated isothermal amplification (LAMP method for detecting blaOXA-23-positive CRAb, the most prevalent form of CRAb in Asia, especially in Thailand, and confirmed its efficacy as a surveillance tool in a clinical setting. Clinical samples of sputum and rectal swabs were collected from patients in a hospital in Bangkok and used for LAMP assays. After boiling and centrifugation, the supernatants were used directly in the assay. In parallel, a culture method was used for comparison purposes to evaluate the specificity and sensitivity of LAMP. As a first step, a total of 120 sputum samples were collected. The sensitivity of LAMP was 88.6% (39/44, and its specificity was 92.1% (70/76 using the culture method as the "gold standard". When surveillance samples including sputum and rectal swabs were analyzed with the LAMP assay, its sensitivity was 100.0%. This method enables the direct analysis of clinical specimens and provides results within 40 minutes of sample collection, making it a useful tool for surveillance even in resource-poor countries.

  5. Tianeptine - A Clinical Review.

    OpenAIRE

    More Patil Vidita; More Patil Vrunda; Yadav KS; Gomes M

    2016-01-01

    Depression is a wide spread disorder. The development of effective pharmacotherapy for major depression is important because it is such a widespread and debilitating mental disorder. The following review is based on the preclinical and clinical studies carried out on Tianeptine, an atypical antidepressant that lowers the adverse effects of stress on brain and memory. It is one of the many drugs being tested these days in the market as nootropics; it is presented as a “Smart Drug”. These are b...

  6. Detection of bla KPC-2 in Proteus mirabilis in Brazil

    Directory of Open Access Journals (Sweden)

    Adriane Borges Cabral

    2015-02-01

    Full Text Available INTRODUCTION : Infections caused by Klebsiella pneumoniae carbapenemase (KPC-producing isolates pose a major worldwide public health problem today. METHODS : A carbapenem-resistant Proteus mirabilis clinical isolate was investigated for plasmid profiles and the occurrence of β-lactamase genes. RESULTS : The isolate exhibited resistance to ertapenem and imipenem and was susceptible to meropenem, polymyxin, and tigecycline. Five plasmids were identified in this isolate. DNA sequencing analysis revealed the presence of bla KPC-2 and bla TEM-1 genes. An additional PCR using plasmid DNA confirmed that bla KPC-2 was present in one of these plasmids. Conclusions: We report the detection of bla KPC-2 in P. mirabilis in Brazil for the first time. This finding highlights the continuous transfer of bla KPC between bacterial genera, which presents a serious challenge to the prevention of infection by multidrug-resistant bacteria.

  7. A new blaLEN-17 gene in a clinical isolate of Staphylococcus epidermidis in Shanghai, China

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ The introduction of the antibiotics into clinical practice has significantly reduced the mortality of infectious diseases.Although chromosomally mediated β-lactamase is natural in many genera of bacteria.the intensive use of antibiotics is the main cause for the increasing emeNence of new β-lactamases.So far,more than 340 β-lactamases have been identified,1 among which,more than 200 are extended-spectrum β-lactamases (ESBLs).3 The most prevalent β-lactamases are class A enzymes,including SHV and TEM.Genes encoding these enzymes generally located in large transferable plasmids.

  8. Coexistence of blaOXA-48 and Truncated blaNDM-1 on Different Plasmids in a Klebsiella pneumoniae Isolate in China

    Science.gov (United States)

    Xie, Lianyan; Dou, Yi; Zhou, Kaixin; Chen, Yue; Han, Lizhong; Guo, Xiaokui; Sun, Jingyong

    2017-01-01

    Objectives: To describe the genetic environment, transferability, and antibiotic susceptibility of one clinical Klebsiella pneumoniae isolate harboring both blaOXA-48 and blaNDM-1 on different plasmids from a Chinese hospital. Methods: The isolate was subjected to antimicrobial susceptibility testing and multilocus sequence typing using Etest and PCR. The plasmids harboring blaOXA-48 and blaNDM-1 were analyzed through conjugation experiments, S1-nuclease pulsed-field gel electrophoresis, and hybridization with specific probes. Plasmid DNA was sequenced using Pacbio RS II and annotated using RAST. Results: K. pneumoniae RJ119, carrying both blaOXA-48 and blaNDM-1, was resistant to almost all carbapenems, cephalosporins, fluoroquinolone, and aminoglycosides and belonged to ST307. blaOXA-48 was located on a 61,748-bp IncL/M conjugative plasmid, which displayed overall nucleotide identity (99%) to pKPN-E1-Nr.7. blaNDM-1 was located on a 335,317-bp conjugative plasmid, which was a fusion of a blaNDM-1-harboring InA/C plasmid pNDM-US (140,825 bp, 99% identity) and an IncFIB plasmid pKPN-c22 (178,563 bp, 99% identity). The transconjugant RJ119-1 harboring blaNDM-1 was susceptible to carbapenem, and there was an insertion of IS10 into the blaNDM-1 gene. Conclusion: This is the first report of the coexistence of blaOXA-48 and blaNDM-1 in one K. pneumoniae clinical isolate in China. OXA-48 in RJ119 contributed to the majority to its high resistance to carbapenems, whereas NDM-1 remained unexpressed, most likely due to the insertion of IS10. Our results provide new insight for the relationship between genetic diagnosis and clinical treatment. They also indicate that increased surveillance of blaOXA-48 is urgently needed in China. PMID:28210248

  9. Tianeptine - A Clinical Review.

    Directory of Open Access Journals (Sweden)

    More Patil Vidita

    2016-06-01

    Full Text Available Depression is a wide spread disorder. The development of effective pharmacotherapy for major depression is important because it is such a widespread and debilitating mental disorder. The following review is based on the preclinical and clinical studies carried out on Tianeptine, an atypical antidepressant that lowers the adverse effects of stress on brain and memory. It is one of the many drugs being tested these days in the market as nootropics; it is presented as a “Smart Drug”. These are believed to be of low-risk and work to improve, enhance, or repair damage done to the brain via injury or disease.

  10. Rosacea: a clinical review

    Directory of Open Access Journals (Sweden)

    Carsten Sauer Mikkelsen

    2016-06-01

    Full Text Available Rosacea is a field within dermatology with new insight within immunological research and new treatment-algorithm. Patient education on rosacea and appropriate treatments is an important aspect in helping patients succeed with therapy. Treatment should be tailored to each individual patient, taking into account: symptoms, trigger factors, patients’ wishes, most bothersome symptoms, psychological aspect, individual needs. A combination of clinical therapies to treat different symptoms concomitantly may offer the best possible outcomes for the patient. In this review article we describe these aspects.

  11. Direct detection of mecA, blaSHV , blaCTX-M , blaTEM and blaOXA genes from positive blood culture bottles by multiplex-touchdown PCR assay.

    Science.gov (United States)

    Wang, M-Y; Geng, J-L; Chen, Y-J; Song, Y; Sun, M; Liu, H-Z; Hu, C-J

    2017-02-01

    Methicillin-resistant staphylococci (MRS) and ESBL(Extended-Spectrum β-Lactamase)-producing bacteria are the most important resistant pathogens in sepsis. In this study, a new multiplex-touchdown PCR method (MT-PCR) was developed to detect rapidly and simultaneously the presence of mecA, blaSHV , blaCTX-M , blaTEM and blaOXA genes from positive blood culture bottles. The technique showed a sensitivity of 10(3 ) CFU ml(-1) for mecA detection and of 10(2)  CFU ml(-1) for other genes, and 100% specificity in the detection of all genes. All genes were detected in the spiked blood culture bottles artificially contaminated with reference strains. Three methicillin-resistant S. aureus (MRSA), two methicillin-resistant S. epidermidis (MRSE) and 32 ESBL-producing bacteria, were isolated from the clinical blood culture specimens in 48 h by standard microbiological procedures. The corresponding genes were detected directly in the three MRSA, two MRSE and 29 ESBL-producing bacteria from the clinical blood culture specimens in 4 h by MT-PCR assay. None of the blaSHV , blaCTX-M , blaTEM and blaOXA genes were detected in three other bottles with ESBL-producing bacteria because of other ESBL genotypes in the pathogens. Likewise, all bottles proven negative by culture remained negative by PCR. The proposed method was rapid, sensitive and specific, and was able to directly detect the genes of MRS and ESBL-producing bacteria from the blood culture bottles.

  12. [Genetic Investigation of bla(CTX-M)-typing in Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae from Clinical Specimens and Commercially Available Chicken Liver].

    Science.gov (United States)

    Kan, Miki; Shinomiya, Hiroto; Kitao, Takashi

    2016-05-01

    A genetic investigation consisting of the bla(CTX-M) typing was performed using 40 extended spectrum β-lactamase (ESBL)-producing Escherichia coli isolates from chicken liver and 43 ESBL-producing E. coli and 42 ESBL-producing Klebsiella pneumoniae isolates from patients. The types were determined using a sequence analysis. In 31 isolates in the bla(CTX-M-1) group, there were 13 with the bla(CTX-M-1) and all were from chicken liver. Nine E. coli isolates from chicken liver and one E. coli isolate from patients were found to be bla(CTX-M-55). In the bla(CTX-M-15), there were 6 E. coli isolates and one K. pneumoniae isolate from patients. All 39 isolates in the bla(CTX-M-2) group had the blac(CTX-M-2). Fifty-five isolates were found in the bla(CTX-M-9) group, the highest detection frequency, with 36 possessing bla(CTX-M-14) : 20 E. coli and 13 K. pneumoniae from patients and 3 E. coli from chicken liver. There were 17 bla(CTX-M-27) isolates, including 10 E. coli and 7 K. pneumoniae from patients. One bla(CTX-M-90) K. pneumoniae isolate and one bla(CTX-M-9) E. coli isolate were also obtained from patients. These results indicate that the E. coli isolates from chicken liver consist of bla(CTX-M-1), bla(CTX-M-2) and bla(CTX-M-55) ; the E. coli isolates from patients consist of bla(CTX-M-14) and bla(CTX-M-27) ; and the K. pneumoniae isolates from patients consist of bla(CTX-M-2), bla(CTX-M-14) and bla(CTX-M-27). Therefore, the bla(CTX-M) type differs in isolates from chicken liver and those from humans. These results suggest that it is unlikely that ESBL-producing E. coli from chicken liver are firmly established in the human intestinal tract.

  13. Characterization of a novel blaIMP gene, blaIMP-58, using whole genome sequencing in a Pseudomonas putida isolate detected in Denmark

    DEFF Research Database (Denmark)

    Holmgaard, Dennis Back; Hansen, Frank; Hasman, Henrik;

    2017-01-01

    A multidrug-resistant strain of Pseudomonas putida was isolated from the urine of a 65-year-old women hospitalized for serious clinical conditions. Using whole genome sequencing a novel blaIMP gene, blaIMP-58 was discovered and characterized....

  14. Two Multiplex Real-Time PCR Assays to Detect and Differentiate Acinetobacter baumannii and Non- baumannii Acinetobacter spp. Carrying blaNDM, blaOXA-23-Like, blaOXA-40-Like, blaOXA-51-Like, and blaOXA-58-Like Genes.

    Science.gov (United States)

    Yang, Qiu; Rui, Yongyu

    2016-01-01

    Nosocomial infections caused by Acinetobacter spp. resistant to carbapenems are increasingly reported worldwide. Carbapenem-resistant Acinetobacter (CRA) is becoming a serious concern with increasing patient morbidity, mortality, and lengths of hospital stay. Therefore, the rapid detection of CRA is essential for epidemiological surveillance. Polymerase chain reaction (PCR) has been extensively used for the rapid identification of most pathogens. In this study, we have developed two multiplex real-time PCR assays to detect and differentiate A. baumannii and non-A. baumannii Acinetobacter spp, and common carbapenemase genes, including blaNDM, blaOXA-23-like, blaOXA-40-like, blaOXA-51-like, and blaOXA-58-like. We demonstrate the potential utility of these assays for the direct detection of blaNDM-, blaOXA-23-like-, blaOXA-40-like-, blaOXA-51-like-, and blaOXA-58-like-positive CRA in clinical specimens. Primers were specifically designed, and two multiplex real-time PCR assays were developed: multiplex real-time PCR assay1 for the detection of Acinetobacter baumannii 16S-23S rRNA internal transcribed spacer sequence, the Acinetobacter recA gene, and class-B-metalloenzyme-encoding gene blaNDM; and multiplex real-time PCR assay2 to detect class-D-oxacillinase-encoding genes (blaOXA-23-like, blaOXA-40-like, blaOXA-51-like,and blaOXA-58-like). The assays were performed on an ABI Prism 7500 FAST Real-Time PCR System. CRA isolates were used to compare the assays with conventional PCR and sequencing. Known amounts of CRA cells were added to sputum and fecal specimens and used to test the multiplex real-time PCR assays. The results for target and nontarget amplification showed that the multiplex real-time PCR assays were specific, the limit of detection for each target was 10 copies per 20 μL reaction volume, the assays were linear over six log dilutions of the target genes (r2 > 0.99), and the Ct values of the coefficients of variation for intra- and interassay

  15. Detection of blaSHV, blaTEM and blaCTX-M antibiotic resistance genes in randomly selected bacterial pathogens from the Steve Biko Academic Hospital.

    Science.gov (United States)

    Ehlers, Marthie M; Veldsman, Chrisna; Makgotlho, Eddy P; Dove, Michael G; Hoosen, Anwar A; Kock, Marleen M

    2009-08-01

    Extended-spectrum beta-lactamases (ESBLs) are considered to be one of the most important antibiotic resistance mechanisms. This study reported the ESBL-producing genes in 53 randomly selected clinical bacterial isolates from the Steve Biko Academic Hospital. The presence of the bla(SHV), bla(TEM) and bla(CTX-M) genes was determined, and the overall prevalence of these genes detected in this study was 87% (46/53) in comparison with the literature; these results were higher when compared with 33% for Escherichia coli in Europe and 0.8% in Denmark for similar pathogens. These research findings indicated that it is crucial to routinely monitor the prevalence of these resistance genes.

  16. Molecular characterization of the bla(KPC-2) gene in clinical isolates of carbapenem-resistant Klebsiella pneumoniae from the pediatric wards of a Chinese hospital.

    Science.gov (United States)

    Liu, Yang; Li, Xiang-Yang; Wan, La-Gen; Jiang, Wei-Yan; Li, Fang-Qu; Yang, Jing-Hong

    2012-10-01

    The present study was conducted to confirm the presence of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae associated with a nosocomial outbreak in a Chinese pediatric hospital. From July 2009 to January 2011, 124 nonduplicated K. pneumoniae isolates were collected from specimens from patients of pediatric units in the hospital. Twelve of the 124 isolates possessed the bla(KPC-2) gene and showed 7 different pulsed-field gel electrophoresis (PFGE) patterns. Meanwhile, 16S rRNA methylase, acc(6')-Ib-cr, and several types of β-lactamases were also produced by the majority of the KPC-producing isolates. Class 1 integron-encoded intI1 integrase gene was subsequently found in all strains, and amplification, sequencing, and comparison of DNA between 5' conserved segment and 3' conserved segment region showed the presence of several known antibiotic resistance gene cassettes of various sizes. The conjugation and plasmid-curing experiments indicated some KPC-2-encoding genes were transmissible. In addition, conjugal cotransfer of multidrug-resistant phenotypes with KPC-positive phenotypes was observed in KPC-producing strains. Restriction endonuclease analysis and DNA hybridization with a KPC-specific probe showed that the bla(KPC-2) gene was carried by plasmid DNA from K. pneumoniae of PFGE pattern B. The overall results indicate that the emergence and outbreak of KPC-producing K. pneumoniae in our pediatric wards occurred in conjunction with plasmids coharboring 16S rRNA methylase and extended-spectrum β-lactamases.

  17. blaKPC RNA Expression Correlates with Two Transcriptional Start Sites but Not Always with Gene Copy Number in Four Genera of Gram-Negative Pathogens▿

    OpenAIRE

    Roth, Amanda L.; Kurpiel, Philip M.; Lister, Philip D.; Hanson, Nancy D.

    2011-01-01

    Klebsiella pneumoniae carbapenemase (KPC)-producing organisms are therapeutically and diagnostically challenging. It is possible that blaKPC gene expression plays a role in the variability observed in clinical susceptibility testing. blaKPC transformants together with 10 clinical isolates representing four genera were evaluated for blaKPC copy number and gene expression and correlated with β-lactam MIC data. The data suggest that mechanisms other than gene copy number and expression of blaKPC...

  18. Relation between blaTEM, blaSHV and blaCTX-M genes and acute urinary tract infections

    Institute of Scientific and Technical Information of China (English)

    Sima Sadat Seyedjavadi; Mehdi Goudarzi; Fattaneh Sabzehali

    2016-01-01

    Objective: To survey the frequency of blaTEM, blaSHV and blaCTX-M genotypes in extended-spectrum b-lactamase (ESBL)-producing Escherichia coli (E. coli) isolated from hospitalized patients with urinary tract infection and the determination of their antibiotic resistance patterns. Methods: During 11-month study, 100 ESBL-producing E. coli were collected from 330 patients who met the definition of urinary tract infection. The phenotypic identification of ESBL was confirmed by double disk synergy test and combined disk diffusion test. In vitro, susceptibility to ESBL isolates than 14 antimicrobial agents was performed by Kirby-Bauer disk diffusion method. The frequency of blaTEM, blaSHV and blaCTX-M ESBL-producing E. coli was assessed by PCR method. Results: The frequency of ESBL-producing E. coli was 40.8%. In vitro, susceptibility to ESBL-producing E. coli showed that the majority of isolates were highly susceptible to amikacin (74%) and imipenem (91%). The rates of resistance to other antibiotics varied from 33% to 96%. Through 100 tested isolates, the prevalence of blaTEM, blaSHV and blaCTX-M genes was determined to be 67%, 45% and 74% respectively. In comparison with other bla genes, the frequency of blaCTX-M was strikingly high. Conclusions: Due to the increase of E. coli with multiple ESBL genes, continuous sur-veillance in order to use appropriate antibiotics and the control of infections is necessary.

  19. First Report of bla(IMP-8) in Raoultella planticola.

    Science.gov (United States)

    Tseng, Sung-Pin; Wang, Jann-Tay; Liang, Chih-Yuan; Lee, Pei-Shan; Chen, Yee-Chun; Lu, Po-Liang

    2014-01-01

    Two carbapenem-resistant Raoultella planticola clinical isolates were isolated from patients with pneumonia and Port-A catheter-related bacteremia, respectively, in Taiwan. These isolates remained susceptible to fluoroquinolone, aminoglycoside, and colistin. Though the two isolates had the same antibiogram, plasmidic carbapenemase blaIMP-8, class 1 integron cassette (dfrA12-orfF-aadA2), and qnrB2, they had different pulsed-field gel electrophoresis patterns, plasmid sizes, and outer membrane protein loss profiles. To our knowledge, this is the first report of blaIMP-8 found in R. planticola. Interestingly, blaIMP-8 is the most common carbapenemase found in Klebsiella pneumoniae in Taiwan. In the literature, carbapenemase genes in R. planticola in each country were also found in carbapenem-resistant Enterobacteriaceae in the same country.

  20. Rapid discrimination of blaIMP-1, blaIMP-6, and blaIMP-34 using a multiplex PCR.

    Science.gov (United States)

    Kayama, Shizuo; Ohge, Hiroki; Sugai, Motoyuki

    2017-04-01

    Stealth-type carbapenem-resistant Enterobacteriaceae that are resistant to almost all β-lactams except imipenem is emerging in Japan. This resistance is mediated by specific variants of the metallo-β-lactamases (blaIMP-6 or blaIMP-34) that differs by one amino acid from the common variant blaIMP-1. We developed an amplification refractory mutation system (ARMS) PCR assay enabling rapid, sequence independent, identification of these variants.

  1. Drug resistance of Acinetobacter baumannii and detection of blaOXA gene%鲍氏不动杆菌耐药性及blaOXA基因检测

    Institute of Scientific and Technical Information of China (English)

    张玉英; 赵志军; 师志云; 李刚; 贾伟

    2014-01-01

    目的:了解鲍氏不动杆菌(ABA)的耐药特点及blaOXA基因类型,为临床合理使用抗菌药物、有效控制医院感染的发生提供科学依据。方法收集医院自2006年1月-2009年12月临床感染标本分离的鲍氏不动杆菌309株采用K-B法进行药敏试验;利用PCR技术检测 blaOX A-23、blaOX A-24、blaOX A-51和 blaOX A-58基因。结果309株ABA对亚胺培南、美罗培南的耐药率最低,分别为19.7%、20.4%,其次是米诺环素29.5%,阿米卡星39.9%,对其余17种抗菌药物的耐药率均在>45.0%;blaOX A-23基因阳性46株,占14.9%,OX A-51基因阳性302株,占97.7%,未检测到blaOX A-24、blaOX A-58基因型。结论鲍氏不动杆菌耐药情况严重,blaOX A-23型碳青酶烯酶基因的产生是鲍氏不动杆菌耐药的重要机制之一。%OBJECTIVE To investigate the characteristics of drug resistance of Acinetobacter baumannii and observe the blaOXA genotypes so as to provide scientific bases for reasonable clinical use of antibiotics and effective control of nosocomial infections .METHODS From Jan 2006 to Dec 2009 ,totally 309 strains of A .baumannii isolated from infectious specimens were collected ,then the drug susceptibility testing was performed with the use of K-B meth-od ,and the PCR technique was employed to detect the blaOXA-23 ,blaOXA-24 ,blaOXA-51 ,and blaOXA-58 gene .RESULTS The drug resistance rate of the 309 strains of A .baumannii to imipenem was 19 .7% ,meropenem 20 .4% ,minocycline 29 .5% ,amikacin 39 .9% ;the drug resistance rates to other 17 antibiotics were more than 45 .0% .There were 46 (14 .9% ) strains with blaOXA-23 tested positive and 302 (97 .7% ) strains with blaOXA-51 tested positive ,while the genotypes of blaOXA-24 and blaOXA-58 have not been detected .CONCLUSION The A .baumannii strains are highly drug resistant ,and the production of carbapenemase gene blaOXA-23 is one of the important mechanisms of resistance

  2. Identification of Acinetobacter baumannii by detection of the blaOXA-51-like carbapenemase gene intrinsic to this species.

    Science.gov (United States)

    Turton, Jane F; Woodford, Neil; Glover, Judith; Yarde, Susannah; Kaufmann, Mary E; Pitt, Tyrone L

    2006-08-01

    bla(OXA-51-like) was sought in clinical isolates of Acinetobacter species in a multiplex PCR, which also detects bla(OXA-23-like) and class 1 integrase genes. All isolates that gave a band for bla(OXA-51-like) identified as A. baumannii. This gene was detected in each of 141 isolates of A. baumannii but not in those of 22 other Acinetobacter species.

  3. Characterization of the genetic environment of the blaKPC-2 gene among Klebsiella pneumoniae isolates from a Chinese Hospital.

    Science.gov (United States)

    Shen, Pinghua; Zhang, Ying; Li, Gang; Jiang, Xiaofei

    2016-01-01

    Infection caused by carbapenem-resistant Klebsiella pneumoniae has become a major healthcare threat and KPC-2 enzyme is a dominant factor mediating carbapenems resistance in K. pneumoniae. This study was designed to determine the genetic environment of blaKPC-2, which prevailed in clinical K. pneumoniae isolates recovered in Huashan Hospital, Shanghai, China. Forty-two clinical isolates were included in this study by blaKPC-2 screening. After multilocus sequence typing and plasmid analyses of PCR-based replicon typing (PBRT), junction PCR, mapping PCR and crossing PCR assays, primer walking, and amplicon sequencing were used to analyze the genetic environment of the blaKPC-2 gene. ST423, ST65, ST977, and ST11 were all detected in KPC-2-producing K. pneumoniae. Two types of blaKPC-2-bearing genetic structure were found: Tn1721-blaKPC-2-Tn3 and Tn1721-blaKPC-2-ΔTn3-IS26; and were carried in IncX and IncFII plasmids, respectively. In conclusion, the genetic environment of the blaKPC-2 gene was diverse and Tn1721-blaKPC-2-ΔTn3-IS26 was dominant in clinical K. pneumoniae isolates in Huashan Hospital. This study sheds some light on the genetic environment and should foster further studies about the mechanism of the blaKPC-2 dissemination.

  4. Real-time PCR assays for the detection and quantification of carbapenemase genes (bla KPC, bla NDM, and bla OXA-48) in environmental samples.

    Science.gov (United States)

    Subirats, Jèssica; Royo, Elena; Balcázar, José Luis; Borrego, Carles M

    2017-01-13

    In this study, we have developed real-time PCR assays using SYBR Green chemistry to detect all known alleles of bla KPC, bla NDM, and bla OXA-48-like carbapenemase genes in water, sediment, and biofilm samples collected from hospital and wastewater treatment plant (WWTP) effluents and rivers receiving chronic WWTP discharges. The amplification of bla KPC, bla NDM, and bla OXA-48 DNA was linear over 7 log dilutions (R (2) between 0.995 and 0.997) and showing efficiencies ranging from 92.6% to 100.3%. The analytical sensitivity indicated that the reaction for bla KPC, bla NDM, and bla OXA-48-like genes was able to detect 35, 16, and 19 copy numbers per assay, respectively. The three carbapenemase genes were detected in hospital effluents, whereas only the bla KPC and bla NDM genes were detected in biofilm and sediment samples collected from wastewater-impacted rivers. The detection of bla KPC, bla NDM, and bla OXA-48-like genes in different matrices suggests that carbapenem-resistant bacteria occur in both planktonic and benthic habitats thus expanding the range of resistance reservoirs for last-resort antibiotics. We believe that these real-time PCR assays would be a powerful tool for the rapid detection and quantification of bla KPC, bla NDM, and bla OXA-48-like genes in complex environmental samples.

  5. PIRIFORMIS SYNDROME: A CLINICAL REVIEW

    Directory of Open Access Journals (Sweden)

    Samarjit

    2013-04-01

    Full Text Available ABSTRACT: Piriformis Syndrome is a cause for Low back pain whi ch is most of the times misdiagnosed as it may mimic with various other con ditions. Abnormal condition of the Piriformis muscle such as hypertrophy, inflammation, or anatomic variations may lead to this condition. Reported incidence rates for Piriformis S yndrome among patients with low back pain vary widely, from 5% to 36%. Etiology of Piriformis Syndrome is also variable. It can be primary due to anatomical problems or secondary due to vario us other causes like trauma, local ischemia, limb-length discrepancy etc. Diagnosis of Piriformis Syndrome is complex. History with various clinical tests along with MRI, EMG (El ectromyography and Diagnostic blocks may help to diagnose this condition. Here is a review of Piriformis syndrome for better understanding of the problem so that the diagnosis a nd management are appropriate. KEY WORDS:Piriformis Syndrome.

  6. [How to write a good clinical review?].

    Science.gov (United States)

    Krause, B J; Khan, C; Antoch, G

    2015-01-01

    Clinical reviews are an important part of the medical literature offering the reader condensed information on a specific topic. In radiology and nuclear medicine most clinical reviews have a subjective character as they have been written in a rather narrative way. Based on their low level of evidence these narrative reviews are frequently not being considered for establishment of clinical guidelines. The aim of this paper is to aid the reader in writing a good clinical review by highlighting the different aspects of a systematic review.

  7. Draft Genome Sequence of Acinetobacter bereziniae HPC229, a Carbapenem-Resistant Clinical Strain from Argentina Harboring blaNDM-1

    Science.gov (United States)

    Brovedan, Marco; Marchiaro, Patricia M.; Morán-Barrio, Jorgelina; Revale, Santiago; Cameranesi, Marcela; Brambilla, Luciano; Viale, Alejandro M.

    2016-01-01

    We report here the draft genome sequence of an NDM-1-producing Acinetobacter bereziniae clinical strain, HPC229. This strain harbors both plasmid and chromosomal resistance determinants toward different β-lactams and aminoglycosides as well as several types of multidrug efflux pumps, most likely representing an adaptation strategy for survival under different environments. PMID:26966220

  8. Evolution of IncA/C blaCMY-₂-carrying plasmids by acquisition of the blaNDM-₁ carbapenemase gene.

    Science.gov (United States)

    Carattoli, Alessandra; Villa, Laura; Poirel, Laurent; Bonnin, Rémy A; Nordmann, Patrice

    2012-02-01

    The bla(NDM-1) gene has been reported to be often located on broad-host-range plasmids of the IncA/C type in clinical but also environmental bacteria recovered from the New Delhi, India, area. IncA/C-type plasmids are the main vehicles for the spread of the cephalosporinase gene bla(CMY-2), frequently identified in the United States, Canada, and Europe. In this study, we completed the sequence of IncA/C plasmid pNDM-KN carrying the bla(NDM-1) gene, recovered from a Klebsiella pneumoniae isolate from Kenya. This sequence was compared with those of three IncA/C-type reference plasmids from Escherichia coli, Yersinia ruckeri, and Photobacterium damselae. Comparative analysis showed that the bla(NDM-1) gene was located on a widely diffused plasmid scaffold known to be responsible for the spread of bla(CMY-2)-like genes and consequently for resistance to broad-spectrum cephalosporins. Considering that IncA/C plasmids possess a broad host range, this scaffold might support a large-scale diffusion of the bla(NDM-1) gene among Gram-negative rods.

  9. Pulmonary aspergillosis: a clinical review

    Directory of Open Access Journals (Sweden)

    M. Kousha

    2011-09-01

    Full Text Available Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.

  10. Multiplex real-time PCR assay for detection and classification of Klebsiella pneumoniae carbapenemase gene (bla KPC) variants.

    Science.gov (United States)

    Chen, Liang; Mediavilla, José R; Endimiani, Andrea; Rosenthal, Marnie E; Zhao, Yanan; Bonomo, Robert A; Kreiswirth, Barry N

    2011-02-01

    Carbapenem resistance mediated by plasmid-borne Klebsiella pneumoniae carbapenemases (KPC) is an emerging problem of significant clinical importance in Gram-negative bacteria. Multiple KPC gene variants (bla(KPC)) have been reported, with KPC-2 (bla(KPC-2)) and KPC-3 (bla(KPC-3)) associated with epidemic outbreaks in New York City and various international settings. Here, we describe the development of a multiplex real-time PCR assay using molecular beacons (MB-PCR) for rapid and accurate identification of bla(KPC) variants. The assay consists of six molecular beacons and two oligonucleotide primer pairs, allowing for detection and classification of all currently described bla(KPC) variants (bla(KPC-2) to bla(KPC-11)). The MB-PCR detection limit was 5 to 40 DNA copies per reaction and 4 CFU per reaction using laboratory-prepared samples. The MB-PCR probes were highly specific for each bla(KPC) variant, and cross-reactivity was not observed using DNA isolated from several bacterial species. A total of 457 clinical Gram-negative isolates were successfully characterized by our MB-PCR assay, with bla(KPC-3) and bla(KPC-2) identified as the most common types in the New York/New Jersey metropolitan region. The MB-PCR assay described herein is rapid, sensitive, and specific and should be useful for understanding the ongoing evolution of carbapenem resistance in Gram-negative bacteria. As novel bla(KPC) variants continue to emerge, the MB-PCR assay can be modified in response to epidemiologic developments.

  11. Crown lengthening: a clinical review.

    Science.gov (United States)

    Talbot, T R; Briggs, P F; Gibson, M T

    1993-09-01

    The use of crown lengthening surgery as an adjunct to restorative therapy was first suggested by Rosen and Gitnick. This technique is designed to increase the clinical crown heights of teeth requiring restoration following extensive wear through attrition, abrasion and erosion. This loss of tooth tissue and resulting clinical crown height may be localized to a few teeth or affect the entire dentition. This clinical problem is reflected by the increasing number of reports of treatment of the worn dentition.

  12. bla(KPC) RNA expression correlates with two transcriptional start sites but not always with gene copy number in four genera of Gram-negative pathogens.

    Science.gov (United States)

    Roth, Amanda L; Kurpiel, Philip M; Lister, Philip D; Hanson, Nancy D

    2011-08-01

    Klebsiella pneumoniae carbapenemase (KPC)-producing organisms are therapeutically and diagnostically challenging. It is possible that bla(KPC) gene expression plays a role in the variability observed in clinical susceptibility testing. bla(KPC) transformants together with 10 clinical isolates representing four genera were evaluated for bla(KPC) copy number and gene expression and correlated with β-lactam MIC data. The data suggest that mechanisms other than gene copy number and expression of bla(KPC) contribute to variability in susceptibility when testing KPC-producing isolates.

  13. Genetic Structure Associated with blaOXA-18, Encoding a Clavulanic Acid-Inhibited Extended-Spectrum Oxacillinase▿

    Science.gov (United States)

    Naas, Thierry; Namdari, Fatemeh; Bogaerts, Pierre; Huang, Te-Din; Glupczynski, Youri; Nordmann, Patrice

    2008-01-01

    The genetic environment of the blaOXA-18 gene encoding a peculiar clavulanic acid-inhibitable Ambler class D extended-spectrum β-lactamase was determined from the prototype OXA-18-producing Pseudomonas aeruginosa MUS clinical isolate. An 8.2-kb genomic DNA fragment containing blaOXA-18 was cloned from P. aeruginosa MUS. Although most oxacillinases are located in integrons, blaOXA-18 lacked gene cassette-specific features. It was bracketed by two duplicated sequences containing ISCR19, a novel insertion sequence of the ISCR family of mobile elements; ΔintI1, a truncated integrase gene; and a truncated Δaac6′-Ib gene cassette. It is likely that ISCR19 was at the origin of the blaOXA-18 gene mobilization by a rolling-circle transposition event followed by homologous recombination. Furthermore, analysis of the cloned genomic DNA fragment revealed the presence of the integron-containing blaOXA-20 gene. Concomitantly, three P. aeruginosa clinical isolates, displaying a synergy image as determined by double-disk diffusion tests on cloxacillin-containing plates, were isolated from three patients hospitalized in different wards over a 9-month period at the Saint-Luc University hospital (Brussels, Belgium). These isolates were positive by PCR for blaOXA-18 and blaOXA-20 genes, genetically related to P. aeruginosa MUS as determined by pulsed-field gel electrophoresis, and carried the same blaOXA-18/blaOXA-20-associated genetic structures. This report characterized the genetic elements likely at the origin of blaOXA-18 gene mobilization in P. aeruginosa and suggests the spread of oxacillin-type extended-spectrum β-lactamases in P. aeruginosa at the Saint-Luc University hospital of Brussels, Belgium. PMID:18663027

  14. A review of clinical guidelines.

    LENUS (Irish Health Repository)

    Andrews, E J

    2012-02-03

    BACKGROUND: Clinical guidelines are increasingly used in patient management but few clinicians are familiar with their origin or appropriate application. METHODS: A Medline search using the terms \\'clinical guidelines\\' and \\'practice guidelines\\' was conducted. Additional references were sourced by manual searching from the bibliographies of articles located. RESULTS AND CONCLUSION: Clinical guidelines originated in the USA in the early 1980s, initially as a cost containment exercise. Significant improvements in the process and outcomes of care have been demonstrated following their introduction, although the extent of improvement varies considerably. The principles for the development of guidelines are well established but many published guidelines fall short of these basic quality criteria. Guidelines are only one aspect of improving quality and should be used within a wider framework of promoting clinical effectiveness. Understanding their limitations as well as their potential benefits should enable clinicians to have a clearer view of their place in everyday practice.

  15. Multidrug-resistant Acinetobacter baumannii strains carrying the bla(OxA-23) and the bla(GES-11) genes in a neonatology center in Tunisia.

    Science.gov (United States)

    Charfi-Kessis, Karama; Mansour, Wejdene; Ben Haj Khalifa, Anis; Mastouri, Maha; Nordmann, Patrice; Aouni, Mahjoub; Poirel, Laurent

    2014-09-01

    Multidrug-resistant and difficult-to-treat Acinetobacter baumannii may be responsible for nosocomial infections. The production of carbapenem-hydrolyzing class D β-lactamases (CHDLs) and extended-spectrum β-lactamase (ESBLs) of the GES type possessing a carbapenemase activity has been increasingly reported worldwide in A. baumannii. The aim of this study was to analyze the resistance mechanisms of two carbapenem resistant A. baumannii clinical isolates recovered in a neonatology center in the center-east of Tunisia. Two carbapenem resistant A. baumannii isolates were recovered. The first isolate co-harbored the blaGES-11 ESBL gene and the blaOxA-23 CHDL gene. Analyses of the genetic location indicated that the blaGES-11 gene was plasmid located (Gr6). However, the blaOxA-23 gene was located on the chromosome. The second strain had only the blaOxA-23 CHDL gene, which was plasmid located. This study showed the first description of the GES-type β-lactamase in A. baumannii in Tunisia.

  16. XML Determination of Phylogenetic Group and Prevalence of blaCTX-M and blaCTX-M-15 Genes in Escherichia Coli Isolates from Intestinal and Urinary Tract Infections in under Five- Year- Old Children

    Directory of Open Access Journals (Sweden)

    Momeni, F. (MSc

    2014-05-01

    Full Text Available Background and Objective: CTX-M type extended spectrum beta-lactamases is a rapidly expanding group of enzymes encountered with increasing fre‌quency, especially, in Escherichia coli (E. coli. There are a few reports on phylogenetic background of E. coli isolates from clinical sources of under five-year- old children in Iran. The purpose of this study was phylotyping of E. coli isolates having blaCTX-M and blaCTX-M-15 genes from under five-year- old children with diarrhea and urinary tract infection (UTI. Material and Methods: A total of 121 E. coli isolates (75 diarrheas and 46 UTI were obtained and identified as E. coli based on standard bacteriological tests. DNA was extracted from E. coli isolates by alkaline lysis method. PCR assay was used because of high frequency of blaCTX-M and blaCTX-M-15 genes in the isolates and also determination of phylogenetic group/subgroups by detection of yjaA and chuA genes and fragment TspE4.C2. Results: The isolates belonged to four phylogenetic groups A (48.77%, B1 (14.04%, B2 (11.57%, and D (25.62%. In the diarrheic isolates,17.37% were positive for blaCTX-M and 14.04% of isolates possessed both blaCTX-M and blaCTX-15genes.Out of 46 UTI isolates, 21.73% were positive for blaCTX-M and 15.21% for blaCTX-M and blaCTX-M-15 genes. Conclusion: A rather high prevalence of E. coli isolates with blaCTX-M and blaCTX-M-15 genes was observed in fewer than five-year- old children in Khoramabad city. Phylotyping of isolates possessing blaCTX-M and blaCTX-15genes showed that most of them belonge to A and D phylo-groups

  17. Medical record review for clinical pertinence.

    Science.gov (United States)

    Lewis, K S

    1991-08-01

    This clinical pertinence review process described was in effect for seven months, after which the author terminated affiliation with the hospital. Despite resistance by many physicians, this monthly review process focused the medical staff's attention on good documentation practices. To the author's knowledge, the plan is still in use.

  18. Osteoarthritis year 2012 in review: clinical.

    Science.gov (United States)

    Hochberg, M C

    2012-12-01

    Epidemiologic and clinical research in osteoarthritis (OA) continues to focus on analytic and descriptive epidemiology, and the role of both nonpharmacologic and pharmacologic therapies in the management of OA, respectively. A systematic literature review was conducted using PubMed for the period between September 1, 2011 and March 31, 2012. Selected articles in these areas are discussed in this narrative review article.

  19. Citicoline: pharmacological and clinical review, 2010 update.

    Science.gov (United States)

    Secades, J J

    2011-03-14

    This review is based on the previous one published in 2006 -Secades JJ, Lorenzo JL. Citicoline: pharmacological and clinical review, 2006 update. Methods Find Exp Clin Pharmacol 2006; 28 (Suppl B): S1-56-, incorporating the new references until now, having all the information available to facilitate the access to the informacion in one document. This review is focused on the main indications of the drug, as acute stroke and its sequelae, including the cognitive impairment, and traumatic brain injury and its sequelae. There are retrieved the most important experimental and clinical data in both indications.

  20. Multiplex Real-Time PCR Assay for Detection and Classification of Klebsiella pneumoniae Carbapenemase Gene (blaKPC) Variants▿

    OpenAIRE

    Chen, Liang; Mediavilla, José R.; Endimiani, Andrea; Rosenthal, Marnie E.; Zhao, Yanan; Robert A Bonomo; Kreiswirth, Barry N.

    2011-01-01

    Carbapenem resistance mediated by plasmid-borne Klebsiella pneumoniae carbapenemases (KPC) is an emerging problem of significant clinical importance in Gram-negative bacteria. Multiple KPC gene variants (blaKPC) have been reported, with KPC-2 (blaKPC-2) and KPC-3 (blaKPC-3) associated with epidemic outbreaks in New York City and various international settings. Here, we describe the development of a multiplex real-time PCR assay using molecular beacons (MB-PCR) for rapid and accurate identific...

  1. Huntington's disease: a clinical review

    Directory of Open Access Journals (Sweden)

    Roos Raymund AC

    2010-12-01

    Full Text Available Abstract Huntington disease (HD is a rare neurodegenerative disorder of the central nervous system characterized by unwanted choreatic movements, behavioral and psychiatric disturbances and dementia. Prevalence in the Caucasian population is estimated at 1/10,000-1/20,000. Mean age at onset of symptoms is 30-50 years. In some cases symptoms start before the age of 20 years with behavior disturbances and learning difficulties at school (Juvenile Huntington's disease; JHD. The classic sign is chorea that gradually spreads to all muscles. All psychomotor processes become severely retarded. Patients experience psychiatric symptoms and cognitive decline. HD is an autosomal dominant inherited disease caused by an elongated CAG repeat (36 repeats or more on the short arm of chromosome 4p16.3 in the Huntingtine gene. The longer the CAG repeat, the earlier the onset of disease. In cases of JHD the repeat often exceeds 55. Diagnosis is based on clinical symptoms and signs in an individual with a parent with proven HD, and is confirmed by DNA determination. Pre-manifest diagnosis should only be performed by multidisciplinary teams in healthy at-risk adult individuals who want to know whether they carry the mutation or not. Differential diagnoses include other causes of chorea including general internal disorders or iatrogenic disorders. Phenocopies (clinically diagnosed cases of HD without the genetic mutation are observed. Prenatal diagnosis is possible by chorionic villus sampling or amniocentesis. Preimplantation diagnosis with in vitro fertilization is offered in several countries. There is no cure. Management should be multidisciplinary and is based on treating symptoms with a view to improving quality of life. Chorea is treated with dopamine receptor blocking or depleting agents. Medication and non-medical care for depression and aggressive behavior may be required. The progression of the disease leads to a complete dependency in daily life, which

  2. The clinical review of ptosis

    Directory of Open Access Journals (Sweden)

    Hong Kwon-Eui

    2006-02-01

    Full Text Available Object : This paper aims to report the clinical effectiveness of acupuncture & herbal treatment on ptosis, which has no way to be treated but the operative method like a tarsectomy. Method : This study was carried out, from February 2003 to December 2003, to the twenty patients who were diagnosed as an acquired ptosis and treated by acupuncture and herbal treatment in the department of Acupuncture & Moxibustion, Daejon University Oriental Hospital. The selected acupoints were hasamhwang(下三黃 in normal side, BL 2(攢竹, BL 60(崑崙, BL 66(通谷, ST 41(解谿, ST 44(內庭, LI 4(合谷, LI 5(陽谿, guhu(球後, emi(魚尾 in abnormal side. The method of acupuncture insertion for each point was neutral(平補平瀉. The treatment frequency was once a day. And all patients were administered the Bojungikkitanggamibang(補中益氣湯加味方, which is known to be able to rise up the Gi of spleen(脾氣. Result & Suggestion : The treatment result showed that excellent was 95%(19 and poor was 5%(1. Through this result, we can know that oriental medical treatment for ptosis is effective. But continuous study about oriental medical treatment for ptosis is needed hereafter.

  3. "Hemicrania continua": a clinical review.

    Science.gov (United States)

    Bordini, C; Antonaci, F; Stovner, L J; Schrader, H; Sjaastad, O

    1991-01-01

    Hemicrania continua (HC) is a headache entity completely responsive to indomethacin. Since 1984, 18 cases have been described, 15 females and 3 males, i.e. a F:M ratio of 5.0. The finding of a female preponderance, like that in chronic paroxysmal hemicrania, is a new observation. HC is, in general, a unilateral headache in the sense that it sets in on one side and subsequently sticks to this side. In two cases, both sides might possibly be involved, when the pain was at its maximum. In another (somewhat dubious) case the headache was bilateral. The pain was continuous from the beginning in 8 of 18 cases (early stage ratio continuous: non-continuous = 0.8). Over time, the headache developed a continuous character in 16 of the 18 cases, producing a "continuous: non-continuous ratio" of 8:1. The intensity of pain generally was moderate and was not reported as excruciatingly severe by any patient. The autonomic involvement from a clinical point of view, was clearly less pronounced than that of other unilateral headaches, such as cluster headache and chronic paroxysmal hemicrania.

  4. Clinical Microbiology Reviews: Genesis of a Journal

    OpenAIRE

    Morello, Josephine A.

    1999-01-01

    In 1986 planning for a new ASM review journal, Clinical Microbiology Reviews (CMR), began. CMR would publish articles primarily of interest to persons concerned with pathogenesis, laboratory diagnosis, epidemiology, and control of human and veterinary pathogens. The first issue was published in January 1988, with quarterly publication since then. The journal quickly became successful in terms of subscribers and impact on the field, earning a strong national and international reputation. The a...

  5. Clinical Review: Emergency management of acute poisoning

    Directory of Open Access Journals (Sweden)

    D.J. van Hoving

    2011-06-01

    The aim of this commissioned review was to establish concise guidelines for the initial management of the acutely poisoned patient in the Emergency Centre. The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists are the international leaders in the field of toxicology and the guidelines in their position papers were generally followed. Most of the dosage regimes are according to the South African Medicines Formulary.

  6. Mechanisms Involved in Acquisition of blaNDM Genes by IncA/C2 and IncFIIY Plasmids.

    Science.gov (United States)

    Wailan, Alexander M; Sidjabat, Hanna E; Yam, Wan Keat; Alikhan, Nabil-Fareed; Petty, Nicola K; Sartor, Anna L; Williamson, Deborah A; Forde, Brian M; Schembri, Mark A; Beatson, Scott A; Paterson, David L; Walsh, Timothy R; Partridge, Sally R

    2016-07-01

    blaNDM genes confer carbapenem resistance and have been identified on transferable plasmids belonging to different incompatibility (Inc) groups. Here we present the complete sequences of four plasmids carrying a blaNDM gene, pKP1-NDM-1, pEC2-NDM-3, pECL3-NDM-1, and pEC4-NDM-6, from four clinical samples originating from four different patients. Different plasmids carry segments that align to different parts of the blaNDM region found on Acinetobacter plasmids. pKP1-NDM-1 and pEC2-NDM-3, from Klebsiella pneumoniae and Escherichia coli, respectively, were identified as type 1 IncA/C2 plasmids with almost identical backbones. Different regions carrying blaNDM are inserted in different locations in the antibiotic resistance island known as ARI-A, and ISCR1 may have been involved in the acquisition of blaNDM-3 by pEC2-NDM-3. pECL3-NDM-1 and pEC4-NDM-6, from Enterobacter cloacae and E. coli, respectively, have similar IncFIIY backbones, but different regions carrying blaNDM are found in different locations. Tn3-derived inverted-repeat transposable elements (TIME) appear to have been involved in the acquisition of blaNDM-6 by pEC4-NDM-6 and the rmtC 16S rRNA methylase gene by IncFIIY plasmids. Characterization of these plasmids further demonstrates that even very closely related plasmids may have acquired blaNDM genes by different mechanisms. These findings also illustrate the complex relationships between antimicrobial resistance genes, transposable elements, and plasmids and provide insights into the possible routes for transmission of blaNDM genes among species of the Enterobacteriaceae family.

  7. Sequential isolation in a patient of Raoultella planticola and Escherichia coli bearing a novel ISCR1 element carrying blaNDM-1.

    Directory of Open Access Journals (Sweden)

    Juan Li

    Full Text Available BACKGROUND: The gene for New Delhi metallo-β-lactamase 1 (NDM-1 has been reported to be transmitted via plasmids which are easily transferable and capable of wide distribution. We report the isolation of two NDM-1 producing strains and possible in vivo transfer of blaNDM-1 in a patient. METHODS: Clinical samples were collected for bacterial culture and antibiotic susceptibility testing from a patient during a 34-day hospitalization. The presence of blaNDM-1 was detected by PCR and sequencing. Plasmids of interest were sequenced. Medical records were reviewed for evidence of association between the administration of antibiotics and the acquisition of the NDM-1 resistance. RESULTS: A NDM-1 positive Raoultella planticola was isolated from blood on the ninth day of hospitalization without administration of any carbapenem antibiotics and a NDM-1 positive Escherichia coli was isolated from feces on the 29th day of hospitalization and eight days after imipenem administration. The blaNDM-1 was carried by a 280 kb plasmid pRpNDM1-1 in R. planticola and a 58 kb plasmid pEcNDM1-4 in E. coli. The two plasmids shared a 4812 bp NDM-1-ISCR1 element which was found to be excisable from the plasmid as a free form and transferrable in vitro to a NDM-1 negative plasmid from E. coli. CONCLUSION: blaNDM-1 was embedded in an ISCR1 complex class 1 integron as a novel 4812 bp NDM-1-ISCR1 element. The element was found to be able to self excise to become a free form, which may provide a new vehicle for NDM-1 dissemination. This mechanism could greatly accelerate the spread of NDM-1 mediated broad spectrum β-lactam resistance.

  8. First report of the blaVIM gene in environmental isolates of Buttiauxella sp.

    Science.gov (United States)

    Pitondo-Silva, André; Martins, Vinicius Vicente; Stehling, Eliana Guedes

    2015-04-01

    Several works have demonstrated the presence of metallo-β-lactamases (MBLs) in clinical bacteria. However, in environmental isolates, few works have reported on these enzymes. In this study, we report for the first time two environmental isolates of Buttiauxella sp. recovered from chrysanthemum plantations in Brazil containing blaVIM gene and producing MBLs.

  9. Aeromonas spp. simultaneously harbouring bla(CTX-M-15), bla(SHV-12), bla(PER-1) and bla(FOX-2), in wild-growing Mediterranean mussel (Mytilus galloprovincialis) from Adriatic Sea, Croatia.

    Science.gov (United States)

    Maravić, Ana; Skočibušić, Mirjana; Samanić, Ivica; Fredotović, Zeljana; Cvjetan, Svjetlana; Jutronić, Marinka; Puizina, Jasna

    2013-09-02

    Aeromonas species are becoming renowned as emerging pathogens by increasingly giving rise to a wide spectrum of food and waterborne infections in humans. Another worrisome feature of aeromonads is the growing frequency of antibiotic resistance as a consequence of their prominent diversity in terms of resistance determinants. This study aimed at determining the antimicrobial resistance pattern, prevalence and characterization of acquired β-lactamases, including extended-spectrum-β-lactamases (ESBLs) and AmpC cephalosporinases, as well as the presence of class 1 and 2 integrons, in Aeromonas isolates from wild-growing Mediterranean mussel (Mytilus galloprovincialis) of the eastern coast of Adriatic Sea, Croatia. Isolates were tested for susceptibility to 16 antibiotics and β-lactam/β-lactamase inhibitor combinations. Cephalosporin-resistant isolates were further screened by PCR for genes encoding AmpC (bla(FOX), bla(CMY), bla(MOX), bla(LAT), bla(BIL), bla(DHA), bla(ACC), bla(MIR), bla(ACT)), ESBLs (bla(TEM), bla(SHV), bla(CTX-M), bla(PER), bla(VEB), bla(GES/IBC), bla(OXA)) and integrases (intI1, intI2, intI3). Location of bla genes was characterized by plasmid DNA fingerprinting and Southern blot hybridization. Plasmids carrying ESBL genes were investigated for transferability by conjugation and PCR-based replicon typed. Out of 147 Aeromonas isolates recovered, 30 (20%) demonstrated multiple resistance profile, with co-resistance most frequently detected against penicillins, piperacillin/sulbactam and tetracycline. ESBL-encoding genes were detected in 21 (13 Aeromonas caviae and 8 Aeromonas hydrophila) isolates, with bla(CTX-M-15) gene identified in 19 and bla(SHV-12) in 12 isolates. Among them, 10 isolates simultaneously harboured bla(CTX-M-15) and bla(SHV-12), while 3 isolates additionally carried an AmpC β-lactamase bla(FOX-2) gene. bla(PER-1) gene was identified in a single isolate also harbouring the bla(CTX-M-15) gene. While bla(SHV-12) was chromosomally

  10. A review of clinical research in orthodontics.

    Science.gov (United States)

    Tulloch, J F; Antczak-Bouckoms, A A; Tuncay, O C

    1989-06-01

    The orthodontic journals should provide valid and reliable information that helps clinicians make appropriate decisions about patient care. The nature of the published literature has not been categorized. The American Journal of Orthodontics and Dentofacial Orthopedics (formerly the American Journal of Orthodontics) was reviewed for the years 1976, 1981, and 1986, to determine the frequency of clinical articles, the topics reported, the study designs used to obtain information, the senior author affiliation, and the major funding sources. This review demonstrates that more than half the articles in this Journal report data on patients, with the majority focusing on the evaluation or description of therapeutic interventions. Academic institutions contribute the majority of the clinical research, although only a few student theses are published. The major support for this work continues to be from departmental resources with little external funding. Despite the introduction of powerful research designs such as randomized clinical trials, these methods have not been widely adopted for orthodontic clinical research. The case report (study containing fewer than 10 patients with no control nor comparison group) continues to be the most frequently published format. Clinicians should become aware of the inherent weakness in the research designs generally used and recognize the limited information that can be obtained from such methods. Support for this research needs to be greatly expanded if the more powerful type of study required to provide valid and reliable clinical information is to be continued.

  11. Infant botulism: review and clinical update.

    Science.gov (United States)

    Rosow, Laura K; Strober, Jonathan B

    2015-05-01

    Botulism is a rare neuromuscular condition, and multiple clinical forms are recognized. Infant botulism was first identified in the 1970s, and it typically occurs in infants younger than 1 year of age who ingest Clostridium botulinum spores. A specific treatment for infant botulism, intravenous botulism immunoglobulin (BIG-IV or BabyBIG®), was developed in 2003, and this treatment has substantially decreased both morbidity and hospital costs associated with this illness. This article will review the pathogenesis of infant botulism as well as the epidemiology, clinical manifestations, diagnosis, and treatment of this condition.

  12. The role of the genetic elements bla oxa and IS Aba 1 in the Acinetobacter calcoaceticus-Acinetobacter baumannii complex in carbapenem resistance in the hospital setting

    Directory of Open Access Journals (Sweden)

    Vanessa Cristine Kobs

    Full Text Available Abstract: INTRODUCTION: Members of the Acinetobacter genus are key pathogens that cause healthcare-associated infections, and they tend to spread and develop new antibiotic resistance mechanisms. Oxacillinases are primarily responsible for resistance to carbapenem antibiotics. Higher rates of carbapenem hydrolysis might be ascribed to insertion sequences, such as the ISAba1 sequence, near bla OXA genes. The present study examined the occurrence of the genetic elements bla OXA and ISAba1 and their relationship with susceptibility to carbapenems in clinical isolates of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex. METHODS: Isolates identified over 6 consecutive years in a general hospital in Joinville, Southern Brazil, were evaluated. The investigation of 5 families of genes encoding oxacillinases and the ISAba1 sequence location relative to bla OXA genes was conducted using polymerase chain reaction. RESULTS: All isolates presented the bla OXA-51-like gene (n = 78, and 91% tested positive for the bla OXA-23-like gene (n = 71. The presence of ISAba1 was exclusively detected in isolates carrying the bla OXA-23-like gene. All isolates in which ISAba1 was found upstream of the bla OXA-23-like gene (n = 69 showed resistance to carbapenems, whereas the only isolate in which ISAba1 was not located near the bla OXA-23-like gene was susceptible to carbapenems. The ISAba1 sequence position of another bla OXA-23-like-positive isolate was inconclusive. The isolates exclusively carrying the bla OXA-51-like gene (n = 7 showed susceptibility to carbapenems. CONCLUSIONS: The presence of the ISAba1 sequence upstream of the bla OXA-23-like gene was strongly associated with carbapenem resistance in isolates of the A. calcoaceticus-A. baumannii complex in the hospital center studied.

  13. Review of clinical medicine and religious practice.

    Science.gov (United States)

    Stewart, William C; Adams, Michelle P; Stewart, Jeanette A; Nelson, Lindsay A

    2013-03-01

    The purpose was to evaluate faith-based studies within the medical literature to determine whether there are ways to help physicians understand how religion affects patients’ lives and diseases. We reviewed articles that assessed the influence of religious practices on medicine as a primary or secondary variable in clinical practice. This review evaluated 49 articles and found that religious faith is important to many patients, particularly those with serious disease, and patients depend on it as a positive coping mechanism. The findings of this review can suggest that patients frequently practice religion and interact with God about their disease state. This spiritual interaction may benefit the patient by providing comfort, increasing knowledge about their disease, greater treatment adherence, and quality of life. The results of prayer on specific disease states appear inconsistent with cardiovascular disease but stronger in other disease states.

  14. The Prediabetic Period: Review of Clinical Aspects

    Directory of Open Access Journals (Sweden)

    Sang Youl Rhee

    2011-04-01

    Full Text Available Hyperglycemia that does not satisfy the diagnostic criteria for diabetes mellitus (DM is generally called prediabetes (preDM. The global prevalence of preDM has been increasing progressively in the past few decades, and it has been established that preDM status is a strong risk factor for DM and cardiovascular disease. Currently, preDM status is classified into two subtypes: impaired fasting glucose and impaired glucose tolerance. Currently, preDM is not regarded as an independent clinical entity, but only as a risk factor for others. In this article, we review various clinical aspects of preDM in terms of the working definition, changes in criteria over the years, epidemiology, and pathophysiological characteristics, and its clinical significance in current medicine.

  15. ESBL, plasmidic AmpC, and associated quinolone resistance determinants in coliforms isolated from hospital effluent: first report of qnrB2, qnrB9, qnrB19, and blaCMY-4 in Algeria.

    Science.gov (United States)

    Anssour, Lynda; Messai, Yamina; Derkaoui, Meriem; Alouache, Souhila; Estepa, Vanesa; Somalo, Sergio; Torres, Carmen; Bakour, Rabah

    2014-04-01

    The characterization of extended-spectrum beta-lactamases , plasmidic AmpC (pAmpC), and associated plasmid-mediated quinolone resistance (PMQR) determinants in cefotaxime-resistant coliforms isolated from hospital effluent in Algiers showed blaCTX-M genes in 89%, blaTEM-1 in 79·8%, and pAmpC genes (blaCIT) in 2·7% isolates. Association of ISEcp1B with blaCTX-M was found in all CTX-M+ isolates, and 97·2% harboured class 1 integrons. Sequencing showed blaCTX-M-15, blaCTX-M-3, and blaCMY-4 genes. blaCTX-M-3 and blaCTX-M-15 were located in Inc L/M conjugative plasmids. The PMQR determinants identified were qnrB1, qnrB2, qnrB9, qnrB19, qnrS2, and aac(6')-Ib-cr. qnrB2, qnrB9, qnrB19, and blaCMY-4 are described for the first time in Algeria and qnrB19 for the first time in non-clinical environments. This study highlights the major potential role of hospital effluents as providers of resistance genes to natural environments.

  16. Osteoarthritis year in review 2014: clinical.

    Science.gov (United States)

    Hawker, G A; Stanaitis, I

    2014-12-01

    A systematic search was conducted for the time period April 1 2013 to March 30 2014 using PubMed to identify major osteoarthritis (OA) clinical research themes of the past year. Articles within each theme were selected for inclusion in this review based on study quality and relevance. Two major themes emerged, which relate to the current understanding of OA as a heterogeneous condition with multiple pathogenic mechanisms and clinical manifestations. Theme 1 stems from the role of systemic inflammation in OA pathogenesis, and the concept of 'metabolic OA'. Over the past year, research has examined the effect of OA on incidence and progression of other 'metabolic syndrome'-related conditions, especially cardiovascular disease (CVD) and diabetes and the impact of multi-morbidity on the clinical management of OA. Theme 2 focuses on the concept of personalized medicine as it relates to the treatment of OA. It is hypothesized that the modest efficacy of available OA treatments is a result of inclusion of heterogeneous groups of OA patients in clinical trials. Prognostic studies in the past year have been helpful in identifying 'OA phenotypes' that are more or less likely to respond to treatments--e.g., the presence of synovitis on imaging, central pain sensitization on quantitative sensory testing (QST), or coping efficacy by self-reported patient questionnaire. Their findings are being increasingly used to target interventions to these identified 'OA responder' subgroups with the hopes that treatment effect will be amplified.

  17. Clinical Aspects of Feline Retroviruses: A Review

    Directory of Open Access Journals (Sweden)

    Katrin Hartmann

    2012-10-01

    Full Text Available Feline leukemia virus (FeLV and feline immunodeficiency virus (FIV are retroviruses with global impact on the health of domestic cats. The two viruses differ in their potential to cause disease. FeLV is more pathogenic, and was long considered to be responsible for more clinical syndromes than any other agent in cats. FeLV can cause tumors (mainly lymphoma, bone marrow suppression syndromes (mainly anemia, and lead to secondary infectious diseases caused by suppressive effects of the virus on bone marrow and the immune system. Today, FeLV is less commonly diagnosed than in the previous 20 years; prevalence has been decreasing in most countries. However, FeLV importance may be underestimated as it has been shown that regressively infected cats (that are negative in routinely used FeLV tests also can develop clinical signs. FIV can cause an acquired immunodeficiency syndrome that increases the risk of opportunistic infections, neurological diseases, and tumors. In most naturally infected cats, however, FIV itself does not cause severe clinical signs, and FIV-infected cats may live many years without any health problems. This article provides a review of clinical syndromes in progressively and regressively FeLV-infected cats as well as in FIV-infected cats.

  18. Identification of bla KPC-2 on different plasmids of three Morganella morganii isolates.

    Science.gov (United States)

    Shi, D-S; Wang, W-P; Kuai, S-G; Shao, H-F; Huang, M

    2012-05-01

    Three Morganella morganii strains resistant to carbapenems were recovered from the surgical intensive care unit (SICU) in our hospital. Carbapenemases and extended-spectrum β-lactamases (ESBLs) were respectively detected by the modified Hodge test and the modified Clinical and Laboratory Standards Institute (CLSI) ESBL confirmatory test in all isolates. Amplification of whole-cell and plasmid DNAs extracted from isolates with primers specific for the bla (KPC) produced an amplicon confirmed to be bla (KPC-2) by sequence analysis. Pulsed-field gel electrophoresis (PFGE) typing revealed that three isolates belonged to two closely related types. Plasmids electrophoresis and restriction analysis revealed that the bla (KPC-2) was located on different plasmids. The transfer of carbapenem resistance from the three original isolates to Escherichia coli EC600 was successful by conjugation. An examination of the outer membrane proteins showed a lack of a 38-kDa outer membrane protein (OMP) compared with M. morganii susceptible to carbapenems. The production of KPC-2 and ESBLs, combined with OMP deficiency, resulted in high-level carbapenem resistance in the M. morganii strains. The genetic environment around bla (KPC-2) analysis revealed that this β-lactamase was located on the same mobile genetic elements which could transfer between different plasmids.

  19. Promoter Deletions of Klebsiella pneumoniae Carbapenemase (KPC)-Encoding Genes (blaKPC-2) and Efflux Pump (AcrAB) on β-Lactam Susceptibility in KPC-Producing Enterobacteriaceae

    OpenAIRE

    Seecoomar, Gomattie D.; Marmol, Brenda C.; Kwon, Dong H.

    2013-01-01

    Klebsiella pneumoniae carbapenemase (KPC)-encoding genes containing promoter-deletions (blaKPC-2a, blaKPC-2b, and blaKPC-2c) have disseminated in Enterobacteriaceae. The minimal inhibitory concentrations (MICs) to β-lactams in clinical KPC-producing Enterobacteriaceae are ranging from susceptible to high-level resistant resulting in diagnostic problems. In order to better understand the variability in β-lactam MICs among KPC-producing Enterobacteriaceae, three isoforms of blaKPC-2 gene were u...

  20. Detection of staphylococcal cassette chromosome mec type XI carrying highly divergent mecA, mecI, mecR1, blaZ, and ccr genes in human clinical isolates of clonal complex 130 methicillin-resistant Staphylococcus aureus.

    LENUS (Irish Health Repository)

    Shore, Anna C

    2011-08-01

    Methicillin resistance in staphylococci is mediated by penicillin binding protein 2a (PBP 2a), encoded by mecA on mobile staphylococcal cassette chromosome mec (SCCmec) elements. In this study, two clonal complex 130 (CC130) methicillin-resistant Staphylococcus aureus (MRSA) isolates from patients in Irish hospitals were identified that were phenotypically PBP 2a positive but lacked mecA by conventional PCR and by DNA microarray screening. The isolates were identified as methicillin-susceptible S. aureus using the GeneXpert real-time PCR assay. Whole-genome sequencing of one isolate (M10\\/0061) revealed a 30-kb SCCmec element encoding a class E mec complex with highly divergent blaZ-mecA-mecR1-mecI, a type 8 cassette chromosome recombinase (ccr) complex consisting of ccrA1-ccrB3, an arsenic resistance operon, and flanking direct repeats (DRs). The SCCmec element was almost identical to that of SCCmec type XI (SCCmec XI) identified by the Sanger Institute in sequence type 425 bovine MRSA strain LGA251 listed on the website of the International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements. The open reading frames (ORFs) identified within SCCmec XI of M10\\/0061 exhibited 21 to 93% amino acid identity to ORFs in GenBank. A third DR was identified ca. 3 kb downstream of SCCmec XI, indicating the presence of a possible SCC remnant. SCCmec XI was also identified in the second CC130 MRSA isolate by PCR and sequencing. The CC130 MRSA isolates may be of animal origin as previously reported CC130 S. aureus strains were predominantly from bovine sources. The highly divergent nature of SCCmec XI relative to other SCCmec elements indicates that it may have originated in another taxon.

  1. Beta-Lactamase Encoded Genes blaTEM and blaCTX Among Acinetobacter baumannii Species Isolated From Medical Devices of Intensive Care Units in Tehran Hospitals

    Science.gov (United States)

    Khalilzadegan, Sara; Sade, Mojtaba; Godarzi, Hussein; Eslami, Gita; Hallajzade, Masoumeh; Fallah, Fatemeh; Yadegarnia, Davood

    2016-01-01

    Background Excessive consumption of antimicrobial materials in hospitals is considered as the main encoder leading to the emergence, development and acquisition of new bacterial resistance to beta-lactamase. Objectives Owing to the lack of proper information regarding the mechanism of the bacterial resistance to antibiotics and responsible genes in the country, the current study aimed to consider the resistance or sensitivity of the Acinetobacter baumannii multi drug resistant (MDR) isolates facing 2% glutaraldehyde. The study was conducted in the selected intensive care units in Tehran hospitals, Iran, in 2013. Materials and Methods In this study conducted over a period of 10 months, A. baumannii species were isolated by bacterial culture following biochemical tests from intensive care units (ICUs) of some hospitals in Tehran, Iran (Fayazbaksh, Taleghani, Imam Khomeini, Valiasr, Labafinejad). The resistance and sensitivity of the isolates to antibiotics were considered according to the clinical and laboratory standard institute CLSI (2012) guidelines. By multiplex PCR method, blaCTX and blaTEM genes were detected and finally, MDR strains were treated with 2% glutaraldehyde. PCR was used for each strain of MDR using specific primers. Results In the current study, 131 A. baumannii isolates (22.3%) out of 588 were studied. The level of resistance to various antibiotics was in the range of 69.4% to 100%. The frequencies of blaTEM and blaCTX genes were 3.2% and 19.4%, respectively. MIC50% and MIC90% of imipenem and meropenem antibiotics were 32 ± 1 µg/mL and 64 ± 1 µg/mL, respectively (P < 0.9). However no resistance to glutaraldehyde was observed. Different bands of MDR strains were observed in the PCR product by electrophoresis. Conclusions It seems that besides the variety and prevalence of blaTEM and blaCTX, enormous mechanisms such as porin and leaking systems (efflux pumps) are responsible for the information of the A. baumannii resistance to disinfectants

  2. Class 1 integrons in non-clonal multidrug-resistant Acinetobacter baumannii from Iran, description of the new blaIMP-55 allele in In1243.

    Science.gov (United States)

    Azizi, Omid; Shakibaie, Mohammad Reza; Badmasti, Farzad; Modarresi, Farzan; Ramazanzadeh, Rashid; Mansouri, Shahla; Shahcheraghi, Fereshteh

    2016-09-01

    Infections and outbreaks caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) are prevalent and have been reported worldwide over the past 20 or more years. Class 1 integron in MDR-AB plays an important role in the spread of antibiotic resistance in clinical settings. This study has been conducted to evaluate the detection of metallo-β-lactamase, characterization of class 1 integron and determination of clonal relatedness among A. baumannii hospital isolates. Sixty-five clinical isolates of MDR-AB were recovered from two Iranian hospital's intensive care units from February to August 2013. Integrase (intI1) and blaIMP genes were detected in 70.8 % (n=46/65) and 9.23 % (n=6/65) of the isolates using PCR assay, respectively. No other metallo-β-lactamase genes (blaVIM, blaSIM and blaNDM) were detected. PCR sequencing of integron gene cassette revealed the following arrays: blaOXA10-aacA4-blaIMP-55-cmlA5 (as a novel array was designated In1243), aacC1 and aadA1. Analysis of blaIMP gene revealed a new allele designated as blaIMP-55. Gene transfer experiment by conjugation showed the 36 kb conjugative plasmid harbouring In1243. The clonal assessment by repetitive extragenic palindromic PCR demonstrated a high-degree relatedness among the strains, but strains harbouring In1243 displayed a different repetitive extragenic palindromic PCR profile. In this study, we found that a novel class 1 integron (In1243) that encoded a new blaIMP allele resided on a transferable plasmid in non-clonal strains of MDR-AB.

  3. Topical antioxidants in radiodermatitis: a clinical review.

    Science.gov (United States)

    Kodiyan, Joyson; Amber, Kyle T

    2015-09-01

    Radiation-induced skin toxicity is the most prevalent side effect of radiation therapy. Not only does it have a significant effect on patients' quality of life, but it also results in poor follow-up and early termination of radiotherapy treatment. Several skin care practices and topical applications have been studied in the field of radiodermatitis, including skin washing, topical steroids, and mechanical skin barriers. Aside from these methods, many patients turn to complementary and alternative medicine for the prevention and treatment of radiodermatitis. Many of these alternative therapies are topically applied antioxidants. While the rationale behind the use of antioxidants in treating radiodermatitis is strong, clinical studies have been far less consistent. Even in large scale randomised controlled trials, findings have been limited by the inconsistent use of topical vehicles and placebos. In this article, the authors review the role of topical antioxidants to better help the practitioner navigate through different available skin directed antioxidants.

  4. Pyridoxine in clinical toxicology: a review.

    Science.gov (United States)

    Lheureux, Philippe; Penaloza, Andrea; Gris, Mireille

    2005-04-01

    Pyridoxine (vitamin B6) is a co-factor in many enzymatic pathways involved in amino acid metabolism: the main biologically active form is pyridoxal 5-phosphate. Pyridoxine has been used as an antidote in acute intoxications, including isoniazid overdose, Gyromitra mushroom or false morrel (monomethylhydrazine) poisoning and hydrazine exposure. It is also recommended as a co-factor to improve the conversion of glyoxylic acid into glycine in ethylene glycol poisoning. Other indications are recommended by some sources (for example crimidine poisoning, zipeprol and theophylline-induced seizures, adjunct to d-penicillamine chelation), without significant supporting data. The value of pyridoxine or its congener metadoxine as an agent for hastening ethanol metabolism or improving vigilance in acute alcohol intoxication is controversial. This paper reviews the various indications of pyridoxine in clinical toxicology and the supporting literature. The potential adverse effects of excessive pyridoxine dosage will also be summarized.

  5. Occupational Therapy clinical documentation: a literature review

    Directory of Open Access Journals (Sweden)

    Carla Simon Benevides Panzeri

    2013-12-01

    Full Text Available Occupational therapy clinical documentation comprises all recorded information about a client/patient/user, from forwarding to discharge, and it may integrate the patient’s record or serve as support for the exclusive practice of occupational therapy. In Brazil, despite being a mandatory and routine practice, little scientific-technical material on the subject is available for the support of professionals. This study aimed to identify, through literature review, information for greater understanding and support to the practice of professional activity. The data were analyzed and presented according to the different themes identified, seeking common, complementary and divergent points on each theme. Twelve articles were included in the study. The information obtained addressed themes such as registration methods, perception and attitudes of professionals, communication and language, quality, and others. It was possible to achieve a preliminary approach to the subject and have an overview of aspects related to occupational therapy clinical documentation, but some segmented information and several weaknesses were found

  6. Measurement of Clinical Performance of Nurses: A Literature Review.

    Science.gov (United States)

    Robb, Yvonne; Fleming, Valerie; Dietert, Christine

    2002-01-01

    A research review (n=12) yielded a number of tools for assessing nurses' clinical competence but none that is universally accepted. The review did identify methods that could be used to develop a useful instrument. (Contains 23 references.) (SK)

  7. Fournier’s gangrene. A clinical review

    Directory of Open Access Journals (Sweden)

    Ariana Singh

    2016-10-01

    Full Text Available Introduction and Hypothesis: Fournier’s gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier’s gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier’s gangrene, in particular the various prognostic indicators and management strategies. Methods: A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations. Results: Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier’s gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available

  8. High diversity of plasmids harbouring blaCMY-2 among clinical Escherichia coli isolates from humans and companion animals in the upper Midwestern USA

    DEFF Research Database (Denmark)

    Bortolaia, Valeria; Hansen, Katrine Hartung; Nielsen, Christine

    2014-01-01

    To determine the population structure and genetic relatedness of plasmids encoding CMY-2 β-lactamase in clinical Escherichia coli from humans and companion animals within a defined geographical area....

  9. Promoter deletions of Klebsiella pneumoniae carbapenemase (KPC)-encoding genes (blaKPC -2) and efflux pump (AcrAB) on β-lactam susceptibility in KPC-producing Enterobacteriaceae.

    Science.gov (United States)

    Seecoomar, Gomattie D; Marmol, Brenda C; Kwon, Dong H

    2013-11-01

    Klebsiella pneumoniae carbapenemase (KPC)-encoding genes containing promoter-deletions (bla(KPC-2a), bla(KPC-2b), and bla(KPC-2c) have disseminated in Enterobacteriaceae. The minimal inhibitory concentrations (MICs) to β-lactams in clinical KPC-producing Enterobacteriaceae range from susceptible to high-level resistant, resulting in diagnostic problems. To better understand the variability in β-lactam MICs among KPC-producing Enterobacteriaceae, three isoforms of bla(KPC-2) gene were used to transform Escherichia coli W4573 and its deletion mutant of an efflux pump (AcrAB) to examine the effects on β-lactam susceptibility. MICs to β-lactams in E. coli W4573 and its acrAB mutant strain increased 1- to 500-fold (MIC from 0.125 to 64 μg mL(-1) of aztreonam) in the bla(KPC-2a), bla(KPC-2b), and bla(KPC-2c) transformants compared with the cloning vector alone. However, transformants of the acrAB mutant strain remained susceptible to all β-lactams tested except for aztreonam and carbenicillin. Levels of the three promoters' length and carbapenemase activities in the transformants harboring the bla(KPC-2a), bla(KPC-2b), and bla(KPC-2c) were correlated to the levels of β-lactam MICs in both E. coli W4573 and its mutant of an efflux pump (AcrAB). Overall, these results suggest that promoter-deletions of bla(KPC-2) gene and AcrAB may be associated with the variability in β-lactam MICs in KPC-producing Enterobacteriaceae.

  10. Molecular typing and genetic environment of the blaKPC gene in Chilean isolates of Klebsiella pneumoniae.

    Science.gov (United States)

    Barría-Loaiza, Carla; Pincheira, Andrea; Quezada, Mario; Vera, Alejandra; Valenzuela, Pedro; Domínguez, Mariana; Lima, Celia A; Araya, Ingrid; Araya, Pamela; Prat, Soledad; Aguayo, Carolina; Fernández, Jorge; Hormazábal, Juan Carlos; Bello-Toledo, Helia; González-Rocha, Gerardo

    2016-03-01

    The aim of this work was to determine the genetic environment and transferability of blaKPC as well as the pulsotypes of KPC-producing Klebsiella pneumoniae strains isolated from clinical samples in Chilean hospitals. Seventeen strains, principally isolated in Santiago (the capital of Chile) during the years 2012 and 2013, were included. The genetic environment of blaKPC was elucidated by PCR mapping and sequencing. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Curing and conjugation experiments were performed with six strains of different sequence types (STs) and pulsotypes. Thirteen pulsotypes and six STs, mainly belonging to clonal complex 258, were found. In addition, seven strains belonged to a new ST assigned ST1161. The blaKPC sequence indicated that 16 strains had the KPC-2 variant; in only one strain (UC331) an amino acid change (R6P) was detected, corresponding to a new KPC variant designated KPC-24. Molecular characterisation of the blaKPC genetic environment revealed two distinct platforms, namely variant 1a and the Tn4401a isoform, with the first being the most common (11/17 strains). Mating experiments failed to produce transconjugants; however, loss of blaKPC was achieved by plasmid curing in all assayed strains. In conclusion, in Chilean strains of K. pneumoniae, blaKPC is primarily found associated with the variant 1a and is located in non-transferable plasmids. In addition, this study highlights the description of the new ST1161 and the new KPC-24 variant.

  11. A Clinical and Genetic Review of Aniridia

    Directory of Open Access Journals (Sweden)

    Reza Jafari

    2015-07-01

    Full Text Available Aniridia is a congenital pan-ocular, bilateral disorder. The term aniridia is a misleading misnomer, since at least a rudimentary iris is always present. Varied forms range from almost total absence to only mild hypoplasia of the iris. It is inherent in a number of syndromes, including Wilms tumor Aniridia-Genital anomalies-retardation (WAGR. Aniridia has been shown to be associated with mutations in the PAX6 gene, located on chromosome 11p13, telomeric to the Wilms’ tumor predisposition gene (WT1. The pair box gene 6 (PAX6 situated at 11p13 has been confirmed to be the leading gene associated with aniridia. The PAX6 mutation is present in individuals worldwide and has been studied in Indian, Malaysian, Chinese and Mexican families. Several categories of PAX6 mutations include: nonsense mutations, splicing mutations, frameshift mutations (deletion or insertion, in-frame insertion or deletion, missense mutations and run-on mutations. A novel de novo frameshift mutation in PAX6 most possibly occurred in the paternal gamete. Mutation in PAX6 brings about amino acid substitution for instance proline to glutamine. Deletion of 11p13 involves the PAX6 (aniridia locus and the adjacent WT1 (Wilms tumor locus. Haploinsufficiency at the PAX6 locus brings on aniridia, a pan-ocular eye condition characterized by iris hypoplasia and various other anterior and posterior eye defects, subtle hypogonadotropic hypogonadism and borderline Growth Hormone (GH deficiency. Aniridia may also be affiliated with retinal tears and detachments. Electroretinograms (ERGs done in aniridia illustrate definite retinal dysfunction. Other clinical aspects related to aniridia are ptosis with reduced levator function and anterior polar cataracts. The PAX6 gene mutation was also associated with early-onset diabetes mellitus and aniridia. Aniridia combined with zonular cataract and polydactyly was also described in a patient with Bardet-Biedl syndrome. Aniridia with sensorineural

  12. Detection of blaSPM-1, blaKPC, blaTEM and blaCTX-M genes in isolates of Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. from cancer patients with healthcare-associated infections.

    Science.gov (United States)

    Jácome, Paula Regina Luna de Araújo; Alves, Lílian Rodrigues; Jácome-Júnior, Agenor Tavares; Silva, Maria Jesuíta Bezerra da; Lima, Jailton Lobo da Costa; Araújo, Paulo Sérgio Ramos; Lopes, Ana Catarina S; Maciel, Maria Amélia Vieira

    2016-07-01

    Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. are three of the pathogens most frequently involved in infections of cancer patients, and the production of β -lactamases is a major mechanism of resistance due to its wide diversity of existing enzymes. Therefore, the aim of the present study was to investigate the microbiological profile and data related to patients and infections, and to search for β -lactamase genes in bacterial isolates from hospitalized cancer patients in a hospital in Recife, Pernambuco, Brazil. A total of 169 isolates were recovered between 2012 and 2014, of which 58 were P. aeruginosa, 36 were Acinetobacter spp. and 75 were Klebsiella spp. A high percentage of carbapenem resistance was observed in P. aeruginosa and Acinetobacter spp. Among the carbapenem-resistant bacteria, the blaSPM-1 gene was detected in P. aeruginosa (35.5 %) and Acinetobacter spp. (3.8 %), while blaKPC was detected in P. aeruginosa (25.8 %) only. Among the third- and fourth-generation cephalosporin-resistant strains, in Klebsiella spp. we detected the genes blaTEM (30.6 %), blaCTX-M (58.3 %) and blaKPC (5.6 %), and in Acinetobacter spp. only blaTEM (25.9 %). This the first report of an Acinetobacter baumannii blaSPM-1 gene carrier that has been isolated in Brazil. The most frequent cancer types were bowel tumour [14.8 %; 95 % confidence interval (CI95 %) 9.8-21.1 %], breast cancer (13.6 %; CI95 % 8.8-19.7 %) and prostate cancer (11.2%; CI95 % 6.9-17.0 %). These results therefore provide knowledge of susceptibility profile and resistance mechanisms and thus can contribute to the strategic formulation of hospital infection control plans and the rational use of antimicrobials, reducing mortality from infection levels in cancer patients.

  13. blaCTX-M-15 carried by IncF-type plasmids is the dominant ESBL gene in Escherichia coli and Klebsiella pneumoniae at a hospital in Ghana.

    Science.gov (United States)

    Agyekum, Alex; Fajardo-Lubián, Alicia; Ansong, Daniel; Partridge, Sally R; Agbenyega, Tsiri; Iredell, Jonathan R

    2016-04-01

    Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamases (ESBLs) are among the most multidrug-resistant pathogens in hospitals and are spreading worldwide. Horizontal gene transfer and spread of high-risk clones are involved in ESBL dissemination. Investigation of the resistance phenotypes of 101 consecutive clinical E. coli (n=58) and K. pneumoniae (n=43) isolated at the Komfo Anokye Teaching Hospital in Ghana over 3 months revealed 63 (62%) with an ESBL phenotype. All 63 had a blaCTX-M gene, and sequence analysis showed that 62 of these were blaCTX-M-15. blaCTX-M-15 was linked to ISEcp1 and orf477Δ in all isolates, and most isolates also carried blaTEM, aac(3)-II, aacA4cr, and/or blaOXA-30 genes on IncF plasmids. XbaI/pulsed-field electrophoresis showed heterogeneity among isolates of both species, suggesting that blaCTX-M-15 dissemination is caused by horizontal gene transfer rather than clonal spread of these species in Ghana.

  14. A REVIEW ON CLINICAL TRIALS: WHY TO INTRODUCE ZERO PHASE

    OpenAIRE

    MANINDER KAUR; AMRITPAL SINGH

    2016-01-01

    Objective: The main objective of this study is to know clinical trials in nutshell and phase 0 clinical trial are to establish at the very earliest opportunity-before large numbers of patients have been accrued and exposed to potential drug-associated toxicity-whether an agent is modulating its target in a tumor, and consequently whether further clinical development is warranted. We review here the fundamental requirements of clinical studies conducted under an exploratory IND and address som...

  15. Systematic Reviewers in Clinical Neurology Do Not Routinely Search Clinical Trials Registries.

    Science.gov (United States)

    Sinnett, Philip Marcus; Carr, Branden; Cook, Gregory; Mucklerath, Halie; Varney, Laura; Weiher, Matt; Yerokhin, Vadim; Vassar, Matt

    2015-01-01

    We examined the use of clinical trials registries in published systematic reviews and meta-analyses from clinical neurology. A review of publications between January 1, 2008 and December 31, 2014 from five neuroscience journals (Annals of Neurology, Brain, Lancet Neurology, Neurology, and The Neuroscientist) was performed to identify eligible systematic reviews. The systematic reviews comprising the final sample were independently appraised to determine if clinical trials registries had been included as part of the search process. Studies acknowledging the use of a trials registry were further examined to determine whether trial data had been incorporated into the analysis. The initial search yielded 194 studies, of which 78 systematic reviews met the selection criteria. Of those, five acknowledged the use of a specific clinical trials registry: four reviewed unpublished trial data and two incorporated unpublished trial data into their results. Based on our sample of systematic reviews, there was no increase in the use of trials registries in systematic review searches over time. Few systematic reviews published in clinical neurology journals included data from relevant clinical trials registries.

  16. Vitespen: a preclinical and clinical review.

    NARCIS (Netherlands)

    Wood, C.G.; Mulders, P.F.A.

    2009-01-01

    Vitespen is a heat shock protein (gp96)-peptide complex purified from resected autologous tumors, developed as a means of capturing the antigenic 'fingerprint' of a specific cancer for use as a patient-specific vaccine. Vitespen has been extensively assessed in animal models, and clinically in a ran

  17. Review on clinical trials of targeted treatments in malignant mesothelioma

    DEFF Research Database (Denmark)

    Jakobsen, Jan Nyrop; Sørensen, Jens Benn

    2011-01-01

    Malignant mesothelioma (MM) is an aggressive tumor of the serosal surfaces with a poor prognosis. Advances in the understanding of tumor biology have led to the development of several targeted treatments, which have been evaluated in clinical trials. This article is a comprehensive review of all...... clinical trials evaluating the effect of targeted treatments in MM....

  18. Loose connections between peer-reviewed clinical journals and clinical practice.

    Science.gov (United States)

    Haynes, R B

    1990-11-01

    Many important advances in medical care are first reported in the biomedical literature, but physicians find the literature overwhelming and, therefore, are often unaware of advances. This article examines the ways in which peer-reviewed clinical journals contribute to this problem and proposes some solutions for both their editors and clinical readers. Peer-reviewed clinical journals impede the dissemination of validated advances to practitioners by mixing a few rigorous studies (communications from scientists to practitioners) with many preliminary investigations (communications from scientists to scientists). Journals wishing to improve communication with practitioners should feature rigorous studies of the nature, cause, prognosis, diagnosis, prevention, and treatment of disease and should feature sound clinical review articles (communications from practitioners to practitioners). Additional strategies for improving communication between medical scientists and practitioners include improving publication standards for clinical journals, proving more informative abstracts for clinical articles, fostering the development of derivative literature services, and enhancing practitioners' skills in critically appraising the medical literature.

  19. Virulence of Klebsiella pneumoniae isolates harboring bla KPC-2 carbapenemase gene in a Caenorhabditis elegans model.

    Directory of Open Access Journals (Sweden)

    Jean-Philippe Lavigne

    Full Text Available Klebsiella pneumoniae carbapenemase (KPC is a carbapenemase increasingly reported worldwide in Enterobacteriaceae. The aim of this study was to analyze the virulence of several KPC-2-producing K. pneumoniae isolates. The studied strains were (i five KPC-2 clinical strains from different geographical origins, belonging to different ST-types and possessing plasmids of different incompatibility groups; (ii seven transformants obtained after electroporation of either these natural KPC plasmids or a recombinant plasmid harboring only the bla KPC-2 gene into reference strains K. pneumoniae ATCC10031/CIP53153; and (iii five clinical strains cured of plasmids. The virulence of K. pneumoniae isolates was evaluated in the Caenorhabditis elegans model. The clinical KPC producers and transformants were significantly less virulent (LT50: 5.5 days than K. pneumoniae reference strain (LT50: 4.3 days (p<0.01. However, the worldwide spread KPC-2 positive K. pneumoniae ST258 strains and reference strains containing plasmids extracted from K. pneumoniae ST258 strains had a higher virulence than KPC-2 strains belonging to other ST types (LT50: 5 days vs. 6 days, p<0.01. The increased virulence observed in cured strains confirmed this trend. The bla KPC-2 gene itself was not associated to increased virulence.

  20. Clinical librarian support for rapid review of clinical utility of cancer molecular biomarkers.

    Science.gov (United States)

    Geng, Yimin; Fowler, Clara S; Fulton, Stephanie

    2015-01-01

    The clinical librarian used a restricted literature searching and quality-filtering approach to provide relevant clinical evidence for the use of cancer molecular biomarkers by institutional policy makers and clinicians in the rapid review process. The librarian-provided evidence was compared with the cited references in the institutional molecular biomarker algorithm. The overall incorporation rate of the librarian-provided references into the algorithm was above 80%. This study suggests the usefulness of clinical librarian expertise for clinical practice. The searching and filtering methods for high-level evidence can be adopted by information professionals who are involved in the rapid literature review.

  1. Clinical reasoning in undergraduate nursing education: a scoping review

    Directory of Open Access Journals (Sweden)

    Sáskia Sampaio Cipriano de Menezes

    2015-12-01

    Full Text Available Abstract OBJECTIVE This study aimed at analyzing the current state of knowledge on clinical reasoning in undergraduate nursing education. METHODS A systematic scoping review through a search strategy applied to the MEDLINE database, and an analysis of the material recovered by extracting data done by two independent reviewers. The extracted data were analyzed and synthesized in a narrative manner. RESULTS From the 1380 citations retrieved in the search, 23 were kept for review and their contents were summarized into five categories: 1 the experience of developing critical thinking/clinical reasoning/decision-making process; 2 teaching strategies related to the development of critical thinking/clinical reasoning/decision-making process; 3 measurement of variables related to the critical thinking/clinical reasoning/decision-making process; 4 relationship of variables involved in the critical thinking/clinical reasoning/decision-making process; and 5 theoretical development models of critical thinking/clinical reasoning/decision-making process for students. CONCLUSION The biggest challenge for developing knowledge on teaching clinical reasoning seems to be finding consistency between theoretical perspectives on the development of clinical reasoning and methodologies, methods, and procedures in research initiatives in this field.

  2. Clinical characteristics of roxatidine acetate: a review.

    Science.gov (United States)

    Dammann, H G; de Looze, S M; Bender, W; Labs, R

    1988-01-01

    Pharmacodynamic studies revealed that 150 mg of roxatidine acetate were optimal in suppressing gastric acid secretion, and that a single bedtime dose of 150 mg was more effective than a dose of 75 mg twice daily in terms of inhibiting nocturnal acid secretion. When administered orally as a capsule containing a granule formulation, the drug displayed modified-release properties, which led to a sustained suppression of gastric acid secretion. Clinical trials revealed that roxatidine acetate, 75 mg twice daily and 150 mg at night, was highly effective in healing duodenal and gastric ulcers and in reducing ulcer pain, over 4, 6, and 8 weeks of therapy. A steady reduction in diameter was observed in those ulcers not completely healed during therapy. The single bedtime dose regimen, while producing the same degree of healing as the divided daily dose during controlled clinical trials, may be of greater value in therapeutic use owing to improved patient compliance. In all efficacy criteria (cure, reduction in ulcer size, and pain relief) there was no significant difference between roxatidine acetate in a total daily dose of 150 mg, ranitidine in a total daily dose of 300 mg, and cimetidine in a total daily dose of 800 mg. Prevention of gastric and duodenal ulcer relapse was achieved by roxatidine acetate, 75 mg at night for 6 months, in about 70% of patients, as determined in open, pilot studies--a rate comparable to those reported for cimetidine and ranitidine. Roxatidine acetate shares with ranitidine an improved safety profile when compared with cimetidine. Human pharmacology studies and short-term and long-term clinical trials have all shown that roxatidine acetate is an exceptionally well tolerated compound, without the antiandrogenic activity and interference with hepatic drug metabolism which have characterized cimetidine treatment. A reason for the improved safety profile of roxatidine acetate may be its greater potency than cimetidine (six times less potent) and

  3. Melasma: a clinical and epidemiological review.

    Science.gov (United States)

    Handel, Ana Carolina; Miot, Luciane Donida Bartoli; Miot, Hélio Amante

    2014-01-01

    Melasma is a chronic acquired hypermelanosis of the skin, characterized by irregular brown macules symmetrically distributed on sun-exposed areas of the body, particularly on the face. It is a common cause of demand for dermatological care that affects mainly women (especially during the menacme), and more pigmented phenotypes (Fitzpatrick skin types III-V). Due to its frequent facial involvement, the disease has an impact on the quality of life of patients. Its pathogeny is not yet completely understood, although there are some known triggering factors such as sun exposure, pregnancy, sexual hormones, inflammatory processes of the skin, use of cosmetics, steroids, and photosensitizing drugs. There is also a clear genetic predisposition, since over 40% of patients reported having relatives affected with the disease. In this manuscript, the authors discuss the main clinical and epidemiological aspects of melasma.

  4. Melasma: a clinical and epidemiological review*

    Science.gov (United States)

    Handel, Ana Carolina; Miot, Luciane Donida Bartoli; Miot, Hélio Amante

    2014-01-01

    Melasma is a chronic acquired hypermelanosis of the skin, characterized by irregular brown macules symmetrically distributed on sun-exposed areas of the body, particularly on the face. It is a common cause of demand for dermatological care that affects mainly women (especially during the menacme), and more pigmented phenotypes (Fitzpatrick skin types III-V). Due to its frequent facial involvement, the disease has an impact on the quality of life of patients. Its pathogeny is not yet completely understood, although there are some known triggering factors such as sun exposure, pregnancy, sexual hormones, inflammatory processes of the skin, use of cosmetics, steroids, and photosensitizing drugs. There is also a clear genetic predisposition, since over 40% of patients reported having relatives affected with the disease. In this manuscript, the authors discuss the main clinical and epidemiological aspects of melasma. PMID:25184917

  5. The ART approach: clinical aspects reviewed

    Directory of Open Access Journals (Sweden)

    Gustavo Fabián Molina

    2009-01-01

    Full Text Available The success of ART as a caries management approach is supported by more than 20 years of scientific evidence. ART follows the contemporary concepts of modern cariology and restorative dentistry. It challenges treatment concepts such as step-wise excavation and the need for complete removal of affected dentine. The ART approach so far has mainly used high-viscosity glass-ionomer as the sealant and restorative material. Cariostatic and remineralization properties have been ascribed to this material which requires further research to establish its clinical relevance. The adhesion of high-viscosity glass-ionomer to enamel in pits and fissures is apparently strong, as its remnants, blocking the pits and fissures, have been considered a possible reason for the low prevalence of carious lesion development after the glass-ionomer has clinically disappeared from it. Encapsulated high-viscosity glass-ionomers may lead to higher restoration survival results than those of the hand-mixed version and should, therefore, not be neglected when using ART. Similarly, the use of resin-modified glass-ionomer with ART should be researched. The effectiveness of ART when compared to conventional caries management approaches has been shown in numerous studies. Proper case selection is an important factor for long-lasting ART restoration survival. This is based on the caries risk situation of the individual, the size of the cavity opening, the strategic position of the cavitated tooth and the presence of adequate caries control measures. As the operator is one of the main causes for failure of ART restorations, attending a well-conducted ART training course is mandatory for successful implementation of ART.

  6. Characteristics of leadership that influence clinical learning: a narrative review.

    Science.gov (United States)

    Walker, Rachel; Cooke, Marie; Henderson, Amanda; Creedy, Debra K

    2011-11-01

    Leadership has been consistently implied in fostering clinical learning. However there is a lack of clarity about the form leadership should take. Limited quantitative research indicated a narrative approach to review literature from a broad perspective. A framework to guide the synthesis was developed to ensure a rigorous review process. Preliminary reading and review of papers using search terms nursing and leadership and clinical learning and learning culture narrowed the inclusion criteria to 245 papers published between 2000 and 2010. Given the diversity of the papers' focus, aim and context, a refined screening process justified the inclusion of twenty-six papers in the review. A critical appraisal of these peer-reviewed quantitative, qualitative and commentary papers identified factors/elements integral to effective leadership. Across the literature leadership was discussed in relation to two broad themes: influence of leadership on organisational learning and development and; influence of leadership on undergraduate clinical education. The factors central to leadership emerged as transformative principles, the role of the nurse unit/ward manager, collaboration and relationship building and role-modelling. The review has raised some suggestions for future research aimed at examining the impact of a leadership capacity building intervention that supports clinical learning.

  7. Hypoxic Hepatitis: A Review and Clinical Update

    Science.gov (United States)

    Waseem, Najeff; Chen, Po-Hung

    2016-01-01

    Abstract Hypoxic hepatitis (HH), also known as ischemic hepatitis or shock liver, is characterized by a massive, rapid rise in serum aminotransferases resulting from reduced oxygen delivery to the liver. The most common predisposing condition is cardiac failure, followed by circulatory failure as occurs in septic shock and respiratory failure. HH does, however, occur in the absence of a documented hypotensive event or shock state in 50% of patients. In intensive care units, the incidence of HH is near 2.5%, but has been reported as high as 10% in some studies. The pathophysiology is multifactorial, but often involves hepatic congestion from right heart failure along with reduced hepatic blood flow, total body hypoxemia, reduced oxygen uptake by hepatocytes or reperfusion injury following ischemia. The diagnosis is primarily clinical, and typically does not require liver biopsy. The definitive treatment of HH involves correction of the underlying disease state, but successful management includes monitoring for the potential complications such as hypoglycemia, hyperglycemia, hyperammonemia and hepatopulmonary syndrome. Prognosis of HH remains poor, especially for cases in which there was a delay in diagnosis. The in-hospital mortality rate is >50%, and the most frequent cause of death is the predisposing condition and not the liver injury itself. PMID:27777895

  8. Diabetes insipidus: the basic and clinical review

    Directory of Open Access Journals (Sweden)

    Muhammad Waseem Abbas

    2016-01-01

    Full Text Available Diabetes insipidus (DI is a complex disease. DI is inability of the body to conserve water. Polydipsia and polyuria are the major manifestations of DI. DI has various variants including central diabetes insipidus (due to defect in ADH secretion, nephrogenic diabetes insipidus (due to defect in ADH receptors or urea receptors, gestational diabetes insipidus (due to catabolism of ADH by placental vasopressinase and primary polydipsia (due to massive fluid intake. The cause of various variants of DI is either acquired or congenital. High plasma osmolality due to hypotonic urine excretion can be fatal because it can cause psychosis, lethargy, seizures, coma or even death. Polyuria and polydipsia help in the diagnosis of DI. Differential diagnosis of various variants of DI can be carried out on the basis of water deprivation test, MRI and other radiological techniques. The proper management of DI is the replenishment of water loss and correction of clinical presentations produced as a result of DI, major is hypernatremia. The best management for primary polydipsia is fluid restriction while fluid intake is used for adipsic diabetes insipidus. ADH replacement therapy is widely used to treat DI. DDAVP or desmopressin is mostly preferred ADH analogue because it has less side effects and resistant to placental vasoprssinase. [Int J Res Med Sci 2016; 4(1.000: 5-11

  9. Review of splanchnic oximetry in clinical medicine

    Science.gov (United States)

    Bailey, Sean M.; Mally, Pradeep V.

    2016-09-01

    Global tissue perfusion and oxygenation are important indicators of physiologic function in humans. The monitoring of splanchnic oximetry through the use of near-infrared spectroscopy (NIRS) is an emerging method used to assess tissue oxygenation status. Splanchnic tissue oxygenation (SrS) is thought to be potentially of high value in critically ill patients because gastrointestinal organs can often be the first to suffer ischemic injury. During conditions of hypovolemia, cardiac dysfunction, or decreased oxygen-carrying capacity, blood flow is diverted toward vital organs, such as the brain and the heart at the expense of the splanchnic circulation. While monitoring SrS has great potential benefit, there are limitations to the technology and techniques. SrS has been found to have a relatively high degree of variability that can potentially make it difficult to interpret. In addition, because splanchnic organs only lie near the skin surface in children and infants, and energy from currently available sensors only penetrates a few centimeters deep, it can be difficult to use clinically in a noninvasive manner in adults. Research thus far is showing that splanchnic oximetry holds great promise in the ability to monitor patient oxygenation status and detect disease states in humans, especially in pediatric populations.

  10. Postural orthostatic tachycardia syndrome: a clinical review.

    Science.gov (United States)

    Johnson, Jonathan N; Mack, Kenneth J; Kuntz, Nancy L; Brands, Chad K; Porter, Coburn J; Fischer, Philip R

    2010-02-01

    Postural orthostatic tachycardia syndrome was defined in adult patients as an increase >30 beats per minute in heart rate of a symptomatic patient when moving from supine to upright position. Clinical signs may include postural tachycardia, headache, abdominal discomfort, dizziness/presyncope, nausea, and fatigue. The most common adolescent presentation involves teenagers within 1-3 years of their growth spurt who, after a period of inactivity from illness or injury, cannot return to normal activity levels because of symptoms induced by upright posture. Postural orthostatic tachycardia syndrome is complex and likely has numerous, concurrent pathophysiologic etiologies, presenting along a wide spectrum of potential symptoms. Nonpharmacologic treatment includes (1) increasing aerobic exercise, (2) lower-extremity strengthening, (3) increasing fluid/salt intake, (4) psychophysiologic training for management of pain/anxiety, and (5) family education. Pharmacologic treatment is recommended on a case-by-case basis, and can include beta-blocking agents to blunt orthostatic increases in heart rate, alpha-adrenergic agents to increase peripheral vascular resistance, mineralocorticoid agents to increase blood volume, and serotonin reuptake inhibitors. An interdisciplinary research approach may determine mechanistic root causes of symptoms, and is investigating novel management plans for affected patients.

  11. Transcatheter therapies for resistant hypertension: Clinical review

    Institute of Scientific and Technical Information of China (English)

    Adil; Lokhandwala; Abhijeet; Dhoble

    2014-01-01

    Resistant hypertension(RHTN) is a commonly encountered clinical problem and its management remains a challenging task for healthcare providers. The prevalence of true RHTN has been difficult to assess due to pseudoresistance and secondary hypertension. Atherosclerotic renal artery stenosis(RAS) has been associated as a secondary cause of RHTN. Initial studies had shown that angioplasty and stenting for RAS were a promising therapeutic option when added to optimal medical management. However, recent randomized controlled trials in larger populations have failed to show any such benefit. Sympathetic autonomic nervous system dysfunction is commonly noted in individuals with resistant hypertension. Surgical sympathectomy was the treatment of choice for malignant hypertension and it significantly improved mortality. However, postsurgical complications and the advent of antihypertensive drugs made this approach less desirable and it was eventually abandoned. Increasing prevalence of RHTN in recent decades has led to the emergence of minimally invasive interventions such as transcatheter renal denervation for better control of blood pressure. It is a minimally invasive procedure which uses radiofrequency energy for selective ablation of renal sympathetic nerves located in the adventitia of the renal artery. It is a quick procedure and has a short recovery time. Early studies in small population showed significant reduction in blood pressure. The most recent Symplicity HTN-3 study, which is the largest randomized control trial and the only one to use a sham procedure in controls, failed to show significant BP reduction at 6 mo.

  12. Review of splanchnic oximetry in clinical medicine.

    Science.gov (United States)

    Bailey, Sean M; Mally, Pradeep V

    2016-09-01

    Global tissue perfusion and oxygenation are important indicators of physiologic function in humans. The monitoring of splanchnic oximetry through the use of near-infrared spectroscopy (NIRS) is an emerging method used to assess tissue oxygenation status. Splanchnic tissue oxygenation (SrSO2) is thought to be potentially of high value in critically ill patients because gastrointestinal organs can often be the first to suffer ischemic injury. During conditions of hypovolemia, cardiac dysfunction, or decreased oxygen-carrying capacity, blood flow is diverted toward vital organs, such as the brain and the heart at the expense of the splanchnic circulation. While monitoring SrSO2 has great potential benefit, there are limitations to the technology and techniques. SrSO2 has been found to have a relatively high degree of variability that can potentially make it difficult to interpret. In addition, because splanchnic organs only lie near the skin surface in children and infants, and energy from currently available sensors only penetrates a few centimeters deep, it can be difficult to use clinically in a noninvasive manner in adults. Research thus far is showing that splanchnic oximetry holds great promise in the ability to monitor patient oxygenation status and detect disease states in humans, especially in pediatric populations.

  13. Feline heartworm disease: a clinical review.

    Science.gov (United States)

    Litster, Annette L; Atwell, Richard B

    2008-04-01

    Feline heartworm disease is caused by the filarial nematode Dirofilaria immitis, and is transmitted by mosquitoes in heartworm-endemic areas worldwide. While dogs are the definitive hosts for this parasite, cats can also be infected, and the overall prevalence in cats is between 5% and 10% of that in dogs in any given area. The spectrum of feline presentations varies from asymptomatic infections to chronic respiratory signs, sometimes accompanied by chronic vomiting to acute death with no premonitory signs. Ante-mortem diagnosis can be challenging and relies on a combination of tests, including antigen and antibody serology, thoracic radiography and echocardiography. As treatment with heartworm adulticidal drugs can be life-threatening and heartworm infection in cats is often self-limiting, infected cats are frequently managed with supportive treatment (corticosteroids, bronchodilators, and anti-emetics). Surgical removal of filariae using extraction devices may be considered in some acute cases where immediate curative treatment is necessary, but filarial breakage during the procedure may result in an acute fatal shock-like reaction. Necropsy findings are mainly pulmonary and include muscular hypertrophy of the pulmonary arteries and arterioles on histopathology. A number of safe and effective macrocytic lactone drugs are available for prophylaxis in cats. These drugs can kill a range of larval and adult life-cycle stage heartworms, which may be advantageous in cases of owner compliance failure or when heartworm infection status is undetermined at the time prophylaxis is commenced. An index of suspicion for feline heartworm disease is warranted in unprotected cats with respiratory signs, and perhaps chronic vomiting, in areas where canine heartworm disease is endemic. Many cats, once diagnosed and with appropriate supportive care and monitoring, will resolve their infection and be free of clinical signs.

  14. Factors associated with clinical inertia: an integrative review

    Science.gov (United States)

    Aujoulat, Isabelle; Jacquemin, Patricia; Rietzschel, Ernst; Scheen, André; Tréfois, Patrick; Wens, Johan; Darras, Elisabeth; Hermans, Michel P

    2014-01-01

    Failure to initiate or intensify therapy according to evidence-based guidelines is increasingly being acknowledged as a phenomenon that contributes to inadequate management of chronic conditions, and is referred to as clinical inertia. However, the number and complexity of factors associated with the clinical reasoning that underlies the decision-making processes in medicine calls for a critical examination of the consistency of the concept. Indeed, in the absence of information on and justification of treatment decisions that were made, clinical inertia may be only apparent, and actually reflect good clinical practice. This integrative review seeks to address the factors generally associated with clinical inaction, in order to better delineate the concept of true clinical inertia. PMID:24868181

  15. Emergence of blaCTX-M-15 Gene and Its Transferability in Enterobacter spp. Isolated From the Hospitals of Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Salimian Rizi

    2015-08-01

    Full Text Available Background Enterobacter spp. is increasingly recognized as an important nosocomial pathogen and implicated in many episodes of hospital acquired infections. Objectives The current study aimed to describe distribution and transferability of blaCTX-M-15 gene, and the antibiotic susceptibility pattern in the clinical isolates of Enterobacter spp. Materials and Methods A total of 110 Enterobacter isolates were collected from five hospitals in Tehran, Iran from May 2012 to April 2013. Enterobacter species were identified by API 20E system. Antibacterial susceptibility was determined by disk diffusion method, and extended spectrum beta lactamase (ESBL production was confirmed by combined disk method. The blaCTX-M-15 gene was identified by PCR with specific primers. The transferability of the blaCTX-M-15was tested by conjugation with broth matting method. Results The prevalence of Enterobacter species was E. cloacae (78.2 %, E. aerogenes (6.13 % and E. sakazakii (8.2%. They were from different clinical sources. Maximal resistance in Enterobacter isolates was noticed against Augmentin®, trimethoprim - sulfamethoxazole and cefoxitin 75.5%, 64.5%, and 59.1%, respectively. Fourteen isolates, showed ESBL phenotype. The blaCTX-M-15 gene frequency in Enterobacter isolates was 11.8%. Three conjugative plasmids containing blaCTX-M-15 were found in one Enterobacter isolate. Conclusions It was the first report on the blaCTX-M-15 gene emergence in clinical Enterobacter spp. in Iran. The current study demonstrated the predominant presence of the gene encoding CTX-M-15 among ESBL producing Enterobacter spp. commonly with a large plasmid, in the setting.

  16. Connective tissue manipulation: a review of theory and clinical evidence.

    Science.gov (United States)

    Holey, Liz A; Dixon, John

    2014-01-01

    Connective tissue manipulation or connective tissue massage (bindegewebsmassage) is a manual reflex therapy in that it is applied with the therapist's hands which are in contact with the patient's skin. The assessment of the patient and the clinical decision-making that directs treatment is based on a theoretical model that assumes a reflex effect on the autonomic nervous system which is induced by manipulating the fascial layers within and beneath the skin to stimulate cutaneo-visceral reflexes. This paper reviews the literature and current research findings to establish the theoretical framework for CTM and the evidence for its clinical effects. The rationale for the principles of treatment are discussed and the evidence for the clinical effectiveness assessed through an analytical review of the clinical research.

  17. Deep vein thrombosis: a clinical review

    Directory of Open Access Journals (Sweden)

    Kesieme EB

    2011-04-01

    Full Text Available Emeka Kesieme1, Chinenye Kesieme2, Nze Jebbin3, Eshiobo Irekpita1, Andrew Dongo11Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Nigeria; 2Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Nigeria; 3Department of Surgery, University of Port Harcourt Teaching Hospital, Port-Harcourt, NigeriaBackground: Deep vein thrombosis (DVT is the formation of blood clots (thrombi in the deep veins. It commonly affects the deep leg veins (such as the calf veins, femoral vein, or popliteal vein or the deep veins of the pelvis. It is a potentially dangerous condition that can lead to preventable morbidity and mortality.Aim: To present an update on the causes and management of DVT.Methods: A review of publications obtained from Medline search, medical libraries, and Google.Results: DVT affects 0.1% of persons per year. It is predominantly a disease of the elderly and has a slight male preponderance. The approach to making a diagnosis currently involves an algorithm combining pretest probability, D-dimer testing, and compression ultrasonography. This will guide further investigations if necessary. Prophylaxis is both mechanical and pharmacological. The goals of treatment are to prevent extension of thrombi, pulmonary embolism, recurrence of thrombi, and the development of complications such as pulmonary hypertension and post-thrombotic syndrome.Conclusion: DVT is a potentially dangerous condition with a myriad of risk factors. Prophylaxis is very important and can be mechanical and pharmacological. The mainstay of treatment is anticoagulant therapy. Low-molecular-weight heparin, unfractionated heparin, and vitamin K antagonists have been the treatment of choice. Currently anticoagulants specifically targeting components of the common pathway have been recommended for prophylaxis. These include fondaparinux, a selective indirect factor Xa inhibitor and the new oral selective direct thrombin inhibitors (dabigatran and selective

  18. Nadroparin calcium: a review of its basic and clinical pharmacology

    OpenAIRE

    Ospina-González, Diego Alexander; Universidad de los Andes; Martínez, Jairo Andrés; Universidad de los Andes; Cifuentes, Luis Fernando; Universidad de los Andes

    2011-01-01

    Objective: To evaluate critically the evidence on the basic and clinical pharmacology of nadroparin calcium. Data source: We conducted a literature review from October 1985 to September 2010 in the electronic databases: Pubmed, Cochrane, MD Cosult, Medscape, Scielo and Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA).Study selection: Studies published in English, Spanish or French made in humans and animals for experimentation which reviewed the basic and clinical pharmac...

  19. Detection of blaIMP4 and blaNDM1 harboring Klebsiella pneumoniae isolates in a university hospital in Malaysia

    Directory of Open Access Journals (Sweden)

    Nurul Izzati Hamzan

    2015-03-01

    Full Text Available Background: Antibiotic resistance among Enterobacteriaceae posts a great challenge to the health care service. The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP is attracting significant attention due to its rapid and global dissemination. The infection is associated with significant morbidity and mortality, thus creating challenges for infection control and managing teams to curb the infection. In Southeast Asia, there have been limited reports and subsequent research regarding CRKP infections. Thus, the study was conducted to characterize CRKP that has been isolated in our setting. Methods: A total of 321 K. pneumoniae were included in the study. Each isolate went through an identification process using an automated identification system. Phenotypic characterization was determined using disk diffusion, modified Hodge test, Epsilometer test, and inhibitor combined disk test. Further detection of carbapenemase genes was carried out using polymerase chain reaction and confirmed by gene sequence analysis. Results: All together, 13 isolates (4.05% were CRKP and the majority of them were resistant to tested antibiotics except colistin and tigercycline. Among seven different carbapenemase genes studied (bla KPC, bla IMP, bla SME, bla NDM, bla IMI, bla VIM, and bla OXA, only two, bla IMP4 (1.87% and bla NDM1 (2.18%, were detected in our setting. Conclusion: Evidence suggests that the prevalence of CRKP in our setting is low, and knowledge of Carbapenem-resistant Enterobacteriaceae and CRKP has improved and become available among clinicians.

  20. Mutations in blaKPC-3 that confer ceftazidime-avibactam resistance encode novel KPC-3 variants that function as extended-spectrum β-lactamases.

    Science.gov (United States)

    Haidar, Ghady; Clancy, Cornelius J; Shields, Ryan K; Hao, Binghua; Cheng, Shaoji; Nguyen, M Hong

    2017-02-21

    We identified four blaKPC-3 mutations in ceftazidime-avibactam resistant clinical Klebsiella pneumoniae isolates, corresponding to D179Y, T243M, D179Y/T243M, and EL165 KPC-3 variants. Using site-directed mutagenesis and transforming vectors into Escherichia coli, we conclusively demonstrated that mutant blaKPC-3 encoded enzymes that functioned as extended-spectrum β-lactamases; mutations directly conferred higher MICs of ceftazidime-avibactam MICs, and decreased MICs of carbapenems and other β-lactams. Impact was strongest for the D179Y mutant, highlighting the importance of the KPC Ω-loop.

  1. IncA/C Plasmid Carrying bla(NDM-1), bla(CMY-16), and fosA3 in a Salmonella enterica Serovar Corvallis Strain Isolated from a Migratory Wild Bird in Germany.

    Science.gov (United States)

    Villa, L; Guerra, B; Schmoger, S; Fischer, J; Helmuth, R; Zong, Z; García-Fernández, A; Carattoli, A

    2015-10-01

    A Salmonella enterica serovar Corvallis strain was isolated from a wild bird in Germany. This strain carried the IncA/C2 pRH-1238 plasmid. Complete sequencing of the plasmid was performed, identifying the blaNDM-1, blaCMY-16, fosA3, sul1, sul2, strA, strB, aac(6')-Ib, aadA5, aphA6, tetA(A), mphA, floR, dfrA7, and merA genes, which confer clinically relevant resistance to most of the antimicrobial classes, including β-lactams with carbapenems, fosfomycin, aminoglycosides, co-trimoxazole, tetracyclines, and macrolides. The strain likely originated from the Asiatic region and was transferred to Germany through the Milvus migrans migratory route.

  2. Systematic reviews, systematic error and the acquisition of clinical knowledge

    Directory of Open Access Journals (Sweden)

    Mickenautsch Steffen

    2010-06-01

    Full Text Available Abstract Background Since its inception, evidence-based medicine and its application through systematic reviews, has been widely accepted. However, it has also been strongly criticised and resisted by some academic groups and clinicians. One of the main criticisms of evidence-based medicine is that it appears to claim to have unique access to absolute scientific truth and thus devalues and replaces other types of knowledge sources. Discussion The various types of clinical knowledge sources are categorised on the basis of Kant's categories of knowledge acquisition, as being either 'analytic' or 'synthetic'. It is shown that these categories do not act in opposition but rather, depend upon each other. The unity of analysis and synthesis in knowledge acquisition is demonstrated during the process of systematic reviewing of clinical trials. Systematic reviews constitute comprehensive synthesis of clinical knowledge but depend upon plausible, analytical hypothesis development for the trials reviewed. The dangers of systematic error regarding the internal validity of acquired knowledge are highlighted on the basis of empirical evidence. It has been shown that the systematic review process reduces systematic error, thus ensuring high internal validity. It is argued that this process does not exclude other types of knowledge sources. Instead, amongst these other types it functions as an integrated element during the acquisition of clinical knowledge. Conclusions The acquisition of clinical knowledge is based on interaction between analysis and synthesis. Systematic reviews provide the highest form of synthetic knowledge acquisition in terms of achieving internal validity of results. In that capacity it informs the analytic knowledge of the clinician but does not replace it.

  3. Emergence of blaCTX-M-15 Gene and Its Transferability in Enterobacter spp. Isolated From the Hospitals of Tehran, Iran

    OpenAIRE

    Salimian Rizi; Najar Peerayeh; Bakhshi; Rahbar

    2015-01-01

    Background Enterobacter spp. is increasingly recognized as an important nosocomial pathogen and implicated in many episodes of hospital acquired infections. Objectives The current study aimed to describe distribution and transferability of blaCTX-M-15 gene, and the antibiotic susceptibility pattern in the clinical isolates of Enterobacter spp. Materials and Methods A total of 110 E...

  4. WhatsApp in Clinical Practice: A Literature Review.

    Science.gov (United States)

    Mars, Maurice; Scott, Richard E

    2016-01-01

    Several spontaneous telemedicine services using WhatsApp Messenger have started in South Africa raising issues of confidentiality, data security and storage, record keeping and reporting. This study reviewed the literature on WhatsApp in clinical practice, to determine how it is used, and users' satisfaction.

  5. Understanding clinical review following a death in custody.

    Science.gov (United States)

    Carter, Helen; Goodwin, Sarah

    This article examines the importance of clinical reviews for people receiving care in custodial settings. A case study is used to illustrate the need for accurate record-keeping, particularly following death. Healthcare professionals have a duty to ensure that prisoners have the same rights as members of the general public in relation to access to health care and opportunities to improve their health.

  6. Public titles of clinical trials should have ethics review.

    Science.gov (United States)

    Saenz, Carla; Reveiz, Ludovic; Tisdale, John F

    2015-09-01

    A key aspect to guarantee that research with human subjects is ethical is being overlooked. Ethics review committees invest great effort examining the informed consent documents of research protocols to ensure that potential participants can provide consent validly and are not deluded into thinking that the experimental intervention they may sign up for is already known to be therapeutic. However, these efforts to avoid what is called the "therapeutic misconception" might be in vain if the title with which the studies are being introduced to the potential participants escapes ethics review. Research participants might be deceived by clinical trials entitled "novel therapy" when the point of the trial is precisely to find out whether the intervention at stake is therapeutic or not. Providing potential research participants with such misleading information hampers their ability to make informed decisions. The well-established scrutiny that ethics review committees exercise with regard to consent forms is limited if the registration of clinical trials, for which a public title is chosen, constitutes a process that is independent from the ethics review. In this article, we examine this problem, assess recent measures to integrate clinical trial registration with ethics review processes, and provide specific recommendations to solve the problem and ultimately enhance the accountability, transparency, and ethics of research with human subjects.

  7. Factors associated with clinical inertia: an integrative review

    Directory of Open Access Journals (Sweden)

    Aujoulat I

    2014-05-01

    Full Text Available Isabelle Aujoulat,1 Patricia Jacquemin,1 Ernst Rietzschel,2 André Scheen,3 Patrick Tréfois,4 Johan Wens,5 Elisabeth Darras,1 Michel P Hermans6 1Université Catholique de Louvain, Institute of Health and Society, Brussels, 2Ghent University, Department of Cardiovascular Diseases and Department of Public Health, Faculty of Medicine and Health Sciences, Ghent, 3University of Liège, Division of Diabetes, Nutrition and Metabolic Disorders and Clinical Pharmacology Unit, CHU Liège, Liège, 4Société Scientifique de Médecine Générale, Brussels, 5University of Antwerp, Faculty of Medicine and Health Sciences, Primary and Interdisciplinary Care Antwerp, 6Université Catholique de Louvain, Institute of Experimental and Clinical Research and Cliniques Universitaires Saint-Luc, Department of Endocrinology and Nutrition, Brussels, Belgium Abstract: Failure to initiate or intensify therapy according to evidence-based guidelines is increasingly being acknowledged as a phenomenon that contributes to inadequate management of chronic conditions, and is referred to as clinical inertia. However, the number and complexity of factors associated with the clinical reasoning that underlies the decision-making processes in medicine calls for a critical examination of the consistency of the concept. Indeed, in the absence of information on and justification of treatment decisions that were made, clinical inertia may be only apparent, and actually reflect good clinical practice. This integrative review seeks to address the factors generally associated with clinical inaction, in order to better delineate the concept of true clinical inertia. Keywords: clinical inertia, evidence-based medicine, clinical decision, integrative review, concept clarification, physician adherence to guidelines

  8. Identification and molecular characterization of Escherichia coli blaSHV genes in a Chinese teaching hospital.

    Science.gov (United States)

    Zhu, Mei; Yang, Guangjian; Li, Ailing; Zong, Li; Dong, Zhaoguang; Lu, Junwan; Zhang, Kaibo; Cheng, Cong; Chang, Qingli; Wu, Xiuying; Ying, Jianchao; Li, Xianneng; Ding, Li; Zheng, Haixiao; Yu, Junping; Ying, Jun; Xu, Teng; Yi, Huiguang; Li, Peizhen; Li, Kewei; Wu, Songquan; Bao, Qiyu; Wang, Junrong

    2017-02-05

    Escherichia coli (E. coli) commonly reside in human intestine and most E. coli strains are harmless, but some serotypes cause serious food poisoning. This study identified and molecularly characterized blaSHV genes from 490 E. coli strains with multi-drug resistance in a hospital population. PCR and molecular cloning and southern blot were performed to assess functions and localizations of this resistant E. coli gene and the pulsed-field gel electrophoresis (PFGE) was utilized to demonstrate the clonal relatedness of the positive E. coli strains. The data showed that 4 of these 490 E. coli strains (4/499, 0.8%) carried blaSHV genes that included EC D2485 (blaSHV-5), EC D2487 (blaSHV-5), EC D2684 (blaSHV-11) and EC D2616 (blaSHV-195, a novel blaSHV). Analysis of blaSHV open-reading frame showed that blaSHV-5 had a high hydrolysis activity to the broad-spectrum penicillin (ampicillin or piperacillin), ceftazidime, ceftriaxone, cefotaxime and aztreonam. blaSHV-195 and blaSHV-11 had similar resistant characteristics with high hydrolysis activities to ampicillin and piperacillin, but low activities to cephalosporins. Moreover, the two blaSHV-5 genes were located on a transferable plasmid (23kb), whereas the other two blaSHV variants (blaSHV-11 and blaSHV-195) seemed to be located in the chromosomal material. Both EC D2485 and EC D2487 clones isolated in 2010 had the same DNA finger printing profile and they might be the siblings of clonal dissemination. The data from the current study suggest that the novel blaSHV and clonal dissemination may be developed, although blaSHV genes were infrequently identified in this hospital population. The results of the work demonstrate the necessity for molecular surveillance in tracking blaSHV-producing strains in large teaching hospital settings and emphasize the need for epidemiological monitoring.

  9. Clinical management of alcohol withdrawal: A systematic review

    Directory of Open Access Journals (Sweden)

    Shivanand Kattimani

    2013-01-01

    Full Text Available Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.

  10. Prevalence of ESBL phenotype,blaCTX-M-1,blaSHV andblaTEM genes among uropathogenicEscherichia coli isolates from 3 military hospitals of Tehran, Iran

    Institute of Scientific and Technical Information of China (English)

    Farshad Nojoomi; Abdolmajid Ghasemian

    2016-01-01

    Objective:To determine the extended-spectrum beta-lactamase (ESBL) production and prevalence ofblaCTX-M-1,blaSHV andblaTEM genes among uropathogenic Escherichia coli(UPEC) isolates from 3 military hospitals of Tehran during 2015–2016. Methods: One-hundred and eleven isolates were adopted. The antibiotic susceptibility testing was conducted according to Clinical and Laboratory Standards Institute guidelines. The combine disk was used for phenotypicESBL production. The ceftazidimeMIC was conducted with the micro-broth dilution test. ThePCR assay was used to detect theblaCTX-M-1,blaSHV and blaTEM genes. Results:In the broth microdilution method, 103 (92.7%) isolates showed minimal inhibitory concentration (MIC)≥1µg/mL, and also in the combined disk method, 89 (80.1% of all) wereESBL positive. On the other hand, among 91 ceftazidime resistant isolates, 86 (77.4% of all) wereESBLpositive. The difference between the two methods forESBL confirmation was not significant. The result ofMIC was similar to the disk diffusion method in the detection of phenotypicESBL production. AmongESBLproducer isolates, the prevalence ofblaCTX-M-1, blaSHV andblaTEM was 77.4% (n= 86), 47.4% (n= 53) and 2.4% (n= 2), respectively. These genes were amplified in a wide rangeMIC of ceftazidime. Conclusions:The prevalence of multi-drug resistantUPEC andESBL positive isolates was high in military hospitals. The majority ofUPEC isolates amplifiedblaCTX-M-I andblaSHV typeβ-lactamase genes. One-third of isolates were positive in presence of both these genes. There was no relation between ceftazidimeMIC and presence of beta-lactamase genes.

  11. Influence of agricultural practice on mobile bla genes: IncI1-bearing CTX-M, SHV, CMY and TEM in Escherichia coli from intensive farming soils.

    Science.gov (United States)

    Jones-Dias, Daniela; Manageiro, Vera; Caniça, Manuela

    2016-01-01

    Many calls have been made to address antibiotic resistance in an environmental perspective. With this study, we showed the widespread presence of high-level antibiotic resistant isolates on a collection of non-susceptible Gram-negative bacteria (n = 232) recovered from soils. Bacteria were selected using amoxicillin, cefotaxime and imipenem, from sites representing different agricultural practices (extensive, intensive and organic). Striking levels of non-susceptibility were noticed in intensive soils for norfloxacin (74%), streptomycin (50.7%) and tetracycline (46.6%); indeed, the exposure to intensive agricultural practices constituted a risk factor for non-susceptibility to many antibiotics, multidrug resistance and production of extended-spectrum β-lactamases (ESBL). Analyses of non-susceptibility highlighted that environmental and clinical bacteria from the same species might not share the same intrinsic resistance patterns, raising concerns for therapy choices in environment-borne infections. The multiple sequence-type IncI1-driven spread of penicillinases (blaTEM-1, blaTEM-135), ESBL (blaSHV-12 and blaCTX-M-1) and plasmid-mediated AmpC β-lactamases (blaCMY-2), produced by isolates that share their molecular features with isolates from humans and animals, suggests contamination of agricultural soils. This is also the first appearance of IncI1/ST28-harbouring blaCTX-M-1, which should be monitored to prevent their establishment as successfully dispersed plasmids. This research may help disclose paths of contamination by mobile antibiotic resistance determinants and the risks for their dissemination.

  12. Clinical correlates of common corneal neovascular diseases: a literature review

    Institute of Scientific and Technical Information of China (English)

    Nizar; Saleh; Abdelfattah; Mohamed; Amgad; Amira; A; Zayed; Hamdy; Salem; Ahmed; E; Elkhanany; Heba; Hussein; Nawal; Abd; El-Baky

    2015-01-01

    A large subset of corneal pathologies involves the formation of new vessels(neovascularization), leading to compromised visual acuity. This article aims to review the clinical causes and presentations of corneal neovascularization(CNV) by examining the mechanisms behind common CNV-related corneal pathologies, with a particular focus on herpes simplex stromal keratitis,contact lenses-induced keratitis and CNV secondary to keratoplasty. Moreover, we reviewed CNV in the context of different types of corneal transplantation and keratoprosthesis, and summarized the most relevant treatment available so far.

  13. Increasing secondary bacterial infections with Enterobacteriaceae harboring blaCTX-M-15 and blaCMY-6 in patients with bronchogenic carcinoma:an emerging point of concern

    Institute of Scientific and Technical Information of China (English)

    Mohammed Shahid; Abida Malik; Rakesh Bhargava

    2011-01-01

    Objective: To look for secondary bacterial infections in bronchogenic carcinoma (BCA) with resistant organisms harboring bla genes considering the paucity of relevant studies. Methods:A total of 137 confirmed cases of BCA and 34 healthy volunteers were studied for the occurrence and prevalence of blaCTX-M and and blaAmpC harboring-enterobacteriaceae. A subset of these patients (n=69) was previously reported for the secondary infection with the Aspergillus species. Bronchoalveolar lavages (BAL) were subjected for bacterial and fungal cultures and the bacterial isolates were screened by multiplex PCRs for the presence of blaCTX-M and blaAmpC. The isolates were also screened for the association of insertion sequence (IS26) by PCR and characterized by RAPD for any clonal relatedness. Results: A total of 143 bacterial isolates were obtained from 137 BAL specimens of BCA patients. The Enterobacteriaceae-isolates were multidrug-resistant showing concomitant resistance to fluoroquinolones and aminoglycosides. Both blaCTX-M and blaAmpC of CIT family were detected in 77.4% and 27.4% isolates, respectively. Sequencing revealed the presence of blaCTX-M-15 and blaCMY-6. Twenty one percent of the isolates were simultaneously harboring blaampC and blaCTX-M-15. IS26 PCR and RAPD typing revealed the presence of diverse bacterial population but no predominant clone was identified. The present study also suggests strong association of aspergillosis with lung cancer and further strengthens the potential use of non-validated serological tests suggested earlier. Conclusions: We emphasize that all patients of bronchogenic carcinoma should also be screened for secondary bacterial infections, along with secondary fungal infections, so as to introduce early and specific antimicrobial therapy and to prevent unwanted deaths.

  14. Semantic Interoperability in Clinical Decision Support Systems: A Systematic Review.

    Science.gov (United States)

    Marco-Ruiz, Luis; Bellika, Johan Gustav

    2015-01-01

    The interoperability of Clinical Decision Support (CDS) systems with other health information systems has become one of the main limitations to their broad adoption. Semantic interoperability must be granted in order to share CDS modules across different health information systems. Currently, numerous standards for different purposes are available to enable the interoperability of CDS systems. We performed a literature review to identify and provide an overview of the available standards that enable CDS interoperability in the areas of clinical information, decision logic, terminology, and web service interfaces.

  15. Heparin-Induced Thrombocytopenia: A Comprehensive Clinical Review.

    Science.gov (United States)

    Salter, Benjamin S; Weiner, Menachem M; Trinh, Muoi A; Heller, Joshua; Evans, Adam S; Adams, David H; Fischer, Gregory W

    2016-05-31

    Heparin-induced thrombocytopenia is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to low-molecular weight heparin. In this comprehensive review, the authors highlight heparin-induced thrombocytopenia's risk factors, clinical presentation, pathophysiology, diagnostic principles, and treatment. The authors place special emphasis on the management of patients requiring procedures using cardiopulmonary bypass or interventions in the catheterization laboratory. Clinical vigilance of this disease process is important to ensure its recognition, diagnosis, and treatment. Misdiagnosis of the syndrome, as well as misunderstanding of the disease process, continues to contribute to its morbidity and mortality.

  16. Review of current and evolving clinical indications forendoscopic ultrasound

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    For the first several years after its development,endoscopic ultrasound (EUS) was primarily limited toidentification of pancreatic malignancies. Since thistime, the field of EUS has advanced at a tremendousspeed in terms of additional clinical diagnostic andtherapeutic uses. The combination of ultrasound withendoscopy provides a unique interventional modalitythat is a minimally invasive alternative to various surgicalinterventions. Given the expanding recommendedindications for EUS, this article will serve to review themost common uses with supporting evidence, while alsoexploring innovative endeavors that may soon becomecommon clinical practice.

  17. A one-step multiplex PCR to identify Klebsiella pneumoniae, Klebsiella variicola, and Klebsiella quasipneumoniae in the clinical routine.

    Science.gov (United States)

    Fonseca, Erica Lourenço; Ramos, Nilceia da Veiga; Andrade, Bruno G Nascimento; Morais, Lena L C S; Marin, Michel F Abanto; Vicente, Ana Carolina P

    2017-04-01

    Klebsiella pneumoniae, Klebsiella variicola and Klebsiella quasipneumoniae are difficult to differentiate phenotypically, leading to misinterpretation of their infection prevalence. We propose a multiplex PCR for blaSHV, blaLEN and blaOKP and their flanking gene (deoR). Since this scheme focuses only on chromosomal genes, it will be feasible for Klebsiella identification in the clinical routine.

  18. Ultrastructural changes caused by polymyxin B and meropenem in multiresistant Klebsiella pneumoniae carrying blaKPC-2 gene.

    Science.gov (United States)

    Scavuzzi, Alexsandra Maria Lima; Alves, Luiz Carlos; Veras, Dyana Leal; Brayner, Fábio André; Lopes, Ana Catarina Souza

    2016-12-01

    The ultrastructural alterations caused by polymyxin B and meropenem and by the association between polymyxin B and meropenem were investigated in two multiresistant isolates of Klebsiella pneumoniae (K3-A2 and K12-A2) carriers of blaKPC-2, coming from infection and colonization in patients in a public hospital in Recife, Brazil. The ultrastructural changes were detected by transmission electron microscopy and scanning. The susceptibility of the isolates to antimicrobials was tested by the disc diffusion method and microdilution in broth. The analysis by electron microscopy showed that the isolates presented morphological and ultrastructural cellular changes when subjected to a clinically relevant concentration of antimicrobials alone or in combination. When subjected to meropenem, they presented retraction of the cytoplasmic material, rupture of the cell wall and extravasation of the cytoplasmic content. When submitted to polymyxin B, the isolates showed condensation of the ribosomes, DNA clotting, cell wall thickening and the presence of membrane compartment. When subjected to polymyxin B and meropenem in combination, the isolates showed a higher intensity of the ultrastructural changes visualized. This is the first report of the ultrastructural changes caused by polymyxin B and meropenem in multiresistant isolates of K. pneumoniae carriers of the blaKPC-2 gene. It should be noted that even when the K. pneumoniae isolates were multiresistant carriers of the blaKPC-2 gene, they underwent important structural change owing to the action of polymyxin B and meropenem.

  19. Peer review in Clinical Pharmacology using the 8-D Assessment

    Science.gov (United States)

    Woodcock, Barry G.

    2017-01-01

    The requirement for editors of clinical pharmacology journals to maintain an overview of the peer review process for manuscripts submitted can be facilitated by use of the 8-D Assessment. The 8-D Assessment comprises peer review criteria to determine if the:1. Design of the study, 2. Diagnoses employed, 3. Drug molecules involved, 4. Dosages applied, 5. Data collected, 6. Discussion of the findings, 7. Deductions made, and 8. Documentation are in accord with the objectives of the study and meet the requirements of evidence-based medicine. This tool, although easy to apply, requires a high level of clinical pharmacology expertise, especially in the fields of drug disposition, pharmacokinetics, and drug action. PMID:28218890

  20. Human Motion Video Analysis in Clinical Practice (Review)

    OpenAIRE

    V.V. Borzikov; N.N. Rukina; O.V. Vorobyova; A.N. Kuznetsov; A. N. Belova

    2015-01-01

    The development of new rehabilitation approaches to neurological and traumatological patients requires understanding of normal and pathological movement patterns. Biomechanical analysis of video images is the most accurate method of investigation and quantitative assessment of human normal and pathological locomotion. The review of currently available methods and systems of optical human motion analysis used in clinical practice is presented here. Short historical background is provi...

  1. Randomized Clinical Trials of Constitutional Acupuncture: A Systematic Review

    OpenAIRE

    Myeong Soo Lee; Byung-Cheul Shin; Sun-Mi Choi; Jong Yeol Kim

    2009-01-01

    The aim of this systematic review is to compile and critically evaluate the evidence from randomized clinical trials (RCTs) for the effectiveness of acupuncture using constitutional medicine compared to standard acupuncture. Ten databases were searched through to December 2008 without language restrictions. We also hand-searched nine Korean journals of oriental medicine. We included prospective RCTs of any form of acupuncture with or without electrical stimulation. The included trials had to ...

  2. Clinical diagnosis and management in early Huntington's disease: a review

    Directory of Open Access Journals (Sweden)

    Schiefer J

    2015-03-01

    Full Text Available Johannes Schiefer,1,* Cornelius J Werner,1,* Kathrin Reetz1,2 1Euregional Huntington Center, 2Jülich Aachen Research Alliance (JARA – Translational Brain Medicine, Department of Neurology, RWTH Aachen University, Aachen, Germany *These authors contributed equally to this work Abstract: This review focuses on clinical diagnosis and both pharmacological and nonpharmacological therapeutic options in early stages of the autosomal dominant inherited neurodegenerative Huntington's disease (HD. The available literature has been reviewed for motor, cognitive, and psychiatric alterations, which are the three major symptom domains of this devastating progressive disease. From a clinical point of view, one has to be aware that the HD phenotype can vary highly across individuals and during the course of the disease. Also, symptoms in juvenile HD can differ substantially from those with adult-onset of HD. Although there is no cure of HD and management is limited, motor and psychiatric symptoms often respond to pharmacotherapy, and nonpharmacological approaches as well as supportive care are essential. International treatment recommendations based on study results, critical statements, and expert opinions have been included. This review is restricted to symptomatic and supportive approaches since all attempts to establish a cure for the disease or modifying therapies have failed so far. Keywords: Neurodegeneration, clinical picture, early symptoms, therapy, treatment

  3. Complete Sequence of Four Multidrug-Resistant MOBQ1 Plasmids Harboring blaGES-5 Isolated from Escherichia coli and Serratia marcescens Persisting in a Hospital in Canada.

    Science.gov (United States)

    Boyd, David; Taylor, Geoffrey; Fuller, Jeff; Bryce, Elizabeth; Embree, Joanne; Gravel, Denise; Katz, Kevin; Kibsey, Pamela; Kuhn, Magdalena; Langley, Joanne; Mataseje, Laura; Mitchell, Robyn; Roscoe, Diane; Simor, Andrew; Thomas, Eva; Turgeon, Nathalie; Mulvey, Michael

    2015-06-01

    The usefulness of carbapenems for gram-negative infections is becoming compromised by organisms harboring carbapenemases, enzymes which can hydrolyze the drug. Currently KPC (class A), NDM (class B), and OXA-48 types (class D) are the most globally widespread carbapenemases. However, among the GES-type class A extended-spectrum β-lactamases (ESBLs) there are variants that hydrolyze carbapenems, with blaGES-5 being the most common. Two Escherichia coli and two Serratia marcescens harboring blaGES-5 on plasmids were isolated by the Canadian Nosocomial Infection Surveillance Program (CNISP) from four different patients in a single hospital over a 2-year period. Complete sequencing of the blaGES-5 plasmids indicated that all four had nearly identical backbones consisting of genes for replication, partitioning, and stability, but contained variant accessory regions consisting of mobile elements and antimicrobial resistance genes. The plasmids were of a novel replicon type, but belonged to the MOBQ1 group based on relaxase sequences, and appeared to be mobilizable, but not self-transmissible. Considering the time periods of bacterial isolation, it would appear the blaGES-5 plasmid has persisted in an environmental niche for at least 2 years in the hospital. This has implications for infection control and clinical care when it is transferred to clinically relevant gram-negative organisms.

  4. [Clonal relationship and detection of blaKPC gene in strains of Klebsiella pneumoniae resistant to carbapenems, at a hospital in Venezuela].

    Science.gov (United States)

    Martínez, Dianny; Araque, Yasmina; Roduifo, Hectorina; Caña, Luisa; García, José; Gonzáiez, Diorelis; Rodríguez, Lucy; De Donato, Marcos

    2016-10-01

    In order to study the clonal relationship and blaKPC gene detection in clinical isolates of Klebsiella pneumoniae resistant to carbapenems, we analyzed 22 clinical isolates of K. pneumoniae with resistance to imipenem and/ or meropenem, isolated in the laboratory of bacteriology at the University Hospital "Antonio Patricio de Alcalá" (HUAPA) from the Cumana city, Sucre state, Venezuela, for a period of five consecutive years. Susceptibility to different antimicrobials was determined, and the presence of carbapenemases was detected by modified Hodge method, phenyl boronic acid synergy and combination discs. blaKPC gene detection was conducted by polymerase chain reaction and the clonal relationship was determined by pulsed field electrophoresis. High rates of antimicrobial resistance were found, five strains were negative, at least one phenotypic method, and all carried the blaKPC gene. Clonal spread was observed only in the intensive care unit (ICU), while in other services, polyclonality was found. We concluded that blaKPC gene is present in K. pneumoniae strains resistant to carbapenems isolated in the HUAPA and clonal spread it was only in the ICU.

  5. Efficacy of clinical gait analysis: A systematic review.

    Science.gov (United States)

    Wren, Tishya A L; Gorton, George E; Ounpuu, Sylvia; Tucker, Carole A

    2011-06-01

    The aim of this systematic review was to evaluate and summarize the current evidence base related to the clinical efficacy of gait analysis. A literature review was conducted to identify references related to human gait analysis published between January 2000 and September 2009 plus relevant older references. The references were assessed independently by four reviewers using a hierarchical model of efficacy adapted for gait analysis, and final scores were agreed upon by at least three of the four reviewers. 1528 references were identified relating to human instrumented gait analysis. Of these, 116 original articles addressed technical accuracy efficacy, 89 addressed diagnostic accuracy efficacy, 11 addressed diagnostic thinking and treatment efficacy, seven addressed patient outcomes efficacy, and one addressed societal efficacy, with some of the articles addressing multiple levels of efficacy. This body of literature provides strong evidence for the technical, diagnostic accuracy, diagnostic thinking and treatment efficacy of gait analysis. The existing evidence also indicates efficacy at the higher levels of patient outcomes and societal cost-effectiveness, but this evidence is more sparse and does not include any randomized controlled trials. Thus, the current evidence supports the clinical efficacy of gait analysis, particularly at the lower levels of efficacy, but additional research is needed to strengthen the evidence base at the higher levels of efficacy.

  6. Statistical challenges for central monitoring in clinical trials: a review.

    Science.gov (United States)

    Oba, Koji

    2016-02-01

    Recently, the complexity and costs of clinical trials have increased dramatically, especially in the area of new drug development. Risk-based monitoring (RBM) has been attracting attention as an efficient and effective trial monitoring approach, which can be applied irrespectively of the trial sponsor, i.e., academic institution or pharmaceutical company. In the RBM paradigm, it is expected that a statistical approach to central monitoring can help improve the effectiveness of on-site monitoring by prioritizing and guiding site visits according to central statistical data checks, as evidenced by examples of actual trial datasets. In this review, several statistical methods for central monitoring are presented. It is important to share knowledge about the role and performance capabilities of statistical methodology among clinical trial team members (i.e., sponsors, investigators, data managers, monitors, and biostatisticians) in order to adopt central statistical monitoring for assessing data quality in the actual clinical trial.

  7. E-textiles in Clinical Rehabilitation: A Scoping Review

    Directory of Open Access Journals (Sweden)

    Amanda Fleury

    2015-02-01

    Full Text Available Electronic textiles have potential for many practical uses in clinical rehabilitation. This scoping review appraises recent and emerging developments of textile-based sensors with applications to rehabilitation. Contributions published from 2009 to 2013 are appraised with a specific focus on the measured physiological or biomechanical phenomenon, current measurement practices, textile innovations, and their merits and limitations. While fabric-based signal quality and sensor integration have advanced considerably, overall system integration (including circuitry and power has not been fully realized. Validation against clinical gold standards is inconsistent at best, and feasibility with clinical populations remains to be demonstrated. The overwhelming focus of research and development has been on remote sensing but the opportunity for textile-mediated feedback to the wearer remains unexplored. Recommendations for future research are provided.

  8. Investigation of diversity of plasmids carrying the blaTEM-52 gene

    DEFF Research Database (Denmark)

    Bielak, Eliza Maria; Bergenholtz, Rikke D.; Jørgensen, Mikael Skaanning;

    2011-01-01

    OBJECTIVES: To investigate the diversity of plasmids that carry blaTEM-52 genes among Escherichia coli and Salmonella enterica originating from animals, meat products and humans. METHODS: A collection of 22 blaTEM-52-encoding plasmids was characterized by restriction fragment length polymorphism...... of self-transfer to a plasmid-free E. coli recipient. CONCLUSIONS: The blaTEM-52 gene found in humans could have been transmitted on transferable plasmids originating from animal sources. Some of the blaTEM-52 plasmids carry replicons that differ from the classical ones. Two novel replicons were detected...

  9. blaCTX-M,blaTEM, andblaSHV inEnterobacteriaceae from North-Indian tertiary hospital:high occurrence of combination genes

    Institute of Scientific and Technical Information of China (English)

    Mohammed Shahid; Anuradha Singh; Farrukh Sobia; Mohammad Rashid; Abida Malik; Indu Shukla; Haris Manzoor Khan

    2011-01-01

    Objective:To delineate the frequency of occurrence ofblaCTX-M,blaTEM, andblaSHV in Enterobacteriaceae from North-Indian tertiary hospital.Methods: A random collection of a subset of45Escherichia coli (E. coli) and28Klebsiella pneumoniae (K. pneumoniae) that was resistant to a third generation cephalosporin and obtained during2007-2008 was selected for detailed screening forblaCTX-M,blaTEM, andblaSHV by monoplexPCRs. The isolates demonstrating the presence of blaCTX-M alleles were characterized for the specificCTX-M-genogroup by using a multiplexPCR.Results:Resistance to cefoperazone, ceftazidime, ceftriaxone, cefotaxime, cefoxitin and piperacillin was 100% each inK. pneumoniae isolates, whereas these resistance-rates forE. coli isolates were93.1%, 83.8%, 91.9%, 93.6%, 97.3% and97.1%, respectively. Concomitant resistance to aminoglycosides, quinolones and aztreonam was also noticed. Presence of any of the bla genes (blaCTX-M,blaTEM, andblaSHV) was noticed in a total of28 (38.4%) isolates of the73isolates studied. Many isolates demonstrated occurrence of these genes in various combinations.blaCTX-M,blaTEM, andblaSHV were noticed in 28.8%,10.9% and13.7% isolates, respectively. MultiplexPCR inblaCTX-Mharboring isolates demonstrated the presence ofCTX-M-Genogroup-1 and sequencing for the specificCTX-M-type revealed presence ofCTX-M-15 type. RAPD typing showed wide diversity in isolates.Conclusions:This is amongst the premier report describing the simultaneous occurrence ofblaTEM,blaSHV, andblaampC in IndianEnterobacteriaceae and that wider dissemination of these genes, as demonstrated by diversity of isolates, raises concern and emphasizes a need for extensive search for the presence of these gene pools in Indian subcontinent.

  10. Complete sequencing of an IncX3 plasmid carrying blaNDM-5 allele reveals an early stage in the dissemination of the blaNDM gene

    Directory of Open Access Journals (Sweden)

    M Krishnaraju

    2015-01-01

    Full Text Available Purpose: The aim of the present study was to perform molecular characterisation of the blaNDM plasmids and to understand the mechanism of its spread among pathogenic bacteria. Materials and Methods: Seventy-six non-repetitive carbapenem-resistant isolates which were collected during Nov 2011 to April 2013 from four hospitals in Chennai were analyzed for the presence of the blaNDM gene by PCR. Further, the genetic context of the blaNDM gene was analyzed by PCR specific to ISAba125 and bleMBL gene. One of the blaNDM plasmid was completely sequenced in the Illumina HiSeq platform. Results: Twenty-three isolates consisting of 8 Escherichia coli, 8 Klebsiella pneumoniae, 3 Klebsiella oxytoca, 3 Acinetobacter baumanii and 1 Pseudomonas aeruginosa were found to carry the blaNDM gene. In 18 isolates the blaNDM gene was associated with a bleMBL gene and the ISAba125 element. The complete sequencing of pNDM-MGR194 revealed an IncX3 replication type plasmid, with a length of 46,253 bp, an average GC content of 47% and 59 putative ORFs. The iteron region contained the blaNDM5 gene and the bleMBL , trpF and dsbC genes downstream and an IS5 inserted within the ISAba125 element upstream. Conclusion: This is the first report where the blaNDM gene insertion in a plasmid is not accompanied by other resistance gene determinants. These observations suggest that the IncX3 plasmid pNDM-MGR194 is an early stage in the dissemination of the blaNDM .

  11. High prevalence of multidrug-resistance in Acinetobacter baumannii and dissemination of carbapenemase-encoding genes blaOXA-23-like, blaOXA-24-like and blaNDM-1 in Algiers hospitals

    Institute of Scientific and Technical Information of China (English)

    Khadidja Khorsi; Yamina Messai; Moufida Hamidi; Houria Ammari; Rabah Bakour

    2015-01-01

    Objective:To assess and characterize antibiotic resistance in Acinetobacter baumannii strains recovered from 5 health-care facilities in Algiers. Methods:Antibiotic susceptibility testing was performed by agar diffusion and agar dilution methods, resistance genes were identified by PCR and sequencing, and molecular typing of isolates was carried out by enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR). Results:Among 125 tested isolates, 117 (93.6%) were multidrug-resistant, of which 94 (75.2%) were imipenem resistant. The blaADC and blaOXA-51-like genes were detected in all isolates, in association with ISAba1 sequence in 84%and 8%(imipenem resistant) of isolates, respectively. The blaOXA-23-like and blaOXA-24-like carbapenemase genes were detected in 67.02%and 20.21%of imipenem-resistant isolates, respectively. The blaOXA-23-like gene is linked to ISAba1 or ISAba4 elements. The metallo-β-lactamase NDM-1 gene was found in 10 (10.6%) imipenem-resistant strains from three hospitals, it is linked to ISAba125 element in nine strains. Extended spectrumβ-lactamases production was not detected. Imipenem and cefotaxime resistance phenotypes could not be transferred to Escherichia coli by conjugation. Outer membrane protein CarO gene was not detected in four imipenem-resistant isolates. The aac(6’)-Ib, sul1, sul2, tetA and tetB genes were present in 5.31%, 36.17%, 77.65%, 1.06%and 65.92%of strains, respectively. Class 1 integrons were detected in 23.4%strains. ERIC-PCR typing showed a genetic diversity among blaOXA-23-like and blaOXA-24-like positive strains, while clonality was observed among blaNDM-1 positives. Conclusions:This study highlighted the high prevalence of imipenem resistance in Acinetobacter baumannii in Algiers hospitals mediated mainly by blaOXA-23-like, blaOXA-24-like, and blaNDM-1 genes.

  12. Review of Positive Psychology Applications in Clinical Medical Populations.

    Science.gov (United States)

    Macaskill, Ann

    2016-09-07

    This review examines the application of positive psychology concepts in physical health care contexts. Positive psychology aims to promote well-being in the general population. Studies identifying character strengths associated with well-being in healthy populations are numerous. Such strengths have been classified and Positive Psychology Interventions (PPIs) have been created to further develop these strengths in individuals. Positive psychology research is increasingly being undertaken in health care contexts. The review identified that most of this research involves measuring character strengths and their association with health outcomes in patients with a range of different conditions, similar to the position in positive psychology research on non-clinical populations. More recently, PPIs are beginning to be applied to clinical populations with physical health problems and this research, although relatively scarce, is reviewed here for cancer, coronary heart disease, and diabetes. In common with PPIs being evaluated in the general population, high quality studies are scarce. Applying PPIs to patients with serious health conditions presents significant challenges to health psychologists. They must ensure that patients are dealt with appropriately and ethically, given that exaggerated claims for PPIs are made on the internet quite frequently. This is discussed along with the need for more high quality research.

  13. A Carbapenem-Resistant Pseudomonas aeruginosa Isolate Harboring Two Copies of blaIMP-34 Encoding a Metallo-β-Lactamase.

    Directory of Open Access Journals (Sweden)

    Tatsuya Tada

    Full Text Available A carbapenem-resistant strain of Pseudomonas aeruginosa, NCGM1984, was isolated in 2012 from a hospitalized patient in Japan. Immunochromatographic assay showed that the isolate was positive for IMP-type metallo-β-lactamase. Complete genome sequencing revealed that NCGM1984 harbored two copies of blaIMP-34, located at different sites on the chromosome. Each blaIMP-34 was present in the same structures of the class 1 integrons, tnpA(ISPa7-intI1-qacG-blaIMP-34-aac(6'-Ib-qacEdelta1-sul1-orf5-tniBdelta-tniA. The isolate belonged to multilocus sequence typing ST235, one of the international high-risk clones. IMP-34, with an amino acid substitution (Glu126Gly compared with IMP-1, hydrolyzed all β-lactamases tested except aztreonam, and its catalytic activities were similar to IMP-1. This is the first report of a clinical isolate of an IMP-34-producing P. aeruginosa harboring two copies of blaIMP-34 on its chromosome.

  14. Pouchitis: an evolving clinical enigma--a review.

    LENUS (Irish Health Repository)

    Coffey, John Calvin

    2009-01-01

    While the overall incidence of pouchitis is low, extensive research continues at clinical and experimental levels in attempts to unravel its etiology. The ileal pouch and pouchitis together represent a unique in vivo opportunity to study mucosal adaptation and inflammation in depth. In the recent past, molecular data relating to pouchitis has significantly expanded. These data provide invaluable insight into intracellular and extracellular events that underpin mucosal adaptation and inflammation. Advances in classification, risk factor evaluation, and prevention have meant that a review of this data, as well as its relationship to our current understanding of pouchitis, is both timely and warranted. Therefore, the aim of this review is to summarize recent data in the context of the established literature.

  15. Perfectionism as a transdiagnostic process: a clinical review.

    Science.gov (United States)

    Egan, Sarah J; Wade, Tracey D; Shafran, Roz

    2011-03-01

    Perfectionism is a risk and maintaining factor for eating disorders, anxiety disorders and depression. The objective of this paper is to review the four bodies of evidence supporting the notion that perfectionism is a transdiagnostic process. First, a review of the literature was conducted that demonstrates the elevation of perfectionism across numerous anxiety disorders, depression, and eating disorders compared to healthy controls. Data is presented that shows perfectionism increases vulnerability for eating disorders, and that it maintains obsessive-compulsive disorder, social anxiety and depression as it predicts treatment outcome in these disorders. Second, evidence is examined showing that elevated perfectionism is associated with co-occurrence of psychopathology. Third, the different conceptualisations of perfectionism are reviewed, including a cognitive-behavioural conceptualisation of clinical perfectionism that can be utilised to understand this transdiagnostic process. Fourth, evidence that treatment of perfectionism results in reductions in anxiety, depression and eating pathology is reviewed. Finally, the importance of clinicians considering the routine assessment and treatment of perfectionism is outlined.

  16. Clinical uses of the medicinal leech: A practical review

    Directory of Open Access Journals (Sweden)

    B S Porshinsky

    2011-01-01

    Full Text Available The medicinal leech, Hirudo medicinalis, is an excellent example of the use of invertebrates in the treatment of human disease. Utilized for various medical indications since the ancient times, the medicinal leech is currently being used in a narrow range of well-defined and scientifically-grounded clinical applications. Hirudotherapy is most commonly used in the setting of venous congestion associated with soft tissue replantations and free flap-based reconstructive surgery. This is a comprehensive review of current clinical applications of hirudotherapy, featuring a comprehensive search of all major medical search engines (i.e. PubMed, Google Scholar, ScientificCommons and other cross-referenced sources. The authors focus on indications, contraindications, practical application/handling of the leech, and therapy-related complications.

  17. Cannabinoids and Dementia: A Review of Clinical and Preclinical Data

    Directory of Open Access Journals (Sweden)

    Michael Halpern

    2010-08-01

    Full Text Available The endocannabinoid system has been shown to be associated with neurodegenerative diseases and dementia. We review the preclinical and clinical data on cannabinoids and four neurodegenerative diseases: Alzheimer’s disease (AD, Huntington’s disease (HD, Parkinson’s disease (PD and vascular dementia (VD. Numerous studies have demonstrated an involvement of the cannabinoid system in neurotransmission, neuropathology and neurobiology of dementias. In addition, several candidate compounds have demonstrated efficacy in vitro. However, some of the substances produced inconclusive results in vivo. Therefore, only few trials have aimed to replicate the effects seen in animal studies in patients. Indeed, the literature on cannabinoid administration in patients is scarce. While preclinical findings suggest causal treatment strategies involving cannabinoids, clinical trials have only assessed the suitability of cannabinoid receptor agonists, antagonists and cannabidiol for the symptomatic treatment of dementia. Further research is needed, including in vivo models of dementia and human studies.

  18. Operating room use of hypertonic solutions: a clinical review

    Directory of Open Access Journals (Sweden)

    Gustavo Azoubel

    2008-01-01

    Full Text Available Hyperosmotic-hyperoncotic solutions have been widely used during prehospital care of trauma patients and have shown positive hemodynamic effects. Recently, there has been a growing interest in intra-operative use of hypertonic solutions. We reviewed 30 clinical studies on the use of hypertonic saline solutions during surgeries, with the majority being cardiac surgeries. Reduced positive fluid balance, increased cardiac index, and decreased systemic vascular resistance were the main beneficial effects of using hypertonic solutions in this population. Well-designed clinical trials are highly needed, particularly in aortic aneurysm repair surgeries, where hypertonic solutions have shown many beneficial effects. Examining the immunomodulatory effects of hypertonic solutions should also be a priority in future studies.

  19. ALOE VERA: A REVIEW OF ITS CLINICAL EFFECTIVENESS

    Directory of Open Access Journals (Sweden)

    Malik Itrat

    2013-08-01

    Full Text Available Aloe vera has been used for over five thousand years. Throughout history, it has been considered a magical plant, almost a panacea, capable of remedying many of mankind’s ailments. It is only in the last 20 years, after a series of proven research, that we can highlight the characteristics of this plant, whose secrets have been hidden behind a blanket of botanical and pharmacological puzzles that only today begin to yield some answers. The Aloe vera plant and its clinical uses are briefly reviewed in this article.

  20. Klebsiella pneumoniae Isolate from a New York City Hospital Belonging to Sequence Type 258 and Carrying blaKPC-2 and blaVIM-4.

    Science.gov (United States)

    Castanheira, Mariana; Deshpande, Lalitagauri M; Mills, Janet C; Jones, Ronald N; Soave, Rosemary; Jenkins, Stephen G; Schuetz, Audrey N

    2016-01-04

    Among 69 of 139 (49.6%) carbapenem-nonsusceptible Enterobacteriaceae carrying blaKPC, 1 Klebsiella pneumoniae was also positive for blaVIM. The isolate belonged to sequence type 258 (ST258) and carried blaKPC-2 on a copy of Tn4401a and blaVIM-4 on a class 1 integron. Genes were located on distinct plasmids belonging to Inc types A/C and FII. Elevated expression of the efflux pump AcrAB-TolC (acrA, 15.3 times) and reduced expression of outer membrane protein genes ompK35 and ompK37 (0.16 and 0.081 times, respectively) associated with various amino acid alterations on OmpK37 were observed. The presence of two carbapenemases in ST258 K. pneumoniae is of great concern due to the ability of this organism to widely disseminate.

  1. Effects of healing touch in clinical practice: a systematic review of randomized clinical trials.

    Science.gov (United States)

    Anderson, Joel G; Taylor, Ann Gill

    2011-09-01

    Hands-on healing and energy-based interventions have been found in cultures throughout history around the world. These complementary therapies, rooted in ancient Eastern healing practices, are becoming mainstream. Healing Touch, a biofield therapy that arose in the nursing field in the late 1980s, is used in a variety of settings (i.e., pain centers, surgical settings, and private practices) with reported benefits (i.e., decreased anxiety, pain, and depressive behaviors; increased relaxation and a sense of well-being). However, clinical trial data concerning the effectiveness of Healing Touch have not been evaluated using a systematic, evidence-based approach. Thus, this systematic review is aimed at critically evaluating the data from randomized clinical trials examining the clinical efficacy of Healing Touch as a supportive care modality for any medical condition.

  2. Cauda equina syndrome: a review of clinical progress

    Institute of Scientific and Technical Information of China (English)

    MA Bin; WU Hong; JIA Lian-shun; YUAN Wen; SHI Guo-dong; SHI Jian-gang

    2009-01-01

    Objective To review the literature on the clinical progress in cauda equina syndrome (CES), including the epidemic history, pathogenesis, diagnosis, treatment policy and prognosis.Data sources All reports on CES in the literature were searched in PubMed, Ovid, Springer, Elsevier, and the Chinese Biomedical Literature Disk using the key terms "cauda equina syndrome", "diagnosis", "treatment', "prognosis" and "evidence-based medicine".Study selection Original milestone articles and critical reviews wdtten by major pioneer investigators about the cauda equina syndrome were selected.Results CES is rare, both atraumatically and traumatically. Males and females are equally affected. The incidence of CES is variable, depending on the etiology of the syndrome. The most common cause of CES is herniation of a lumbar intervertebral disc. CES symptoms may have sudden onset and evolve rapidly or sometimes chronic ally. Each type of CES has different typical signs and symptoms. Low back pain may be the most significant symptoms, accompanied by sciatica, lower extremities weakness, saddle or perianal hypoesthesia, sexual impotence, and sphincter dysfunction. MRI is usually the preferred investigation approach. Patients who have had CES are difficult to return to a normal status.Conclusions The diagnosis of CES is primarily based on a careful history inquiry and clinical examination, assisted by elective radiologic investigations. Early diagnosis and early surgical decompression are crucial for a favorable outcome in most CES cases.

  3. [Clinical research VIII. Structured review of an article].

    Science.gov (United States)

    Talavera, Juan O; Rivas-Ruiz, Rodolfo

    2012-01-01

    There has been proposed several strategies to select an article under the assumption of quality and relevance. Mostly depend on the presence or absence of a number of features and others, depends of the judgment of other people. However, these strategies do not allow us to know the magnitude of the error contained within each article. And considering that there is not a perfect one, it is important to identify the magnitude of the error and the impact of this in the final result; consequently, it is necessary to develop skills that allow us to review a paper, identify potential errors, and generate a sense of the impact of it over the result. Using the information contained in Clinical Research Series I-VII, we have tried to show its application in a structured review of an article of causality beginning with the revision of the baseline, the maneuver and the outcome, with systematic errors (bias) generated in each section, followed by the appropriate of the statistical test and the sample size used, and finally, the clinical relevance.

  4. Clinical TVA-based studies: a general review

    Directory of Open Access Journals (Sweden)

    Thomas eHabekost

    2015-03-01

    Full Text Available In combination with whole report and partial report tasks, the Theory of Visual Attention (TVA can be used to estimate individual differences in five basic attentional parameters: The visual processing speed, the storage capacity of visual short-term memory, the perceptual threshold, the efficiency of top-down selectivity, and the spatial bias of attentional weighting. TVA-based assessment has been used in about 30 studies to investigate attentional deficits in a range of neurological and psychiatric conditions: (a neglect and simultanagnosia, (b reading disturbances, (c aging and neurodegenerative diseases, and most recently (d neurodevelopmental disorders. The article introduces TVA based assessment, discusses its methodology and psychometric properties, and reviews the progress made in each of the four research fields. The empirical results demonstrate the general usefulness of TVA-based assessment for many types of clinical neuropsychological research. The method’s most important qualities are cognitive specificity and theoretical grounding, but it is also characterized by good reliability and sensitivity to minor deficits. The review concludes by pointing to promising new areas for clinical TVA-based research.

  5. β-Lactam Resistance Genes: Characterization, Epidemiology, and First Detection of blaCTX-M-1 and blaCTX-M-14 in Salmonella spp. Isolated from Poultry in Brazil-Brazil Ministry of Agriculture's Pathogen Reduction Program.

    Science.gov (United States)

    Fitch, Fernanda Marques; Carmo-Rodrigues, Mirian Silva; Oliveira, Vinicius Gomes Sales; Gaspari, Marcus Vinicius; Dos Santos, Amaury; de Freitas, Josinete Barros; Pignatari, Antonio C C

    2016-03-01

    Salmonella spp. are widespread in nature; however, human infections occur mainly through ingestion of contaminated food, specially poultry and eggs. In Brazil, the Ministry of Agriculture (MAPA) oversees food production in general, with the goal of preventing transmission of pathogens through the food chain. In 2004, MAPA initiated a program to monitor and control levels of Salmonella in poultry during slaughter. This study analyzes isolates from MAPA's program for β-lactam resistance and the resistance genes involved, as well as the geographic distributions of potentially clonal populations of resistant isolates within Brazil. Initially, 1,939 Salmonella spp. isolated between 2004 and 2011 were examined. These isolates were tested for antimicrobial susceptibility, and 100 isolates resistant or intermediate to ampicillin and ceftriaxone were screened initially for the presence of blaSHV, blaTEM, blaOXA, blaPSA, blaCMY-1, and blaCMY-2 genes. There were 55 isolates whose resistance genes were not identified by this panel and these isolates are the subject of this report. These 55 isolates were differentiated into 31 distinct ribogroups, with multiple β-lactam resistance genes, including AmpC blaCMY, blaTEM, blaCTX-M-1, blaCTX-M-2, blaCTX-M-8, and blaCTX-M-14. Isolates carrying variants of blaCTX-M were identified in three geographic regions. Salmonella carrying particular genetic variants of blaCTX-M and belonging to the same ribogroup were identified from multiple poultry slaughtering facilities. In some instances, these presumptive clonal-related isolates were from facilities over 300 miles apart, indicating potential clonal spread between two geographic regions. This is the first report of blaCTX-M-1 and blaCTX-M-14 in Salmonella in Brazil.

  6. The Clinical Features of Myositis-Associated Autoantibodies: a Review.

    Science.gov (United States)

    Gunawardena, Harsha

    2017-02-01

    The idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases traditionally defined by clinical manifestations including skeletal muscle weakness, skin rashes, elevated skeletal muscle enzymes, and neurophysiological and/or histological evidence of muscle inflammation. Patients with myositis overlap can develop other features including parenchymal lung disease, inflammatory arthritis, gastrointestinal manifestations and marked constitutional symptoms. Although patients may be diagnosed as having polymyositis (PM) or dermatomyositis (DM) under the IIM spectrum, it is quite clear that disease course between subgroups of patients is different. For example, interstitial lung disease may predominate in some, whereas cutaneous complications, cancer risk, or severe refractory myopathy may be a significant feature in others. Therefore, tools that facilitate diagnosis and indicate which patients require more detailed investigation for disease complications are invaluable in clinical practice. The expanding field of autoantibodies (autoAbs) associated with connective tissue disease (CTD)-myositis overlap has generated considerable interest over the last few years. Using an immunological diagnostic approach, this group of heterogeneous conditions can be separated into a number of distinct clinical phenotypes. Rather than diagnose a patient as simply having PM, DM or overlap CTD, we can define syndromes to differentiate disease subsets that emphasise clinical outcomes and guide management. There are now over 15 CTD-myositis overlap autoAbs found in patients with a range of clinical manifestations including interstitial pneumonia, cutaneous disease, cancer-associated myositis and autoimmune-mediated necrotising myopathy. This review describes their diagnostic utility, potential role in disease monitoring and response to treatment. In the future, routine use of these autoAb will allow a stratified approach to managing this complex set of conditions.

  7. Systematic review of clinical outcomes after prophylactic surgery.

    Science.gov (United States)

    Davis, C R; Trevatt, Aej; Dixit, A; Datta, V

    2016-07-01

    Introduction Prophylactic appendicectomy is performed prior to military, polar and space expeditions to prevent acute appendicitis in the field. However, the risk-benefit ratio of prophylactic surgery is controversial. This study aimed to systematically review the evidence for prophylactic appendicectomy. It is supplemented by a clinical example of prophylactic surgery resulting in life-threatening complications. Methods A systematic review was performed using MEDLINE(®) and the Cochrane Central Register of Controlled Trials. Keyword variants of 'prophylaxis' and 'appendicectomy' were combined to identify potential papers for inclusion. Papers related to prophylactic appendicectomy risks and benefits were reviewed. Results Overall, 511 papers were identified, with 37 papers satisfying the inclusion criteria. Nine reported outcomes after incidental appendicectomy during concurrent surgical procedures. No papers focused explicitly on prophylactic appendicectomy in asymptomatic patients. The clinical example outlined acute obstruction secondary to adhesions from a prophylactic appendicectomy. Complications after elective appendicectomy versus the natural history of acute appendicitis in scenarios such as polar expeditions or covert operations suggest prophylactic appendicectomy may be appropriate prior to extreme situations. Nevertheless, the long-term risk of adhesion related complications render prophylactic appendicectomy feasible only when the short-term risk of acute appendicitis outweighs the long-term risks of surgery. Conclusions Prophylactic appendicectomy is rarely performed and not without risk. This is the first documented evidence of long-term complications following prophylactic appendicectomy. Surgery should be considered on an individual basis by balancing the risks of acute appendicitis in the field with the potential consequences of an otherwise unnecessary surgical procedure in a healthy patient.

  8. Clinical outcomes resulting from telemedicine interventions: a systematic review

    Directory of Open Access Journals (Sweden)

    Kraemer Dale

    2001-11-01

    Full Text Available Abstract Background The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. Methods Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis. All included articles were abstracted and graded for quality and direction of the evidence. Results A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. Conclusions Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.

  9. Autogenic training: a narrative and quantitative review of clinical outcome.

    Science.gov (United States)

    Linden, W

    1994-09-01

    This review of controlled outcome research on Autogenic Training complements the literature by pooling narrative and quantitative approaches, by including only studies with experimental controls, by integrating the English and German literature, and by adding research findings published since the last review. Whereas previous reviews have already reported positive effects of Autogenic Training for migraine, insomnia, and test anxiety, additional supportive findings for angina pectoris, asthma, childbirth, eczema, hypertension, infertility, Raynaud's disease, and recovery from myocardial infarction are discussed here. The impact of protocol variations on outcome is described, and the specificity of Autogenic Training relative to other stress management techniques is highlighted. Quantitative findings suggested that Autogenic Training was associated with medium-sized pre- to posttreatment effects ranging from d = .43 for biological indices of change to d = .58 for psychological and behavioral indices thus matching effect sizes for other biobehavioral treatment techniques like biofeedback and muscular relaxation. Length of treatment did not affect clinical outcome. The discussion emphasizes how narrative and quantitative strategies complement one another.

  10. The clinical phenotypes of autoimmune hepatitis: A comprehensive review.

    Science.gov (United States)

    Wang, Qixia; Yang, Fan; Miao, Qi; Krawitt, Edward L; Gershwin, M Eric; Ma, Xiong

    2016-01-01

    Autoimmune hepatitis (AIH) fulfills the generally accepted contemporary criteria of an autoimmune liver disease: the presence of autoantibodies and autoreactive T cells, a female gender bias, association with other autoimmune diseases, response to immunosuppressive therapy and strong associations with the major histocompatibility complex HLA loci. It occurs worldwide in both children and adults and is marked by both etiopathogenic and clinical heterogeneity, differing from the other putative autoimmune liver diseases, primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC), albeit occasionally presenting with overlapping features of PBC or PSC. Although diagnostic criteria have been established and validated, there are still major issues to be clarified due to its variability, such as autoantibody-negative AIH, drug-induced AIH, AIH sharing features with PBC or PSC, and post-transplant de novo AIH. In view of the diverse presentations and courses, including classical chronic onset, acute and acute severe onset, cirrhosis and decompensated cirrhosis, individualized management of patients is indicated. Each patient should receive a personalized analysis of the benefits and side effect risks of drugs. Herein we describe a comprehensive review of the clinical phenotypes of AIH underscoring its clinical heterogeneity.

  11. Best herbs for managing diabetes: a review of clinical studies

    Directory of Open Access Journals (Sweden)

    Ahmad Ghorbani

    2013-09-01

    Full Text Available Diabetes mellitus is a public health problem which leads to serious complications over time. Experimentally, many herbs have been recommended for treating diabetes. In most cases, however, the recommendations are based on animal studies and limited pieces of evidence exist about their clinical usefulness. This review focused on the herbs, the hypoglycemic actions of which have been supported by three or more clinical studies. The search was done in Google Scholar, Medline and Science Direct databases using the key terms diabetes, plants, herbs, glucose and patients. According to the clinical studies, Aegle marmelos, Allium cepa, Gymnema sylvestre, Momordica charantia, Ocimum sanctum, Nigella sativa, Ocimum sanctum, Panax quinquefolius, Salacia reticulate, Silybum marianum and Trigonella foenum-graecum have shown hypoglycemic and, in some cases, hypolipidemic activities in diabetic patients. Among them, Gymnema sylvestre, Momordica charantia, Silybum marianum and Trigonella foenum-graecum have acquired enough reputation for managing diabetes. Thus, it seems that physicians can rely on these herbs and advise for the patients to improve management of diabetes.

  12. CYP17A1: a biochemistry, chemistry, and clinical review.

    Science.gov (United States)

    Porubek, David

    2013-01-01

    Cytochrome P450 17A1 (CYP17A1; also P450c17and P450sccII) is a critically important enzyme in humans that catalyzes the formation of all endogenous androgens. It is an atypical cytochrome P450 enzyme in that it catalyzes two distinct types of substrate oxidation. Through its hydroxylase activity, it catalyzes the 17α-hydroxylation of pregnenolone to 17α-OH pregnenolone. Subsequently, through its C17,20lyase activity, it can further convert 17α-OH pregnenolone to the androgen dehydroepiandrosterone, which is a precursor to androstenedione, testosterone, and dihydrotestosterone. The importance of androgens in diseases such as prostate cancer has been appreciated for decades and the discovery of extra-testicular formation of androgens has helped clarify the pathology of the disease, especially the castrate- resistant disease. Therefore, specific inhibition of CYP17A1 by therapeutic intervention has been an area of considerable effort in several research laboratories. This basic research has led to the discovery of several promising drug candidates followed by the conduct of several clinical trials. Recently, all these efforts have culminated in the first approval by FDA of an inhibitor of CYP17A1 for the treatment of castrate-resistant prostate cancer. Ongoing clinical trials are now evaluating the agent in earlier stages of prostate cancer and even rare forms of androgen-dependent breast cancer. Accordingly, this review focuses on the biochemistry, chemistry, and clinical inhibitors of CYP17A1.

  13. Liver involvement in Gaucher disease - Review and clinical approach.

    Science.gov (United States)

    Adar, Tomer; Ilan, Yaron; Elstein, Deborah; Zimran, Ari

    2016-10-19

    Gaucher disease (GD), one of the most prevalent lysosomal storage diseases, is associated with glucocerebroside accumulation in cells of the monocyte-macrophage system in various organs, including the liver. Evaluating and managing liver disease in patients with Gaucher disease may be challenging. While hepatic involvement is common in Gaucher disease, its severity, and clinical significance span a wide spectrum, ranging from sub-clinical involvement to liver cirrhosis with its associated complications including portal hypertension. Apart from liver involvement in Gaucher disease, patients with may also suffer from other comorbidities involving the liver. That Gaucher disease itself can mimic hepatic lesions, affect laboratory tests used to characterize liver disease, and may be associated with non-cirrhotic portal hypertension, complicates the diagnostic approach even more. Better understanding of liver involvement in Gaucher disease can spare patients unnecessary invasive testing, and assist physicians in decision making when evaluating patients with Gaucher disease suspected for significant liver disease. This review describes the various clinical manifestations, laboratory and imaging abnormalities that may be encountered when following patients with Gaucher disease for liver involvement. The mechanism for liver disease are discussed, as well as the possible hepato-protective effect of glucocerebroside, and the a diagnostic and treatment approaches.

  14. Clinical applications of bovine colostrum therapy: a systematic review.

    Science.gov (United States)

    Rathe, Mathias; Müller, Klaus; Sangild, Per Torp; Husby, Steffen

    2014-04-01

    Bovine colostrum, the first milk that cows produce after parturition, contains high levels of growth factors and immunomodulatory components. Some healthy and diseased individuals may gain health benefits by consuming bovine colostrum as a food supplement. This review provides a systematic, critical evaluation of the current state of knowledge in this area. Fifty-one eligible studies were identified from the following databases: Medline, Embase, Global Health, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Studies were heterogeneous with regard to populations, outcomes, and methodological quality, as judged by the Jadad assessment tool. Many studies used surrogate markers to study the effects of bovine colostrum. Studies suggesting clinical benefits of colostrum supplementation were generally of poor methodological quality, and results could not be confirmed by other investigators. Bovine colostrum may provide gastrointestinal and immunological benefits, but further studies are required before recommendations can be made for clinical application. Animal models may help researchers to better understand the mechanisms of bovine colostrum supplementation, the dosage regimens required to obtain clinical benefits, and the optimal methods for testing these effects in humans.

  15. Whole-animal imaging of bacterial infection using endoscopic excitation of β-lactamase (BlaC)-specific fluorogenic probe

    Science.gov (United States)

    Nooshabadi, Fatemeh; Yang, Hee-Jeong; Cheng, Yunfeng; Xie, Hexin; Rao, Jianghong; Cirillo, Jeffrey D.; Maitland, Kristen C.

    2016-03-01

    Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains one of the most frequent causes of death worldwide. The slow growth rate of Mtb limits progress toward understanding tuberculosis including diagnosis of infections and evaluating therapeutic efficacy. Development of near-infrared (NIR) β-lactamase (BlaC)-specific fluorogenic substrate has made a significant breakthrough in the whole-animal imaging to detect Mtb infection. The reporter enzyme fluorescence (REF) system using a BlaC-specific fluorogenic substrate has improved the detection sensitivity in whole-animal optical imaging down to ~104 colony forming units (CFU) of bacteria, about 100-fold improvement over recombinant strains. However, improvement of detection sensitivity is strongly needed for clinical diagnosis of early stage infection at greater tissue depth. In order to improve detection sensitivity, we have integrated a fiber-based microendoscpe into a whole-animal imaging system to transmit the excitation light from the fiber bundle to the fluorescent target directly and measure fluorescent level using BlaC-specific REF substrate in the mouse lung. REF substrate, CNIR800, was delivered via aerosol route to the pulmonary infected mice with M. bovis BCG strain at 24 hours post-infection and groups of mice were imaged at 1-4 hours post-administration of the substrate using the integrated imaging system. In this study we evaluated the kinetics of CNIR800 substrate using REF technology using the integrated imaging system. Integration of these technologies has great promise for improved detection sensitivity allowing pre-clinical imaging for evaluation of new therapeutic agents.

  16. Spread of the blaOXA–23-Containing Tn2008 in Carbapenem-Resistant Acinetobacter baumannii Isolates Grouped in CC92 from China

    Science.gov (United States)

    Chen, Yisheng; Gao, Jing; Zhang, Haomin; Ying, Chunmei

    2017-01-01

    The rapid expansion of carbapenem-resistant Acinetobacter baumannii (CRAB) clinical isolates is a big issue. We investigated the antibiotic susceptibility, molecular epidemiology and resistance gene of A. baumannii collected at two hospitals in Shanghai, China. Besides, the A. baumannii PCR-based replicon typing method (AB-PBRT) was conducted to categorize the plasmids into homogeneous groups on the basis of replicase genes. Most CRAB isolates showed high-level resistance to almost all antibiotics but retain susceptibility to colistin and tigecycline. A total of 101 isolates carried blaOXA-51-like gene. Sequencing identified the presence of blaOXA-66 for CRAB isolates. blaOXA–23 gene were discovered in all CRAB isolates. Each CRAB isolate contained 1–3 of 19 different plasmid replicase (rep) gene homology groups (GRs) and the GR6 (repAci6) was ubiquitous. Genotyping by Multilocus Sequence Typing (MLST) showed seven defined MLST patterns and three novel STs were found. eBURST analysis indicated they were all grouped in CC92 (GCII) with the most frequent ST208 (50%). Two blaOXA–23-bearing transposons were found: Tn2006 and Tn2008. Tn2008 were detected in 54 (96.4%) isolates and Tn2006 in two remaining isolates. The blaOXA–23 carbapenem gene was vitally associated with repAci6 plasmid belong to CC92 clonal group. Our survey revealed severe drug resistance in A. baumannii isolates. Tn2008-containing CC92 A. baumannii were endemic, which may facilitate the blaoxa23 dissemination. PMID:28220115

  17. Yersinia enterocolitica and Photorhabdus asymbiotica β-lactamases BlaA are exported by the twin-arginine translocation pathway.

    Science.gov (United States)

    Schriefer, Eva-Maria; Hoffmann-Thoms, Stephanie; Schmid, Franz X; Schmid, Annika; Heesemann, Jürgen

    2013-01-01

    In general, β-lactamases of medically important Gram-negative bacteria are Sec-dependently translocated into the periplasm. In contrast, β-lactamases of Mycobacteria spp. (BlaC, BlaS) and the Gram-negative environmental bacteria Stenotrophomonas maltophilia (L2) and Xanthomonas campestris (Bla(XCC-1)) have been reported to be secreted by the twin-arginine translocation (Tat) system. Yersinia enterocolitica carries 2 distinct β-lactamase genes (blaA and blaB) encoding BlaA(Ye) and the AmpC-like β-lactamase BlaB, respectively. By using the software PRED-TAT for prediction and discrimination of Sec from Tat signal peptides, we identified a functional Tat signal sequence for Yersinia BlaA(Ye). The Tat-dependent translocation of BlaA(Ye) could be clearly demonstrated by using a Y. enterocolitica tatC-mutant and cell fractionation. Moreover, we could demonstrate a unique unusual temperature-dependent activity profile of BlaA(Ye) ranging from 15 to 60 °C and a high 'melting temperature' (T(M)=44.3°) in comparison to the related Sec-dependent β-lactamase TEM-1 (20-50°C, T(M)=34.9 °C). Strikingly, the blaA gene of Y. enterocolitica is present in diverse environmental Yersinia spp. and a blaA homolog gene could be identified in the closely related Photorhabdus asymbiotica (BlaA(Pa); 69% identity to BlaA(Ye)). For BlaA(Pa) of P. asymbiotica, we could also demonstrate Tat-dependent secretion. These results suggest that Yersinia BlaA-related β-lactamases may be the prototype of a large Tat-dependent β-lactamase family, which originated from environmental bacteria.

  18. Fulminant hepatitis: a clinical review of 11 years

    Directory of Open Access Journals (Sweden)

    Anna Sara Shafferman Levin

    1989-08-01

    Full Text Available 24 cases of fulminant hepatitis (FH hospitalized in the Clínica de Doenças Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo during the period from January 1976 to December 1986 were reviewed from their clinical, epidemiological and laboratorial aspects. 88% of the patients died; 20 patients (83% presented hemorrhages and, of these, 19 died. Bacterial infections occurred in 14 patients (58% all of whom died. Ascitis was noted in 3 cases; cerebral edema was present in 16 cases. Maximal ALT levels for each patient during hospitalization ranged widely from 81 to 4,460 UI/l. Thirteen patients presented high creatinine levels (54%. Prothrombin time activity ranged from 2.1% to 67%. Fever was present in 20 cases (83%. Encephalopathy occurred within the first 2 weeks of illness in 72% of the cases. In 7 cases other illnesses were present. The etiology could not be determined in 13 cases. In 3 cases it was due to yellow fever and 6 cases were caused by viruses other than yellow fever. In one case the cause was drug usage and in another case, possibly alcohol. The authors believe that the clinical definition of FH requires further discussion before it is established. In this study FH is a young person's disease. The mortality found was similar to that by other authors. Factors that contributed to death were: hemorrhages and bacterial infection. Factors that worsened the prognosis of hepatitis were: associated illnesses and surgical procedure. The levels of ALT during hospitalization did not correlate well with the severity of the hepatitis. The authors believe that yellow fever should be considered a cause of FH where the clinical picture meets the criteria for such, although its mechanisms of encephalopathy remain obscure. The clinical details of the 3 cases of yellow fever are presented.

  19. Clinical manifestations and managements in jellyfish envenomation A systematic review

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    Negar Taheri

    2013-11-01

    Full Text Available Background: The phylum Cnidarians have over nine thousand species that approximately, one hundred species are dangerous for humans. Annually, a large number of deaths were reported due to jellyfish stings. The manifestations depend on their species and kind of venoms, and include the local and systemic manifestations. A number of methods and compounds were used and under investigation for management of injuries with jellyfishes. Due to the lack of an integrated systematic review, the current study was done. Materials and Methods: The PubMed data bank was searched for the term “Jellyfish”. A total of 1677 papers were found. These papers were divided into three categories: medical, biomedical and biotechnological fields. The medical category was further divided into three subcategories comprising systemic manifestations, cutaneous manifestations and treatments for the stings of jellyfishes. The biomedical category was further subdivided into genomics, proteomics, and biology of venoms, mechanisms of actions and products of biomedical significance. In this part of systematic review, the medical aspects of injuries with jellyfishes were evaluated. Results: The clinical manifestations in jellyfish envenomation depend on their species and the nature of venoms. The most common clinical manifestations of jellyfish stings are cutaneous presentations like urticasia, erythema, swelling, vesicles and severe dermonectoric manifestations. Systemic manifestations were seen in the stings of box jellyfishes, Portuguese man-of-war and in Irukandji syndrome. The most common recommendations for jellyfish envenomation managements include decreasing the local effects of venom, prevention of the venomous nematocysts release, and Controlling of systemic reactions. Application of commercial vinegar (4 - 6% acetic acid, hot water immersion (HWI (42 ° C for 20 minutes, ice packs, sea water rinsing for inactivating nematocysts, administration of topical and parenteral

  20. Aloe vera: A review of toxicity and adverse clinical effects.

    Science.gov (United States)

    Guo, Xiaoqing; Mei, Nan

    2016-04-01

    The Aloe plant is employed as a dietary supplement in a variety of foods and as an ingredient in cosmetic products. The widespread human exposure and its potential toxic and carcinogenic activities raise safety concerns. Chemical analysis reveals that the Aloe plant contains various polysaccharides and phenolic chemicals, notably anthraquinones. Ingestion of Aloe preparations is associated with diarrhea, hypokalemia, pseudomelanosis coli, kidney failure, as well as phototoxicity and hypersensitive reactions. Recently, Aloe vera whole leaf extract showed clear evidence of carcinogenic activity in rats, and was classified by the International Agency for Research on Cancer as a possible human carcinogen (Group 2B). This review presents updated information on the toxicological effects, including the cytotoxicity, genotoxicity, carcinogenicity, and adverse clinical effects of Aloe vera whole leaf extract, gel, and latex.

  1. Platelet Function Tests: A Review of Progresses in Clinical Application

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    Jae-Lim Choi

    2014-01-01

    Full Text Available The major goal of traditional platelet function tests has been to screen and diagnose patients who present with bleeding problems. However, as the central role of platelets implicated in the etiology of arterial thrombotic diseases such as myocardial infarction and stroke became widely known, platelet function tests are now being promoted to monitor the efficacy of antiplatelet drugs and also to potentially identify patients at increased risk of thrombosis. Beyond hemostasis and thrombosis, an increasing number of studies indicate that platelets play an integral role in intercellular communication, are mediators of inflammation, and have immunomodulatory activity. As new potential biomarkers and technologies arrive at the horizon, platelet functions testing appears to take on a new aspect. This review article discusses currently available clinical application of platelet function tests, placing emphasis on essential characteristics.

  2. [Laryngeal amyloidosis: a clinical case and review of literature].

    Science.gov (United States)

    Fries, S; Pasche, P; Brunel, C; Schweizer, V

    2015-09-30

    Amyloidosis consists of different forms of systemic or isolated organ lesions characterised by fibrillary protein deposits in extra-cellular tissue. The isolated involvement of the larynx is the most frequent form in the ENT sphere. We present a clinical case of a 67 year-old woman addressed for a sub-acute laryngitis resistant to conservative treatment, and finally diagnosed with laryngeal amyloidosis. We reviewed its physiopathology, the scientific literature as well as the different possibilities of management. Laryngeal amyloidosis is rare. A thorough additional work-up for the research of multifocal or systemic forms is highly recommended. The treatment aims at a minimal invasive endoscopic surgery with functional organ preservation.

  3. Virulence of Klebsiella pneumoniae isolates harboring bla KPC-2 carbapenemase gene in a Caenorhabditis elegans model.

    Science.gov (United States)

    Lavigne, Jean-Philippe; Cuzon, Gaelle; Combescure, Christophe; Bourg, Gisèle; Sotto, Albert; Nordmann, Patrice

    2013-01-01

    Klebsiella pneumoniae carbapenemase (KPC) is a carbapenemase increasingly reported worldwide in Enterobacteriaceae. The aim of this study was to analyze the virulence of several KPC-2-producing K. pneumoniae isolates. The studied strains were (i) five KPC-2 clinical strains from different geographical origins, belonging to different ST-types and possessing plasmids of different incompatibility groups; (ii) seven transformants obtained after electroporation of either these natural KPC plasmids or a recombinant plasmid harboring only the bla KPC-2 gene into reference strains K. pneumoniae ATCC10031/CIP53153; and (iii) five clinical strains cured of plasmids. The virulence of K. pneumoniae isolates was evaluated in the Caenorhabditis elegans model. The clinical KPC producers and transformants were significantly less virulent (LT50: 5.5 days) than K. pneumoniae reference strain (LT50: 4.3 days) (pKPC-2 positive K. pneumoniae ST258 strains and reference strains containing plasmids extracted from K. pneumoniae ST258 strains had a higher virulence than KPC-2 strains belonging to other ST types (LT50: 5 days vs. 6 days, pKPC-2 gene itself was not associated to increased virulence.

  4. The HELLP syndrome: Clinical issues and management. A Review

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    Svendsen Einar

    2009-02-01

    Full Text Available Abstract Background The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence. Methods Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases. Results and conclusion About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L, AST (≥ 70 U/L, and platelets 9/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (≥ 48 hours is controversial but may be considered in selected cases

  5. Neuroleptic Malignant Syndrome: A Review from a Clinically Oriented Perspective.

    Science.gov (United States)

    Tse, Lurdes; Barr, Alasdair M; Scarapicchia, Vanessa; Vila-Rodriguez, Fidel

    2015-01-01

    Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening side-effect that can occur in response to treatment with antipsychotic drugs. Symptoms commonly include hyperpyrexia, muscle rigidity, autonomic dysfunction and altered mental status. In the current review we provide an overview on past and current developments in understanding the causes and treatment of NMS. Studies on the epidemiological incidence of NMS are evaluated, and we provide new data from the Canada Vigilance Adverse Reaction Online database to elaborate on drug-specific and antipsychotic drug polypharmacy instances of NMS reported between 1965 and 2012. Established risk factors are summarized with an emphasis on pharmacological and environmental causes. Leading theories about the etiopathology of NMS are discussed, including the potential contribution of the impact of dopamine receptor blockade and musculoskeletal fiber toxicity. A clinical perspective is provided whereby the clinical presentation and phenomenology of NMS is detailed, while the diagnosis of NMS and its differential is expounded. Current therapeutic strategies are outlined and the role for both pharmacological and non-pharmacological treatment strategies in alleviating the symptoms of NMS are discussed.

  6. Review of clinical presentation and diagnosis of mucopolysaccharidosis IVA.

    Science.gov (United States)

    Hendriksz, C J; Harmatz, P; Beck, M; Jones, S; Wood, T; Lachman, R; Gravance, C G; Orii, T; Tomatsu, S

    2013-01-01

    Mucopolysaccharidosis type IVA (MPS IVA) was described in 1929 by Luis Morquio from Uruguay and James Brailsford from England, and was later found as an autosomal recessive lysosomal storage disease. MPS IVA is caused by mutations in the gene encoding the enzyme, N-acetylgalactosamine-6-sulfate sulfatase (GALNS). Reduced GALNS activity results in impaired catabolism of two glycosaminoglycans (GAGs), chondroitin-6-sulfate (C6S) and keratan sulfate (KS). Clinical presentations of MPS IVA reflect a spectrum of progression from a severe "classical" phenotype to a mild "attenuated" phenotype. More than 180 different mutations have been identified in the GALNS gene, which likely explains the phenotypic heterogeneity of the disorder. Accumulation of C6S and KS manifests predominantly as short stature and skeletal dysplasia (dysostosis multiplex), including atlantoaxial instability and cervical cord compression. However, abnormalities in the visual, auditory, cardiovascular, and respiratory systems can also affect individuals with MPS IVA. Diagnosis is typically based on clinical examination, skeletal radiographs, urinary GAG, and enzymatic activity of GALNS in blood cells or fibroblasts. Deficiency of GALNS activity is a common assessment for the laboratory diagnosis of MPS IVA; however, with recently increased availability, gene sequencing for MPS IVA is often used to confirm enzyme results. As multiple clinical presentations are observed, diagnosis of MPS IVA may require multi-system considerations. This review provides a history of defining MPS IVA and how the understanding of the disease manifestations has changed over time. A summary of the accumulated knowledge is presented, including information from the International Morquio Registry. The classical phenotype is contrasted with attenuated cases, which are now being recognized and diagnosed more frequently. Laboratory based diagnoses of MPS IVA are also discussed.

  7. Clinical spectrum of food allergies: a comprehensive review.

    Science.gov (United States)

    Ho, Marco H-K; Wong, Wilfred H-S; Chang, Christopher

    2014-06-01

    Food allergy is defined as an adverse immune response towards food proteins or as a form of a food intolerance associated with a hypersensitive immune response. It should also be reproducible by a double-blind placebo-controlled food challenge. Many reported that food reactions are not allergic but are intolerances. Food allergy often presents to clinicians as a symptom complex. This review focuses on the clinical spectrum and manifestations of various forms of food allergies. According to clinical presentations and allergy testing, there are three types of food allergy: IgE mediated, mixed (IgE/Non-IgE), and non-IgE mediated (cellular, delayed type hypersensitivity). Recent advances in food allergy in early childhood have highlighted increasing recognition of a spectrum of delayed-onset non-IgE-mediated manifestation of food allergy. Common presentations of food allergy in infancy including atopic eczema, infantile colic, and gastroesophageal reflux. These clinical observations are frequently associated with food hypersensitivity and respond to dietary elimination. Non-IgE-mediated food allergy includes a wide range of diseases, from atopic dermatitis to food protein-induced enterocolitis and from eosinophilic esophagitis to celiac disease. The most common food allergies in children include milk, egg, soy, wheat, peanut, treenut, fish, and shellfish. Milk and egg allergies are usually outgrown, but peanut and treenut allergy tends to persist. The prevalence of food allergy in infancy is increasing and may affect up to 15-20 % of infants. The alarming rate of increase calls for a public health approach in the prevention and treatment of food allergy in children.

  8. 3D Pseudocontinuous arterial spin labeling in routine clinical practice: A review of clinically significant artifacts.

    Science.gov (United States)

    Amukotuwa, Shalini A; Yu, Caroline; Zaharchuk, Gregory

    2016-01-01

    Arterial spin labeling (ASL) is a completely noninvasive magnetic resonance imaging (MRI) perfusion method for quantitatively measuring cerebral blood flow utilizing magnetically labeled arterial water. Advances in the technique have enabled the major MRI vendors to make the sequence available to the clinical neuroimaging community. Consequently, ASL is being increasingly incorporated into the routine neuroimaging protocol. Although a variety of ASL techniques are available, the ISMRM Perfusion Study Group and the European ASL in Dementia Consortium have released consensus guidelines recommending standardized implementation of 3D pseudocontinuous ASL with background suppression. The purpose of this review, aimed at the large number of neuroimaging clinicians who have either no or limited experience with this 3D pseudocontinuous ASL, is to discuss the common and clinically significant artifacts that may be encountered with this technique. While some of these artifacts hinder accurate interpretation of studies, either by degrading the images or mimicking pathology, there are other artifacts that are of clinical utility, because they increase the conspicuity of pathology. Cognizance of these artifacts will help the physician interpreting ASL to avoid potential diagnostic pitfalls, and increase their level of comfort with the technique.

  9. Applicable or non-applicable: investigations of clinical heterogeneity in systematic reviews

    Directory of Open Access Journals (Sweden)

    Laura E. Chess

    2016-02-01

    Full Text Available Abstract Background Clinical heterogeneity can be defined as differences in participant characteristics, types or timing of outcome measurements and intervention characteristics. Clinical heterogeneity in systematic reviews has the possibility to significantly affect statistical heterogeneity leading to inaccurate conclusions and misled decision making. The aim of this study is to identify to what extent investigators are assessing clinical heterogeneity in both Cochrane and non-Cochrane systematic reviews. Methods The most recent 100 systematic reviews from the top five journals in medicine—JAMA, Archives of Internal Medicine, British Medical Journal, The Lancet, and PLOS Medicine—and the 100 most recently published and/or updated systematic reviews from Cochrane were collected. Various defined items of clinical heterogeneity were extracted from the included reviews. Investigators used chi-squared tests, logarithmic modeling and linear regressions to determine if the presence of such items served as a predictor for clinical heterogeneity when comparing Cochrane to non-Cochrane reviews. Extracted variables include number of studies, number of participants, presence of quantitative synthesis, exploration of clinical heterogeneity, heterogeneous characteristics explored, basis and methods used for investigating clinical heterogeneity, plotting/visual aids, author contact, inferences from clinical heterogeneity investigation, reporting assessment, and the presence of a priori or post-hoc analysis. Results A total of 317 systematic reviews were considered, of which 199 were in the final analysis. A total of 81 % of Cochrane reviews and 90 % of non-Cochrane reviews explored characteristics that are considered aspects of clinical heterogeneity and also described the methods they planned to use to investigate the influence of those characteristics. Only 1 % of non-Cochrane reviews and 8 % of Cochrane reviews explored the clinical

  10. Evidence-based review of clinical studies on pulpotomy.

    Science.gov (United States)

    2009-08-01

    Although pulpotomy procedures have a long history of clinical application, comparatively few dental clinical trials have evaluated this treatment approach. In this section, we provide an analysis of recent clinical studies evaluating pulpotomy procedures in dental patients.

  11. A review on the clinical uses of SPECT/CT

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    Mariani, Giuliano; Bruselli, Laura [University of Pisa Medical School, Regional Center of Nuclear Medicine, Pisa (Italy); Kuwert, Torsten [Friedrich-Alexander-University, Clinic of Nuclear Medicine, Erlangen-Nuremberg (Germany); Kim, Edmund E. [MD Anderson Cancer Center, Nuclear Medicine Service, Houston, TX (United States); Flotats, Albert [Universitat Autonoma de Barcelona, Hospital de Sant Pau, Nuclear Medicine Department, Barcelona (Spain); Israel, Ora [Rambam Health Care Campus, Department of Nuclear Medicine, Haifa (Israel); Dondi, Maurizio [International Atomic Energy Agency, Nuclear Medicine Section, Division of Human Health, Vienna (Austria); Watanabe, Naoyuki [International Atomic Energy Agency, Nuclear Medicine Section, Division of Human Health, Vienna (Austria); Gunma Prefectural College of Health Sciences, Department of Radiological Technology, Gunma (Japan)

    2010-10-15

    In the era when positron emission tomography (PET) seems to constitute the most advanced application of nuclear medicine imaging, still the conventional procedure of single photon emission computed tomography (SPECT) is far from being obsolete, especially if combined with computed tomography (CT). In fact, this dual modality imaging technique (SPECT/CT) lends itself to a wide variety of useful diagnostic applications whose clinical impact is in most instances already well established, while the evidence is growing for newer applications. The increasing availability of new hybrid SPECT/CT devices with advanced technology offers the opportunity to shorten acquisition time and to provide accurate attenuation correction and fusion imaging. In this review we analyse and discuss the capabilities of SPECT/CT for improving sensitivity and specificity in the imaging of both oncological and non-oncological diseases. The main advantages of SPECT/CT are represented by better attenuation correction, increased specificity, and accurate depiction of the localization of disease and of possible involvement of adjacent tissues. Endocrine and neuroendocrine tumours are accurately localized and characterized by SPECT/CT, as also are solitary pulmonary nodules and lung cancers, brain tumours, lymphoma, prostate cancer, malignant and benign bone lesions, and infection. Furthermore, hybrid SPECT/CT imaging is especially suited to support the increasing applications of minimally invasive surgery, as well as to precisely define the diagnostic and prognostic profile of cardiovascular patients. Finally, the applications of SPECT/CT to other clinical disorders or malignant tumours is currently under extensive investigation, with encouraging results in terms of diagnostic accuracy. (orig.)

  12. Clinical experience of baclofen in alcohol dependence: A chart review

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    Abhijit R Rozatkar

    2016-01-01

    Full Text Available Introduction: Craving is recognized as a formidable barrier in the management of patients with alcohol dependence. Among pharmacological agents that have been used in experimental studies for reduction in craving, baclofen appears to have a significant advantage over other agents. Methodology: The study is retrospective chart review of patients (n = 113 who have been treated with baclofen for alcohol dependence in a tertiary hospital of North India. Baseline assessments included sociodemography, motivation, quantity-frequency of alcohol use, and other alcohol-related clinical parameters. Weekly assessments, for a period of 4 weeks, were extracted from records which included dose of baclofen, craving intensity, and alcohol consumption. Results: The study sample was predominantly male, mean age of 41.49 (±9.75 years, most having a family history of substance use (70.97%, and many reporting binge use pattern in last year (49.46%. Baseline assessment revealed 48.7% of the sample was in precontemplation phase for alcohol use and 70% reported severe and persistent craving. This persistent craving was reported by only 15% of the sample by the end of 4 weeks treatment with baclofen (20–40 mg/day. Thirty-four percent of patients reported continued problematic use of alcohol by the end of 4 weeks. Conclusion: Our clinical experience suggests that baclofen reduces craving and alcohol consumption including in those with poor motivation. The drug causes few side effects and does not add to the intoxication effect of alcohol. Considering that baclofen is safe in those with liver cirrhosis and reduces withdrawal symptoms due to alcohol, a controlled trial comparing it with standard treatment is required.

  13. [Ethic review on clinical experiments of medical devices in medical institutions].

    Science.gov (United States)

    Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining

    2011-07-01

    Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed.

  14. Agreement between Cochrane Neonatal reviews and clinical practice guidelines for newborns in Denmark a cross sectional study

    DEFF Research Database (Denmark)

    Brok, Jesper; Greisen, Gorm; Madsen, Lars P

    2007-01-01

    OBJECTIVE: To assess agreement between Cochrane Neonatal Group reviews and clinical practice guidelines in Denmark. DESIGN: Retrospective analysis of clinical guidelines for newborn infants. Materials:All Cochrane neonatal reviews and Danish local clinical guidelines for newborn infants. MAIN OUT...

  15. Review of clinical and laboratory features of human Brucellosis

    Directory of Open Access Journals (Sweden)

    Mantur B

    2007-01-01

    Full Text Available Infection with Brucella spp. continues to pose a human health risk globally despite strides in eradicating the disease from domestic animals. Brucellosis has been an emerging disease since the discovery of Brucella melitensis by Sir David Bruce in 1887. Although many countries have eradicated B. abortus from cattle, in some areas B. melitensis and B. suis have emerged as causes of this infection in cattle, leading to human infections. Currently B. melitensis remains the principal cause of human brucellosis worldwide including India. The recent isolation of distinct strains of Brucella from marine mammals as well as humans is an indicator of an emerging zoonotic disease. Brucellosis in endemic and non-endemic regions remains a diagnostic puzzle due to misleading non-specific manifestations and increasing unusual presentations. Fewer than 10% of human cases of brucellosis may be clinically recognized and treated or reported. Routine serological surveillance is not practiced even in Brucella - endemic countries and we suggest that this should be a part of laboratory testing coupled with a high index of clinical suspicion to improve the level of case detection. The screening of family members of index cases of acute brucellosis in an endemic area should be undertaken to pick up additional unrecognised cases. Rapid and reliable, sensitive and specific, easy to perform and automated detection systems for Brucella spp. are urgently needed to allow early diagnosis and adequate antibiotic therapy in time to decrease morbidity / mortality. The history of travel to endemic countries along with exposure to animals and exotic foods are usually critical to making the clinical diagnosis. Laboratory testing is indispensable for diagnosis. Therefore alertness of clinician and close collaboration with microbiologist are essential even in endemic areas to correctly diagnose and treat this protean human infection. Existing treatment options, largely based on

  16. A Review of Glass-Ionomer Cements for Clinical Dentistry.

    Science.gov (United States)

    Sidhu, Sharanbir K; Nicholson, John W

    2016-06-28

    This article is an updated review of the published literature on glass-ionomer cements and covers their structure, properties and clinical uses within dentistry, with an emphasis on findings from the last five years or so. Glass-ionomers are shown to set by an acid-base reaction within 2-3 min and to form hard, reasonably strong materials with acceptable appearance. They release fluoride and are bioactive, so that they gradually develop a strong, durable interfacial ion-exchange layer at the interface with the tooth, which is responsible for their adhesion. Modified forms of glass-ionomers, namely resin-modified glass-ionomers and glass carbomer, are also described and their properties and applications covered. Physical properties of the resin-modified glass-ionomers are shown to be good, and comparable with those of conventional glass-ionomers, but biocompatibility is somewhat compromised by the presence of the resin component, 2 hydroxyethyl methacrylate. Properties of glass carbomer appear to be slightly inferior to those of the best modern conventional glass-ionomers, and there is not yet sufficient information to determine how their bioactivity compares, although they have been formulated to enhance this particular feature.

  17. Clinical Pharmacology of Furosemide in Neonates: A Review

    Directory of Open Access Journals (Sweden)

    Gian Maria Pacifici

    2013-09-01

    Full Text Available Furosemide is the diuretic most used in newborn infants. It blocks the Na+-K+-2Cl− symporter in the thick ascending limb of the loop of Henle increasing urinary excretion of Na+ and Cl−. This article aimed to review the published data on the clinical pharmacology of furosemide in neonates to provide a critical, comprehensive, authoritative and, updated survey on the metabolism, pharmacokinetics, pharmacodynamics and side-effects of furosemide in neonates. The bibliographic search was performed using PubMed and EMBASE databases as search engines; January 2013 was the cutoff point. Furosemide half-life (t1/2 is 6 to 20-fold longer, clearance (Cl is 1.2 to 14-fold smaller and volume of distribution (Vd is 1.3 to 6-fold larger than the adult values. t1/2 shortens and Cl increases as the neonatal maturation proceeds. Continuous intravenous infusion of furosemide yields more controlled diuresis than the intermittent intravenous infusion. Furosemide may be administered by inhalation to infants with chronic lung disease to improve pulmonary mechanics. Furosemide stimulates prostaglandin E2 synthesis, a potent dilator of the patent ductus arteriosus, and the administration of furosemide to any preterm infants should be carefully weighed against the risk of precipitation of a symptomatic patent ductus arteriosus. Infants with low birthweight treated with chronic furosemide are at risk for the development of intra-renal calcifications.

  18. Clinical pharmacology of fentanyl in preterm infants. A review.

    Science.gov (United States)

    Pacifici, Gian Maria

    2015-06-01

    Fentanyl is a synthetic opioid that is very important in anesthetic practice because of its relatively short time to peak analgesic effect and the rapid termination of action after small bolus doses. The objective of this survey is to review the clinical pharmacology of fentanyl in preterm infants. The bibliographic search was performed using PubMed and EMBASE databases as search engines. In addition, the books Neofax: A manual of drugs used in neonatal care and Neonatal formulary were consulted. Fentanyl is N-dealkylated by CYP3A4 into the inactive norfentanyl. Fentanyl may be administered as bolus doses or as a continuous infusion. In neonates, there is a remarkable interindividual variability in the kinetic parameters. In neonates, fentanyl half-life ranges from 317 minutes to 1266 minutes and in adults it is 222 minutes. Respiratory depression occurs when fentanyl doses are >5 μg/kg. Chest wall rigidity may occur in neonates and occasionally is associated with laryngospasm. Tolerance to fentanyl may develop after prolonged use of this drug. Significant withdrawal symptoms have been reported in infants treated with continuous infusion for 5 days or longer. Fentanyl is an extremely potent analgesic and is the opioid analgesic most frequently used in the neonatal intensive care unit.

  19. Portal annular pancreas: a systematic review of a clinical challenge.

    Science.gov (United States)

    Harnoss, Jonathan M; Harnoss, Julian C; Diener, Markus K; Contin, Pietro; Ulrich, Alexis B; Büchler, Markus W; Schmitz-Winnenthal, Friedrich H

    2014-10-01

    Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the study was to determine the role of PAP in pancreatic surgery as well as its management and potential complication, specifically, postoperative pancreatic fistula (POPF).On the basis of a case report, the MEDLINE and ISI Web of Science databases were systematically reviewed up to September 2012. All articles describing a case of PAP were considered.In summary, 21 studies with 59 cases were included. The overall prevalence of PAP was 2.4% and the patients' mean (SD) age was 55.9 (16.2) years. The POPF rate in patients with PAP (12 pancreaticoduodenectomies and 3 distal pancreatectomies) was 46.7% (in accordance with the definition of the International Study Group of Pancreatic Surgery).Portal annular pancreas is a quite unattended pancreatic variant with high prevalence and therefore still remains a clinical challenge to avoid postoperative complications. To decrease the risk for POPF, attentive preoperative diagnostics should also focus on PAP. In pancreaticoduodenectomy, a shift of the resection plane to the pancreas tail should be considered; in extensive pancreatectomy, coverage of the pancreatic remnant by the falciform ligament could be a treatment option.

  20. Epidemiological, clinical, and immunological characteristics of neuromyelitis optica: A review.

    Science.gov (United States)

    Pereira, Wildéa Lice de Carvalho Jennings; Reiche, Edna Maria Vissoci; Kallaur, Ana Paula; Kaimen-Maciel, Damacio Ramón

    2015-08-15

    The aim of this study was to review the epidemiological and clinical characteristics of neuromyelitis optica (NMO) and the immunopathological mechanisms involved in the neuronal damage. NMO is an inflammatory demyelinating autoimmune disease of the central nervous system that most commonly affects the optic nerves and spinal cord. NMO is thought to be more prevalent among non-Caucasians and where multiple sclerosis (MS) prevalence is low. NMO follows a relapsing course in more than 80-90% of cases, which is more commonly in women. It is a complex disease with an interaction between host genetic and environmental factors and the main immunological feature is the presence of anti-aquaporin 4 (AQP4) antibodies in a subset of patients. NMO is frequently associated with multiple other autoantibodies and there is a strong association between NMO with other systemic autoimmune diseases. AQP4-IgG can cause antibody-dependent cellular cytotoxicity (ADCC) when effector cells are present and complement-dependent cytotoxicity (CDC) when complement is present. Acute therapies, including corticosteroids and plasma exchange, are designed to minimize injury and accelerate recovery. Several aspects of NMO pathogenesis remain unclear. More advances in the understanding of NMO disease mechanisms are needed in order to identify more specific biomarkers to NMO diagnosis.

  1. Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review

    Directory of Open Access Journals (Sweden)

    Nancy L. Moureau

    2015-01-01

    Full Text Available Background. Needleless connectors (NC are used on virtually all intravascular devices, providing an easy access point for infusion connection. Colonization of NC is considered the cause of 50% of postinsertion catheter-related infections. Breaks in aseptic technique, from failure to disinfect, result in contamination and subsequent biofilm formation within NC and catheters increasing the potential for infection of central and peripheral catheters. Methods. This systematic review evaluated 140 studies and 34 abstracts on NC disinfection practices, the impact of hub contamination on infection, and measures of education and compliance. Results. The greatest risk for contamination of the catheter after insertion is the NC with 33–45% contaminated, and compliance with disinfection as low as 10%. The optimal technique or disinfection time has not been identified, although scrubbing with 70% alcohol for 5–60 seconds is recommended. Studies have reported statistically significant results in infection reduction when passive alcohol disinfection caps are used (48–86% reduction. Clinical Implications. It is critical for healthcare facilities and clinicians to take responsibility for compliance with basic principles of asepsis compliance, to involve frontline staff in strategies, to facilitate education that promotes understanding of the consequences of failure, and to comply with the standard of care for hub disinfection.

  2. Cytochrome P450 structure, function and clinical significance: A review.

    Science.gov (United States)

    Palrasu, Manikandan; Nagini, Siddavaram

    2017-01-25

    The cytochrome P450 (CYP) enzymes are membrane-bound hemoproteins that play a pivotal role in the detoxification of xenobiotics, cellular metabolism and homeostasis. Induction or inhibition of CYP enzymes is a major mechanism that underlies drug-drug interactions. CYP enzymes can be transcriptionally activated by various xenobiotics and endogenous substrates through receptor-dependent mechanisms. CYP enzyme inhibition is a principal mechanism for metabolism-based drug-drug interactions. Many chemotherapeutic drugs can cause drug interactions due to their ability to either inhibit or induce the CYP enzyme system. Predictions based on in silico analyses followed by validation have identified several microRNAs that regulate CYPs. Genetic polymorphisms and epigenetic changes in CYP genes may be responsible for inter-individual and inter-ethnic variations in disease susceptibility and the therapeutic efficacy of drugs. Knowledge about the substrates, inducers, inhibitors of CYP isoforms, and the polymorphisms of CYP enzymes may be used as an aid by clinicians to determine therapeutic strategy, and treatment doses for drugs that are metabolized by CYP gene products. The present review is a comprehensive compilation of cytochrome P450 structure, function, pharmacogenetics, and pharmacoepigenetics and clinical significance.

  3. Randomized clinical trials of constitutional acupuncture: a systematic review.

    Science.gov (United States)

    Lee, Myeong Soo; Shin, Byung-Cheul; Choi, Sun-Mi; Kim, Jong Yeol

    2009-09-01

    The aim of this systematic review is to compile and critically evaluate the evidence from randomized clinical trials (RCTs) for the effectiveness of acupuncture using constitutional medicine compared to standard acupuncture. Ten databases were searched through to December 2008 without language restrictions. We also hand-searched nine Korean journals of oriental medicine. We included prospective RCTs of any form of acupuncture with or without electrical stimulation. The included trials had to investigate constitutional medicine. There were no restrictions on population characteristics. Forty-one relevant studies were identified, and three RCTs were included. The methodological quality of the trials was variable. One RCT found Sasang constitutional acupuncture to be superior to standard acupuncture in terms of the Unified PD Rating Scale and freezing gate in Parkinson's disease (PD). Another two RCTs reported favorable effects of eight constitutional acupuncture on pain reduction in patients with herniated nucleus pulposi and knee osteoarthritis. Meta-analysis demonstrated positive results for eight constitutional acupuncture compared to standard acupuncture on pain reduction (weighted mean difference: 10 cm VAS, 1.69, 95% CI 0.85-2.54, P acupuncture in treating pain conditions compared to standard acupuncture. However, the total number of RCTs and the total sample size included in our analysis were too small to draw definite conclusions. Future RCTs should assess larger patient samples with longer treatment periods and appropriate controls.

  4. Personal series with clinical review of fracture penis.

    Science.gov (United States)

    Bhuiyan, Z H; Khan, S A; Tawhid, M H; Islam, M F

    2007-07-01

    Penile fracture is an uncommon Urological emergency. In flaccid state it allows significant degree of deformation without any injury to the vital structures but in erected state it is vulnerable to blunt injury. The tumescent corpora cavernosa may have got injured due to nonphysiological bending of penile shaft. The true incidence of penile fracture is not known even in western countries. It is either under reported or hidden for potential social embracement. We have reviewed all of our cases of penile fracture and has been conducted a retrospective study in the Department of Urology, Bangladesh Medical College, Dhaka. The study period was from October 2001 to January 2006. The sample size was 23. All patients have got classical history of penile fracture. The time between the onset of symptom and seeking of medical care ranges from 02 hours to 07 days. The diagnosis was made on the basis of history and clinical examination only. All the patients were underwent surgery. The potency was well preserved in all of our patients. The local tissue healing process is better among the patients, reported earlier. The overall result is excellent.

  5. A Review of Glass-Ionomer Cements for Clinical Dentistry

    Directory of Open Access Journals (Sweden)

    Sharanbir K. Sidhu

    2016-06-01

    Full Text Available This article is an updated review of the published literature on glass-ionomer cements and covers their structure, properties and clinical uses within dentistry, with an emphasis on findings from the last five years or so. Glass-ionomers are shown to set by an acid-base reaction within 2–3 min and to form hard, reasonably strong materials with acceptable appearance. They release fluoride and are bioactive, so that they gradually develop a strong, durable interfacial ion-exchange layer at the interface with the tooth, which is responsible for their adhesion. Modified forms of glass-ionomers, namely resin-modified glass-ionomers and glass carbomer, are also described and their properties and applications covered. Physical properties of the resin-modified glass-ionomers are shown to be good, and comparable with those of conventional glass-ionomers, but biocompatibility is somewhat compromised by the presence of the resin component, 2 hydroxyethyl methacrylate. Properties of glass carbomer appear to be slightly inferior to those of the best modern conventional glass-ionomers, and there is not yet sufficient information to determine how their bioactivity compares, although they have been formulated to enhance this particular feature.

  6. Occurrence of blaNDM-1 & absence of blaKPC genes encoding carbapenem resistance in uropathogens from a tertiary care centre from north India

    Directory of Open Access Journals (Sweden)

    Balvinder Mohan

    2015-01-01

    Interpretation & conclusions: The bla NDM-1 gene was absent in our isolates obtained during 2008 but was present amongst Enterobacteriaceae isolated in 2012. The bla KPC gene was also not found. Nine isolates obtained during the two years had multiple genes encoding carbapenemases confirming the previous reports of emergence of GNB containing genes encoding multiple carbapenemases. Typing using BOX-PCR indicated that this emergence was not because of clonal expansion of a single strain, and multiple strains were circulating at a single point of time.

  7. Carbapenem-resistant Acinetobacter pittii strain harboring blaOXA-72 from Brazil.

    Science.gov (United States)

    Chagas, Thiago Pavoni Gomes; Tavares E Oliveira, Thamirys Rachel; D'Alincourt Carvalho-Assef, Ana Paula; Albano, Rodolpho M; Asensi, Marise Dutra

    2017-02-06

    In this study, we report the isolation of OXA-72-producing Acinetobacter pittii in Brazil. A carbapenem-resistant A. pittii strain was recovered from a hospitalized female patient from Espírito Santo, Southeastern Brazil. PCR screening and DNA sequencing allowed us to identify the presence of blaOXA-72. We observed blaOXA-72 in a ~11kb plasmid and flanked by XerC/XerD-binding sites.

  8. Persistence of Multidrug-Resistant Acinetobacter baumannii Isolates Harboring blaOXA-23 and bap for 5 Years.

    Science.gov (United States)

    Sung, Ji Youn; Koo, Sun Hoe; Kim, Semi; Kwon, Gye Cheol

    2016-08-28

    The emergence and dissemination of carbapenemase-producing Acinetobacter baumannii isolates have been reported worldwide, and A. baumannii isolates harboring blaOXA-23 are often resistant to various antimicrobial agents. Antimicrobial resistance can be particularly strong for biofilm-forming A. baumannii isolates. We investigated the genetic basis for carbapenem resistance and biofilm-forming ability of multidrug-resistant (MDR) clinical isolates. Ninety-two MDR A. baumannii isolates were collected from one university hospital located in the Chungcheong area of Korea over a 5-year period. Multiplex PCR and DNA sequencing were performed to characterize carbapenemase and bap genes. Clonal characteristics were analyzed using REP-PCR. In addition, imaging and quantification of biofilms were performed using a crystal violet assay. All 92 MDR A. baumannii isolates involved in our study contained the blaOXA-23 and bap genes. The average absorbance of biomass in Bap-producing strains was much greater than that in non-Bap-producing strains. In our study, only three REP-PCR types were found, and the isolates showing type A or type B were found more than 60 times among unique patients during the 5 years of surveillance. These results suggest that the isolates have persisted and colonized for 5 years, and biofilm formation ability has been responsible for their persistence and colonization.

  9. Detection of Staphylococcal Cassette Chromosome mec Type XI Carrying Highly Divergent mecA, mecI, mecR1, blaZ, and ccr Genes in Human Clinical Isolates of Clonal Complex 130 Methicillin-Resistant Staphylococcus aureus▿†

    Science.gov (United States)

    Shore, Anna C.; Deasy, Emily C.; Slickers, Peter; Brennan, Grainne; O'Connell, Brian; Monecke, Stefan; Ehricht, Ralf; Coleman, David C.

    2011-01-01

    Methicillin resistance in staphylococci is mediated by penicillin binding protein 2a (PBP 2a), encoded by mecA on mobile staphylococcal cassette chromosome mec (SCCmec) elements. In this study, two clonal complex 130 (CC130) methicillin-resistant Staphylococcus aureus (MRSA) isolates from patients in Irish hospitals were identified that were phenotypically PBP 2a positive but lacked mecA by conventional PCR and by DNA microarray screening. The isolates were identified as methicillin-susceptible S. aureus using the GeneXpert real-time PCR assay. Whole-genome sequencing of one isolate (M10/0061) revealed a 30-kb SCCmec element encoding a class E mec complex with highly divergent blaZ-mecA-mecR1-mecI, a type 8 cassette chromosome recombinase (ccr) complex consisting of ccrA1-ccrB3, an arsenic resistance operon, and flanking direct repeats (DRs). The SCCmec element was almost identical to that of SCCmec type XI (SCCmec XI) identified by the Sanger Institute in sequence type 425 bovine MRSA strain LGA251 listed on the website of the International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements. The open reading frames (ORFs) identified within SCCmec XI of M10/0061 exhibited 21 to 93% amino acid identity to ORFs in GenBank. A third DR was identified ca. 3 kb downstream of SCCmec XI, indicating the presence of a possible SCC remnant. SCCmec XI was also identified in the second CC130 MRSA isolate by PCR and sequencing. The CC130 MRSA isolates may be of animal origin as previously reported CC130 S. aureus strains were predominantly from bovine sources. The highly divergent nature of SCCmec XI relative to other SCCmec elements indicates that it may have originated in another taxon. PMID:21636525

  10. Global Escherichia coli Sequence Type 131 Clade with blaCTX-M-27 Gene.

    Science.gov (United States)

    Matsumura, Yasufumi; Pitout, Johann D D; Gomi, Ryota; Matsuda, Tomonari; Noguchi, Taro; Yamamoto, Masaki; Peirano, Gisele; DeVinney, Rebekah; Bradford, Patricia A; Motyl, Mary R; Tanaka, Michio; Nagao, Miki; Takakura, Shunji; Ichiyama, Satoshi

    2016-11-01

    The Escherichia coli sequence type (ST) 131 C2/H30Rx clade with the blaCTX-M-15 gene had been most responsible for the global dissemination of extended-spectrum β-lactamase (ESBL)-producing E. coli. ST131 C1/H30R with blaCTX-M-27 emerged among ESBL-producing E. coli in Japan during the late 2000s. To investigate the possible expansion of a single clade, we performed whole-genome sequencing for 43 Japan and 10 global ST131 isolates with blaCTX-M-27 (n = 16), blaCTX-M-14 (n = 16), blaCTX-M-15 (n = 13), and others (n = 8). We also included 8 ST131 genomes available in public databases. Core genome-based analysis of 61 isolates showed that ST131 with blaCTX-M-27 from 5 countries formed a distinct cluster within the C1/H30R clade, named C1-M27 clade. Accessory genome analysis identified a unique prophage-like region, supporting C1-M27 as a distinct clade. Our findings indicate that the increase of ESBL-producing E. coli in Japan is due mainly to emergence of the C1-M27 clade.

  11. Evaluation of instruments developed to measure the clinical learning environment: an integrative review.

    Science.gov (United States)

    Hooven, Katie

    2014-01-01

    The nature of the clinical learning environment has a huge impact on student learning. This article reviews current methods available for evaluating the clinical learning environment. Five instruments were identified that measure the clinical learning environment. All of these instruments focus solely on the student perspective of the clinical learning environment. Although gaining student input is important, there are other perspectives that offer valuable insights on the nature of the clinical learning environment. The findings from this integrative review indicate the need for future development and testing of an instrument to evaluate the clinical learning environment from the staff nurse and nurse faculty perspective.

  12. Towards combinatorial targeted therapy in melanoma: from pre-clinical evidence to clinical application (review).

    Science.gov (United States)

    Grazia, Giulia; Penna, Ilaria; Perotti, Valentina; Anichini, Andrea; Tassi, Elena

    2014-09-01

    Over the last few years, clinical trials with BRAF and mitogen-activated protein/extracellular signal-regulated kinase (MEK) inhibitors have shown significant clinical activity in melanoma, but only a fraction of patients respond to these therapies, and development of resistance is frequent. This has prompted a large set of preclinical studies looking at several new combinatorial approaches of pathway- or target-specific inhibitors. At least five main drug association strategies have been verified in vitro and in preclinical models. The most promising include: i) vertical targeting of either MEK or phosphoinositide-3 kinase (PI3K)/mammalian target of rapamycin (mTOR) pathways, or their combined blockade; ii) association of receptor tyrosine kinases (RTKs) inhibitors with other pro-apoptotic strategies; iii) engagement of death receptors in combination with MEK-, mTOR/PI3K-, histone deacetylase (HDAC)-inhibitors, or with anti-apoptotic molecules modulators; iv) strategies aimed at blocking anti-apoptotic proteins belonging to B-cell lymphoma (Bcl-2) or inhibitors of apoptosis (IAP) families associated with MEK/BRAF/p38 inhibition; v) co-inhibition of other molecules important for survival [proteasome, HDAC and Signal transducers and activators of transcription (Stat)3] and the major pathways activated in melanoma; vi) simultaneous targeting of multiple anti-apoptotic molecules. Here we review the anti-melanoma efficacy and mechanism of action of the above-mentioned combinatorial strategies, together with the potential clinical application of the most promising studies that may eventually lead to therapeutic benefit.

  13. Preceptorship versus Clinical Teaching Partnership: Literature Review and Recommendations for Implementation in Ghana

    Directory of Open Access Journals (Sweden)

    Confidence Alorse Atakro

    2016-01-01

    Full Text Available Clinical education is an essential component of the education of nursing students. However clinical nursing education in Ghana is currently facing challenges of poor working relations between hospitals and health training institutions, inadequate preceptor preparations, and inadequate faculty supervisions. Although the dominant clinical education model used in Ghana is the preceptorship model, health service and education industries are faced with challenges of lack of qualified staff, inadequately prepared preceptors, and inadequate supervision from faculty. These challenges undermine the effectiveness of the clinical learning environment and the use of the preceptorship model. The purpose of this paper was to review preceptorship and clinical teaching partnership (CTP and make recommendations for improving clinical nursing education in Ghana. A literature review was undertaken through a search of databases that included Google Scholar, EBSCOhost, CINAHL, and HINARI. A literature review identified advantages for using clinical teaching partnership (CTP in clinical nursing education in Ghana. Recommendations were made for the use of CTP in Ghana.

  14. Fair inclusion of pregnant women in clinical research : a systematic review of reported reasons for exclusion

    NARCIS (Netherlands)

    van der Zande, ISE; Verhave, R; Browne, JL; van Delden, Johannes

    2016-01-01

    This empirical chapter provides a systematic review of literature relevant to the inclusion of pregnant women in clinical trials. In particular, it addresses barriers to fair inclusion identified within the literature. The 31 articles reviewed discuss the exclusion of pregnant women from clinical tr

  15. Randomized Clinical Trials of Constitutional Acupuncture: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Myeong Soo Lee

    2009-01-01

    Full Text Available The aim of this systematic review is to compile and critically evaluate the evidence from randomized clinical trials (RCTs for the effectiveness of acupuncture using constitutional medicine compared to standard acupuncture. Ten databases were searched through to December 2008 without language restrictions. We also hand-searched nine Korean journals of oriental medicine. We included prospective RCTs of any form of acupuncture with or without electrical stimulation. The included trials had to investigate constitutional medicine. There were no restrictions on population characteristics. Forty-one relevant studies were identified, and three RCTs were included. The methodological quality of the trials was variable. One RCT found Sasang constitutional acupuncture to be superior to standard acupuncture in terms of the Unified PD Rating Scale and freezing gate in Parkinson's disease (PD. Another two RCTs reported favorable effects of eight constitutional acupuncture on pain reduction in patients with herniated nucleus pulposi and knee osteoarthritis. Meta-analysis demonstrated positive results for eight constitutional acupuncture compared to standard acupuncture on pain reduction (weighted mean difference: 10 cm VAS, 1.69, 95% CI 0.85–2.54, P < 0.0001; heterogeneity: τ2 = 0.00, Χ2 = 0.00, P = 0.96, I2 = 0%. Our results provide suggestive evidence for the effectiveness of constitutional acupuncture in treating pain conditions compared to standard acupuncture. However, the total number of RCTs and the total sample size included in our analysis were too small to draw definite conclusions. Future RCTs should assess larger patient samples with longer treatment periods and appropriate controls.

  16. Cervical spine alignment, sagittal deformity, and clinical implications: a review.

    Science.gov (United States)

    Scheer, Justin K; Tang, Jessica A; Smith, Justin S; Acosta, Frank L; Protopsaltis, Themistocles S; Blondel, Benjamin; Bess, Shay; Shaffrey, Christopher I; Deviren, Vedat; Lafage, Virginie; Schwab, Frank; Ames, Christopher P

    2013-08-01

    This paper is a narrative review of normal cervical alignment, methods for quantifying alignment, and how alignment is associated with cervical deformity, myelopathy, and adjacent-segment disease (ASD), with discussions of health-related quality of life (HRQOL). Popular methods currently used to quantify cervical alignment are discussed including cervical lordosis, sagittal vertical axis, and horizontal gaze with the chin-brow to vertical angle. Cervical deformity is examined in detail as deformities localized to the cervical spine affect, and are affected by, other parameters of the spine in preserving global sagittal alignment. An evolving trend is defining cervical sagittal alignment. Evidence from a few recent studies suggests correlations between radiographic parameters in the cervical spine and HRQOL. Analysis of the cervical regional alignment with respect to overall spinal pelvic alignment is critical. The article details mechanisms by which cervical kyphotic deformity potentially leads to ASD and discusses previous studies that suggest how postoperative sagittal malalignment may promote ASD. Further clinical studies are needed to explore the relationship of cervical malalignment and the development of ASD. Sagittal alignment of the cervical spine may play a substantial role in the development of cervical myelopathy as cervical deformity can lead to spinal cord compression and cord tension. Surgical correction of cervical myelopathy should always take into consideration cervical sagittal alignment, as decompression alone may not decrease cord tension induced by kyphosis. Awareness of the development of postlaminectomy kyphosis is critical as it relates to cervical myelopathy. The future direction of cervical deformity correction should include a comprehensive approach in assessing global cervicalpelvic relationships. Just as understanding pelvic incidence as it relates to lumbar lordosis was crucial in building our knowledge of thoracolumbar deformities, T

  17. Craniofacial muscle pain: review of mechanisms and clinical manifestations.

    Science.gov (United States)

    Svensson, P; Graven-Nielsen, T

    2001-01-01

    Epidemiologic surveys of temporomandibular disorders (TMD) have demonstrated that a considerable proportion of the population--up to 5% or 6%--will experience persistent pain severe enough to seek treatment. Unfortunately, the current diagnostic classification of craniofacial muscle pain is based on descriptions of signs and symptoms rather than on knowledge of pain mechanisms. Furthermore, the pathophysiology and etiology of craniofacial muscle pain are not known in sufficient detail to allow causal treatment. Many hypotheses have been proposed to explain cause-effect relationships; however, it is still uncertain what may be the cause of muscle pain and what is the effect of muscle pain. This article reviews the literature in which craniofacial muscle pain has been induced by experimental techniques in animals and human volunteers and in which the effects on somatosensory and motor function have been assessed under standardized conditions. This information is compared to the clinical correlates, which can be derived from the numerous cross-sectional studies in patients with craniofacial muscle pain. The experimental literature clearly indicates that muscle pain has significant effects on both somatosensory and craniofacial motor function. Typical somatosensory manifestations of experimental muscle pain are referred pain and increased sensitivity of homotopic areas. The craniofacial motor function is inhibited mainly during experimental muscle pain, but phase-dependent excitation is also found during mastication to reduce the amplitude and velocity of jaw movements. The underlying neurobiologic mechanisms probably involve varying combinations of sensitization of peripheral afferents, hyperexcitability of central neurons, and imbalance in descending pain modulatory systems. Reflex circuits in the brain stem seem important for the adjustment of sensorimotor function in the presence of craniofacial pain. Changes in somatosensory and motor function may therefore be

  18. Penicillinase-producing plasmid types in Neisseria gonorrhoeae clinical isolates from Australia.

    Science.gov (United States)

    Whiley, David; Trembizki, Ella; Buckley, Cameron; Freeman, Kevin; Lawrence, Andrew; Limnios, Athena; Pearson, Julie; Smith, Helen; Stevens, Kerrie; Lahra, Monica M

    2014-12-01

    Penicillinase-producing Neisseria gonorrhoeae (PPNG) carrying the blaTEM-135 gene is of particular concern, as it is considered a stepping stone toward resistance to extended-spectrum cephalosporins. Here, we sought to characterize plasmid types and the occurrence of the blaTEM-135 gene for N. gonorrhoeae clinical isolates from Australia. We found that blaTEM-135 was prevalent in Australian PPNG and was detected on all three major plasmid types.

  19. Association between susceptible genotypes to periodontitis and clinical outcomes of periodontal regenerative therapy: a systematic review

    OpenAIRE

    Chatzopoulos, Georgios S.; Koidou, Vasiliki-Petros

    2016-01-01

    Background The aim of this review is to systematically investigate the effect of a susceptible genotype to periodontitis with the clinical outcomes of periodontal regeneration. Material and Methods Based on a focused question, an electronic search identified 155 unique citations. Three journals (Journal of Periodontology, Journal of Clinical Periodontology and Journal of Periodontal Research), references of relevant studies and review articles were hand-searched. Two independent reviewers imp...

  20. Test Review: Advanced Clinical Solutions for WAIS-IV and WMS-IV

    Science.gov (United States)

    Chu, Yiting; Lai, Mark H. C.; Xu, Yining; Zhou, Yuanyuan

    2012-01-01

    The authors review the "Advanced Clinical Solutions for WAIS-IV and WMS-IV". The "Advanced Clinical Solutions (ACS) for the Wechsler Adult Intelligence Scale-Fourth Edition" (WAIS-IV; Wechsler, 2008) and the "Wechsler Memory Scale-Fourth Edition" (WMS-IV; Wechsler, 2009) was published by Pearson in 2009. It is a clinical tool for extending the…

  1. How to identify Raoultella spp. including R. ornithinolytica isolates negative for ornithine decarboxylase? The reliability of the chromosomal bla gene.

    Science.gov (United States)

    Walckenaer, Estelle; Leflon-Guibout, Véronique; Nicolas-Chanoine, Marie-Hélène

    2008-12-01

    Although Raoultella planticola and Raoultella ornithinolytica were described more than 20 years ago, identifying them remains difficult. The reliability of the chromosomal bla gene for this identification was evaluated in comparison with that of the 16S rDNA and rpoB genes in 35 Raoultella strains from different origins. Of the 26 strains previously identified as R. planticola by biochemical tests alone or in association with molecular methods, 21 harboured a bla gene with 99.8% identity with the bla gene of two reference R. ornithinolytica strains (bla(ORN) gene) and 5 harboured a bla gene with 99.2% identity with the bla gene of two reference R. planticola strains (bla(PLA) gene). The 9 isolates previously identified as R. ornithinolytica harboured a bla(ORN) gene. The bla gene-based identification was confirmed by 16S rDNA and rpoB sequencing. The 21 isolates newly identified as R. ornithinolytica had a test negative for ornithine decarboxylase (ODC). Molecular experiments suggested one copy of ODC-encoding gene in both ODC-negative R. ornithinolytica and R. planticola strains and two copies in ODC-positive R. orninthinolytica strains. Analysis of the 35 bla genes allowed us (i) to confirm an identity of only 94% between the bla genes of the two Raoultella species while this identity was > 98% for rpoB and > 99% for 16S rDNA genes and (ii) to develop and successfully apply a bla PCR RFLP assay for Raoultella spp. identification. Overall, this study allowed us to discover ODC-negative R. ornithinolytica and to provide a reliable Raoultella identification method widely available as not requiring sequencing equipment.

  2. Perception of nursing students face clinical supervision: literature review

    OpenAIRE

    Certo, Ana; Galvão, Ana Maria; Louçano, Ana

    2015-01-01

    Currently, without theoretical clinical training is not possible for the nursing student adequately meet their clinical practices.In this regard, clinical supervision plays a key role monitoring and development of the same. However,so that the student can be supervised, requires evidence of nurse supervisor competence in this context. In contemporary literature, this issue has been much debated, as the target of numerous different scientific studies. Aim of the study was, under...

  3. Classification and clinical features of headache disorders in Pakistan: a retrospective review of clinical data.

    Directory of Open Access Journals (Sweden)

    Muhammed Murtaza

    Full Text Available BACKGROUND: Morbidity associated with primary headache disorders is a major public health problem with an overall prevalence of 46%. Tension-type headache and migraine are the two most prevalent causes. However, headache has not been sufficiently studied as a cause of morbidity in the developing world. Literature on prevalence and classification of these disorders in South Asia is scarce. The aim of this study is to describe the classification and clinical features of headache patients who seek medical advice in Pakistan. METHODS AND RESULTS: Medical records of 255 consecutive patients who presented to a headache clinic at a tertiary care hospital were reviewed. Demographic details, onset and lifetime duration of illness, pattern of headache, associated features and family history were recorded. International Classification of Headache Disorders version 2 was applied. 66% of all patients were women and 81% of them were between 16 and 49 years of age. Migraine was the most common disorder (206 patients followed by tension-type headache (58 patients, medication-overuse headache (6 patients and cluster headache (4 patients. Chronic daily headache was seen in 99 patients. Patients with tension-type headache suffered from more frequent episodes of headache than patients with migraine (p<0.001. Duration of each headache episode was higher in women with menstrually related migraine (p = 0.015. Median age at presentation and at onset was lower in patients with migraine who reported a first-degree family history of the disease (p = 0.003 and p<0.001 respectively. CONCLUSIONS/SIGNIFICANCE: Patients who seek medical advice for headache in Pakistan are usually in their most productive ages. Migraine and tension-type headache are the most common clinical presentations of headache. Onset of migraine is earlier in patients with first-degree family history. Menstrually related migraine affects women with headache episodes of longer duration than other patients

  4. Review of clinical and basic approaches of fungal keratitis

    Science.gov (United States)

    Wu, Jie; Zhang, Wen-Song; Zhao, Jing; Zhou, Hong-Yan

    2016-01-01

    Fungal keratitis (FK) is a serious disease which can cause blindness. This review has current information about the pathogenesis, limitations of traditional diagnosis and therapeutic strategies, immune recognition and the diagnosis and therapy of FK. The information of this summary was reviewed regularly and updated as what we need in the diagnosis and therapy of FK nowadays. PMID:27990375

  5. 'Clinical features of women with gout arthritis' : a systematic review

    NARCIS (Netherlands)

    Dirken-Heukensfeldt, K.J.; Teunissen, T.A.M.; Lisdonk, E.H. van de; Lagro-Janssen, A.L.M.

    2010-01-01

    Clinically, gout is generally considered as a preferential male disease. However, it definitely does not occur exclusively in males. Our aim was to assess differences in the clinical features of gout arthritis between female and male patients. Five electronic databases were searched to identify rele

  6. Pulpal healing following acute dental trauma: clinical and radiographic review.

    Science.gov (United States)

    Andreasen, F M

    2001-05-01

    Successful treatment of tooth luxations, crown fractures, and root fractures is often compromised by the emergency nature of the injury. Precise radiographic and clinical evaluation is required to facilitate healing and treatment selection. While traditional treatment protocols indicate that dental injuries implying pulpal ischemia require immediate endodontic therapy to avoid healing complications, the clinical investigations discussed herein suggest that a variety of etiologies for pulp survival/pulp necrosis exist. This article discusses the long-term prognosis of pulp necrosis following traumatic dental injuries, and clinical and radiographic criteria for its diagnosis.

  7. Perioperative Clinical Nurse Specialist Role Delineation: A Systematic Review

    Science.gov (United States)

    2006-06-01

    data during translation by the research team. A review summary table (RST) was developed to record data gathered from the systematic review. The table...of the data during translation by the research team. Articles that were included in the final bibliography, but then determined not to meet any of the...care nurses. Heart Lung, 19(3), 236-242. Coleman, S., & Henneman , E. A. (1991). Comprehensive patient care and documentation through unit-based

  8. Initial Assessment of the Molecular Epidemiology of blaNDM-1 in Colombia

    Science.gov (United States)

    Rojas, Laura J.; Wright, Meredith S.; De La Cadena, Elsa; Motoa, Gabriel; Hujer, Kristine M.; Villegas, Maria V.

    2016-01-01

    We report complete genome sequences of four blaNDM-1-harboring Gram-negative multidrug-resistant (MDR) isolates from Colombia. The blaNDM-1 genes were located on 193-kb Inc FIA, 178-kb Inc A/C2, and 47-kb (unknown Inc type) plasmids. Multilocus sequence typing (MLST) revealed that these isolates belong to sequence type 10 (ST10) (Escherichia coli), ST392 (Klebsiella pneumoniae), and ST322 and ST464 (Acinetobacter baumannii and Acinetobacter nosocomialis, respectively). Our analysis identified that the Inc A/C2 plasmid in E. coli contained a novel complex transposon (Tn125 and Tn5393 with three copies of blaNDM-1) and a recombination “hot spot” for the acquisition of new resistance determinants. PMID:27067339

  9. PER, CTX-M, TEM and SHV Beta-lactamases in Clinical Isolates of Klebsiella pneumoniae Isolated from Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Leila Nasehi

    2010-06-01

    Full Text Available Objective(sDifferent types of extended spectrum beta-lactamases (ESBLs are encountered in the clinical settings worldwide. There are a few studies regarding the prevalence of ESBL genes among Klebsiella pneumoniae isolates at Tehran especially those of blaPER and blaCTX. The aim of this study was to determine the prevalence of blaSHV, blaTEM ,blaPER and blaCTX genes among clinical K. pneumoniae of different hospitals in Tehran.Materials and MethodsTwo hundred isolates of K. pneumoniae were received from different clinical specimens. The susceptibility of the isolates to 10 different antibiotics was examined by disk diffusion test. The MICs for ceftazidime were also determined using micro-broth dilution assay. Isolates showing MIC 4 μg/ml for ceftazidime were screened for ESBL production by phenotypic confirmatory test (PCT and subjected to PCR for studied genes. Variation among four amplified genes was evaluated using PCR-RFLP.ResultsBy disk diffusion test, resistance to ceftazidime and cefotaxime were 34.7% and 33.5% respectively. However, all strains were susceptible to imipenem. Eighty isolates showed MICs≥ 4 μg/ml for ceftazidime of which 77 (96% were positive for ESBL in PCT. The prevalence of blaSHV, blaCTX-M, blaTEM and blaPER among these isolates were 26%, 24.5%, 18% and 7.5%, respectively. No variation was detected in the genes by PCR-RFLP.ConclusionAs far as we know this is the first report of the blaPER-1 in K. pneumoniae in Iran. The blaCTX-M was the second most common gene detected among the ESBL positive isolates of K. pneumoniae. For rapid identification of ESBL producing isolates it was recommended that clinical laboratories adopt simple test based on CLSI recommendation for confirming ESBL production in enterobacterial species.

  10. Crystal Structure of a Dimerized Cockroach Allergen Bla g 2 Complexed with a Monoclonal Antibody

    Energy Technology Data Exchange (ETDEWEB)

    Li, Mi; Gustchina, Alla; Alexandratos, Jerry; Wlodawer, Alexander; Wünschmann, Sabina; Kepley, Christopher L.; Chapman, Martin D.; Pomes, Anna (INDOOR Bio.); (VCU); (NIH)

    2008-09-03

    The crystal structure of a 1:1 complex between the German cockroach allergen Bla g 2 and the Fab' fragment of a monoclonal antibody 7C11 was solved at 2.8-{angstrom} resolution. Bla g 2 binds to the antibody through four loops that include residues 60-70, 83-86, 98-100, and 129-132. Cation-{pi} interactions exist between Lys-65, Arg-83, and Lys-132 in Bla g 2 and several tyrosines in 7C11. In the complex with Fab', Bla g 2 forms a dimer, which is stabilized by a quasi-four-helix bundle comprised of an {alpha}-helix and a helical turn from each allergen monomer, exhibiting a novel dimerization mode for an aspartic protease. A disulfide bridge between C51a and C113, unique to the aspartic protease family, connects the two helical elements within each Bla g 2 monomer, thus facilitating formation of the bundle. Mutation of these cysteines, as well as the residues Asn-52, Gln-110, and Ile-114, involved in hydrophobic interactions within the bundle, resulted in a protein that did not dimerize. The mutant proteins induced less {beta}-hexosaminidase release from mast cells than the wild-type Bla g 2, suggesting a functional role of dimerization in allergenicity. Because 7C11 shares a binding epitope with IgE, the information gained by analysis of the crystal structure of its complex provided guidance for site-directed mutagenesis of the allergen epitope. We have now identified key residues involved in IgE antibody binding; this information will be useful for the design of vaccines for immunotherapy.

  11. The Noonan Syndrome--A Review of the Clinical and Genetic Features of 27 Cases

    Science.gov (United States)

    Collins, Edith; Turner, Gillian

    1973-01-01

    Reviewed were clinical and genetic features of 27 cases of the Noonan Syndrome, a condition with characteristics such as webbing of the neck, short stature, frequent congential heart lesions, and chromosomal irregularities. (DB)

  12. [Review of 1,172 clinical cases with human communication disorders].

    Science.gov (United States)

    de Díaz, M R; de Pustilnik, N F; Tortolero, Y

    1976-01-01

    The study comprised 1,172 clinical cases that were classified according to sex, age and speech disorders. A review is made on the most common alterations that they present, the selective treatment in each type and their rehabilitation.

  13. Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

    NARCIS (Netherlands)

    Olde Rikkert, M.G.M.; Tona, K.D.; Janssen, L.; Burns, A.; Lobo, A.; Robert, P.; Sartorius, N.; Stoppe, G.; Waldemar, G.

    2011-01-01

    New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles describ

  14. Clinical evaluation for chin augmentation: literature review and algorithm proposal

    Directory of Open Access Journals (Sweden)

    Helena Hotz Arroyo

    Full Text Available ABSTRACT INTRODUCTION: The esthetic balance of the face results from harmonic and symmetrical facial proportions. The literature describes several methods for lower-third facial analysis, but lacks a simple and practical method. OBJECTIVE: To review the methods of analysis of the ideal projections of the chin based on soft tissues, showing the advantages and disadvantages of each. METHODS: Literature review through the PubMed database. RESULTS: The following methods for chin analysis based on soft tissues were reviewed: Gonzalles-Ulloa, Goode, Merrifield, Silver, Legan, Gibson & Calhoun, cervicomentual angle, and mentocervical angle. CONCLUSION: An adequate analysis of the proportions of the face and facial disharmony is essential for the correct indication of the necessary procedures and good surgical outcome. The authors propose an algorithm to facilitate the indication for chin augmentation surgery.

  15. Clonal spread of blaOXA-72-carrying Acinetobacter baumannii sequence type 512 in Taiwan.

    Science.gov (United States)

    Kuo, Han-Yueh; Hsu, Po-Jui; Chen, Jiann-Yuan; Liao, Po-Cheng; Lu, Chia-Wei; Chen, Chang-Hua; Liou, Ming-Li

    2016-07-01

    This is the first report to show an insidious outbreak of armA- and blaOXA-72-carrying Acinetobacter baumannii sequence type 512 (ST512) at a study hospital in northern Taiwan. Multilocus sequence typing revealed that this was a ST512 clone. All of the isolates with ST512 carried a novel 12,056-bp repGR2 in combination with a repGR12-type plasmid. This plasmid, designated pAB-ML, had one copy of the blaOXA-72 gene that was flanked by XerC/XerD-like sites and conferred resistance to carbapenems.

  16. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success

    Science.gov (United States)

    Kawamoto, Kensaku; Houlihan, Caitlin A; Balas, E Andrew; Lobach, David F

    2005-01-01

    Objective To identify features of clinical decision support systems critical for improving clinical practice. Design Systematic review of randomised controlled trials. Data sources Literature searches via Medline, CINAHL, and the Cochrane Controlled Trials Register up to 2003; and searches of reference lists of included studies and relevant reviews. Study selection Studies had to evaluate the ability of decision support systems to improve clinical practice. Data extraction Studies were assessed for statistically and clinically significant improvement in clinical practice and for the presence of 15 decision support system features whose importance had been repeatedly suggested in the literature. Results Seventy studies were included. Decision support systems significantly improved clinical practice in 68% of trials. Univariate analyses revealed that, for five of the system features, interventions possessing the feature were significantly more likely to improve clinical practice than interventions lacking the feature. Multiple logistic regression analysis identified four features as independent predictors of improved clinical practice: automatic provision of decision support as part of clinician workflow (P < 0.00001), provision of recommendations rather than just assessments (P = 0.0187), provision of decision support at the time and location of decision making (P = 0.0263), and computer based decision support (P = 0.0294). Of 32 systems possessing all four features, 30 (94%) significantly improved clinical practice. Furthermore, direct experimental justification was found for providing periodic performance feedback, sharing recommendations with patients, and requesting documentation of reasons for not following recommendations. Conclusions Several features were closely correlated with decision support systems' ability to improve patient care significantly. Clinicians and other stakeholders should implement clinical decision support systems that incorporate these

  17. Non-O1/Non-O139 Vibrio cholerae Avian Isolate from France Cocarrying the bla(VIM-1) and bla(VIM-4) Genes.

    Science.gov (United States)

    Aberkane, Salim; Compain, Fabrice; Barraud, Olivier; Ouédraogo, Abdoul-Salam; Bouzinbi, Nicolas; Vittecoq, Marion; Jean-Pierre, Hélène; Decré, Dominique; Godreuil, Sylvain

    2015-10-01

    We describe here a non-O1/non-O139 Vibrio cholerae isolate producing both VIM-1 and VIM-4 carbapenemases. It was isolated from a yellow-legged gull in southern France. The blaVIM genes were part of a class 1 integron structure located in an IncA/C plasmid. This study emphasizes the presence of carbapenemase genes in wildlife microbiota.

  18. Intranasal administration of oxytocin: Behavioral and clinical effects, a review

    NARCIS (Netherlands)

    Veening, J.G.; Olivier, B.

    2013-01-01

    The intranasal (IN-) administration of substances is attracting attention from scientists as well as pharmaceutical companies. The effects are surprisingly fast and specific. The present review explores our current knowledge about the routes of access to the cranial cavity. 'Direct-access-pathways'

  19. Breast cancer in pregnancy: A brief clinical review.

    Science.gov (United States)

    Becker, Sven

    2016-05-01

    As global wealth increases and demographic changes similar to Europe and North America start affecting other societies, the global breast cancer epidemic will coincide with a delayed maternal age during first and subsequent pregnancies. Breast cancer in pregnancy will continue to increase, and standardized treatment strategies are required to be developed. This study will review current diagnostic and treatment approaches.

  20. The first report of infection with Klebsiella pneumoniae carrying the bla kpc gene in State of Mato Grosso do Sul, Brazil

    Directory of Open Access Journals (Sweden)

    Marilene Rodrigues Chang

    2013-01-01

    Full Text Available The increased frequency and dissemination of enterobacteria resistant to various antimicrobials is currently worldwide concern. In January 2010, a 94-year-old patient with chronic lymphocytic leukemia was admitted to the University Hospital. This patient died 21 days after hospitalization due to the clinical worsening. Klebsiella pneumoniae producing of extended-spectrum β-lactamases (ESBLs was isolated of urine culture. This bacterium demonstrated resistance to ceftazidime, ciprofloxacin, levofloxacin, ertapenem and imipenem. Susceptibility to cefoxitin, cefepime, meropenem, colistin and tigecycline. This study reports the first case of infection by Klebsiella pneumoniae carrying the bla kpc gene in the State of Mato Grosso do Sul, Brazil.

  1. Clinical Pharmacology of Citrus bergamia: A Systematic Review.

    Science.gov (United States)

    Mannucci, Carmen; Navarra, Michele; Calapai, Fabrizio; Squeri, Raffaele; Gangemi, Sebastiano; Calapai, Gioacchino

    2017-01-01

    Citrus bergamia Risso et Poiteau ("Bergamot") originated from the Mediterranean ecoregion (southern Italy, Calabria). Bergamot essential oil (BEO) is used in perfumes, cosmetics, and for stress reduction. Juice from C. bergamia has been used for hyperlipidemia. We evaluated literature published on C. bergamia clinical applications. Clinical trials on C. bergamia not combined with other substances, published in English, were searched. We selected ten articles, six describing BEO effects on stress, three reporting effects of polyphenolic fraction of C. bergamia juice in hyperlipidemia and the last describing BEO effects in chronic psoriasis. Clinical studies were analyzed following Consolidated Standards of Reporting Trials for herbal therapy. Studies were conducted on small sample sizes and not have high quality level. Analysis indicates that BEO aromatherapy could be safe and useful to reduce stress symptoms. One study suggests its potential supportive role in ultraviolet B therapy against psoriasis. Supplementation with polyphenols from bergamot juice reduces plasma lipids and improves lipoprotein profile in moderate hyperlipidemia. Effectiveness and safety of C. bergamia cannot be definitively drawn because of publication bias and low quality level of the majority of studies. Further large-scale trials with rigorous design are required to define the role of C. bergamia in clinical practice. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Understanding Pica Behavior: A Review for Clinical and Education Professionals

    Science.gov (United States)

    Stiegler, Lillian N.

    2005-01-01

    Pica is defined as the compulsive, recurrent consumption of nonnutritive items. Pica behavior often occurs in individuals with developmental disabilities; therefore, education and clinical professionals may be required to participate in various aspects of management, including identification, assessment, and treatment. This article will discuss…

  3. Hyposplenism: a comprehensive review. Part II: clinical manifestations, diagnosis, and management.

    Science.gov (United States)

    William, Basem M; Thawani, Nitika; Sae-Tia, Sutthichai; Corazza, Gino R

    2007-04-01

    In the first part of this review, we described the physiological basis of splenic function and hypofunction. We also described the wide spectrum of diseases that can result in functional hyposplenism. In the second part of this review, we will be discussing the clinical picture, including complications, diagnostic methods, and management of hyposplenism.

  4. 75 FR 81611 - Submission for OMB Review; Comment Request; National Evaluation of the Clinical and Translational...

    Science.gov (United States)

    2010-12-28

    ... collected will be used to provide analytical and policy support to NCRR, assisting NIH in making decisions... HUMAN SERVICES Submission for OMB Review; Comment Request; National Evaluation of the Clinical and... Health has submitted to the Office of Management and Budget (OMB) a request to review and approve...

  5. Test Review: Advanced Clinical Solutions for WAIS-IV and WMS-IV

    Science.gov (United States)

    Chu, Yiting; Lai, Mark H. C.; Xu, Yining; Zhou, Yuanyuan

    2012-01-01

    The authors review the "Advanced Clinical Solutions for WAIS-IV and WMS-IV". The "Advanced Clinical Solutions (ACS) for the Wechsler Adult Intelligence Scale-Fourth Edition" (WAIS-IV; Wechsler, 2008) and the "Wechsler Memory Scale-Fourth Edition" (WMS-IV; Wechsler, 2009) was published by Pearson in 2009. It is a…

  6. 76 FR 80948 - Draft Guidance for Industry, Clinical Investigators, Institutional Review Boards, and Food and...

    Science.gov (United States)

    2011-12-27

    ... developed to promote the initiation of clinical investigations to evaluate the medical devices under FDA's... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry, Clinical Investigators, Institutional Review Boards, and Food and Drug Administration Staff; Food and Drug Administration Decisions...

  7. Systematic review of clinical prediction tools and prognostic factors in aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Benjamin W. Y. Lo

    2015-01-01

    Conclusions: Systematic reviews for clinical prognostic factors and clinical prediction tools in aneurysmal SAH face a number of methodological challenges. These include within and between study patient heterogeneity, regional variations in treatment protocols, patient referral biases, and differences in treatment, and prognosis viewpoints across different cultures.

  8. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    Science.gov (United States)

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  9. International nursing students and what impacts their clinical learning: literature review.

    Science.gov (United States)

    Edgecombe, Kay; Jennings, Michele; Bowden, Margaret

    2013-02-01

    This paper reviews the sparse literature about international nursing students' clinical learning experiences, and also draws on the literature about international higher education students' learning experiences across disciplines as well as nursing students' experiences when undertaking international clinical placements. The paper aims to identify factors that may impact international nursing students' clinical learning with a view to initiating further research into these students' attributes and how to work with these to enhance the students' clinical learning. Issues commonly cited as affecting international students are socialisation, communication, culture, relationships, and unmet expectations and aspirations. International student attributes tend to be included by implication rather than as part of the literature's focus. The review concludes that recognition and valuing of international nursing students' attributes in academic and clinical contexts are needed to facilitate effective strategies to support their clinical practice in new environments.

  10. Investigation of blaKPC and blaNDM of carbapenem-resistant Enterobacteriaceae%耐碳青霉烯类肠杆菌科细菌 KPC 与 NDM 的研究

    Institute of Scientific and Technical Information of China (English)

    陈丽; 员静; 杨洁; 热那古艾山; 季萍

    2016-01-01

    目的:检测耐碳青霉烯类肠杆菌科细菌的K PC和NDM 耐药基因,分析耐碳青霉烯类的耐药机制。方法收集2014年1月-2015年6月医院27株对碳青霉烯类抗菌药物敏感性降低的肠杆菌科细菌,筛选出耐亚胺培南或美罗培南的肠杆菌科细菌,采用改良Hodge试验初筛,聚合酶链反应(PCR)扩增检测细菌产KPC和 NDM耐药基因。结果针对碳青霉烯类抗菌药物耐药的27株菌,用改良的H o dg e试验5株阳性,有9株经PC R扩增检测细菌产KPC基因,有13株经PCR扩增检测细菌产NDM 耐药基因;基因测序比对结果为KPC‐2型碳青霉烯酶和NDM‐1型耐药基因。结论耐碳青霉烯类肠杆菌科细菌耐药机制主要携带K PC -2型碳青霉烯酶耐药基因和NDM‐1型耐药基因,临床与实验室应引起重视。%OBJECTIVE To detect blaK PC and blaNDM of carbapenem‐resistant Enterobacteriaceae ,and investi‐gate the mechanism of carbapenem‐resistance in Enterobacteriaceae .METHODS A total of 27 strains of carbapen‐em‐resistant Enterobacteriaceae from Jan .2014 to Jun .2015 were collected . Enterobacteriaceae bacteria which were resistant to imipenem or meropenem or both of them were screened .Modified Hodge test was used for early screening ,and polymerase chain reaction (PCR) amplification was used to detect drug‐resistant genes sequencing of producing KPC and NDM .RESULTS A total of 5 strains from 27 isolated strains were positive in modified Hodge test ,and there were 9 strains carrying blaK PC carbapenem‐resistant gene and 13 strains carrying blaNDM carbapenem‐resistant gene were detected by PCR .Genetic sequencing showed that KPC‐2 type carbon penicillium enzyme and NDM‐1 type resistant genes were related to drug‐resistance .CONCLUSION The mechanism of carbap‐enem‐resistance in Enterobacteriaceae is mainly due to KPC‐2 type carbon penicillium enzyme and NDM‐1 type re‐sistant genes ,which should be

  11. Acquired childhood dysarthria: review of its clinical presentation.

    Science.gov (United States)

    van Mourik, M; Catsman-Berrevoets, C E; Paquier, P F; Yousef-Bak, E; van Dongen, H R

    1997-11-01

    The adult classification of dysarthria correlating with the pathophysiology of the motor systems is usually applied to classify acquired childhood dysarthria. However, the validity of this adult model for children has not been studied systematically. All studies pertaining to analysis of speech features in acquired childhood dysarthria published since 1980 were reviewed. Studies were classified on the basis of neuroradiologic evidence of lesion site and associated motor disorder. This review demonstrates that knowledge of acquired childhood dysarthria is based on a limited number of single case studies, most of which pertain to dysarthria occurring after resection of cerebellar tumor. Definite similarities to adult dysarthria were not evident. Some similarity to acquired childhood dysarthria due to basal ganglia lesions was detected. We conclude that acquired childhood dysarthria requires its own classification.

  12. Review of Positive Psychology Applications in Clinical Medical Populations

    OpenAIRE

    Ann Macaskill

    2016-01-01

    This review examines the application of positive psychology concepts in physical health care contexts. Positive psychology aims to promote well-being in the general population. Studies identifying character strengths associated with well-being in healthy populations are numerous. Such strengths have been classified and Positive Psychology Interventions (PPIs) have been created to further develop these strengths in individuals. Positive psychology research is increasingly being undertaken in h...

  13. Clinical implications of antithrombotic therapy in dentistry: a literature review

    OpenAIRE

    Seguro, Joel David Martinho

    2016-01-01

    Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2016 Introduction: The therapeutical approach of patients under chronic antithrombotic therapy needing dental procedures causes great controversy. The increased hemorrhage risk associated with these procedures when the patient is undergoing this therapy must be taken into account relatively to the increased thrombotic risk caused by its interruption. The aim of this study was to review the current ...

  14. Clinical review: Interpretation of arterial pressure wave in shock states

    OpenAIRE

    Lamia, Bouchra; Chemla, Denis; Richard, Christian; Teboul, Jean-Louis

    2005-01-01

    In critically ill patients monitored with an arterial catheter, the arterial pressure signal provides two types of information that may help the clinician to interpret haemodynamic status better: the mean values of systolic, diastolic, mean and pulse pressures; and the magnitude of the respiratory variation in arterial pressure in patients undergoing mechanical ventilation. In this review we briefly discuss the physiological mechanisms responsible for arterial pressure generation, with specia...

  15. Ameloblastoma: a clinical review and trends in management.

    Science.gov (United States)

    McClary, Andrew C; West, Robert B; McClary, Ashley C; Pollack, Jonathan R; Fischbein, Nancy J; Holsinger, Christopher F; Sunwoo, John; Colevas, A Dimitrios; Sirjani, Davud

    2016-07-01

    Ameloblastoma is a rare odontogenic neoplasm of the mandible and maxilla, with multiple histologic variants, and high recurrence rates if improperly treated. The current mainstay of treatment is wide local excision with appropriate margins and immediate reconstruction. Here we review the ameloblastoma literature, using the available evidence to highlight the change in management over the past several decades. In addition, we explore the recent molecular characterization of these tumors which may point towards new potential avenues of personalized treatment.

  16. Clinical research evidence of cupping therapy in China: a systematic literature review

    OpenAIRE

    Wang Qian; Shang Yongmei; Dong Shangjuan; Li Xun; Han Mei; Cao Huijuan; Xu Shu; Liu Jianping

    2010-01-01

    Abstract Background Though cupping therapy has been used in China for thousands of years, there has been no systematic summary of clinical research on it. This review is to evaluate the therapeutic effect of cupping therapy using evidence-based approach based on all available clinical studies. Methods We included all clinical studies on cupping therapy for all kinds of diseases. We searched six electronic databases, all searches ended in December 2008. We extracted data on the type of cupping...

  17. First Indian report of IncX3 plasmid carrying blaNDM-7 in Escherichia coli from bloodstream infection: potential for rapid dissemination.

    Science.gov (United States)

    Devanga Ragupathi, N K; Muthuirulandi Sethuvel, D P; Gajendiran, R; Daniel, J L K; Walia, K; Veeraraghavan, B

    2017-05-01

    Enterobacteriaceae with blaNDM-7 is only infrequently observed. Self-transmissible plasmids carrying the blaNDM gene increase the dissemination of carbapenem resistance in developing countries. This study investigates the whole genome sequence of a blaNDM-7-positive Escherichia coli. The isolate was an extended-spectrum β-lactamase producer by combined disc diffusion test and carbapenemase producer by CarbaNP method. Sequencing results revealed the isolate as E. coli ST-167 with IncX3 plasmid carrying blaNDM-7 in addition to blaTEM-1 and blaCMY-42 genes. The identification of IncX3-blaNDM-7 combination is the first report in India where blaNDM-7 is known to cause higher resistance to carbapenems compared to its variants.

  18. The clinical effects of Synsepalum dulcificum: a review.

    Science.gov (United States)

    Swamy, Kaki B; Hadi, Suwaibah Abd; Sekaran, Muniandy; Pichika, Mallikarjuna Rao

    2014-11-01

    Synsepalum dulcificum or the "miracle fruit" is well known for its taste-modifying ability. The aim of this review was to assess the published medically beneficial as well as potential characteristics of this fruit. A search in three databases, including PubMed, ScienceDirect, and Google Scholar, was made with appropriate keywords. The resulting articles were screened in different stages based on the title, abstract, and content. A total of nine articles were included in this review. This review summarized the findings of previously published studies on the effects of miracle fruit. The main studied characteristic of the fruit was its effect on the taste receptors, resulting in the sweet sensation when substances with acidic content were ingested. This effect was shown to be related to a glycoprotein called "miraculin." Other beneficial characteristics of this fruit were its antioxidant and anticancer abilities that are due to the various amides existing in the miracle fruit. Apart from the above, the other observed effect of this fruit was its antidiabetic effect that was tested in rats. Further studies should be conducted to establish the findings. The miracle fruit can be a healthy additive due to its unique characteristics, including sour taste sensation modification as well as its antioxidant and antidiabetic effects.

  19. LEPROSY NEPHROPATHY: A REVIEW OF CLINICAL AND HISTOPATHOLOGICAL FEATURES

    Directory of Open Access Journals (Sweden)

    Geraldo Bezerra da Silva Junior

    2015-02-01

    Full Text Available Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

  20. A clinical review of the treatment of catatonia

    Directory of Open Access Journals (Sweden)

    Pascal eSienaert

    2014-12-01

    Full Text Available Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination. Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines, such as lorazepam, and electroconvulsive therapy.

  1. A clinical review of the treatment of catatonia.

    Science.gov (United States)

    Sienaert, Pascal; Dhossche, Dirk M; Vancampfort, Davy; De Hert, Marc; Gazdag, Gábor

    2014-01-01

    Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination. Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines, such as lorazepam, and electroconvulsive therapy.

  2. LEPROSY NEPHROPATHY: A REVIEW OF CLINICAL AND HISTOPATHOLOGICAL FEATURES

    Science.gov (United States)

    da Silva, Geraldo Bezerra; Daher, Elizabeth De Francesco; Pires, Roberto da Justa; Pereira, Eanes Delgado Barros; Meneses, Gdayllon Cavalcante; Araújo, Sônia Maria Holanda Almeida; Barros, Elvino José Guardão

    2015-01-01

    Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes. PMID:25651321

  3. A review of analytics and clinical informatics in health care.

    Science.gov (United States)

    Simpao, Allan F; Ahumada, Luis M; Gálvez, Jorge A; Rehman, Mohamed A

    2014-04-01

    Federal investment in health information technology has incentivized the adoption of electronic health record systems by physicians and health care organizations; the result has been a massive rise in the collection of patient data in electronic form (i.e. "Big Data"). Health care systems have leveraged Big Data for quality and performance improvements using analytics-the systematic use of data combined with quantitative as well as qualitative analysis to make decisions. Analytics have been utilized in various aspects of health care including predictive risk assessment, clinical decision support, home health monitoring, finance, and resource allocation. Visual analytics is one example of an analytics technique with an array of health care and research applications that are well described in the literature. The proliferation of Big Data and analytics in health care has spawned a growing demand for clinical informatics professionals who can bridge the gap between the medical and information sciences.

  4. The survey of clinical human experimentation research in ethical review of postgraduates students.

    Science.gov (United States)

    Xu, Yifan; Zhu, Zheng; Wang, Liyu

    2012-06-01

    An anonymous questionnaire was used to investigate the status quo of ethics review of human subject experiments among postgraduate students in clinical practice with the main conclusions as follows: Human subject experiments make up a large ratio of clinical research; the construction of an ethics review has been initially formulated, but there exists a gap in ethics awareness between advisors and the postgraduates with the desperate need to receive ethics review. It is necessary to realize the importance of informed consent and to strengthen the strict supervision of placebo application.

  5. Magnetic resonance spectroscopy of the brain: review of metabolites and clinical applications

    Energy Technology Data Exchange (ETDEWEB)

    Soares, D.P. [Section of Radiology, Department of Surgery, Radiology, Anaesthetics, and Intensive Care, University Hospital of the West Indies, Mona, Kingston (Jamaica)], E-mail: dpsoares@cwjamaica.com; Law, M. [Department of Radiology and Neurosurgery, Mount Sinai Medical Centre, New York, New York (United States)

    2009-01-15

    Magnetic resonance imaging (MRI) provides anatomic images and morphometric characterization of disease, whereas magnetic resonance spectroscopy (MRS) provides metabolite/biochemical information about tissues non-invasively in vivo. MRS has been used clinically for more than two decades. The major applications of this advanced MRI tool are in the investigation of neurological and neurosurgical disorders. MRS has also been used in the evaluation of the prostate gland and muscle tissue, but these applications will not be addressed in this review. The aim of this review is to attempt to introduce the technique, review the metabolites and literature, as well as briefly describe our clinical experience.

  6. A clinical review of the treatment of catatonia

    OpenAIRE

    Pascal eSienaert; Dhossche, Dirk M.; Davy eVancampfort; Marc eDe Hert; Gábor eGazdag

    2014-01-01

    Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia ...

  7. A Clinical Review of the Treatment of Catatonia

    OpenAIRE

    Sienaert, Pascal; Dhossche, Dirk M.; Vancampfort,Davy; De Hert, Marc; Gazdag, Gábor

    2014-01-01

    Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia ...

  8. Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review

    OpenAIRE

    Turner, J. Rick; Viera, Anthony J.; Shimbo, Daichi

    2014-01-01

    Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not on antihypertensive medication show elevated blood pressure in a clinical setting but show non-elevated blood pressure averages when assessed by ambulatory blood pressure monitoring. Additionally, readings ca...

  9. Safety of amisulpride (Solian): a review of 11 clinical studies.

    Science.gov (United States)

    Coulouvrat, C; Dondey-Nouvel, L

    1999-07-01

    We assessed the overall safety profile of amisulpride based on the results from 11 clinical studies performed in patients suffering from schizophrenia with predominance of positive or negative symptoms. A total of 1933 patients were randomly assigned to treatment with amisulpride (n = 1247) or haloperidol (n = 309), risperidone (n = 113), flupentixol (n = 62) and placebo (n = 202). Safety data collection was performed using open reporting, UKU scales or specific extrapyramidal side-effect scales; electrocardiogram recording and vital signs examination; laboratory data collection. Amisulpride demonstrated a satisfactory global safety profile in the range of doses usually prescribed. The number of patients having at least one extrapyramidal side-effect was higher in haloperidol patients compared with both amisulpride and risperidone patients (50% versus 30% in the two latter groups). For endocrine events, a similar rate was observed between amisulpride and risperidone groups (4% versus 6%, respectively) versus 1% in the haloperidol group. Electrocardiogram results were satisfactory, confirmed by the absence of cardiovascular events. The overall laboratory safety profile of amisulpride did not show clinically relevant abnormalities in liver function tests nor haematological abnormalities. Our extensive clinical data confirm the satisfactory safety profile of amisulpride which is superior to standard reference compounds.

  10. Paranasal sinuses malignancies: A 12-year review of clinical characteristics

    Science.gov (United States)

    Sarafraz, Alireza; Chamani, Mojtaba; Derakhshandeh, Hossein

    2016-01-01

    Background Inadequate epidemiologic investigations of the paranasal sinuses malignancies prompted this retrospective study with special emphasis on a major group of 111 tumors. Material and Methods Clinical records of 111 patients with histologically confirmed malignant tumors of the paranasal sinuses were investigated retrospectively from April 2000 to January 2012. Collection of data included demographic information, clinical manifestations, treatment plans, and histopathology of the tumor. Results There were 69 (62.16%) male and 42 (37.83%) female patients (male-to-female ratio of 1.6:1), with a median age of 49±12.2 years (range 21 to 88 years). A high level of occurrence was noticed in the fifth (26.3%) decade of life. The most frequent histological types were squamous cell carcinoma (43.5%) and adenoid cystic carcinoma (19%). Among clinical manifestations, nasal obstruction was the most frequent followed by diplopia, and facial swelling. Fifty three patients (47.74%) were treated with combined approach of surgery and radiation therapy. Conclusions Paranasal sinuses malignancies are rare conditions with nonspecific symptoms which make early diagnosis of the lesions more challenging. The optimal therapeutic protocol for patients suffering from these tumors is still a somewhat controversial entity and requires further studies. Key words:Paranasal sinuses, malignancy, surgery,radiotherapy. PMID:27475693

  11. [Review of the 2008 revision of the ethical guidelines for clinical studies].

    Science.gov (United States)

    Imoto, Masakatsu

    2010-05-01

    The ethical guidelines for clinical studies were revised in 2008 and enforced in April 2009. This was the second revision but first regular revision and largely reviewed. In particular, articles under the purview of the Institutional Review Board (IRB) for clinical studies are reviewed and enhanced. This additional role further increases the authority of the IRB, and those who fix the IRB must exhibit the activity of the IRB to the public and report to the MHLW annually. The provision of compensation for clinical studies on the evaluation of drugs and medical devices has been added to this version of the ethical guidelines. The compensation for interventional clinical studies using drugs and medical devices has not yet been decided, similar to "chiken," which is defined in pharmaceutical affairs laws (PAL). Since April 2009, some insurance offices have started offering special insurance covers for clinical studies. New registration rules have been established for clinical studies. Moreover, there is now a database for clinical study registration called "Japan Primary Registries Network (JPRN)," which is certified by WHO. This database comprises 3 open databases, which were originally independent, related to clinical trials in Japan. They are however under the purview of the National Institute of Public Health. This institution works in collaboration with the "International Clinical Trials Registry Platform (ICTRP)" of WHO.

  12. Diversity and evolution of blaZ from Staphylococcus aureus and coagulase-negative staphylococci

    DEFF Research Database (Denmark)

    Olsen, John E.; Christensen, Henrik; Aarestrup, Frank Møller

    2006-01-01

    NS) and Staphylococcus aureus of bovine origin. Methods: blaZ was detected in 143 strains of penicillin-resistant S. aureus and CoNS from five Danish cattle herds (n = 25/23), random CoNS isolates from Denmark (n = 37), a collection of S. aureus from six different countries (n = 52), humans in Denmark (n = 3) and beta...... and sequences retrieved from public databases were compared. A phylogenetic tree showed that blaZ exists in three evolutionary lines: one group was of plasmid origin, one group was of chromosomal origin and one intermediate group. Sixty-nine sequence types were demonstrated. They translated into 11 BlaZ protein...... types. The major types all contained strains of both human and bovine origin, and more than one Staphylococcus species, demonstrating a shared gene pool. In a comparison of S. aureus and CoNS obtained from five Danish cattle herds, the same type of blaZ was only detected in one case. Conclusions...

  13. Enhancing nursing education via academic–clinical partnership: An integrative review

    Directory of Open Access Journals (Sweden)

    Thokozani Bvumbwe

    2016-09-01

    Full Text Available A competent nursing workforce is important for an effective healthcare system. However, concerns on the poor quality of nursing care and poor competencies among nursing students, nurses, and midwives are increasing in Malawi. Anecdotal notes from stakeholders show shortfalls in nursing education. Furthermore, a large gap between theory and practice exists. This study described the role of academic–clinical partnership in strengthening nursing education. A search of ScienceDirect, PubMed, Medline, and PsychINFO on EBCSOhost and Google Scholar was conducted using the following key words: academic–clinical collaboration, academic–clinical partnership, academic practitioner gap, and college hospital partnership or/and nursing. Furthermore, peer reviewed reports on academic–clinical partnership in nursing were included in the search. Thirty-three records from 2002 to 2016 were reviewed. Six themes emerged from the review: mutual and shared goals, evidence-based practice, resource sharing and collaboration, capacity building, partnership elements, and challenges of academic clinical partnership. The review highlighted that academic–practice partnerships promote shared goal development for the healthcare system. The gap between theory and practice is reduced by the sharing of expertise and by increasing evidence-based practice. Academic clinical partnership improves competencies among students and the safety and health outcomes of patients. The study concluded that the nursing education implemented within an academic clinical partnership becomes relevant to the needs and demands of the healthcare system.

  14. Clinical review: Reunification of acid–base physiology

    OpenAIRE

    2005-01-01

    Recent advances in acid–base physiology and in the epidemiology of acid–base disorders have refined our understanding of the basic control mechanisms that determine blood pH in health and disease. These refinements have also brought parity between the newer, quantitative and older, descriptive approaches to acid–base physiology. This review explores how the new and older approaches to acid–base physiology can be reconciled and combined to result in a powerful bedside tool. A case based tutori...

  15. Pathogenic free-living amoebae: epidemiology and clinical review.

    Science.gov (United States)

    Trabelsi, H; Dendana, F; Sellami, A; Sellami, H; Cheikhrouhou, F; Neji, S; Makni, F; Ayadi, A

    2012-12-01

    Free-living amoebae are widely distributed in soil and water. Small number of them was implicated in human disease: Acanthamoeba spp., Naegleria fowleri, Balamuthia mandrillaris and Sappinia diploidea. Some of the infections were opportunistic, occurring mainly in immunocompromised hosts (Acanthamoeba and Balamuthia encephalitis) while others are non opportunistic (Acanthamoeba keratitis, Naegleria meningoencephalitis and some cases of Balamuthia encephalitis). Although, the number of infections caused by these amoebae is low, their diagnosis was still difficult to confirm and so there was a higher mortality, particularly, associated with encephalitis. In this review, we present some information about epidemiology, ecology and the types of diseases caused by these pathogens amoebae.

  16. Clinical and histopathological review of 229 cases of ranula.

    Science.gov (United States)

    Jia, Yulin; Zhao, Yifang; Chen, Xinming

    2011-10-01

    The purpose of this paper was to evaluate the relationship between the thrombosis and secretory duct dilation, lesion size, clinical types, nature (primary or recurrent) and duration of illness in the development of ranula. A total of 229 cases of sublingual gland cysts were treated with surgical resection from Jan. 1990 to Feb. 2010. The patients' data were investigated on histopathological findings, size of ranula, the clinical types, nature of ranula (primary or recurrent) and duration of illness. Sections from the paraffin-embedded blocks were HE-stained. CK expression was immunohistochemically detected. Among 229 cases the incidence of venous thrombosis was 58.52%. The incidence of venous thrombosis with or without duct dilation was 73.25% and 26.39% respectively, with a significant difference between the two groups (Pranulas with diameter larger or less than 3 cm was 72.22% and 46.28% (Pranula, plunging ranula and mixed ranula was 49.37%, 77.19% and 85.71% respectively, with a significant difference found between oral and plunging or mixed ranula (Pranula patients with duration of illness longer or less than 3 months was 69.77% and 51.75% (Pranulas was 51.85% and 64.85%, without a significant difference noted between them (P>0.05). It is concluded that the formation of venous thrombosis was related to the dilation of secretory duct, lesion size, clinical types, duration of lesion but formation of venous thrombosis was not related to the nature (primary or recurrent) of ranulas.

  17. Clinical manifestations of Kingella kingae infections: case report and review.

    Science.gov (United States)

    Morrison, V A; Wagner, K F

    1989-01-01

    A patient with antecedent coccidioidal pulmonary cavitary disease who developed an empyema due to Kingella kingae prompted our analysis of the literature regarding this unusual bacterial pathogen. Formerly classified among other genera and considered a nonpathogen, K. kingae has been increasingly recognized as a cause of human infection. While the most commonly diagnosed infections due to this organism are endocarditis and septic arthritis, there have also been isolated reports of bacteremia, diskitis, abscesses, meningitis, and oropharyngeal infections. The treatment of choice is penicillin, to which K. kingae strains are uniformly susceptible. Recognition of the potential pathogenicity of this microorganism in appropriate clinical settings will probably result in more prompt and specific therapy.

  18. Infectious bovine keratoconjunctivitis: a review of cases in clinical practice.

    Science.gov (United States)

    Alexander, Dominic

    2010-11-01

    Infectious bovine keratoconjunctivitis (IBK) is a painful ocular disease affecting cattle worldwide. The publications documenting this condition focus on what is the accepted cause of IBK--Moraxella bovis. This article draws on experience and recorded data made at the time of the initial examination and follow-up visits. Laboratory culture of ocular swabs was undertaken where appropriate. Diagnosis of IBK is usually based on clinical signs, environment, and history. Misdiagnosis of the organisms involved is a genuine possibility. This article focuses on recent outbreaks of bovine ocular disease in the United Kingdom in three counties over a 12-month period.

  19. Filicide: a review of eight years of clinical experience.

    Science.gov (United States)

    Farooque, Rokeya; Ernst, Frederick A

    2003-01-01

    Filicide is a form of family violence in which a child is killed by his or her own parent. Most of the literature on filicide addresses the association of mental illness, motivation, and other risk factors with the perpetration of filicide. However, almost no research has addressed the intellectual functioning of perpetrators. We investigated intellectual functioning in a collection of forensic cases seen by the first author over an eight-year period. Nineteen patients who underwent forensic psychiatric evaluation for filicide from August of 1993 to April of 2001 were studied using retrospective case review methodology. Data were obtained from medical and forensic records, reports of family members, legal documents, and other collateral sources. We found that mental illness is common among perpetrators, supporting other findings in the literature. In addition, we found a high frequency of substance abuse among parents who killed their children. However, we also found a significant frequency of intellectual impairment and argue that this factor may have been overlooked in the history of filicide investigations. Familial psychodynamics of filicide will be reviewed and discussed.

  20. Chronic lymphocytic leukemia: a clinical review including Korean cohorts

    Science.gov (United States)

    Jeon, Young-Woo; Cho, Seok-Goo

    2016-01-01

    Only 5th decade ago, chronic lymphocytic leukemia (CLL) was only recognized as disease group of presenting features like peripheral lymphocytosis, organomegaly including of splenomegaly. As understanding of disease biology and molecular diagnostic tools are getting improved gradually, characterization of variation in CLL’s clinical courses was facilitated, resulting in better risk stratification and targeted treatments. Consequently multiple new targeted agents have been used in treatment of CLL, it makes improved clinical outcome. Rituximab containing chemoimmunotherapy (combination of rituximab, fludarabine, and cyclophosphamide) have shown better overall response rate and progression-free survival on fit patients’ group in front-line setting, result in standard first-line therapeutic option for CLL. Furthermore, after introducing that the B-cell receptor is crucial for the evolution and progression of CLL, emerging treatments targeting highly activated surface antigens and oncogenic signaling pathways have been associated with several successes in recent decades. These include new anti-CD 20 monoclonal antibody (obinutuzumab), the bruton tyrosine kinase inhibitor (ibrutinib), the phosphatidylinositol 3-kinase inhibitor (idelalisib), and B-cell CLL/lymphoma 2 inhibitor (ABT-199 and ABT-263). So, we discuss not only general pathophysiology of CLL, but also rapidly advancing treatment strategies that are being studied or approved for treatment of CLL. PMID:27044858

  1. Molar incisor hypomineralization: review and recommendations for clinical management.

    Science.gov (United States)

    William, Vanessa; Messer, Louise B; Burrow, Michael F

    2006-01-01

    Molar incisor hypomineralization (MIH) describes the clinical picture of hypomineralization of systemic origin affecting one or more first permanent molars (FPMs) that are associated frequently with affected incisors. Etiological associations with systemic conditions or environmental insults during the child's first 3 years have been implicated. The complex care involved in treating affected children must address their behavior and anxiety, aiming to provide a durable restoration under pain-free conditions. The challenges include adequate anaesthesia, suitable cavity design, and choice of restorative materials. Restorations in hypomineralized molars appear to fail frequently; there is little evidence-based literature to facilitate clinical decisions on cavity design and material choice. A 6-step approach to management is described: (1) risk identification; (2) early diagnosis; (3) remineralization and desensitization; (4) prevention of caries and posteruption breakdown; (5) restorations and extractions; and (6) maintenance. The high prevalence of MIH indicates the need for research to clarify etiological factors and improve the durability of restorations in affected teeth. The purpose of this paper was to describe the diagnosis, prevalence, putative etiological factors, and features of hypomineralized enamel in molar incisor hypomineralization and to present a sequential approach to management.

  2. Genetic structures at the origin of acquisition of the beta-lactamase bla KPC gene.

    Science.gov (United States)

    Naas, Thierry; Cuzon, Gaelle; Villegas, Maria-Virginia; Lartigue, Marie-Frédérique; Quinn, John P; Nordmann, Patrice

    2008-04-01

    Genetic structures surrounding the carbapenem-hydrolyzing Ambler class A bla KPC gene were characterized in several KPC-positive Klebsiella pneumoniae and Pseudomonas aeruginosa strains isolated from the United States, Colombia, and Greece. The bla KPC genes were associated in all cases with transposon-related structures. In the K. pneumoniae YC isolate from the United States, the beta-lactamase bla KPC-2 gene was located on a novel Tn3-based transposon, Tn4401. Tn4401 was 10 kb in size, was delimited by two 39-bp imperfect inverted repeat sequences, and harbored, in addition to the beta-lactamase bla KPC-2 gene, a transposase gene, a resolvase gene, and two novel insertion sequences, ISKpn6 and ISKpn7. Tn4401 has been identified in all isolates. However, two isoforms of this transposon were found: Tn4401a was found in K. pneumoniae YC and K. pneumoniae GR from the United States and Greece, respectively, and differed by a 100-bp deletion, located just upstream of the bla KPC-2 gene, compared to the sequence of Tn4401b, which was found in the Colombian isolates. In all isolates tested, Tn4401 was flanked by a 5-bp target site duplication, the signature of a recent transposition event, and was inserted in different open reading frames located on plasmids that varied in size and nature. Tn4401 is likely at the origin of carbapenem-hydrolyzing beta-lactamase KPC mobilization to plasmids and its further insertion into various-sized plasmids identified in nonclonally related K. pneumoniae and P. aeruginosa isolates.

  3. Trauma-induced coagulopathy--a review of the systematic reviews: is there sufficient evidence to guide clinical transfusion practice?

    Science.gov (United States)

    Curry, Nicola; Stanworth, Simon; Hopewell, Sally; Dorée, Carolyn; Brohi, Karim; Hyde, Chris

    2011-07-01

    Systematic reviews are accepted as a robust and less biased means of appraising and synthesizing results from high-quality studies. This report collated and summarized all the systematic review evidence relating to the diagnosis and management of trauma-related coagulopathy and transfusion, thereby covering the widest possible body of literature. We defined 4 key clinical questions: (1) What are the best methods of predicting and diagnosing trauma-related coagulopathy? (2) Which methods of clinical management correct coagulopathy? (3) Which methods of clinical management correct bleeding? and (4) What are the outcomes of transfusion in trauma? Thirty-seven systematic reviews were identified through searches of MEDLINE (1950-July 2010), EMBASE (1980-July 2010), The Cochrane Library (Issue 7, 2010), National Guidelines Clearing House, National Library for Health Guidelines Finder, and UKBTS SRI Transfusion Evidence Library (www.transfusionevidencelibrary.com). The evidence from the systematic review literature was scanty with many gaps, and we were not able to conclusively answer any of our 4 questions. Much more needs to be understood about how coagulopathy and bleeding in trauma are altered by transfusion practices and, most importantly, whether this translates into improved survival. There is a need for randomized controlled trials to answer these questions. The approach described in this report provides a framework for incorporating new evidence.

  4. Musical obsessions: a comprehensive review of neglected clinical phenomena.

    Science.gov (United States)

    Taylor, Steven; McKay, Dean; Miguel, Euripedes C; De Mathis, Maria Alice; Andrade, Chittaranjan; Ahuja, Niraj; Sookman, Debbie; Kwon, Jun Soo; Huh, Min Jung; Riemann, Bradley C; Cottraux, Jean; O'Connor, Kieron; Hale, Lisa R; Abramowitz, Jonathan S; Fontenelle, Leonardo F; Storch, Eric A

    2014-08-01

    Intrusive musical imagery (IMI) consists of involuntarily recalled, short, looping fragments of melodies. Musical obsessions are distressing, impairing forms of IMI that merit investigation in their own right and, more generally, research into these phenomena may broaden our understanding of obsessive-compulsive disorder (OCD), which is phenomenologically and etiologically heterogeneous. We present the first comprehensive review of musical obsessions, based on the largest set of case descriptions ever assembled (N=96). Characteristics of musical obsessions are described and compared with normal IMI, musical hallucinations, and visual obsessional imagery. Assessment, differential diagnosis, comorbidity, etiologic hypotheses, and treatments are described. Musical obsessions may be under-diagnosed because they are not adequately assessed by current measures of OCD. Musical obsessions have been misdiagnosed as psychotic phenomena, which has led to ineffective treatment. Accurate diagnosis is important for appropriate treatment. Musical obsessions may respond to treatments that are not recommended for prototypic OCD symptoms.

  5. Clinical, Molecular, and Genetic Characteristics of PAPA Syndrome: A Review.

    Science.gov (United States)

    Smith, Elisabeth J; Allantaz, Florence; Bennett, Lynda; Zhang, Dongping; Gao, Xiaochong; Wood, Geryl; Kastner, Daniel L; Punaro, Marilynn; Aksentijevich, Ivona; Pascual, Virginia; Wise, Carol A

    2010-11-01

    PAPA syndrome (Pyogenic Arthritis, Pyoderma gangrenosum, and Acne) is an autosomal dominant, hereditary auto-inflammatory disease arising from mutations in the PSTPIP1/CD2BP1 gene on chromosome 15q. These mutations produce a hyper-phosphorylated PSTPIP1 protein and alter its participation in activation of the "inflammasome" involved in interleukin-1 (IL-1β) production. Overproduction of IL-1β is a clear molecular feature of PAPA syndrome. Ongoing research is implicating other biochemical pathways that may be relevant to the distinct pyogenic inflammation of the skin and joints characteristic of this disease. This review summarizes the recent and rapidly accumulating knowledge on these molecular aspects of PAPA syndrome and related disorders.

  6. Reporting and methods in clinical prediction research: a systematic review.

    Directory of Open Access Journals (Sweden)

    Walter Bouwmeester

    Full Text Available BACKGROUND: We investigated the reporting and methods of prediction studies, focusing on aims, designs, participant selection, outcomes, predictors, statistical power, statistical methods, and predictive performance measures. METHODS AND FINDINGS: We used a full hand search to identify all prediction studies published in 2008 in six high impact general medical journals. We developed a comprehensive item list to systematically score conduct and reporting of the studies, based on recent recommendations for prediction research. Two reviewers independently scored the studies. We retrieved 71 papers for full text review: 51 were predictor finding studies, 14 were prediction model development studies, three addressed an external validation of a previously developed model, and three reported on a model's impact on participant outcome. Study design was unclear in 15% of studies, and a prospective cohort was used in most studies (60%. Descriptions of the participants and definitions of predictor and outcome were generally good. Despite many recommendations against doing so, continuous predictors were often dichotomized (32% of studies. The number of events per predictor as a measure of statistical power could not be determined in 67% of the studies; of the remainder, 53% had fewer than the commonly recommended value of ten events per predictor. Methods for a priori selection of candidate predictors were described in most studies (68%. A substantial number of studies relied on a p-value cut-off of p<0.05 to select predictors in the multivariable analyses (29%. Predictive model performance measures, i.e., calibration and discrimination, were reported in 12% and 27% of studies, respectively. CONCLUSIONS: The majority of prediction studies in high impact journals do not follow current methodological recommendations, limiting their reliability and applicability.

  7. Dehydroepiandrosterone biosynthesis, metabolism, biological effects, and clinical use (analytical review

    Directory of Open Access Journals (Sweden)

    N. P. Goncharov

    2015-04-01

    Full Text Available The review presents the fundamental information on the metabolism of dehydroepiandrosterone (DHEA, its biological role and possibilities of its use for replacement therapy. There were studied species differences in the synthesis of DHEA in the adrenal cortex. It was found that DHEA and DHEA-sulfate are produced only by the adrenal glands of humans and monkeys, including lower monkeys. Their biosynthesis involves the following steps: cholesterol → pregnenolone → 17-hydroxypregnenolone → DHEA. The adrenal glands of other species, including rats and mice do not synthesize DHEA. At the same time, in certain brain structures not only in man and monkey, but also in other animals DHEA and its precursors are synthesized de novo which are denoted as neurosteroids. It was demonstrated that Purkinje cells which play an important role in memory formation and learning are mainly place neurosteroid formation in mammals and other vertebrates. To establish the relationship of age and the level of DHEA and other steroids we studied the dynamics of their levels at different periods of postnatal development of people. Peak concentration DHEA observed in aged 25–30 years. In the interval from 20 to 90 years in humans the level falls approximately for 90 %. Cortisol levels in blood does not vary with age, leading to an imbalance in the ratio of cortisol/DHEA. Proved a major role of DHEA as a source (precursor for the synthesis of biologically active sex steroids – testosterone, estradiol and estrone in peripheral tissues. This review presents the bioavailability of DHEA in various physiological and pathological processes in humans and animals. In animal experiments has shown a higher bioavailability of DHEA in transdermal administration as compared with oral administration as in this case there is no steroid rapid inactivation in the liver during its first passage. According to recent studies there is a pronounced dependence of bioavailability of DHEA

  8. Dehydroepiandrosterone biosynthesis, metabolism, biological effects, and clinical use (analytical review

    Directory of Open Access Journals (Sweden)

    N. P. Goncharov

    2015-01-01

    Full Text Available The review presents the fundamental information on the metabolism of dehydroepiandrosterone (DHEA, its biological role and possibilities of its use for replacement therapy. There were studied species differences in the synthesis of DHEA in the adrenal cortex. It was found that DHEA and DHEA-sulfate are produced only by the adrenal glands of humans and monkeys, including lower monkeys. Their biosynthesis involves the following steps: cholesterol → pregnenolone → 17-hydroxypregnenolone → DHEA. The adrenal glands of other species, including rats and mice do not synthesize DHEA. At the same time, in certain brain structures not only in man and monkey, but also in other animals DHEA and its precursors are synthesized de novo which are denoted as neurosteroids. It was demonstrated that Purkinje cells which play an important role in memory formation and learning are mainly place neurosteroid formation in mammals and other vertebrates. To establish the relationship of age and the level of DHEA and other steroids we studied the dynamics of their levels at different periods of postnatal development of people. Peak concentration DHEA observed in aged 25–30 years. In the interval from 20 to 90 years in humans the level falls approximately for 90 %. Cortisol levels in blood does not vary with age, leading to an imbalance in the ratio of cortisol/DHEA. Proved a major role of DHEA as a source (precursor for the synthesis of biologically active sex steroids – testosterone, estradiol and estrone in peripheral tissues. This review presents the bioavailability of DHEA in various physiological and pathological processes in humans and animals. In animal experiments has shown a higher bioavailability of DHEA in transdermal administration as compared with oral administration as in this case there is no steroid rapid inactivation in the liver during its first passage. According to recent studies there is a pronounced dependence of bioavailability of DHEA

  9. Summary measures for clinical gait analysis: a literature review.

    Science.gov (United States)

    Cimolin, Veronica; Galli, Manuela

    2014-04-01

    Instrumented 3D-gait analysis (3D-GA) is an important method used to obtain information that is crucial for establishing the level of functional limitation due to pathology, observing its evolution over time and evaluating rehabilitative intervention effects. However, a typical 3D-GA evaluation produces a vast amount of data, and despite its objectivity, its use is complicated, and the data interpretation is difficult. It is even more difficult to obtain an overview on patient cohorts for a comparison. Moreover, there is a growing awareness of the need for a concise index, specifically, a single measure of the 'quality' of a particular gait pattern. Several gait summary measures, which have been used in conjunction with 3D-GA, have been proposed to objectify clinical impression, quantify the degree of gait deviation from normal, stratify the severity of pathology, document the changes in gait patterns over time and evaluate interventions.

  10. Clinical considerations in restorative dentistry - A narrative review

    Directory of Open Access Journals (Sweden)

    Ashwini Tumkur Shivakumar

    2015-01-01

    Full Text Available The relationship between periodontal health and the restoration of teeth is intimate and inseparable. Human teeth are designed in such a way that the individual tooth contributes significantly to their own support as well as collectively the teeth in the arch. Decay on the proximal surfaces occurs mainly due to the faulty interrelationship between the contact area, marginal ridge, the embrasures and the gingiva. An adequate understanding of the relationship between periodontal tissues and restorative dentistry is paramount to ensure an adequate form, function, aesthetics and comfort of the dentition. For long-term survival of restoration, both functionally and esthetically, certain biological considerations are very critical to preserve the health of the periodontium and thus must be given due importance in clinical practice. While most clinicians are aware of this important relationship, uncertainly remains regarding specific concept such as biologic width and its maintainces.

  11. Nutritional therapy for the management of diabetic gastroparesis: clinical review

    Directory of Open Access Journals (Sweden)

    Sadiya A

    2012-09-01

    Full Text Available Amena SadiyaLifestyle Clinic, Rashid Centre for Diabetes and Research, Ministry of Health, Ajman, United Arab EmiratesAbstract: Diabetic gastroparesis (DGP, or slow emptying of the stomach, is a well-established complication of diabetes mellitus and is typically considered to occur in individuals with long-standing type 1 and type 2 diabetes mellitus. Clinical consequences of DGP include induction of gastrointestinal (GI symptoms (early satiety, abdominal distension, reflux, stomach spasm, postprandial nausea, vomiting, alteration in drug absorption, and destabilization of glycemic control (due to mismatched postprandial glycemic and insulin peaks. Effective nutritional management not only helps in alleviating the symptoms, but also in facilitating better glycemic control. Although there have been no evidence-based guidelines pertaining to the nutrition care process of the DGP, the current dietary recommendations are based on expert opinions or observational studies. The dietary management of gastroparesis needs to be tailored according to the severity of malnutrition and kind of upper GI symptom by changing the volume, consistency, frequency, fiber, fat, and carbohydrates in the meal. Small frequent meals, using more liquid calories, reducing high fat or high fiber, consuming bezoar forming foods, and adjusting meal carbohydrates based on medications or insulin helps in improving the upper GI symptoms and glycemic control. Enteral nutrition can be an option for patients who fail to stabilize their weight loss, or for those who cannot gain weight with oral feedings, while total parenteral nutrition is rarely necessary for the patient with gastroparesis.Keywords: diabetic gastroparesis, delayed gastric emptying, diabetes mellitus, bezoar, GI symptoms, glycemic control

  12. [Optic nerve pits: clinical and therapeutic review of 21 cases].

    Science.gov (United States)

    Montenegro, M; Bonnet, M

    1989-01-01

    A retrospective study of optic nerve pits in patients referred to our clinic during the last 15 years was conducted. The study included 21 eyes in 19 patients. The optic pit was associated with a serous macular detachment (SMD) in 19 eyes (90%). Various treatments of the SMD were used depending on the time period. Systemic corticosteroids were used in five patients. The SMD did not respond to this treatment. Argon laser photocoagulation was applied to the temporal side of the optic disc in five patients. Intravitreal injection of pure gas was used as an adjunct to photocoagulation treatment in eleven eyes. Pure SF 6 was used in 8 eyes, and C 3 F 8 in 3 eyes. The follow-up after treatment was over 6 months in 10 patients who underwent photocoagulation or the combination of photocoagulation and gas injection. The SMD remained unchanged in two eyes which underwent photocoagulation treatment without gas injection. In the group of patients treated by photocoagulation in association with SF 6 injection, the SMD totally reattached in one eye, decreased in 2 eyes and remained unchanged in 2 eyes. Total resorption of subretinal fluid and permanent retinal reattachment occurred in the 3 eyes treated by intravitreal injection of pure C 3 F 8 as an adjunct to photocoagulation treatment. Further clinical investigations on large series of patients are required to determine whether prolonged retinal tamponade by C 3 F 8 gas in association with photocoagulation treatment is a valuable method in the management of SMD complicating optic nerve pits.

  13. Newer endovascular tools: a review of experimental and clinical aspects.

    Science.gov (United States)

    Sorenson, Thomas; Brinjikji, Waleed; Lanzino, Giuseppe

    2016-03-01

    The history of treatment of intracranial aneurysms dates back to the late 18th century. These early physicians largely based their crude techniques around "wire insertion alone, galvanopuncture (electrothrombosis), and fili-galvanopuncture (wire insertion together with electrothrombosis)," albeit with overwhelmingly unfavorable outcomes. By the end of the 20th century, treatment options progressed to include two highly effective, and safe, procedures: surgical clipping and endovascular coiling. These methods have been found to be effective treatments for a large portion of aneurysms, but there still exists a subset of patients that do not respond well to these therapies. While much progress has been made in stent-assisted coiling including the development of newer stents aimed at keep the coil ball from protruding into the parent vessel, the introduction of flow diverters has characterized a new phase in the endovascular treatment of intracranial aneurysms. This treatment paradigm is rapidly becoming the treatment of choice for large and complex aneurysms internal carotid artery. Intrasaccular flow diverters such as the Woven EndoBridge device (WEB) and Luna device are showing promise in the treatment of wide neck bifurcation aneurysms. Other newer devices including the pCONus Bifurcating Aneurysm Implant and Endovascular Clip Systems (eCLIPs) are showing promise in small clinical and preclinical studies. As technology improves, newer devices with ingenious designs are constantly being introduced into the clinical arena. Most of these devices try to address the limitations of traditional endovascular methods in regard to providing a safe and effective treatment of wide-necked bifurcation aneurysms. Several large prospective studies are underway and once completed, the role of these newer devices will be better defined. It is easy to anticipate that with advances in 3D techniques and printing, a future in which customized devices are designed based on the individual

  14. Review of nemonoxacin with special focus on clinical development

    Directory of Open Access Journals (Sweden)

    Qin X

    2014-07-01

    Full Text Available Xiaohua Qin, Haihui Huang Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China Abstract: Nemonoxacin is a novel C-8-methoxy nonfluorinated quinolone with remarkably enhanced in vitro activity against a wide variety of clinically relevant pathogens, especially gram-positive bacteria, including multidrug-resistant Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus. It has a low propensity for selecting resistant pathogens than fluoroquinolones, since bacteria become resistant to nemonoxacin only when three different mutations occur in their quinolone resistance-determining regions. Nemonoxacin shows greater efficacy than most of the widely used fluoroquinolones in the murine model of systemic, pulmonary, or ascending urinary tract infection. Nemonoxacin has a sound PK profile in healthy volunteers. It rapidly reaches maximum concentration Cmax 1–2 hours after oral administration in the fasting state and has a relatively long elimination half-life of more than 10 hours, which is similar to fluoroquinolones. Approximately 60%–75% of the administered dose is excreted in unchanged form via kidneys over 24–72 hours. Phase II and III studies of oral nemonoxacin and Phase II studies of intravenous nemonoxacin have been completed in patients with community-acquired pneumonia (CAP, before which the Phase I studies of oral and intravenous nemonoxacin indicated sound tolerance and safety with healthy volunteers. The published results demonstrate that an oral dose of either 500 mg or 750 mg nemonoxacin once daily for 7 days is as effective and safe as levofloxacin 500 mg once daily for 7 days. Nemonoxacin is well-tolerated in patients with CAP. The most common adverse events of oral administration are observed in the gastrointestinal and nervous system, the incidence of which is similar to levofloxacin treatment. The Phase III studies of intravenous nemonoxacin for treating CAP and oral

  15. Using Data Mining Strategies in Clinical Decision Making: A Literature Review.

    Science.gov (United States)

    Chen, Lu-Yen A; Fawcett, Tonks N

    2016-10-01

    Several data-mining models have been embedded in the clinical environment to improve decision making and patient safety. Consequently, it is crucial to survey the principal data-mining strategies currently used in clinical decision making and to determine the disadvantages and advantages of using these strategies in data mining in clinical decision making. A literature review was conducted, which identified 21 relevant articles. The article findings showed that multiple models of data mining were used in clinical decision making. Although data mining is efficient and accurate, the models are limited with respect to disease and condition.

  16. Prevalence and characterization of plasmid-mediated blaESBL with their genetic environment in Escherichia coli and Klebsiella pneumoniae in patients with pneumonia

    Institute of Scientific and Technical Information of China (English)

    WANG Xiao-rong; CHEN Ji-chao; KANG Yu; JIANG Ning; AN Shu-chang; GAO Zhan-cheng

    2012-01-01

    Background The extended spectrum β-lactamase (ESBL)-producing Escherichia coli (E.coli) and Klebsiella pneumoniae (K.pneumoniae) are the major pathogens causing pneumonia and have a significant impact on the clinical course.Limited data exist on molecular characterization of ESBL-producing E.coli and K.pneumoniae that cause pneumonia.The aim of this study was to investigate the comprehensive multilevel characteristics of E.coli and K.pneumoniae causing pneumonia in China for the first time.Methods E.coli (17) and K.pneumoniae (21) isolates responsible for pneumonia were isolated from 1270 specimens collected in a prospective multi-center study in eight teaching hospitals in China from June to December in 2007.The susceptibilities,ESBL confirmation,sequence typing,blaCTX-M and blaSHV genes,their genetic environment and plasmid Inc/rep types were determined.Results Sixteen E.coli (94.1%) and eleven K.pneumoniae (52.4%) isolates were ESBL producers.About 77.8% and 66.7% of them were resistance to ciprofloxacin and levofloxacin,and 100% were susceptible to imipenem.The most prevalent ESBL gene was CTX-M-14,followed by SHV-2,CTX-M-15,CTX-M-3,CTX-M-65,SHV-12,SHV-26 and SHV-28.SHV-1 and SHV-11 were also detected and coexisted with blaCTX-Ms in five strains,and three strains contained only SHV-1.All CTX-M-14 were detected ISEcp1 upstream and nine were found IS903 downstream and the majority of them (64.3%) were carried by IncF plasmids.All blasHv were flanked by recFand deoR,located on IncF,IncN,IncX and IncH plasmids.Two SHV-2,one SHV-1 and the only SHV-28 were further preceded by IS26.Genes lacYand lacZwere detected at further upstream of two blaSHv-1.The K.pneumoniae carrying SHV-28 was susceptible to β-lactams,and no mutations or deletions in gene or promoter sequences were identified to account for susceptibility.Multilocus sequence typing experiments showed the ESBL-producing strains were genetically diverse.Conclusions The rate of occurrence of bla

  17. Huge parathyroid carcinoma: Clinical considerations and literature review

    Directory of Open Access Journals (Sweden)

    Marone Ugo

    2005-06-01

    Full Text Available Abstract Background Parathyroid carcinoma is a rare malignancy, with an incidence of 0.5 to 4% of all cases of primary hyperparathyroidism. Surgery is the only curative treatment. Case presentation We report the case of a 66-year-old man referred for a large suspicious substernal goitre associated with severe hypercalcemia due to hyperparathyroidism. After normalization of serum calcium levels, patient underwent surgery. The voluminous cervicomediastinal firm mass could not be removed through the cervical incision; therefore a cervicothoracic approach was employed. Histopathology revealed a giant parathyroid cancer of 450 grams. A review of the literature was also undertaken to summarize the current treatment approaches for this rare malignancy. Conclusion Parathyroid cancer is usually not recognized either preoperatively or intra-operatively. En bloc resection of the tumour with the adjacent tissue is the treatment of choice and it is very important to avoid the rupture of the capsule during operation. Neither tumour size, nor the lymph node status appears to play a role in prognosis. The management of parathyroid carcinoma is a challenge even for experienced surgeons.

  18. Nutritional therapy for the management of diabetic gastroparesis: clinical review.

    Science.gov (United States)

    Sadiya, Amena

    2012-01-01

    Diabetic gastroparesis (DGP), or slow emptying of the stomach, is a well-established complication of diabetes mellitus and is typically considered to occur in individuals with long-standing type 1 and type 2 diabetes mellitus. Clinical consequences of DGP include induction of gastrointestinal (GI) symptoms (early satiety, abdominal distension, reflux, stomach spasm, postprandial nausea, vomiting), alteration in drug absorption, and destabilization of glycemic control (due to mismatched postprandial glycemic and insulin peaks). Effective nutritional management not only helps in alleviating the symptoms, but also in facilitating better glycemic control. Although there have been no evidence-based guidelines pertaining to the nutrition care process of the DGP, the current dietary recommendations are based on expert opinions or observational studies. The dietary management of gastroparesis needs to be tailored according to the severity of malnutrition and kind of upper GI symptom by changing the volume, consistency, frequency, fiber, fat, and carbohydrates in the meal. Small frequent meals, using more liquid calories, reducing high fat or high fiber, consuming bezoar forming foods, and adjusting meal carbohydrates based on medications or insulin helps in improving the upper GI symptoms and glycemic control. Enteral nutrition can be an option for patients who fail to stabilize their weight loss, or for those who cannot gain weight with oral feedings, while total parenteral nutrition is rarely necessary for the patient with gastroparesis.

  19. Nutritional therapy for the management of diabetic gastroparesis: clinical review

    Science.gov (United States)

    Sadiya, Amena

    2012-01-01

    Diabetic gastroparesis (DGP), or slow emptying of the stomach, is a well-established complication of diabetes mellitus and is typically considered to occur in individuals with long-standing type 1 and type 2 diabetes mellitus. Clinical consequences of DGP include induction of gastrointestinal (GI) symptoms (early satiety, abdominal distension, reflux, stomach spasm, postprandial nausea, vomiting), alteration in drug absorption, and destabilization of glycemic control (due to mismatched postprandial glycemic and insulin peaks). Effective nutritional management not only helps in alleviating the symptoms, but also in facilitating better glycemic control. Although there have been no evidence-based guidelines pertaining to the nutrition care process of the DGP, the current dietary recommendations are based on expert opinions or observational studies. The dietary management of gastroparesis needs to be tailored according to the severity of malnutrition and kind of upper GI symptom by changing the volume, consistency, frequency, fiber, fat, and carbohydrates in the meal. Small frequent meals, using more liquid calories, reducing high fat or high fiber, consuming bezoar forming foods, and adjusting meal carbohydrates based on medications or insulin helps in improving the upper GI symptoms and glycemic control. Enteral nutrition can be an option for patients who fail to stabilize their weight loss, or for those who cannot gain weight with oral feedings, while total parenteral nutrition is rarely necessary for the patient with gastroparesis. PMID:23055757

  20. Use of magnetic therapy in clinical neurology: literature review

    Energy Technology Data Exchange (ETDEWEB)

    Shogam, I.I.; Lenchin, V.N.; Baranovskaya, A.V.

    1985-01-01

    A literature survey is presented on the current status of magnetic therapy in clinical neurology. It is generally accepted that the high susceptibility of the nervous system to the magnetic field is due to a large extent to the automatic component. Furthermore, it has also become clear that glial cells are far more susceptible to magnetic fields than are neurons. Controversy prevails on the question of whether the therapeutic effectiveness of magnetic fields involves a direct mechanism of action or an indirect one via reflex mechanisms. Nevertheless, effectiveness of magnetic therapy has been demonstrated and generally accepted in cases dealing with lagophthalmia, ptosis, various neuralgia, radiculitis, neuritis, vascular and infectious pathology of the brain, and so forth. Basically, the effectiveness of such therapy is strongly dependent on the location and the nature of the pathologic process, as well as on the functional status of the autonomic nervous system. In view of this, effective magnetic therapy is highly dependent on individualization of a given approach. 111 References.

  1. Clinical considerations for increasing occlusal vertical dimension: a review.

    Science.gov (United States)

    Abduo, J; Lyons, K

    2012-03-01

    The purpose of this article is to discuss the clinical considerations related to increasing the occlusal vertical dimension (OVD) when restoring a patient's dentition. Thorough extraoral and intraoral evaluations are mandatory to assess the suitability of increasing OVD. In the literature, multiple techniques have been proposed to quantify OVD loss. However, the techniques lack consistency and reliability, which in turn affects the decision of whether to increase the OVD. Therefore, increasing OVD should be determined on the basis of the dental restorative needs and aesthetic demands. In general, a minimal increase in OVD should be applied, though a 5 mm maximum increase in OVD can be justified to provide adequate occlusal space for the restorative material and to improve anterior teeth aesthetics. The literature reflects the safety of increasing the OVD permanently, and although signs and symptoms may develop, these are usually of an interim nature. Whenever indicated, the increase in OVD should be achieved with fixed restorations rather than a removable appliance, due to the predictable patient adaptation. The exception to this is for patients with TMD, where increasing the OVD should still be achieved using removable appliances to control TMD-associated symptoms before considering any form of irreversible procedure.

  2. Postradiation sarcoma of bone: review of 78 Mayo Clinic cases

    Energy Technology Data Exchange (ETDEWEB)

    Weatherby, R.P.; Dahlin, D.C.; Ivins, J.C.

    1981-05-01

    Postradiation sarcoma of bone is an uncommon but serious sequela of radiation therapy. Seventy-eight Mayo Clinic patients have been treated for sarcomas arising in irradiated bones. They received their initial radiotherapy for a wide variety of nonneoplastic and neoplastic conditions, both benign and malignant. Thirty-five sarcomas arose in bone that was normal at the time of radiotherapy, and 43 arose in irradiated preexisting osseous lesions. The latent period between radiotherapy and diagnosis of sarcoma averaged 14.3 years. Ninety percent of the postradiation sarcomas were either osteosarcomas or fibrosarcomas; chondrosarcoma, malignant (fibrous) histiocytoma, malignant lymphoma, Ewing's tumor, and metastasizing chondroblastoma also occurred. Prompt radical surgery, when feasible, is usually the treatment of choice for the sarcoma. About 30% of patients with sarcomas of the extremities or craniofacial bones survived 5 years without recurrence; there were no disease-free survivors among patients with tumors of the vertebral column, pelvis, or shoulder girdle. The low risk of sarcoma following radiotherapy for the treatment of cancer should not be a contraindication to its use in these patients; however, radiation therapy for benign bone tumors should be reserved for lesions that are not amenable to surgical treatment. An unusual case is also reported herein in which a fibrosarcoma was discovered in the humerus of a patient who had received radiotherapy 55 years previously for a verified osteosarcoma in the same site.

  3. Neonatal staphylococcal scalded skin syndrome: clinical and outbreak containment review.

    LENUS (Irish Health Repository)

    Neylon, Orla

    2012-01-31

    Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated exfoliating skin condition predominated by desquamation and blistering. Neonatal outbreaks have already been reported; however, our outbreak highlights the potential for SSSS following neonatal health promotion measures such as intra-muscular vitamin K administration and metabolic screening (heel prick) as well as effective case containment measures and the value of staff screening. Between February and June 2007, five confirmed cases of neonatal SSSS were identified in full-term neonates born in an Irish regional maternity hospital. All infants were treated successfully. Analysis of contact and environmental screening was undertaken, including family members and healthcare workers. Molecular typing on isolates was carried out. An outbreak control team (OCT) was assembled and took successful prospective steps to prevent further cases. All five Staphylococcus aureus isolates tested positive for exfoliative toxin A, of which two distinct strains were identified on pulsed-field gel electrophoresis analysis. Two cases followed staphylococcal inoculation during preventive measures such as intra-muscular vitamin K administration and metabolic screening (heel prick). None of the neonatal isolates were methicillin resistant. Of 259 hospital staff (70% of staff) screened, 30% were colonised with S. aureus, and 6% were positive for MRSA carriage. This is the first reported outbreak of neonatal SSSS in Ireland. Effective case containment measures and clinical value of OCT is demonstrated. Results of staff screening underlines the need for vigilance and compliance in hand disinfection strategies in maternity hospitals especially during neonatal screening and preventive procedures.

  4. Schwannoma located in the palate: clinical case and literature review.

    Science.gov (United States)

    López-Carriches, Carmen; Baca-Pérez-Bryan, Rafael; Montalvo-Montero, Santiago

    2009-09-01

    Schwannoma is a benign tumor that originates from the presence of Schwann cells of the peripheral nerves. They are usually asymptomatic, do not recur, and malignant transformation is rare. The preoperative diagnosis is often difficult, and although computed tomography and magnetic resonance imaging are very helpful, in the majority of cases, the diagnosis can only be made during surgery and by histological study. The immunohistochemistry reveals that the Schwannoma cells test positive for S-100 protein. We describe a clinical case of Schwannoma located in the palate of a 15-year-old patient. It is important to highlight that the Schwannoma is usually found in the head and neck, and rarely in the oral cavity. When it does occur in this area, it is more likely to be found in the tongue. Other locations in the oral cavity include: the floor of the mouth, palate, gingiva, vestibular mucosa, lips and mental nerve area, listed from most common to least common. There has been no sign of recurrence two years after surgery.

  5. Dissemination of multidrug-resistant blaCTX-M-15/IncFIIk plasmids in Klebsiella pneumoniae isolates from hospital- and community-acquired human infections in Tunisia.

    Science.gov (United States)

    Mansour, Wejdene; Grami, Raoudha; Ben Haj Khalifa, Anis; Dahmen, Safia; Châtre, Pierre; Haenni, Marisa; Aouni, Mahjoub; Madec, Jean-Yves

    2015-11-01

    This study investigated the molecular features of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae from hospital- and community-acquired (HA/CA) infections in the region of Mahdia, Tunisia. Among 336 K. pneumoniae isolates recovered from both clinical contexts between July 2009 and December 2011, 49 and 15 were ESBL producers and originated from clinical and community sources, respectively. All isolates produced the CTX-M-15 enzyme. As shown by Southern blot on S1 nuclease treatment followed by pulsed-field gel electrophoresis (PFGE) gels, the blaCTX-M-15 gene was carried on IncFII (n=4), IncFIIk (n=25), IncL/M (n=4), IncK (n=1), or untypeable (n=15) plasmids in HA isolates. In CA isolates, the blaCTX-M-15 gene was carried on IncFIIk (n=6), IncFII (n=1), IncHI1 (n=1), or untypeable (n=7) plasmids. In all, 23 and 11 PFGE types were found among the HA and CA isolates. Multilocus sequence typing on representative isolates shows diverse sequence types (STs), such as ST307, ST101, ST39, ST4, ST140, ST15, and ST307 in HA isolates and ST101, ST664, and ST323 in CA isolates. This study is the first comprehensive report of ESBL plasmids in K. pneumoniae from HA and CA infections in Tunisia.

  6. Clinical perspective: creating an effective practice peer review process-a primer.

    Science.gov (United States)

    Gandhi, Manisha; Louis, Frances S; Wilson, Shae H; Clark, Steven L

    2017-03-01

    Peer review serves as an important adjunct to other hospital quality and safety programs. Despite its importance, the available literature contains virtually no guidance regarding the structure and function of effective peer review committees. This Clinical Perspective provides a summary of the purposes, structure, and functioning of effective peer review committees. We also discuss important legal considerations that are a necessary component of such processes. This discussion includes useful templates for case selection and review. Proper committee structure, membership, work flow, and leadership as well as close cooperation with the hospital medical executive committee and legal representatives are essential to any effective peer review process. A thoughtful, fair, systematic, and organized approach to creating a peer review process will lead to confidence in the committee by providers, hospital leadership, and patients. If properly constructed, such committees may also assist in monitoring and enforcing compliance with departmental protocols, thus reducing harm and promoting high-quality practice.

  7. In vivo Acquisition of Carbapenemase Gene blaKPC-2 in Multiple Species of Enterobacteriaceae through Horizontal Transfer of Insertion Sequence or Plasmid

    Science.gov (United States)

    Ding, Baixing; Shen, Zhen; Hu, Fupin; Ye, Meiping; Xu, Xiaogang; Guo, Qinglan; Wang, Minggui

    2016-01-01

    Objectives: Current worldwide spread of carbapenem resistance in Enterobacteriaceae constitutes a critical public health threat. This study aims to investigate how carbapenem resistance is acquired in Enterobacteriaceae in patients during antimicrobial therapy. Methods: Clinical strains from the same anatomical site of the same patients that converted from carbapenem-susceptible to resistant during antimicrobial therapy and showed identical or similar PFGE patterns were identified. The similarly sized plasmids carried by the susceptible and resistant strains, the latter containing the carbapenemase genes, were sequenced and analyzed. Results: Paired strains were identified from four patients: three had neurosurgical conditions while the other had acute exacerbation of COPD. Two pairs of Klebsiella pneumoniae (KP1-S/R and KP2-S/R, S and R indicating susceptible and resistant strains, respectively), one pair of Morganella morganii (MM-S/R) and one pair of Enterobacter aerogenes (EA-S/R) were collected. All four carbapenem-resistant strains carried plasmids harboring blaKPC−2. Compared with the similarly sized plasmids in KP1-S and KP2-S, an insertion sequence that includes ISKpn6-like, blaKPC−2 and ISKpn8 was noted in pKP1-R and pKP2-R. Strains MM-R and EA-R had blaKPC−2-carrying plasmids not resembling plasmids in strains MM-S and EA-S suggesting their new acquisition while on therapy. Conclusions: Enterobacteriaceae can acquire carbapenem resistance during antimicrobial therapy through horizontal transfer of an insertion sequence or plasmid. PMID:27818649

  8. In Vivo Acquisition of Carbapenemase Gene blaKPC-2 in Multiple Species of Enterobacteriaceae through Horizontal Transfer of Insertion Sequence or Plasmid

    Directory of Open Access Journals (Sweden)

    Baixing Ding

    2016-10-01

    Full Text Available Objectives: Current worldwide spread of carbapenem resistance in Enterobacteriaceae constitutes a critical public health threat. This study aims to investigate how carbapenem resistance is acquired in Enterobacteriaceae in patients during antimicrobial therapy. Methods: Clinical strains from the same anatomical site of the same patients that converted from carbapenem-susceptible to resistant during antimicrobial therapy and showed identical or similar PFGE patterns were identified. The similarly sized plasmids carried by the susceptible and resistant strains, the latter containing the carbapenemase genes, were sequenced and analyzed. Results: Paired strains were identified from four patients: three had neurosurgical conditions while the other had acute exacerbation of COPD. Two pairs of Klebsiella pneumoniae (KP1-S/R and KP2-S/R, S and R indicating susceptible and resistant strains, respectively, one pair of Morganella morganii (MM-S/R and one pair of Enterobacter aerogenes (EA-S/R were collected. All four carbapenem-resistant strains carried plasmids harboring blaKPC-2. Compared with the similarly sized plasmids in KP1-S and KP2-S, an insertion sequence that includes ISKpn6-like, blaKPC-2 and ISKpn8 was noted in pKP1-R and pKP2-R. Strains MM-R and EA-R had blaKPC-2-carrying plasmids not resembling plasmids in strains MM-S and EA-S suggesting their new acquisition while on therapy. Conclusions: Enterobacteriaceae can acquire carbapenem resistance during antimicrobial therapy through horizontal transfer of an insertion sequence or plasmid.

  9. Hydrolysis of Clavulanate by Mycobacterium tuberculosis β-Lactamase BlaC Harboring a Canonical SDN Motif

    Science.gov (United States)

    Soroka, Daria; Li de la Sierra-Gallay, Inès; Dubée, Vincent; Triboulet, Sébastien; van Tilbeurgh, Herman; Compain, Fabrice; Ballell, Lluis; Barros, David; Mainardi, Jean-Luc

    2015-01-01

    Combinations of β-lactams with clavulanate are currently being investigated for tuberculosis treatment. Since Mycobacterium tuberculosis produces a broad spectrum β-lactamase, BlaC, the success of this approach could be compromised by the emergence of clavulanate-resistant variants, as observed for inhibitor-resistant TEM variants in enterobacteria. Previous analyses based on site-directed mutagenesis of BlaC have led to the conclusion that this risk was limited. Here, we used a different approach based on determination of the crystal structure of β-lactamase BlaMAb of Mycobacterium abscessus, which efficiently hydrolyzes clavulanate. Comparison of BlaMAb and BlaC allowed for structure-assisted site-directed mutagenesis of BlaC and identification of the G132N substitution that was sufficient to switch the interaction of BlaC with clavulanate from irreversible inactivation to efficient hydrolysis. The substitution, which restored the canonical SDN motif (SDG→SDN), allowed for efficient hydrolysis of clavulanate, with a more than 104-fold increase in kcat (0.41 s−1), without affecting the hydrolysis of other β-lactams. Mass spectrometry revealed that acylation of BlaC and of its G132N variant by clavulanate follows similar paths, involving sequential formation of two acylenzymes. Decarboxylation of the first acylenzyme results in a stable secondary acylenzyme in BlaC, whereas hydrolysis occurs in the G132N variant. The SDN/SDG polymorphism defines two mycobacterial lineages comprising rapidly and slowly growing species, respectively. Together, these results suggest that the efficacy of β-lactam–clavulanate combinations may be limited by the emergence of resistance. β-Lactams active without clavulanate, such as faropenem, should be prioritized for the development of new therapies. PMID:26149997

  10. High prevalence of blaCTX-M group genes in Aeromonas dhakensis isolated from aquaculture fish species in South Korea.

    Science.gov (United States)

    Yi, Seung-Won; Chung, Tae-Ho; Joh, Seong-Joon; Park, Chul; Park, Byoung-Yong; Shin, Gee-Wook

    2014-12-01

    The prevalence of resistant genes against β-lactams in 119 Aeromonas strains was determined. A large number (99.2%) of the present fish strains were resistant to one or more β- lactams including ceftiofur, amoxicillin-clavulanic acid, ampicillin, piperacillin and cefpodoxime. Among antibiotic resistance phenotypes, the simultaneous resistance to all β-lactams occurred in 25.2% (n=30) of all strains, which consisted of 18 strains of A. dhakensis, 8 strains of A. caviae, 2 strains of A. hydrophila and only one strain of A. veronii. For exploring genetic background of the antibiotic resistances, multiple PCR assays were subjected to detect β-lactamase-encoding genes, bla(TEM), bla(OXA-B) and bla(CTX-M). In the results, the bla(TEM-1) gene was harbored in all strains, whereas only 3 strains harbored bla(OXA) gene. In the case of bla(CTX-M) gene, the gene was detected in 21.0% (25 out of 119) of all strains, which countered with 80% (20 out of 25) of A. dhakensis, 8% (2 out of 25) of A. caviae and 12% (3 out of 25) of A. hydrophila. In addition, most of the bla(CTX-M) positive strains showed simultaneous resistance to all β-lactams (18 out of 30 strains). In sequence analysis for bla(CTX-M) genes detected, they were CTX-M group 1-encoding genes including bla(CTX-M-33) from 3 eel strains of A. dhakensis. Therefore, A. dhakensis obtained from cultured fish could represent a reservoir for spreading genes encoding CTX-M group 1 enzymes and hence should be carefully monitored, especially for its potential risk to public health.

  11. A Review on Technical and Clinical Impact of Microsoft Kinect on Physical Therapy and Rehabilitation.

    Science.gov (United States)

    Mousavi Hondori, Hossein; Khademi, Maryam

    2014-01-01

    This paper reviews technical and clinical impact of the Microsoft Kinect in physical therapy and rehabilitation. It covers the studies on patients with neurological disorders including stroke, Parkinson's, cerebral palsy, and MS as well as the elderly patients. Search results in Pubmed and Google scholar reveal increasing interest in using Kinect in medical application. Relevant papers are reviewed and divided into three groups: (1) papers which evaluated Kinect's accuracy and reliability, (2) papers which used Kinect for a rehabilitation system and provided clinical evaluation involving patients, and (3) papers which proposed a Kinect-based system for rehabilitation but fell short of providing clinical validation. At last, to serve as technical comparison to help future rehabilitation design other sensors similar to Kinect are reviewed.

  12. A Review on Technical and Clinical Impact of Microsoft Kinect on Physical Therapy and Rehabilitation

    Directory of Open Access Journals (Sweden)

    Hossein Mousavi Hondori

    2014-01-01

    Full Text Available This paper reviews technical and clinical impact of the Microsoft Kinect in physical therapy and rehabilitation. It covers the studies on patients with neurological disorders including stroke, Parkinson’s, cerebral palsy, and MS as well as the elderly patients. Search results in Pubmed and Google scholar reveal increasing interest in using Kinect in medical application. Relevant papers are reviewed and divided into three groups: (1 papers which evaluated Kinect’s accuracy and reliability, (2 papers which used Kinect for a rehabilitation system and provided clinical evaluation involving patients, and (3 papers which proposed a Kinect-based system for rehabilitation but fell short of providing clinical validation. At last, to serve as technical comparison to help future rehabilitation design other sensors similar to Kinect are reviewed.

  13. Teleconsultation and Clinical Decision Making: a Systematic Review

    Science.gov (United States)

    Deldar, Kolsoum; Bahaadinbeigy, Kambiz; Tara, Seyed Mahmood

    2016-01-01

    Background: The goal of teleconsultation is to omit geographical and functional distance between two or more geographically separated health care providers. The purpose of present study is to review and analyze physician-physician teleconsultations. Method: The PubMed electronic database was searched. The primary search was done on January 2015 and was updated on December 2015. A fetch and tag plan was designed by the researchers using an online Zotero library. Results: 174 full-text articles of 1702 records met inclusion criteria. Teleconsultation for pediatric patients accounts for 14.36 percent of accepted articles. Surgery and general medicine were the most prevalent medical fields in the adults and pediatrics, respectively. Most teleconsultations were inland experiences (no=135), and the USA, Italy and Australia were the three top countries in this group. Non-specialists health care providers/centers were the dominant group who requested teleconsultation (no=130). Real time, store and forward, and hybrid technologies were used in 50, 31, and 16.7 percent of articles, respectively. The teleconsultation were reported to result in change in treatment plan, referral or evacuation rate, change in diagnosis, educational effects, and rapid decision making. Use of structured or semi-structured template had been noticed only in a very few articles. Conclusion: The present study focused on the recent ten years of published articles on physician-physician teleconsultations. Our findings showed that although there are positive impacts of teleconsultation as improving patient management, still have gaps that need to be repaired. PMID:27708494

  14. Pharmacogenetic testing in psychiatry: a review of features and clinical realities.

    Science.gov (United States)

    de Leon, José; Arranz, Maria J; Ruaño, Gualberto

    2008-12-01

    This article focuses on the first generation of pharmacogenetic tests that are potentially useful in psychiatry. All pharmacogenetic tests currently on the market, or soon to be marketed in psychiatry, for which some information has been published in peer-reviewed journal articles (or abstracts), were selected. Five pharmacogenetic tests are reviewed in detail: the Roche AmpliChip CYP450 Test, the Luminex Tag-It Mutation Detection Kit, the LGC clozapine response test, the PGxPredict: Clozapine test, and the Genomas PhyzioType system. After reviewing these tests, three practical aspects of implementing pharmacogenetic testing in psychiatric clinical practice are briefly reviewed: (1) the evaluation of these tests in clinical practice, (2) cost-effectiveness, and (3) regulatory oversight. Finally, the future of these and other pharmacogenetic tests in psychiatry is discussed.

  15. Adverse drug reactions associated with asthma medications in children: systematic review of clinical trials

    DEFF Research Database (Denmark)

    Aagaard, Lise; Hansen, Ebba Holme

    2014-01-01

    Background Respiratory medications are frequently prescribed for use in children. Several studies have reported information on the safety of asthma medications in clinical studies in adults, but information about safety in children is scarce. Objective To review published clinical trials......, age and gender, type and seriousness of ADRs, design, setting, observation period, type of assessors, and funding sources was extracted from the articles. Results Literature searches resulted in 162 potential relevant articles. However only 12 of these studies were included in this review...... on the occurrence and characteristics of adverse drug reactions (ADRs) in children, reported for asthma medications licensed for paediatric use. Methods We systematically reviewed the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. PubMed, Embase...

  16. Clinical review: Clinical imaging of the sublingual microcirculation in the critically ill - where do we stand?

    NARCIS (Netherlands)

    R. Bezemer (Rick); S.A. Bartels (Sebastiaan); J. Bakker (Jan); C. Ince (Can)

    2012-01-01

    textabstractA growing body of evidence exists associating depressed microcirculatory function and morbidity and mortality in a wide array of clinical scenarios. It has been suggested that volume replacement therapy using fluids and/or blood in combination with vasoactive agents to modulate macro- an

  17. Functional Characterization of Tn4401, a Tn3-Based Transposon Involved in blaKPC Gene Mobilization

    OpenAIRE

    G Cuzon; Naas, T; Nordmann, P

    2011-01-01

    The carbapenemase gene blaKPC, which is rapidly spreading worldwide, is located on a Tn3-based transposon, Tn4401. In a transposition-conjugation assay, Tn4401 was able to mobilize blaKPC-2 gene at a frequency of 4.4 × 10−6/recipient cell. A 5-bp target site duplication was evidenced upon each insertion without target site specificity. This study demonstrated that Tn4401 is an active transposon capable of mobilizing blaKPC genes at high frequency.

  18. Evaluating clinical competence during nursing education: A comprehensive integrative literature review.

    Science.gov (United States)

    Lejonqvist, Gun-Britt; Eriksson, Katie; Meretoja, Riitta

    2016-04-01

    This paper explored concepts, definitions and theoretical perspectives evaluating clinical competence during nursing education. The questions were: (i) How is clinical competence evaluated? and (ii) What is evaluated? An integrative review of 19 original research articles from 2009 to 2013 was performed. Results showed that evaluation tools were used in 14, observations in 2 and reflecting writing in 3 studies. The students participated in all but one evaluation alone or together with peers, faculty members or preceptors. Three themes were found: (i) professional practice with a caring perspective; (ii) clinical skills and reflective practice; and (iii) cognitive, affective and psychomotor skills both with a nursing perspective. This review shows an emphasis on structured methods with a risk reducing nursing to tasks and skills why combinations with qualitative evaluations are recommended. A holistic view of competence dominated and in designing evaluations, explicit perspectives and operationalized definitions of clinical competence became evident.

  19. Assessing preregistration nursing students' clinical competence: a systematic review of objective measures.

    Science.gov (United States)

    Cant, Robyn; McKenna, Lisa; Cooper, Simon

    2013-04-01

    Nursing students are required to develop clinical knowledge, skills and attitudes for professional practice. However, objectivity and parity of students' clinical assessments has been questioned. In the last decade, more objective techniques have been developed, with increased use of Objective Structured Clinical Examinations. We reviewed objective clinical assessment measures used in preregistration nursing courses to determine utilization and the validity and reliability of assessment techniques. A systematic search was made of quantitative research publications between 2000 and May 2011, identifying 16 studies that were subsequently reviewed. The validity and reliability of studies varied, with six studies judged as high quality, using various methodologies. This paper describes methods of instrument development and reports on their application in preregistration nursing programs.

  20. A review of how the quality of HIV clinical services has been evaluated or improved.

    Science.gov (United States)

    Hung, Anna; Pradel, Françoise

    2015-06-01

    To examine approaches being used to evaluate and improve quality of HIV clinical services we searched the MEDLINE, Cochrane Library collection, EMBASE, Global Health, and Web of Science databases for articles and abstracts focused on evaluating or improving quality of HIV clinical services. We extracted country income level, targeted clinical services, and quality evaluation approaches, data sources, and criteria. Fifty journal articles and 46 meeting abstracts were included. Of the 96 studies reviewed, 65% were programme evaluations, 71% focused on low- and middle-income countries, and 65% focused on antiretroviral therapy services. With regard to quality, 45% used a quality improvement model or programme, 13% set a quality threshold, and 51% examined patient records to evaluate quality. No studies provided a definition for quality HIV care. Quality assurance and improvement of HIV clinical services is increasingly important. This review highlights gaps in knowledge for future research, and may also help countries and programmes develop their HIV care quality improvement frameworks.

  1. Association between susceptible genotypes to periodontitis and clinical outcomes of periodontal regenerative therapy: A systematic review

    Science.gov (United States)

    Koidou, Vasiliki-Petros

    2016-01-01

    Background The aim of this review is to systematically investigate the effect of a susceptible genotype to periodontitis with the clinical outcomes of periodontal regeneration. Material and Methods Based on a focused question, an electronic search identified 155 unique citations. Three journals (Journal of Periodontology, Journal of Clinical Periodontology and Journal of Periodontal Research), references of relevant studies and review articles were hand-searched. Two independent reviewers implementing eligibility inclusion criteria selected the studies. Results Of the 155, four studies fulfilled the inclusion criteria. All studies were published between 2000 and 2004 and the samples’ size was 40 to 86 patients. Polymorphisms of Interleukin-1 (IL-1) gene were included in all. Three out of four studies failed to identify an association between susceptible genotypes to periodontitis and clinical outcomes of periodontal regeneration, while one found an association. The heterogeneity and small number of studies included prevented the conduct of a meta-analysis. No studies were identified evaluating the effect of other genotypes and as a result only IL-1 genotype studies were included. Conclusions Within the limits of the present review, no direct conclusion for the effect of a susceptible IL-1 genotype status to the clinical outcome after periodontal regeneration could be drawn. The need of more qualitative studies to explore a possible association emerges. Key words:Periodontitis, genotype, periodontal therapy, regeneration, susceptibility, systematic review. PMID:26946210

  2. Clinical Features and Management of Cartilage-Hair Hypoplasia: A Narrative Review

    OpenAIRE

    Kobra Shiasi Arani

    2015-01-01

    Context: Cartilage-hair hypoplasia is a rare hereditary cause of short stature. The aim of this study was to familiarize physicians with this rare but important disease. Evidence Acquisition: This article is a narrative review of the scientific literature to inform about clinical features and management of Cartilage-hair hypoplasia. A systematic search identified 127 papers include original and review articles and case reports. Results: Cartilage-Hair Hypoplasia characterized by short...

  3. Review of zolmitriptan and its clinical applications in migraine.

    Science.gov (United States)

    Dowson, Andrew J; Charlesworth, Bruce

    2002-07-01

    Preclinical studies have shown that zolmitriptan is a selective serotonin 5-HT(1B/1D) receptor agonist (triptan). Randomised, placebo-controlled, double-blind trials in patients with migraine have shown that zolmitriptan has good efficacy measured using 2 h response and pain-free rates. Migraine-associated symptoms, including nausea, photophobia and phonophobia, are also improved with zolmitriptan. Oral zolmitriptan (2.5 and 5 mg) has an onset of action within 45 min and efficacy is sustained in most patients who respond at 2 h. The orally-disintegrating zolmitriptan tablet has the advantage that it may be taken immediately, without the need for additional fluids, any time a migraine headache occurs. Patients may benefit in terms of improved efficacy from the convenience of the disintegrating tablet, since there is evidence that taking triptan therapy as early as possible in an attack is advantageous. For similar reasons, as well as improved efficacy, a nasal spray formulation is in development. Zolmitriptan is effective in the treatment of migraine associated with menses and migraine with aura. There is no tachyphylaxis following repeated doses for multiple attacks of migraine over a prolonged period of time. Compared to placebo, the incidence of persistent migraine headache is reduced by zolmitriptan and recurrent migraine headache occurs less frequently. Zolmitriptan has also shown efficacy in the treatment of persistent and/or recurrent migraine headache. Comparative clinical studies have shown overall that zolmitriptan has similar or superior efficacy to sumatriptan in the treatment of migraine. Specifically, zolmitriptan 2.5 mg was significantly more effective than sumatriptan 25 or 50 mg according to a number of end points, including headache response at 2 h. Oral zolmitriptan is also effective in the acute treatment of cluster headache. Zolmitriptan is generally well tolerated, with most adverse events being mild-to-moderate, transient and resolving without

  4. Neurofibromatosis type 2 (NF2: A clinical and molecular review

    Directory of Open Access Journals (Sweden)

    Evans D Gareth R

    2009-06-01

    Full Text Available Abstract Neurofibromatosis type 2 (NF2 is a tumour-prone disorder characterised by the development of multiple schwannomas and meningiomas. Prevalence (initially estimated at 1: 200,000 is around 1 in 60,000. Affected individuals inevitably develop schwannomas, typically affecting both vestibular nerves and leading to hearing loss and deafness. The majority of patients present with hearing loss, which is usually unilateral at onset and may be accompanied or preceded by tinnitus. Vestibular schwannomas may also cause dizziness or imbalance as a first symptom. Nausea, vomiting or true vertigo are rare symptoms, except in late-stage disease. The other main tumours are schwannomas of the other cranial, spinal and peripheral nerves; meningiomas both intracranial (including optic nerve meningiomas and intraspinal, and some low-grade central nervous system malignancies (ependymomas. Ophthalmic features are also prominent and include reduced visual acuity and cataract. About 70% of NF2 patients have skin tumours (intracutaneous plaque-like lesions or more deep-seated subcutaneous nodular tumours. Neurofibromatosis type 2 is a dominantly inherited tumour predisposition syndrome caused by mutations in the NF2 gene on chromosome 22. More than 50% of patients represent new mutations and as many as one-third are mosaic for the underlying disease-causing mutation. Although truncating mutations (nonsense and frameshifts are the most frequent germline event and cause the most severe disease, single and multiple exon deletions are common. A strategy for detection of the latter is vital for a sensitive analysis. Diagnosis is based on clinical and neuroimaging studies. Presymptomatic genetic testing is an integral part of the management of NF2 families. Prenatal diagnosis and pre-implantation genetic diagnosis is possible. The main differential diagnosis of NF2 is schwannomatosis. NF2 represents a difficult management problem with most patients facing substantial

  5. Yoga & Cancer Interventions: A Review of the Clinical Significance of Patient Reported Outcomes for Cancer Survivors

    Directory of Open Access Journals (Sweden)

    S. Nicole Culos-Reed

    2012-01-01

    Full Text Available Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004–2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies.

  6. Assessing mental imagery in clinical psychology: A review of imagery measures and a guiding framework

    OpenAIRE

    Pearson, David G.; Deeprose, Catherine; Wallace-Hadrill, Sophie M. A.; Heyes, Stephanie Burnett; Holmes, Emily A.

    2013-01-01

    Mental imagery is an under-explored field in clinical psychology research but presents a topic of potential interest and relevance across many clinical disorders, including social phobia, schizophrenia, depression, and post-traumatic stress disorder. There is currently a lack of a guiding framework from which clinicians may select the domains or associated measures most likely to be of appropriate use in mental imagery research. We adopt an interdisciplinary approach and present a review of s...

  7. Primary complement C5 deficiencies – Molecular characterization and clinical review of two families

    DEFF Research Database (Denmark)

    Schejbel, Lone; Fadnes, Dag; Permin, Henrik

    2013-01-01

    of the Norwegian patient, previously diagnosed as homozygous C5 deficient and suffering four Neisseria infections, an additional case of C5 deficiency was discovered, who had experienced one episode of Neisseria infections. Detailed review of the clinical history of the patients and their healthy relatives did...... infections, which is not covered by the current vaccines. These data support the clinical guidelines for patients treated with C5 inhibitors, who are functional C5 deficient by the treatment....

  8. Comparison of treatment effects between animal experiments and clinical trials: systematic review

    OpenAIRE

    2006-01-01

    Objective To examine concordance between treatment effects in animal experiments and clinical trials.Study design Systematic review.Data sources Medline, Embase, SIGLE, NTIS, Science Citation Index, CAB, BIOSIS.Study selection Animal studies for interventions with unambiguous evidence of a treatment effect (benefit or harm) in clinical trials: head injury, antifibrinolytics in haemorrhage, thrombolysis in acute ischaemic stroke, tirilazad in acute ischaemic stroke, antenatal corticosteroids t...

  9. Utility of pharmacists on clinical outcomes of patients in palliative care: A short review

    OpenAIRE

    Brkić, Jovana; Tasić, Ljiljana; id_orcid 0000-0001-9584-0341; Krajnović, Dušanka

    2014-01-01

    Pharmacists as the most accessible health care professionals in outpatient settings can improve palliative patient care. The aim of this review was to assess utility of pharmacists (the effectiveness of pharmacists' interventions) on clinical outcomes of patients in palliative care at all levels of health care and in home care. Two electronic databases were searched: PubMed and SCOPUS (last searched August 2014). Primary studies, of any type of research design, in English, related to clinical...

  10. Mobile clinical decision support systems and applications: a literature and commercial review.

    Science.gov (United States)

    Martínez-Pérez, Borja; de la Torre-Díez, Isabel; López-Coronado, Miguel; Sainz-de-Abajo, Beatriz; Robles, Montserrat; García-Gómez, Juan Miguel

    2014-01-01

    The latest advances in eHealth and mHealth have propitiated the rapidly creation and expansion of mobile applications for health care. One of these types of applications are the clinical decision support systems, which nowadays are being implemented in mobile apps to facilitate the access to health care professionals in their daily clinical decisions. The aim of this paper is twofold. Firstly, to make a review of the current systems available in the literature and in commercial stores. Secondly, to analyze a sample of applications in order to obtain some conclusions and recommendations. Two reviews have been done: a literature review on Scopus, IEEE Xplore, Web of Knowledge and PubMed and a commercial review on Google play and the App Store. Five applications from each review have been selected to develop an in-depth analysis and to obtain more information about the mobile clinical decision support systems. Ninety-two relevant papers and 192 commercial apps were found. Forty-four papers were focused only on mobile clinical decision support systems. One hundred seventy-one apps were available on Google play and 21 on the App Store. The apps are designed for general medicine and 37 different specialties, with some features common in all of them despite of the different medical fields objective. The number of mobile clinical decision support applications and their inclusion in clinical practices has risen in the last years. However, developers must be careful with their interface or the easiness of use, which can impoverish the experience of the users.

  11. Isolation of Enterobacter aerogenes carrying blaTEM-1 and blaKPC-3 genes recovered from a hospital Intensive Care Unit.

    Science.gov (United States)

    Pulcrano, Giovanna; Pignanelli, Salvatore; Vollaro, Adriana; Esposito, Matilde; Iula, Vita Dora; Roscetto, Emanuela; Soriano, Amata Amy; Catania, Maria Rosaria

    2016-06-01

    Enterobacter aerogenes has recently emerged as an important hospital pathogen. In this study, we showed the emergence of E. aerogenes isolates carrying the blaKPC gene in patients colonized by carbapenem-resistant Klebsiella pneumoniae strains. Two multiresistant E. aerogenes isolates were recovered from bronchial aspirates of two patients hospitalized in the Intensive Care Unit at the "Santa Maria della Scaletta" Hospital, Imola. The antimicrobial susceptibility test showed the high resistance to carbapenems and double-disk synergy test confirmed the phenotype of KPC and AmpC production. Other investigation revealed that ESBL and blaKPC genes were carried on the conjugative pKpQIL plasmid. This is a relevant report in Italy that describes a nosocomial infection due to the production of KPC beta-lactamases by an E. aerogenes isolate in patients previously colonized by K. pneumoniae carbapenem-resistant. In conclusion, it's necessary a continuous monitoring of multidrug-resistant strains for the detection of any KPC-producing bacteria that could expand the circulation of carbapenem-resistant pathogens.

  12. blaGES carrying Pseudomonas aeruginosa isolates from a public hospital in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Flávia L. P. C. Pellegrino

    2006-08-01

    Full Text Available Previous analysis of Pseudomonas aeruginosa class-1 integrons from Rio de Janeiro, Brazil, revealed the blaGES gene in one isolate. We screened isolates of two widespread PFGE genotypes, A and B, at a public hospital in Rio, for the presence of blaGES. The gene was detected in all seven P. aeruginosa isolates belonging to genotype B. Three of the seven genotype-B isolates were resistant to amikacin, aztreonam, ceftazidime, cefepime, ciprofloxacin, gentamicin, imipenem, meropenem, piperacillin-tazobactam and ticarcillin-clavulanic acid. The other four isolates were resistant to all these agents, except gentamicin, imipenem, meropenem and piperacillin-tazobactam. A synergistic effect between ceftazidime and imipenem or clavulanic acid suggested the production of GES-type ESBL.

  13. Characterization of blaOXA-143 variants in Acinetobacter baumannii and Acinetobacter pittii.

    Science.gov (United States)

    Zander, Esther; Bonnin, Rémy A; Seifert, Harald; Higgins, Paul G

    2014-05-01

    The acquired carbapenem-hydrolyzing oxacillinase (OXA) OXA-143 has thus far been detected only in Acinetobacter baumannii isolates from Brazil. The aim of this study was to characterize three OXA-143 variants: OXA-231 and OXA-253 from carbapenem-resistant A. baumannii isolates and OXA-255 in a carbapenem-susceptible Acinetobacter pittii isolate originating from Brazil, Honduras, and the United States, respectively. The 5' rapid amplification of cDNA ends (RACE) technique identified the same transcription initiation site for all blaOXA-143-like genes and revealed differences in the putative promoter regions. However, all cloned OXA-143 variants conferred carbapenem resistance on A. baumannii ATCC 17978 and OXA-255 conferred carbapenem resistance on A. pittii SH024, which was correlated with blaOXA-255 gene expression. This is the first description of OXA-143-like outside A. baumannii. Detection of OXA-143-like in the United States and Honduras indicates its dissemination through the American continent.

  14. Clinical Case Reporting in the Peer-Reviewed Physical Therapy Literature: Time to Move Toward Functioning.

    Science.gov (United States)

    Davenport, Todd E

    2015-12-01

    Physical therapists increasingly are contributing clinical case reports to the health literature, which form the basis for higher quality evidence that has been incorporated into clinical practice guidelines. Yet, few resources exist to assist physical therapists with the basic mechanics and quality standards of producing a clinical case report. This situation is further complicated by the absence of uniform standards for quality in case reporting. The importance of including a concise yet comprehensive description of patient functioning in all physical therapy case reports suggest the potential appropriateness of basing quality guidelines on the World Health Organization's International Classification of Functioning Disability and Health (ICF) model. The purpose of this paper is to assist physical therapists in creating high-quality clinical case reports for the peer-reviewed literature using the ICF model as a guiding framework. Along these lines, current recommendations related to the basic mechanics of writing a successful clinical case report are reviewed, as well and a proposal for uniform clinical case reporting requirements is introduced with the aim to improve the quality and feasibility of clinical case reporting in physical therapy that are informed by the ICF model.

  15. Clinical Applications of Saffron (Crocus sativus) and its Constituents: A Review.

    Science.gov (United States)

    Moshiri, M; Vahabzadeh, M; Hosseinzadeh, H

    2015-06-01

    Commonly known as saffron, Crocus sativus L and its active components have shown several useful pharmacological effects such as anticonvulsant, antidepressant, anti-inflammatory, antitumor, radical scavenger effects, learning and memory improving effects, etc. There has been an increasing body of data on saffron use in medical databases within the last 20 years. In the current review, the strengths and weaknesses of some of the clinical trials about different pharmacological effects of saffron will be discussed C. sativus extract has been studied in 8 anti-depressant clinical trials in comparison to placebo or some antidepressant drugs, in which saffron showed effectiveness as an antidepressant drug. Clinical trials on anti-Alzheimer effect of saffron demonstrated that it was more effective than the placebo, and as effective as donepezil. 2 clinical trials on antipruritic and complexion promoter in skin care effects of saffron both confirmed that saffron was more efficient than the placebo. In another clinical trial, it was proved that in addition to the weight loss treatment, saffron could reduce snacking frequency. Clinical trials conducted on women with premenstrual syndrome showed that saffron could reduce suffering symptoms more than the placebo and similar to standard treatments.Furthermore, additional clinical trials on effects of saffron on erection dysfunction, allergies, cardiovascular and immune system as well as its safety, toxicity and human pharmacokinetics are reviewed herein.

  16. Mobile technology and its use in clinical nursing education: a literature review.

    Science.gov (United States)

    O'Connor, Siobhan; Andrews, Tom

    2015-03-01

    Nursing students face a variety of challenges to learning in clinical practice, from the theory-practice gap, to a lack of clinical supervision and the ad hoc nature of learning in clinical environments. Mobile technology is proposed as one way to address these challenges. This article comprehensively summarizes and critically reviews the available literature on mobile technology used in undergraduate clinical nursing education. It identifies the lack of clear definitions and theory in the current body of evidence; the variety of mobile devices and applications used; the benefits of mobile platforms in nursing education; and the complexity of sociotechnical factors, such as the cost, usability, portability, and quality of mobile tools, that affect their use in undergraduate clinical nursing education. Implications for nursing education and practice are outlined, and recommendations for future research are discussed.

  17. Assessing the Clinical Skills of Dental Students: A Review of the Literature

    Science.gov (United States)

    Taylor, Carly L.; Grey, Nick; Satterthwaite, Julian D.

    2013-01-01

    Education, from a student perspective, is largely driven by assessment. An effective assessment tool should be both valid and reliable, yet this is often not achieved. The aim of this literature review is to identify and appraise the evidence base for assessment tools used primarily in evaluating clinical skills of dental students. Methods:…

  18. [Arterial steal via an arteriovenous fistula for hemodialysis. A clinical case and review of the literature].

    Science.gov (United States)

    Juliá Montoya, J; Lozano Vilardell, P; Corominas Roura, C; Blanes Mompó, I; Flores López, D; Manuel-Rimbau Muñoz, E; García de la Torre, A

    1993-01-01

    We related a case of arterial atrappment in the left upper limb by an arteriovenous humerus-cephalic hyperfunctioning fistula. Surgical procedure consisted on the insertion of a PTFE's banding around the arterialized vein obtaining satisfactory clinic and functional results. We review in the literature, the frequency the pathogeny and the therapeutics possibilities.

  19. Fringe phenotypes in autism: a review of clinical, biochemical and cognitive studies.

    Science.gov (United States)

    Goussé, Véronique; Plumet, Marie Hélène; Chabane, Nadia; Mouren-Siméoni, Marie-Christine; Ferradian, Nathalie; Leboyer, Marion

    2002-05-01

    Progress in identifying the genetic vulnerability factors in autism requires correct identification of the inherited phenotype(s). This can be achieved not only by the accurate description of the affected subject but also by the identification of vulnerability traits in non-affected relatives of autistic probands. This review will focus on this last strategy and principally on clinical, biochemical and cognitive traits.

  20. Hand dermatitis: a review of clinical features, therapeutic options, and long-term outcomes.

    Science.gov (United States)

    Warshaw, Erin; Lee, Gina; Storrs, Francis J

    2003-09-01

    Hand dermatitis is a common skin condition that may be chronic, debilitating, and costly for patients, insurers, and employers. The epidemiology, clinical features, occupational issues, and long-term outcomes of hand dermatitis are summarized in this review. Therapeutic options are also discussed in detail, focusing on treatment of recalcitrant hand dermatitis.

  1. Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy : Systematic review of clinical risk markers

    NARCIS (Netherlands)

    Christiaans, Imke; Van Engelen, Klaartje; Van Langen, Irene M.; Birnie, Erwin; Bonsel, Gouke J.; Elliott, Perry M.; Wilde, Arthur A.M.

    2010-01-01

    We performed a systematic literature review of recommended 'major' and 'possible' clinical risk markers for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). We searched the Medline, Embase and Cochrane databases for articles published between 1971 and 2007. We included English langua

  2. Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy: systematic review of clinical risk markers

    NARCIS (Netherlands)

    I. Christiaans; K. van Engelen; I.M. van Langen; E. Birnie; G.J. Bonsel; P.M. Elliott; A.A.M. Wilde

    2010-01-01

    We performed a systematic literature review of recommended 'major' and 'possible' clinical risk markers for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). We searched the Medline, Embase and Cochrane databases for articles published between 1971 and 2007. We included English langua

  3. Symptoms and signs of syncope: a review of the link between physiology and clinical clues

    NARCIS (Netherlands)

    W. Wieling; R.D. Thijs; N. van Dijk; A.A.M. Wilde; D.G. Benditt; J.G. van Dijk

    2009-01-01

    Detailed history taking is of paramount importance to establish a reliable diagnosis in patients with transient loss of consciousness. In this article the clinical symptoms and signs of the successive phases of a syncopal episode are reviewed. A failure of the systemic circulation to perfuse the bra

  4. Robot-Mediated Upper Limb Physiotherapy: Review and Recommendations for Future Clinical Trials

    Science.gov (United States)

    Peter, Orsolya; Fazekas, Gabor; Zsiga, Katalin; Denes, Zoltan

    2011-01-01

    Robot-mediated physiotherapy provides a new possibility for improving the outcome of rehabilitation of patients who are recovering from stroke. This study is a review of robot-supported upper limb physiotherapy focusing on the shoulder, elbow, and wrist. A literature search was carried out in PubMed, OVID, and EBSCO for clinical trials with robots…

  5. 75 FR 4827 - Submission for OMB Review; Comment Request Clinical Trials Reporting Program (CTRP) Database (NCI)

    Science.gov (United States)

    2010-01-29

    ... purpose and safety of clinical trials conducted outside of the United States. An e-mail response was sent... information to facilitate routine review of safety, efficacy, and administrative data reported from on-going... feasible the results of cancer research undertaken in any country for the use of any person involved...

  6. Alternative Methodologies in Research Literature Review: Links between Clinical Work and MFT Effectiveness.

    Science.gov (United States)

    Addison, Shelia M.; Sandberg, Jonathan G.; Corby, Joy; Robila, Mihaela; Platt, Jason J.

    2002-01-01

    Reviews 15 years of clinical research in three family therapy (FT) journals that provide evidence for the effectiveness of marriage and family therapy. Considers designs that are being utilized in reports on the effectiveness of various models of FT. Makes connections between research and the everyday work of clinicians to make the work more…

  7. 75 FR 1790 - Draft Guidance for Institutional Review Boards, Clinical Investigators, and Sponsors: IRB...

    Science.gov (United States)

    2010-01-13

    ... of February 3, 2006 (71 FR 5861), which describes FDA's intention to update the process for... HUMAN SERVICES Food and Drug Administration Draft Guidance for Institutional Review Boards, Clinical...: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA)...

  8. Religion and Spirituality within Counselling/Clinical Psychology Training Programmes: A Systematic Review

    Science.gov (United States)

    Jafari, Simon

    2016-01-01

    In recent years, there have been increasing efforts to attend to religious and spiritual issues within clinical/counselling psychology. However, there is limited research demonstrating how successfully such content is integrated into existing training programmes. This investigation sought to review primary research literature related to training…

  9. Clinical presentation of childhood leukaemia : a systematic review and meta-analysis

    NARCIS (Netherlands)

    Clarke, Rachel T; Van den Bruel, Ann; Bankhead, Clare; Mitchell, Christopher D; Phillips, Bob; Thompson, Matthew J

    2016-01-01

    OBJECTIVE: Leukaemia is the most common cancer of childhood, accounting for a third of cases. In order to assist clinicians in its early detection, we systematically reviewed all existing data on its clinical presentation and estimated the frequency of signs and symptoms presenting at or prior to di

  10. Review of Self-Awareness and Its Clinical Application in Stroke Rehabilitation

    Science.gov (United States)

    Leung, Daniel P. K.; Liu, Karen P. Y.

    2011-01-01

    The objectives of this study were (i) to explore, following a literature review, the concepts of self-awareness, its assessment, and intervention for self-awareness deficits, as well as its clinical significance in stroke rehabilitation; and (ii) to apply the concepts of self-awareness in the context of a rehabilitation program. The search was…

  11. Music Therapy with Children: A Review of Clinical Utility and Application to Special Populations.

    Science.gov (United States)

    Yeaw, John David Andrew

    This paper reviews the effectiveness of music therapy in treating children with psychiatric and developmental problems. The clinical utility of music therapy is first evaluated by examining the foundational effects of music on affect and behavior. Next, the two broad approaches to music therapy, active and passive music therapy, are discussed.…

  12. Review of clinical, cytogenetic, and molecular aspects of Ph-negative CML

    NARCIS (Netherlands)

    D. van der Plas (D.); G.C. Grosveld (Gerard); A. Hagemeijer (Anne)

    1991-01-01

    markdownabstractAbstract Between 1985 and 1989, many cases of Philadelphia (Ph) chromosome negative chronic myelogenous leukemia (CML) were reported. For this review, the following selection criteria were used: the original articles on Ph-negative cases should provide clinical, hematologic, cytoge

  13. Registered nurses' perceptions of new nursing graduates' clinical competence: A systematic integrative review.

    Science.gov (United States)

    Missen, Karen; McKenna, Lisa; Beauchamp, Alison

    2016-06-01

    Over the past decade, many questions have been raised about graduates' clinical competence and fitness for practice upon completion of their undergraduate education. Despite the significance of this issue, the perspectives of registered nurses have rarely been examined. This systematic review explores the perceptions of experienced registered nurses regarding the clinical competence of new nursing graduates. Original research studies published between 2004-2014 were identified using electronic databases, reference lists, and by searching "grey literature." Papers were critically reviewed and relevant data extracted and synthesized using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis. From 153 studies initially identified, 15 original research papers were included. Four main research themes were identified: clinical/technical skills, critical thinking, interaction/communication, and overall readiness for practice. Areas of concern in relation to the clinical competence of new nursing graduates specifically related to two themes: critical thinking and clinical/technical skills. Further research is required on strategies identified within the literature with the ultimate aim of ensuring new nursing graduates are safe and competent practitioners.

  14. Colistin- and Carbapenem-Resistant Escherichia coli Harboring mcr-1 and blaNDM-5, Causing a Complicated Urinary Tract Infection in a Patient from the United States

    Directory of Open Access Journals (Sweden)

    José R. Mediavilla

    2016-08-01

    Full Text Available Colistin is increasingly used as an antibiotic of last resort for the treatment of carbapenem-resistant Gram-negative infections. The plasmid-borne colistin resistance gene mcr-1 was initially identified in animal and clinical samples from China and subsequently reported worldwide, including in the United States. Of particular concern is the spread of mcr-1 into carbapenem-resistant bacteria, thereby creating strains that approach pan-resistance. While several reports of mcr-1 have involved carbapenem-resistant strains, no such isolates have been described in the United States. Here, we report the isolation and identification of an Escherichia coli strain harboring both mcr-1 and carbapenemase gene blaNDM-5 from a urine sample in a patient without recent travel outside the United States. The isolate exhibited resistance to both colistin and carbapenems, but was susceptible to amikacin, aztreonam, gentamicin, nitrofurantoin, tigecycline, and trimethoprim-sulfamethoxazole. The mcr-1- and blaNDM-5-harboring plasmids were completely sequenced and shown to be highly similar to plasmids previously reported from China. The strain in this report was first isolated in August 2014, highlighting an earlier presence of mcr-1 within the United States than previously recognized.

  15. The Journal of Allergy and Clinical Immunology: In Practice - 2016 Year in Review.

    Science.gov (United States)

    Schatz, Michael; Sicherer, Scott H; Zeiger, Robert S

    2017-01-28

    As editors, we concluded that it would be helpful to our readers to write a Year in Review article that highlights the Review, Original, and Clinical Communication articles published in 2016 in The Journal of Allergy and Clinical Immunology: In Practice. We summarized articles on the topics of asthma, rhinitis/rhinosinusitis, food allergy, anaphylaxis, drug allergy, urticarial/angioedema, eosinophilic disorders, and immunodeficiency. Within each topic, epidemiologic findings are presented, relevant aspects of prevention are described, and diagnostic and therapeutic advances are enumerated. Diagnostic tools described include history, skin tests, and in vitro tests. Treatments discussed include behavioral therapy, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help you, our readers, consolidate and use this extensive and practical knowledge for the benefit of your patients.

  16. Applications of capillary electrophoresis with chemiluminescence detection in clinical, environmental and food analysis. A review

    Energy Technology Data Exchange (ETDEWEB)

    Lara, Francisco J.; Airado-Rodríguez, Diego; Moreno-González, David; Huertas-Pérez, José F.; García-Campaña, Ana M., E-mail: amgarcia@ugr.es

    2016-03-24

    This paper reviews the latest developments and analytical applications of chemiluminescence detection coupled to capillary electrophoresis (CE-CL). Different sections considering the most common CL systems have been included, such as the tris(2,2′-bipyridine)ruthenium(II) system, the luminol and acridinium derivative reactions, the peroxyoxalate CL or direct oxidations. Improvements in instrumental designs, new strategies for improving both resolution and sensitivity, and applications in different fields such as clinical, pharmaceutical, environmental and food analysis have been included. This review covers the literature from 2010 to 2015. - Highlights: • An up-to-date critical review about the evolution of CE-CL is presented. • Tris(2,2′-bipyridine)ruthenium(II) and luminol as the most used CL systems. • Instrumental designs and strategies for improving resolution and sensitivity. • Applications in clinical, pharmaceutical, environmental and food analysis.

  17. Use of objective structured clinical examination and structured clinical instruction module for interprofessional education on cancer: A focused review

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2012-01-01

    Full Text Available American association for cancer education had emphasized the role of structured educational programs for medical students and residents in primary care specialties in order to improve palliative oncology education. Dissatisfaction with the conventional methods of clinical assessment on the part of teachers and students led assessors to search for appropriate alternatives and in 1975, Harden and his colleagues introduced the objective structured clinical examination (OSCE. OSCE was introduced as a standardized tool for objectively assessing clinical competencies−including history-taking, physical examination, communication skills, data interpretation, etc. It consists of a circuit of stations connected in series, with each station devoted to the assessment of a particular competency using pre-determined guidelines or checklists. The Structured Clinical Instruction Module (SCIM modifies the OSCE for teaching purposes. The objective of this review is to provide a focused update on the status and applicability of SCIM and OSCE in cancer for educational use in palliative care. From the 12 studies which were on OSCE and 6 studies which were on SCIM, it appears that the two competency-based evaluation methodologies used in cancer education namely the OSCE and the SCIM are well validated and reliably used across settings and samples of students, practitioners, and patients. Future studies in Indian palliative care settings are warranted prior to extrapolation of existing evidence.

  18. Yoga for Health Care in Korea: A Protocol for Systematic Review of Clinical Trials.

    Science.gov (United States)

    Choi, Jiae; Jun, Ji Hee; Lee, Ju Ah; Lee, Myeong Soo

    2016-08-01

    This systematic review aims to evaluate the therapeutic effects of yoga therapy using an evidence-based approach and investigates the relationship between yoga and the meridian energies based on all available clinical studies in Korea. Sixteen electronic databases will be searched from the inception of the study until January 2016. All clinical evidences that evaluate any type of yoga and any type of control in individuals with any type of condition will be eligible. The methodological quality will be assessed using the Cochrane risk of bias tool for randomized clinical trials and the Newcastle-Ottawa scale for nonrandomized studies. Two authors will independently assess each study for eligibility and the risk of bias, and then they will extract the data. With its extensive, unbiased search of the Korean literature from various databases without any language restrictions, this systematic review will be useful for both practitioners in the field of yoga research as well as for patients.

  19. Investigation of signal transduction routes within the sensor/transducer protein BlaR1 of Staphylococcus aureus.

    Science.gov (United States)

    Staude, Michael W; Frederick, Thomas E; Natarajan, Sivanandam V; Wilson, Brian D; Tanner, Carol E; Ruggiero, Steven T; Mobashery, Shahriar; Peng, Jeffrey W

    2015-03-03

    The transmembrane antibiotic sensor/signal transducer protein BlaR1 is part of a cohort of proteins that confer β-lactam antibiotic resistance in methicillin-resistant Staphylococcus aureus (MRSA) [Fisher, J. F., Meroueh, S. O., and Mobashery, S. (2005) Chem. Rev. 105, 395-424; Llarrull, L. I., Fisher, J. F., and Mobashery, S. (2009) Antimicrob. Agents Chemother. 53, 4051-4063; Llarrull, L. I., Toth, M., Champion, M. M., and Mobashery, S. (2011) J. Biol. Chem. 286, 38148-38158]. Specifically, BlaR1 regulates the inducible expression of β-lactamases that hydrolytically destroy β-lactam antibiotics. The resistance phenotype starts with β-lactam antibiotic acylation of the BlaR1 extracellular domain (BlaRS). The acylation activates the cytoplasmic protease domain through an obscure signal transduction mechanism. Here, we compare protein dynamics of apo versus antibiotic-acylated BlaRS using nuclear magnetic resonance. Our analyses reveal inter-residue interactions that relay acylation-induced perturbations within the antibiotic-binding site to the transmembrane helix regions near the membrane surface. These are the first insights into the process of signal transduction by BlaR1.

  20. High prevalence of extensively drug-resistant and metallo beta-lactamase-producing clinical Acinetobacter baumannii in Iran.

    Science.gov (United States)

    Maspi, Hossein; Mahmoodzadeh Hosseini, Hamideh; Amin, Mohsen; Imani Fooladi, Abbas Ali

    2016-09-01

    Acinetobacter species particularly Acinetobacter baumannii (A. baumannii) have been widely reported as broad-spectrum antibiotic resistant pathogens. Expression of various types of metallo beta-lactamases (MBL), classified as Ambler class B, has been associated with carbapenem resistance. Here, we attempted to assess the frequency of extensively drug-resistant (XDR) and MBL-producing A. baumannii among clinical isolates. 86 clinical A. baumannii strains were collected from 2014 to 2015 and their susceptibility to meropenem (10 μg), imipenem (10 μg), azteronem (30 μg), pipracillin (100 μg) tazobactam (110 μg), tobramycin (10 μg), fosfomycin (200 μg), rifampicin (5 μg), colistin (10 μg), tigecycline (15 μg), sulbactam/ampicillin (10 μg + 10 μg) and polymixin B (300 U) was evaluated using disk diffusion method. The MBL-producing isolates were screened using combined disc diffusion method. Furthermore, the presence of blaVIM, blaIMP, blaSPM, blaGIM, blaSIM and blaNDM was detected by PCR. 34.9% of isolates were recovered from bronchoalveolar lavage (BAL). 81 (94.2%) and 62 (71.2%) isolates were multidrug resistance (MDR) and XDR, respectively. 44 (51.2%) and 65 (75.6%) isolates were MBL-producing strains with resistance to imipenem and meropenem, respectively. 2 (2.3%), 13 (15.1%), 2 (2.3%), 4 (4.7%) and 2 (2.3%) isolates carried blaVIM, blaIMP, blaSPM, blaGIM and blaSIM genes, respectively. Our data showed that the rate of XDR and MBL A. baumannii is on the rise.

  1. Clinical review

    DEFF Research Database (Denmark)

    Overgaard-Steensen, Christian; Ring, Troels

    2013-01-01

    . A practical approach includes treatment of the underlying diseases and restoration of the distorted water and salt balances. Multiple combined mechanisms are common and must be searched for. Importantly, hypernatraemia is not only a matter of water deficit, and treatment of the critically ill patient......Disturbances in sodium concentration are common in the critically ill patient and associated with increased mortality. The key principle in treatment and prevention is that plasma [Na+] (P-[Na+]) is determined by external water and cation balances. P-[Na+] determines plasma tonicity. An important...... with an accumulated fluid balance of 20 litres and corresponding weight gain should not comprise more water, but measures to invoke a negative cation balance. Reduction of hypernatraemia/hypertonicity is critical, but should not exceed 12 mmol/l/day in order to reduce the risk of rebounding brain oedema....

  2. Clinical review

    DEFF Research Database (Denmark)

    Hjortrup, Peter Buhl; Haase, Nicolai; Wetterslev, Mik

    2013-01-01

    to evaluate the value of plasma and urinary NGAL to predict AKI in these patients. We conducted a systematic electronic literature search of MEDLINE through PubMed, EMBASE, and Cochrane Library for all English language research publications evaluating the predictive value of plasma or urinary NGAL (or both......) for AKI in adult intensive care patients. Two authors independently extracted data by using a standardized extraction sheet including study characteristics, type of NGAL measurements, and type of outcome measures. The primary summary measure was area under receiver operating characteristic curve (Au...

  3. Clinical Interdisciplinary Collaboration Models and Frameworks From Similarities to Differences: A Systematic Review

    Science.gov (United States)

    Mahdizadeh, Mousa; Heydari, Abbas; Moonaghi, Hossien Karimi

    2015-01-01

    Introduction: So far, various models of interdisciplinary collaboration in clinical nursing have been presented, however, yet a comprehensive model is not available. The purpose of this study is to review the evidences that had presented model or framework with qualitative approach about interdisciplinary collaboration in clinical nursing. Methods: All the articles and theses published from 1990 to 10 June 2014 which in both English and Persian models or frameworks of clinicians had presented model or framework of clinical collaboration were searched using databases of Proquest, Scopus, pub Med, Science Direct, and Iranian databases of Sid, Magiran, and Iranmedex. In this review, for published articles and theses, keywords according with MESH such as nurse-physician relations, care team, collaboration, interdisciplinary relations and their Persian equivalents were used. Results: In this study contexts, processes and outcomes of interdisciplinary collaboration as findings were extracted. One of the major components affecting on collaboration that most of the models had emphasized was background of collaboration. Most of studies suggested that the outcome of collaboration were improved care, doctors and nurses’ satisfaction, controlling costs, reducing clinical errors and patient’s safety. Conclusion: Models and frameworks had different structures, backgrounds, and conditions, but the outcomes were similar. Organizational structure, culture and social factors are important aspects of clinical collaboration. So it is necessary to improve the quality and effectiveness of clinical collaboration these factors to be considered. PMID:26153158

  4. A systematic review of the relationship between blood loss and clinical signs.

    Directory of Open Access Journals (Sweden)

    Rodolfo Carvalho Pacagnella

    Full Text Available INTRODUCTION: This systematic review examines the relationship between blood loss and clinical signs and explores its use to trigger clinical interventions in the management of obstetric haemorrhage. METHODS: A systematic review of the literature was carried out using a comprehensive search strategy to identify studies presenting data on the relationship of clinical signs & symptoms and blood loss. Methodological quality was assessed using the STROBE checklist and the general guidelines of MOOSE. RESULTS: 30 studies were included and five were performed in women with pregnancy-related haemorrhage (other studies were carried in non-obstetric populations. Heart rate (HR, systolic blood pressure (SBP and shock index were the parameters most frequently studied. An association between blood loss and HR changes was observed in 22 out of 24 studies, and between blood loss and SBP was observed in 17 out of 23 studies. An association was found in all papers reporting on the relationship of shock index and blood loss. Seven studies have used Receiver Operating Characteristic Curves to determine the accuracy of clinical signs in predicting blood loss. In those studies the AUC ranged from 0.56 to 0.74 for HR, from 0.56 to 0.79 for SBP and from 0.77 to 0.84 for shock index. In some studies, HR, SBP and shock index were associated with increased mortality. CONCLUSION: We found a substantial variability in the relationship between blood loss and clinical signs, making it difficult to establish specific cut-off points for clinical signs that could be used as triggers for clinical interventions. However, the shock index can be an accurate indicator of compensatory changes in the cardiovascular system due to blood loss. Considering that most of the evidence included in this systematic review is derived from studies in non-obstetric populations, further research on the use of the shock index in obstetric populations is needed.

  5. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes

    DEFF Research Database (Denmark)

    Hansen, Trine Graabæk; Kjeldsen, Lene Juel

    2013-01-01

    and outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases (MEDLINE, EMBASE......, CINAHL, Web of Science and the Cochrane Library) were searched from their inception to 2011 in addition to citation tracking and hand search. Only original research papers published in English describing pharmacist-led medication reviews in a hospital setting including minimum 100 patients or 100......Suboptimal medication use may lead to morbidity, mortality and increased costs. To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists. Some recent studies have indicated a positive effect of this service, but the quality...

  6. Evaluation of modified hodge test as an indicator of klebsiella pneumoniae carbapenemase (KPC production by using bla kpc gene PCR

    Directory of Open Access Journals (Sweden)

    Priyadarshini Shanmugam, Nirupa Soundararajan, Jeya Meenakshisundaram

    2014-03-01

    Full Text Available Introduction: Carbapenems belong to the Beta Lactam group of antimicrobial agents. They are often used as “last-line agents” or “antibiotics of last resort” in critically ill patients. Carbapenem resistance in Enterobacteriaceae may be due to various reasons but Klebsiella pneumoniae Carbapenemase (KPC enzyme production is the commonest. Phenotypic as well as genotypic methods can be used to detect Carbapenemases. Among the phenotypic tests, Modified Hodge Test (MHT is relatively easy to perform. Aims and Objectives: This study aimed to determine the prevalence of carbapenem resistance among Enterobacteriaceae isolates and calculate the sensitivity of MHT as an indicator of KPC production. Materials and Methods: All Enterobacteriaceae isolates from clinical samples were included in this study and were screened for Carbapenem resistance. 45 randomly chosen Carbapenem Resistant Enterobacteriaceae isolates were subjected to MHT and blaKPC gene detection by PCR. Results: 2035 Enterobacteriaceae isolates were tested and 5.2% were found to be resistant to Imipenem, 22.9 % were resistant to Meropenem and 4.42 % were resistant to both Imipenem and Meropenem. The sensitivity of MHT was calculated to be 90% and specificity was calculated to be 60%

  7. A review of signal processing techniques for heart sound analysis in clinical diagnosis.

    Science.gov (United States)

    Emmanuel, Babatunde S

    2012-08-01

    This paper presents an overview of approaches to analysis of heart sound signals. The paper reviews the milestones in the development of phonocardiogram (PCG) signal analysis. It describes the various stages involved in the analysis of heart sounds and discrete wavelet transform as a preferred method for bio-signal processing. In addition, the gaps that still exist between contemporary methods of signal analysis of heart sounds and their applications for clinical diagnosis is reviewed. A lot of progress has been made but crucial gaps still exist. The findings of this review paper are as follows: there is a lack of consensus in research outputs; inter-patient adaptability of signal processing algorithm is still problematic; the process of clinical validation of analysis techniques was not sufficiently rigorous in most of the reviewed literature; and as such data integrity and measurement are still in doubt, which most of the time led to inaccurate interpretation of results. In addition, the existing diagnostic systems are too complex and expensive. The paper concluded that the ability to correctly acquire, analyse and interpret heart sound signals for improved clinical diagnostic processes has become a priority.

  8. Measuring and reporting quality of life outcomes in clinical trials in cystic fibrosis: a critical review

    Directory of Open Access Journals (Sweden)

    Hart Anna

    2005-03-01

    Full Text Available Abstract Good quality clinical trials are essential to inform the best cystic fibrosis (CF management and care, by determining and comparing the effectiveness of new and existing therapies and drug delivery systems. The formal inclusion of quality of life (QoL as an outcome measure in CF clinical trials is becoming more common. Both an appropriate QoL measure and sound methodology are required in order to draw valid inferences about treatments and QoL. A review was undertaken of randomised controlled trials in cystic fibrosis where QoL was measured. EMBASE, MEDLINE and ISI Web of Science were searched to locate all full papers in the English language reporting randomised controlled trials in cystic fibrosis, published between January 1991 and December 2004. All Cochrane reviews published before December 2004 were hand searched. Papers were included if the authors had reported that they had measured QoL or well being in the trial. 16 trials were identified. The interventions investigated were: antibiotics (4; home versus hospital administration of antibiotics (1; steroids (1; mucolytic therapies (6; exercise (3 and pancreatic enzymes (1. Not one trial evaluated in this review provided conclusive results concerning QoL. This review highlights many of the pitfalls of QoL measurement in CF clinical trials and provides constructive information concerning the design and reporting of trials measuring QoL.

  9. Factors influencing nursing students' academic and clinical performance and attrition: an integrative literature review.

    Science.gov (United States)

    Pitt, Victoria; Powis, David; Levett-Jones, Tracy; Hunter, Sharyn

    2012-11-01

    Predicted workforce shortages have resulted in government initiatives to increase student numbers in preregistration nursing education. In tandem schools of nursing need to ensure students' progress and complete. The aim of this review was to identify factors that influence preregistration nursing students' academic performance, clinical performance and attrition. An integrative review of both quantitative and qualitative literature was conducted using validated appraisal checklists. The review included studies published from 1999 to 2011 in the databases: MEDLINE, CINAHL, Proquest nursing, Proquest Education (via Proquest 5000), ERIC, Journals@Ovid, PsychINFO and ScienceDirect. Studies were categorised according to their impact on academic progression, clinical progression and attrition. Forty four studies were found; most used quantitative methodologies. The review identified that few studies explored factors that impact on students' clinical performance. The four categories that potentially impact on nursing students' academic performance and attrition were: demographic, academic, cognitive and personality/behavioural factors. The challenge for universities committed to students' success is to develop strategies aimed at addressing these factors that are appropriate to specific contexts and student cohorts.

  10. Education and training to support the use of clinical telehealth: A review of the literature.

    Science.gov (United States)

    Edirippulige, S; Armfield, N R

    2017-02-01

    Introduction Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.

  11. Promoting Clinical Reasoning in Undergraduate Physical Therapy Education: A Review of Strategies and Approaches

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    2015-01-01

    curricula. Under the broad paradigm of Problem Based Learning (PBL), which is being viewed as the key shift in educations in the last few years, many other models have been proposed. Strategies such as case based teaching, blended learning, co-operative learning, interactive learning, blogging and clinical......Title: Promoting Clinical Reasoning in Undergraduate Physical Therapy Education: A Review of Strategies and Approaches Juneja H1, Brekke A F2 1,2 Physical Therapy Education, University College Zealand, Denmark Background: Clinical reasoning (CR) also referred to as “critical thinking” or “decision...... in this area. This has resulted in diverse methods and strategies to transfer reasoning skills effectively to students. Awareness about recommended pedagogical techniques to enhance clinical reasoning skills can significantly influence the educator’s choice of methods within and beyond the classroom teaching...

  12. [Major depression in primary care and clinical impacts of treatment strategies: a literature review].

    Science.gov (United States)

    Beaucage, Clément; Cardinal, Lise; Kavanagh, Mélanie; Aubé, Denise

    2009-01-01

    Major or clinical depression represents a frequent mental illness that is often associated with a high level of morbidity and mortality. Yet, major depression remains under-diagnosed and under-treated. On the level of treatment, it would appear desirable for reasons of better prognosis, to aim more than the simple reduction of depressive symptoms and target their remission resolutely and the fastest return to the individual's optimal functioning. This article presents a systematic review of the literature relating to the clinical impacts of treatment strategies aiming at the improvement of services offered to people who suffer of clinical depression and who consult in primary care. The authors summarize results drawn from 41 studies that include a measurement of the clinical impacts (reduction of symptoms, response, remission and functioning) of various treatment strategies. It appears that using complex treatment strategies favour positive outcomes. The authors propose various paths of research to further increase current knowledge.

  13. The Ultimaster Biodegradable-Polymer Sirolimus-Eluting Stent: An Updated Review of Clinical Evidence.

    Science.gov (United States)

    Chisari, Alberto; Pistritto, Anna Maria; Piccolo, Raffaele; La Manna, Alessio; Danzi, Gian Battista

    2016-09-06

    The Ultimaster coronary stent system (Terumo Corporation, Tokyo, Japan) represents a new iteration in drug-eluting stent (DES) technology that has recently received the Conformité Européenne (CE) mark approval for clinical use. The Ultimaster is a thin-strut, cobalt chromium, biodegradable-polymer, sirolimus-eluting coronary stent. The high elasticity of the biodegradable-polymer (PDLLA-PCL) and the abluminal gradient coating technology are additional novel features of this coronary device. The Ultimaster DES has undergone extensive clinical evaluation in two studies: The CENTURY I and II trials. Results from these two landmark studies suggested an excellent efficacy and safety profile of the Ultimaster DES across several lesion and patient subsets, with similar clinical outcomes to contemporary, new-generation DES. The aim of this review is to summarize the rationale behind this novel DES technology and to provide an update of available evidence about the clinical performance of the Ultimaster DES.

  14. Hepato-biliary clinical trials and their inclusion in the Cochrane Hepato-Biliary Group register and reviews

    DEFF Research Database (Denmark)

    Klingenberg, Sarah Louise; Nikolova, Dimitrinka; Alexakis, Nicholas

    2011-01-01

    The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews wi...

  15. Clinical results of coracoacromial ligament transfer in acromioclavicular dislocations: A review of published literature

    Directory of Open Access Journals (Sweden)

    Sood Aman

    2008-01-01

    Full Text Available Acromioclavicular joint dislocations are common injuries, which typically occur with trauma in young men. Treatment recommendations for these injuries are highly variable and controversial. There are greater than 100 surgical techniques described for operative treatment of this injury. One of the most widely recommended methods of surgical reconstruction for acromioclavicular joint dislocations is to utilize the coracoacromial ligament for stabilization of the distal clavicle. Several modifications of this procedure have been described which have involved adjunct coracoclavicular fixation or fixation across acromioclavicular joint. Although the literature is replete with descriptive papers, there is paucity of studies evaluating the surgical outcome of this procedure. We systematically reviewed the English language published literature in peer reviewed journals (Medline, EMBASE, SCOPUS and assigned a level of evidence for available studies. We critically reviewed each paper for the flaws and biases and then evaluated the comparable clinical outcomes for various procedures and their modifications. The published literature consists entirely of case series (Level IV evidence with variability in surgical technique and outcome measures. On review there is low level evidence to support the use of coracoacromial ligament for acromioclavicular dislocation but it has been associated with high rate of deformity recurrence. Adjunct fixation does not improve clinical results when compared to isolated coracoacromial ligament transfer. This is in part because of the high incidence of fixation related complications. Similar results are reported with coracoacromial ligament reconstruction for acute and chronic cases. The development of secondary acromioclavicular joint symptoms with distal clavicle retention is poorly reported with the incidence rate varying from 12% to 32%. Despite this, the retention or excision of distal clavicle did not affect overall

  16. Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

    Science.gov (United States)

    Lambert, Veronica; Matthews, Anne; MacDonell, Rachel; Fitzsimons, John

    2017-01-01

    Objective To systematically review the available evidence on paediatric early warning systems (PEWS) for use in acute paediatric healthcare settings for the detection of, and timely response to, clinical deterioration in children. Method The electronic databases PubMed, MEDLINE, CINAHL, EMBASE and Cochrane were searched systematically from inception up to August 2016. Eligible studies had to refer to PEWS, inclusive of rapid response systems and teams. Outcomes had to be specific to the identification of and/or response to clinical deterioration in children (including neonates) in paediatric hospital settings (including emergency departments). 2 review authors independently completed the screening and selection process, the quality appraisal of the retrieved evidence and data extraction; with a third reviewer resolving any discrepancies, as required. Results were narratively synthesised. Results From a total screening of 2742 papers, 90 papers, of varied designs, were identified as eligible for inclusion in the review. Findings revealed that PEWS are extensively used internationally in paediatric inpatient hospital settings. However, robust empirical evidence on which PEWS is most effective was limited. The studies examined did however highlight some evidence of positive directional trends in improving clinical and process-based outcomes for clinically deteriorating children. Favourable outcomes were also identified for enhanced multidisciplinary team work, communication and confidence in recognising, reporting and making decisions about child clinical deterioration. Conclusions Despite many studies reporting on the complexity and multifaceted nature of PEWS, no evidence was sourced which examined PEWS as a complex healthcare intervention. Future research needs to investigate PEWS as a complex multifaceted sociotechnical system that is embedded in a wider safety culture influenced by many organisational and human factors. PEWS should be embraced as a part of a

  17. Is Clinical Research in Oesophageal Cancer in South Africa in Crisis? A Systematic Review.

    Science.gov (United States)

    Loots, E; Sartorius, B; Madiba, T E; Mulder, C J J; Clarke, D L

    2017-03-01

    Oesophageal cancer (OC) is responsible for the second highest number of cancer-related deaths in South Africa (SA). Squamous cell carcinoma is the most prevalent type with an incidence of 46.7/100,000 and 19.2/100,000 for males and females. This is a systematic review of the clinical diagnosis and management of OC within the South African context. This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016034053) with adherence to PRISMA guidelines. An online search was performed using MEDLINE, EBSCOHost and PubMed. Eligibility criteria for articles included published, original peer-reviewed research addressing clinical management of oesophageal cancer in South Africa. Review articles, case reports, scientific letters and studies published in languages other than English or Afrikaans were excluded. The research terms were 'etiology', 'human', 'esophageal cancer', 'esophageal carcinoma', 'oesophageal cancer', and 'oesophageal carcinoma', 'squamous cell carcinoma', 'Africa' and 'South Africa'. A total of 336 articles were identified. Of these, 146 were immediately excluded and a further 159 were excluded after review. A total of 31 appropriate articles, i.e. 9.2% of searched articles, were included. Thirteen articles addressed chemotherapy and/or radiotherapy, 9 oesophageal luminal therapy, 7 oesophageal surgery and 2 screening. OC research of in SA over the last two decades has mainly been in the form of reviews and opinion papers. Clinical research, auditing and prospectively analysing OC management and outcomes in SA hospitals are sorely needed and should be promoted by both healthcare workers and policy makers alike.

  18. Diabetic Osteoporosis: A Review of Its Traditional Chinese Medicinal Use and Clinical and Preclinical Research

    Directory of Open Access Journals (Sweden)

    Rufeng Ma

    2016-01-01

    Full Text Available Aim. The incidence of diabetic osteoporosis (DOP is increasing due to lack of effective management over the past few decades. This review aims to summarize traditional Chinese medicine (TCM suitability in the pathogenesis and clinical and preclinical management of DOP. Methods. Literature sources used were from Medline (Pubmed, CNKI (China Knowledge Resource Integrated Database, and CSTJ (China Science and Technology Journal Database online databases. For the consultation, keywords such as diabetic osteoporosis (DOP, TCM, clinical study, animal experiment, toxicity, and research progress were used in various combinations. Around 100 research papers and reviews were visited. Results. Liver-spleen-kidney insufficiency may result in development of DOP. 18 clinical trials are identified to use TCM compound prescriptions for management of patients with DOP. TCM herbs and their active ingredients are effective in preventing the development of DOP in streptozotocin (STZ and alloxan as well as STZ combined with ovariectomy insulted rats. Among them, most frequently used TCM herbs in clinical trials are Radix Astragali, Radix et Rhizoma Salviae Miltiorrhizae, Radix Rehmanniae Preparata, and Herba Epimedii. Some of TCM herbs also exhibit toxicities in clinical and preclinical research. Conclusions. TCM herbs may act as the novel sources of anti-DOP drugs by improving bone and glucolipid metabolisms. However, the pathogenesis of DOP and the material base of TCM herbs still merit further study.

  19. Clinical implications of spirituality to mental health: review of evidence and practical guidelines

    Directory of Open Access Journals (Sweden)

    Alexander Moreira-Almeida

    2014-04-01

    Full Text Available Objective: Despite empirical evidence of a relationship between religiosity/spirituality (R/S and mental health and recommendations by professional associations that these research findings be integrated into clinical practice, application of this knowledge in the clinic remains a challenge. This paper reviews the current state of the evidence and provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment. Methods: PubMed searches of relevant terms yielded 1,109 papers. We selected empirical studies and reviews that addressed assessment of R/S in clinical practice. Results: The most widely acknowledged and agreed-upon application of R/S to clinical practice is the need to take a spiritual history (SH, which may improve patient compliance, satisfaction with care, and health outcomes. We found 25 instruments for SH collection, several of which were validated and of good clinical utility. Conclusions: This paper provides practical guidelines for spiritual assessment and integration thereof into mental health treatment, as well as suggestions for future research on the topic.

  20. Do calculation errors by nurses cause medication errors in clinical practice? A literature review.

    Science.gov (United States)

    Wright, Kerri

    2010-01-01

    This review aims to examine the literature available to ascertain whether medication errors in clinical practice are the result of nurses' miscalculating drug dosages. The research studies highlighting poor calculation skills of nurses and student nurses have been tested using written drug calculation tests in formal classroom settings [Kapborg, I., 1994. Calculation and administration of drug dosage by Swedish nurses, student nurses and physicians. International Journal for Quality in Health Care 6(4): 389 -395; Hutton, M., 1998. Nursing Mathematics: the importance of application Nursing Standard 13(11): 35-38; Weeks, K., Lynne, P., Torrance, C., 2000. Written drug dosage errors made by students: the threat to clinical effectiveness and the need for a new approach. Clinical Effectiveness in Nursing 4, 20-29]; Wright, K., 2004. Investigation to find strategies to improve student nurses' maths skills. British Journal Nursing 13(21) 1280-1287; Wright, K., 2005. An exploration into the most effective way to teach drug calculation skills to nursing students. Nurse Education Today 25, 430-436], but there have been no reviews of the literature on medication errors in practice that specifically look to see whether the medication errors are caused by nurses' poor calculation skills. The databases Medline, CINAHL, British Nursing Index (BNI), Journal of American Medical Association (JAMA) and Archives and Cochrane reviews were searched for research studies or systematic reviews which reported on the incidence or causes of drug errors in clinical practice. In total 33 articles met the criteria for this review. There were no studies that examined nurses' drug calculation errors in practice. As a result studies and systematic reviews that investigated the types and causes of drug errors were examined to establish whether miscalculations by nurses were the causes of errors. The review found insufficient evidence to suggest that medication errors are caused by nurses' poor

  1. Music therapy services in pediatric oncology: a national clinical practice review.

    Science.gov (United States)

    Tucquet, Belinda; Leung, Maggie

    2014-01-01

    This article presents the results of a national clinical practice review conducted in Australia of music therapy services in pediatric oncology hospitals. Literature specifically related to music therapy and symptom management in pediatric oncology is reviewed. The results from a national benchmarking survey distributed to all music therapists working with children with cancer in Australian pediatric hospitals are discussed. Patient and family feedback provided from a quality improvement activity conducted at a major pediatric tertiary hospital is summarized, and considerations for future growth as a profession and further research is proposed.

  2. Madura foot: two case reports, review of the literature, and new developments with clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    White, Eric A. [University of Southern California, Department of Radiology, Los Angeles, CA (United States); Patel, Dakshesh B.; Forrester, Deborah M.; Gottsegen, Christopher J.; O' Rourke, Emily; Holtom, Paul; Charlton, Timothy; Matcuk, George R. [USC University Hospital, Los Angeles, CA (United States)

    2014-04-15

    ''Madura foot'' or pedal mycetoma is a rare destructive infection of the skin and subcutaneous tissues of the foot, progressing to involve muscle and bone. The infection can be caused by both bacteria and fungi. Infection typically follows traumatic implantation of bacteria or fungal spores, which are present in soil or on plant material. Clinically, this entity can be difficult to diagnose and can have an indolent and progressive course. Early diagnosis is important to prevent patient morbidity and mortality. We present two cases of pedal mycetoma, review the literature, review new developments in diagnosis, and discuss magnetic resonance imaging (MRI) features of this unusual entity. (orig.)

  3. Translational research platforms integrating clinical and omics data: a review of publicly available solutions

    OpenAIRE

    2014-01-01

    The rise of personalized medicine and the availability of high-throughput molecular analyses in the context of clinical care have increased the need for adequate tools for translational researchers to manage and explore these data. We reviewed the biomedical literature for translational platforms allowing the management and exploration of clinical and omics data, and identified seven platforms: BRISK, caTRIP, cBio Cancer Portal, G-DOC, iCOD, iDASH and tranSMART. We analyzed these platforms al...

  4. Review on the efficacy, safety and clinical applications of polihexanide, a modern wound antiseptic.

    Science.gov (United States)

    Hübner, N-O; Kramer, A

    2010-01-01

    Infected wounds are still one of the great challenges in medicine. In the last decade, it has become increasingly clear that antimicrobial chemotherapy is limited by the spread of antimicrobial resistance. Fortunately, new, highly effective antiseptic substances with a broad antimicrobial spectrum are available, so local treatment is expected to get increasingly more important in wound therapy. This paper reviews the antiseptic agent polihexanide (polyhexamethylene biguanide, PHMB), one of the most promising substances available today, from a clinical point of view, focusing on efficacy, safety and clinical applications.

  5. What do we know about pulmonary blastoma?: review of literature and clinical case report.

    Science.gov (United States)

    Brodowska-Kania, Dorota; Kotwica, Ewa; Paturej, Aleksandra; Sośnicki, Witold; Patera, Janusz; Giżewska, Agnieszka; Niemczyk, Stanisław

    2016-12-01

    Pulmonary blastoma (PB) is a rare form of lung tumour and is accountable for 0.25-0.5% of primary pulmonary malignancies. Initially pulmonary blastoma was divided into three subtypes: biphasic pulmonary blastoma (BPB) consisting of an epithelial and mesenchymal component, well differentiated fetal adenocarcinoma (WDFA) built of well differentiated epithelium and a mesenchymal component and malignant pleuropulmonary blastoma (PPB). Prognosis in this type of cancer is really poor. We present a current review of literature and a clinical case report. Treatment of PB is very difficult. Data and recommendations about the treatment of pulmonary blastoma are still available therefore we should use only observations and clinical case reports.

  6. Human bartonellosis: seroepidemiological and clinical features with an emphasis on data from Brazil - A review

    Directory of Open Access Journals (Sweden)

    C Lamas

    2008-05-01

    Full Text Available Bartonellae are fastidious Gram-negative bacteria that are widespread in nature with several animal reservoirs (mainly cats, dogs, and rodents and insect vectors (mainly fleas, sandflies, and human lice. Thirteen species or subspecies of Bartonella have been recognized as agents causing human disease, including B. bacilliformis, B. quintana, B. vinsonii berkhoffii, B. henselae, B. elizabethae, B. grahamii, B. washoensis, B. koehlerae, B. rocha-limaea, and B. tamiae. The clinical spectrum of infection includes lymphadenopathy, fever of unknown origin, endocarditis, neurological and ophthalmological syndromes, Carrion's disease, and others. This review provides updated information on clinical manifestations and seroepidemiological studies with an emphasis on data available from Brazil.

  7. Erosive vulval lichen planus--a diagnosis not to be missed: a clinical review.

    Science.gov (United States)

    Lewis, F M; Bogliatto, F

    2013-12-01

    Lichen planus is one of the inflammatory dermatoses that have a predilection for the genital mucosa, and the erosive type is particularly important. This can also affect other mucosal sites and scarring may occur, leading to significant symptoms and an effect on quality of life for patients. There is often a delay before the correct diagnosis is made and appropriate treatment instituted. This clinical review covers the clinical features and management options for this important disease and emphasises the need for a multi-disciplinary approach.

  8. Systemic Arthritis in Children: A Review of Clinical Presentation and Treatment

    Directory of Open Access Journals (Sweden)

    R. Gurion

    2012-01-01

    Full Text Available Systemic juvenile idiopathic arthritis (sJIA constitutes a small part of juvenile idiopathic arthritis (JIA, yet has a disproportionally higher rate of mortality. Despite being grouped under JIA, it is considered to be a multifactorial autoinflammatory disease. The objective of this paper is to review the epidemiology, pathogenesis, genetics, clinical manifestations, complications, therapy, prognosis, and outcome of sJIA. The presentation and clinical manifestations of sJIA have not changed much in the past several decades, but the collective understanding of the pathogenesis and the development of new targeted therapies (particularly the biologic agents have transformed and improved the disease outcome for children with sJIA.

  9. Hepato-biliary clinical trials and their inclusion in the Cochrane Hepato-Biliary Group register and reviews

    DEFF Research Database (Denmark)

    Klingenberg, Sarah Louise; Nikolova, Dimitrinka; Alexakis, Nicholas

    2011-01-01

    The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews...... with meta-analyses of the trials. In this overview, we present the growth of The CHBG Controlled Trials Register, as well as the systematic reviews that have been produced since March 1996....

  10. Chromosomal Integration of the Klebsiella pneumoniae Carbapenemase Gene, blaKPC, in Klebsiella Species Is Elusive but Not Rare

    Science.gov (United States)

    Chai, Weidong; Carroll, Joanne; Barry, Katie; Cherunvanky, Anita; Sebra, Robert; Kasarskis, Andrew; Peto, Tim E.; Walker, A. Sarah; Sifri, Costi D.; Crook, Derrick W.; Sheppard, Anna E.

    2016-01-01

    ABSTRACT Carbapenemase genes in Enterobacteriaceae are mostly described as being plasmid associated. However, the genetic context of carbapenemase genes is not always confirmed in epidemiological surveys, and the frequency of their chromosomal integration therefore is unknown. A previously sequenced collection of blaKPC-positive Enterobacteriaceae from a single U.S. institution (2007 to 2012; n = 281 isolates from 182 patients) was analyzed to identify chromosomal insertions of Tn4401, the transposon most frequently harboring blaKPC. Using a combination of short- and long-read sequencing, we confirmed five independent chromosomal integration events from 6/182 (3%) patients, corresponding to 15/281 (5%) isolates. Three patients had isolates identified by perirectal screening, and three had infections which were all successfully treated. When a single copy of blaKPC was in the chromosome, one or both of the phenotypic carbapenemase tests were negative. All chromosomally integrated blaKPC genes were from Klebsiella spp., predominantly K. pneumoniae clonal group 258 (CG258), even though these represented only a small proportion of the isolates. Integration occurred via IS15-ΔI-mediated transposition of a larger, composite region encompassing Tn4401 at one locus of chromosomal integration, seen in the same strain (K. pneumoniae ST340) in two patients. In summary, we identified five independent chromosomal integrations of blaKPC in a large outbreak, demonstrating that this is not a rare event. blaKPC was more frequently integrated into the chromosome of epidemic CG258 K. pneumoniae lineages (ST11, ST258, and ST340) and was more difficult to detect by routine phenotypic methods in this context. The presence of chromosomally integrated blaKPC within successful, globally disseminated K. pneumoniae strains therefore is likely underestimated. PMID:28031204

  11. Physical activity in type II Diabetes Mellitus, an effective therapeutic element: review of the clinical impact

    Directory of Open Access Journals (Sweden)

    Pedro Iván Arias-Vázquez

    2015-07-01

    Full Text Available A review was conducted in databases (PubMed, PEDro of type studies clinical trial, cohort study, systematic reviews, meta-analysis and clinical practice guidelines based on evidence they have studied the benefits of physical activity in the prevention , treatment and decreased risk of complications and death in patients with Type II Diabetes Mellitus. Realization regular physical activity is associated with a decreased risk of developing Diabetes Mellitus; likewise was associated with decrease in glycated hemoglobin percentage A1C values. Diabetic patients undergoing high levels of physical activity had decreased risk of complications and death from cardiovascular disease and all causes. At present the scientific evidence on the impact of physical activity in the prevention and treatment of Diabetes Mellitus is solid, so it must be emphasized promoting physical activity as a fundamental part of the therapeutic regimens for this disease.

  12. Effect of clinical specialist physiotherapists in orthopaedic diagnostic setting - A systematic review

    DEFF Research Database (Denmark)

    Trøstrup, Jeanette; Mikkelsen, Lone Ramer; Juhl, Carsten

    2016-01-01

    Trøstrup J1, Mikkelsen LR1, Juhl CB2 1 Center for Planlagt Kirurgi, Regionshospitalet Silkeborg 2 Forskningsenheden for Muskuloskeletal Funktion og Fysioterapi (FoF), Institut for idræt og biomekanik, Syddansk Universitet Aim: To evaluate the effectiveness of clinical assessment of patients...... with musculoskeletal complaint performed by Clinical Specialist Physiotherapists (CSP) compared to Orthopaedic Surgeons (OS) on diagnostic agreement, economic cost and patient satisfaction. Methods: A systematic review was performed by searching in MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL......), EMBASE, CINAHL, PEDro and reference lists of included studies and previously published systematic reviews. Studies evaluating 1) adults (18+) with a musculoskeletal complaint referred to orthopaedic outpatient assessment and 2) patient assessment performed by CSP were included. Studies conducted...

  13. Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

    DEFF Research Database (Denmark)

    Rikkert, Marcel G M Olde; Tona, Klodiana Daphne; Janssen, Lieneke;

    2011-01-01

    New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles desc......, and is available in 14 languages. Taking into account the increasing differentiation of Alzheimer's disease in preclinical and predementia stages, there is an urgent need for global rating scales to be refined as well.......New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles...... describing 12 staging instruments were identified (N = 6109 participants, age 65-87). Reliability was studied in most (91%) of the articles and was judged moderate to good. Approximately 78% of the articles evaluated concurrent validity, which was good to very good, while discriminant validity was assessed...

  14. Adipose Derived Mesenchymal Stem Cells In Wound Healing: A Clinical Review

    Directory of Open Access Journals (Sweden)

    Gunalp Uzun

    2014-08-01

    Full Text Available The aim of this article is to review clinical studies on the use of adipose derived mesenchymal stem cells in the treatment of chronic wounds. A search on PubMed was performed on April 30th, 2014 to identify the relevant clinical studies. We reviewed 13 articles that reported the use adipose derived stem cells in the treatment of different types of wounds. Adipose derived stem cells have the potential to be used in the treatment of chronic wounds. However, standard methods for isolation, storage and application of these cells are needed. New materials to transfer these stem cells to injured tissues should be investigated. [Dis Mol Med 2014; 2(4.000: 57-64

  15. Dengue in children: a systematic review of clinical and laboratory factors associated with severity.

    Science.gov (United States)

    Wakimoto, Mayumi Duarte; Camacho, Luiz Antonio Bastos; Guaraldo, Lusiele; Damasceno, Luana Santana; Brasil, Patrícia

    2015-01-01

    Dengue is a potentially life-threatening illness, and children are at higher risk of severity. This review aimed to systematize the identified clinical and laboratory parameters associated with severe dengue in children, as monitoring these signs and fluid-replacement therapy are actually the cornerstones of dengue treatment. Of the 527 studies initially reviewed, 21 were selected as follows: three cohort studies, three case-control studies, 14 cross-sectional studies and one not defined. Eighteen studies were carried out in Asia and three in the Americas. Hepatomegaly, lethargy, abdominal pain, bleeding, hemoconcentration and thrombocytopenia, all referenced as warning signs in the WHO 2009 Guidelines, were the clinical and laboratory parameters independently associated with severity in more than one study. The recognition of these known warning signs associated to severe dengue disease underlines the usefulness of the WHO 2009 classification.

  16. Yoga for low back pain: a systematic review of randomized clinical trials.

    Science.gov (United States)

    Posadzki, Paul; Ernst, Edzard

    2011-09-01

    It has been suggested that yoga has a positive effect on low back pain and function. The objective of this systematic review was to assess the effectiveness of yoga as a treatment option for low back pain. Seven databases were searched from their inception to March 2011. Randomized clinical trials were considered if they investigated yoga in patients with low back pain and if they assessed pain as an outcome measure. The selection of studies, data extraction and validation were performed independently by two reviewers. Seven randomized controlled clinical trials (RCTs) met the inclusion criteria. Their methodological quality ranged between 2 and 4 on the Jadad scale. Five RCTs suggested that yoga leads to a significantly greater reduction in low back pain than usual care, education or conventional therapeutic exercises. Two RCTs showed no between-group differences. It is concluded that yoga has the potential to alleviate low back pain. However, any definitive claims should be treated with caution.

  17. Assessing clinical trials of Internet addiction treatment: a systematic review and CONSORT evaluation.

    Science.gov (United States)

    King, Daniel L; Delfabbro, Paul H; Griffiths, Mark D; Gradisar, Michael

    2011-11-01

    Although there is ongoing debate concerning the clinical status of Internet addiction, and the quality of the extant literature in this emerging field is not optimal, several clinical trials of both pharmacological and psychological treatments for Internet addiction have been published in recent years. A systematic review investigating the reporting quality of eight treatment studies is presented. Reporting quality was defined according to the 2010 Consolidating Standards of Reporting Trials (CONSORT) statement. An evaluation of the reviewed studies highlighted several key limitations, including (a) inconsistencies in the definition and diagnosis of Internet addiction, (b) a lack of randomization and blinding techniques, (c) a lack of adequate controls or other comparison groups, and (d) insufficient information concerning recruitment dates, sample characteristics, and treatment effect sizes. It is concluded that improvements in future studies' design and reporting would be of significant benefit to both researchers and clinicians, and to the overall positioning of Internet addiction in the behavioral addiction field.

  18. Diffusion tensor imaging for Alzheimer's disease: A review of concepts and potential clinical applicability

    OpenAIRE

    Luciano de Gois Vasconcelos; Sonia Maria Dozzi Brucki; Andrea Parolin Jackowiski; Orlando Francisco Amodeo Bueno

    2009-01-01

    Abstract In view of the urgent need to identify an early and specific biomarker for Alzheimer's disease (AD), a PubMed database search was performed using the terms "Alzheimer disease" and "Diffusion Magnetic Resonance Imaging" to enable review of Diffusion tensor imaging (DTI) concepts and its potential clinical role in AD evaluation. Detailed analysis of selected abstracts showed that the main DTI measures, fractional anisotropy and apparent diffusion coefficient, indicators of fiber tract ...

  19. Acupuncture for Posttraumatic Stress Disorder: A Systematic Review of Randomized Controlled Trials and Prospective Clinical Trials

    OpenAIRE

    Young-Dae Kim; In Heo; Byung-Cheul Shin; Cindy Crawford; Hyung-Won Kang; Jung-Hwa Lim

    2013-01-01

    To evaluate the current evidence for effectiveness of acupuncture for posttraumatic stress disorder (PTSD) in the form of a systematic review, a systematic literature search was conducted in 23 electronic databases. Grey literature was also searched. The key search terms were “acupuncture” and “PTSD.” No language restrictions were imposed. We included all randomized or prospective clinical trials that evaluated acupuncture and its variants against a waitlist, sham acupuncture, conventional th...

  20. BRIEF REVIEW ON DIAGNOSTIC TECHNIQUE AND NOVEL MOLECULES IN CLINICAL TRIALS FOR TREATMENT OF BREAST CANCER

    Directory of Open Access Journals (Sweden)

    VISHAL KUMAR S. MODI

    2015-01-01

    Full Text Available Breast cancer is the most common cancer in women in both developed and undeveloped countries, and the second most frequent cause of cancer deaths after lung cancer. Although there have been many chemotherapeutic agents like 5-fluorouracil, taxol, tamoxifen, doxorubicin, cisplatin, and camptothecin and hormones are used to treat breast cancer. This review focuses on the causes of breast cancer, latest diagnostic techniques and various molecules under clinical trials for the treatment of breast cancer.

  1. Modern dental imaging: a review of the current technology and clinical applications in dental practice

    Energy Technology Data Exchange (ETDEWEB)

    Vandenberghe, Bart; Jacobs, Reinhilde [Katholieke Universiteit Leuven, Oral Imaging Centre, Faculty of Medicine, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Leuven (Belgium); Bosmans, Hilde [Katholieke Universiteit Leuven, Radiology Section, Department of Medical Diagnostic Sciences, Leuven (Belgium)

    2010-11-15

    A review of modern imaging techniques commonly used in dental practice and their clinical applications is presented. The current dental examinations consist of intraoral imaging with digital indirect and direct receptors, while extraoral imaging is divided into traditional tomographic/panoramic imaging and the more recently introduced cone beam computed tomography. Applications, limitations and current trends of these dental ''in-office'' radiographic techniques are discussed. (orig.)

  2. Research gaps identified during systematic reviews of clinical trials: glass-ionomer cements

    OpenAIRE

    Mickenautsch Steffen

    2012-01-01

    Abstract Background To report the results of an audit concerning research gaps in clinical trials that were accepted for appraisal in authored and published systematic reviews regarding the application of glass-ionomer cements (GIC) in dental practice Methods Information concerning research gaps in trial precision was extracted, following a framework that included classification of the research gap reasons: ‘imprecision of information (results)’, ‘biased information’, ‘inconsistency or unknow...

  3. Book review of: "Clinical aspects of electroporation" by Stephen T Kee, Julie Gehl, Edward W Lee

    Directory of Open Access Journals (Sweden)

    Spugnini Enrico

    2011-10-01

    Full Text Available Abstract This article is a review of the book: Clinical aspects of electroporation, by Stephen T. Kee, Julie Gehl, Edward W Lee, which is published by Springer Press. Basic information that should be helpful in deciding whether to read the book and whether to use it as a reference book is presented. This includes an introduction, a description of all the sections of the book, and a comparison with recently published books on the topic.

  4. Clinical Features of Abdominopelvic Actinomycosis: Report of Twenty Cases and Literature Review

    OpenAIRE

    2009-01-01

    Purpose Intrabdominal actinomycosis is difficult to diagnose preoperatively. This chronic infection has a propensity to mimic many other diseases and may present with a wide variety of symptoms. The aim of this study was to evaluate the characteristic clinical features with review of the literature. Materials and Methods We retrospectively analyzed 22 patients with intrabdominal actinomycosis between January 2000 and January 2006. Results There were two men and 20 women with a mean age of 42....

  5. OXA-Carbapenemases Present in Clinical Acinetobacter baumannii-calcoaceticus Complex Isolates from Patients in Kurdistan Region, Iraq.

    Science.gov (United States)

    Ganjo, Aryann R; Maghdid, Delshad M; Mansoor, Isam Y; Kok, Dik J; Severin, Juliette A; Verbrugh, Henri A; Kreft, Deborah; Fatah, M H; Alnakshabandi, A A; Dlnya, Asad; Hammerum, Anette M; Ng, Kim; Goessens, Wil

    2016-12-01

    In addition to intrinsic resistance in Acinetobacter baumannii, many different types of acquired resistance mechanisms have been reported, including the presence of VIM and IMP metallo β-lactamases and also of blaOXA-23-like and blaOXA-58-like enzymes. In the Kurdistan region of Iraq, the multiresistant A. baumannii-calcoaceticus complex is prevalent. We characterized the different mechanisms of resistance present in clinical isolates collected from different wards and different hospitals from the Kurdistan region. One hundred twenty clinical nonduplicate A. baumannii-calcoaceticus complex isolates were collected from four hospitals between January 2012 and October 2013. The identification of the isolates was confirmed by MALDI-TOF. The susceptibility to different antibiotics was determined by disk diffusion and analyzed in accordance to EUCAST guidelines. By PCR, the presence of blaOXA-51-like, blaOXA-23-like, blaOXA-24-like, and blaOXA-58-like genes was determined as well as the presence of the insertion element ISAba1. Clonal diversity was analyzed by pulsed-field gel electrophoresis (PFGE) using the restriction enzyme ApaI and, in addition, multilocus sequence typing (MLST) was performed on a selected subset of 15 isolates. All 120 A. baumannii isolates harbored blaOXA-51-like genes. One hundred one out of 110 (92%) imipenem (IMP)-resistant A. baumannii-calcoaceticus complex isolates additionally carried the blaOXA-23-like gene and four isolates (3%) were positive for blaOXA-24-like. All 101 blaOXA-23-like-positive isolates had the ISAba1 insertion sequence, 1,600 bp upstream of the blaOXA-23-like gene. The blaOXA-58-like gene was not detected in any of the 110 IMP-resistant strains. Eight different PFGE clusters were identified and distributed over the different hospitals. MLST analysis performed on a subset of 15 representative isolates revealed the presence of the international clone ST2 (Pasteur). Besides ST2 (Pasteur), also many other STs (Pasteur) were

  6. Effective strategies for global health research, training and clinical care: a narrative review.

    Science.gov (United States)

    Walker, Rebekah J; Campbell, Jennifer A; Egede, Leonard E

    2014-09-29

    The purpose of this narrative review was to synthesize the evidence on effective strategies for global health research, training and clinical care in order to identify common structures that have been used to guide program development. A Medline search from 2001 to 2011 produced 951 articles, which were reviewed and categorized. Thirty articles met criteria to be included in this review. Eleven articles discussed recommendations for research, 8 discussed training and 11 discussed clinical care. Global health program development should be completed within the framework of a larger institutional commitment or partnership. Support from leadership in the university or NGO, and an engaged local community are both integral to success and sustainability of efforts. It is also important for program development to engage local partners from the onset, jointly exploring issues and developing goals and objectives. Evaluation is a recommended way to determine if goals are being met, and should include considerations of sustainability, partnership building, and capacity. Global health research programs should consider details regarding the research process, context of research, partnerships, and community relationships. Training for global health should involve mentorship, pre-departure preparation of students, and elements developed to increase impact. Clinical care programs should focus on collaboration, sustainability, meeting local needs, and appropriate process considerations.

  7. CLINICAL-RADIOGRAPHIC CORRELATION OF DEGENERATIVE CHANGES OF THE SPINE - SYSTEMATIC REVIEW

    Directory of Open Access Journals (Sweden)

    Emiliano Neves Vialle

    Full Text Available ABSTRACT Systematic review of the literature on the evaluation of images of degenerative changes of the spine and its clinical correlation. A systematic literature review was conducted, and the results evaluated for the presence of clinical correlation, as well as the type of imaging method used. The search terms were "Intervertebral Disc Degeneration", "Intervertebral disc", "Classification", "Anulus fibrosus", "Nucleus pulposus", "Lumbar spine", "Degenerative disc disease", "Degeneration", "Zygapophyseal Joint". We also assessed whether there were inter- and intraobserver agreement in the selected works and possible guidelines regarding the treatment and prognosis of patients. Of the 91 reviewed abstracts, 31 articles were selected that met the inclusion criteria. Six articles were related to the cervical spine, 13 to the lumbar spine and 12 were about changes not related specifically to a single segment of the spine. Articles that determined limiting values considered normal were also included, since variations were considered signs of degeneration or pathology. It was not possible to establish the relationship between the changes identified in imaging and the clinical history of patients, either define treatment and prognosis guidelines.

  8. Subjective endpoints in clinical trials: the case for blinded independent central review

    Directory of Open Access Journals (Sweden)

    Walovitch R

    2013-09-01

    Full Text Available Richard Walovitch,1 Bin Yao,2 Patrick Chokron,1 Helen Le,1 Glenn Bubley3 1WorldCare Clinical, LLC, Boston, MA, USA; 2Amgen, Inc, Thousand Oaks, CA, USA; 3Director of Genitourinary Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA Abstract: Primary efficacy and safety endpoints in clinical trials are often subjective assessments made by site personnel. For international confirmatory trials conducted over broad geographic regions and different clinical practice settings, variability in these subjective assessments can be substantial. Centralized endpoint assessment committees (EACs offer a mechanism through which to reduce assessment bias and potentially increase assessment precision and accuracy, particularly in open-label trials. An overview of regulatory agencies' rationales for an EAC is reviewed. In addition, the two main types of EACs, the blinded independent central review, and the consensus panel are compared. Selection of endpoints for EAC evaluation and design of EAC process to maximize EAC value proposition are also discussed. Keywords: endpoint assessment committee, FDA, central review, BICR, adjudication, consensus panel

  9. Clinical guidelines of non-alcoholic fatty liver disease: A systematic review

    Science.gov (United States)

    Zhu, Jin-Zhou; Hollis-Hansen, Kelseanna; Wan, Xing-Yong; Fei, Su-Juan; Pang, Xun-Lei; Meng, Fan-Dong; Yu, Chao-Hui; Li, You-Ming

    2016-01-01

    AIM To perform a systematic review to grade guidelines and present recommendations for clinical management of non-alcoholic fatty liver disease (NAFLD). METHODS A database search was conducted on PubMed for guidelines published before May 2016, supplemented by reviewing relevant websites. The Appraisal of Guidelines for Research and Evaluation (ARGEE) Instrument II was a tool designed to appraise the methodological rigor and transparency in which a clinical guideline is developed and it is used internationally. It was used to appraise the quality of guidelines in this study. The inclusion criteria include: clinical NAFLD guidelines for adults, published in English, and released by governmental agencies or key organizations. RESULTS Eleven guidelines were included in this study. Since 2007, guidelines have been released in Asia (3 in China, 1 in South Korea, and 1 in Japan), Europe (1 in Italy), America (1 in United States and 1 in Chile) and three international agencies [European associations joint, Asia-Pacific Working Party and World Gastroenterology Organization (WGO)]. Using the ARGEE II instrument, we found US 2012 and Europe 2016 had the highest scores, especially in the areas of rigor of development and applicability. Additionally, Italy 2010 and Korea 2013 also presented comprehensive content, rigorous procedures and good applicability. And WGO 2014 offered various algorithms for clinical practice. Lastly, a practical algorithm for the clinical management was developed, based on the recommended guidelines. CONCLUSION This is the first systematic review of NAFLD guidelines. It may yield insights for physicians and policy-makers in the development and application of guidelines. PMID:27688665

  10. Sneddon syndrome: rare disease or under diagnosed clinical entity? Review of the literature related to a clinical case.

    Science.gov (United States)

    Orac, Amalia; Artenie, Anca; Toader, Mihaela Paula; Harnagea, Raluca; Dinu-Mitrofan, Diana; Grigorovici, Mirela; Ungureanu, G

    2014-01-01

    Sneddon syndrome is defined by the association of livedo racemosa and recurrent cerebrovascular ischemic lesions. The annual incidence is 4/1,000,000. This syndrome particularly affects young women, some reports suggesting a family predisposition. It is a chronic, progressive, arterio-occlusive disease of unknown etiology that involves small and medium-sized arteries. It is usually associated with antiphospholipid antibodies. We report the case of a female patient with Sneddon syndrome with significant family history, personal history of stroke, epilepsy, migraine, cardiovascular involvement, three miscarriages, cognitive decline, noncompliant to therapy, in the absence of antiphospholipid antibodies. This paper aims to analyze the main characteristic features and management of Sneddon syndrome by conducting a literature review related to a clinical case.

  11. Safety of telemental healthcare delivered to clinically unsupervised settings: a systematic review.

    Science.gov (United States)

    Luxton, David D; Sirotin, Anton P; Mishkind, Matthew C

    2010-01-01

    The safety of telemental healthcare delivered to clinically unsupervised settings, such as a personal residence, must be established to inform policy and further the dissemination of telemental health programs. The aim of this article is to provide an overview of safety issues associated with telemental healthcare and, through a systematic literature review, evaluate the safety of telemental healthcare delivered to unsupervised settings. The review resulted in a total of nine studies that specifically evaluated the delivery of telemental healthcare to unsupervised settings. Six of the nine studies reviewed explicitly described safety plans or specific precautions that could be used if necessary. Two of the nine studies reported events that required the researchers to use safety procedures to effectively respond to concerns they had regarding participant safety. In both of these studies, the issues were resolved with prescribed safety procedures. Recommendations and future directions for the development and evaluation of safety protocols are discussed.

  12. Miscellaneous conditions of the shoulder: Anatomical, clinical, and pictorial review emphasizing potential pitfalls in imaging diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Farid, Nikdokht [University of California San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States); Bruce, Dean [University of California San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States); University of Alberta, Edmonton, Alberta (Canada); Chung, Christine B. [University of California San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States)], E-mail: cbchung@ucsd.edu

    2008-10-15

    The purpose of this article is to review the key imaging findings in major categories of pathology affecting the shoulder joint including hydroxyapatite deposition disease, rotator cuff interval pathology, acromioclavicular joint pathology, glenohumeral osteoarthrosis, and synovial inflammatory processes, with specific emphasis on findings that have associated pitfalls in imaging diagnosis. The pathophysiology and clinical manifestations of the above mentioned categories of pathology will be reviewed, followed in each section by a detailed pictorial review of the key imaging findings in each category including plain film, computed tomography, and magnetic resonance imaging findings as applicable. Imaging challenges that relate to both diagnosis and characterization will be addressed with each type of pathology. The goal is that after reading this article, the reader will be able to recognize the key imaging findings in major categories of pathology affecting the shoulder joint and will become familiar with the potential pitfalls in their imaging diagnosis.

  13. An updated review on the phytochemistry, pharmacology, and clinical trials of Salacia oblonga

    Directory of Open Access Journals (Sweden)

    Priya Singh Kushwaha

    2016-01-01

    Full Text Available Salacia oblonga (S. oblonga, a perennial herb, has been used for thousands of years in ayurvedic medicine and is closely associated with prevention, treatment, and cure of various human ailments such as obesity and diabetes. A vast and wide range of chemical compounds such as polyphenols, friedelane-type triterpenes, norfriedelane-type triterpenes, eudesmane-type sesquiterpenes including various glycosides had been isolated from this plant. This review is aimed to survey the literature covering the phytochemistry and pharmacology of S. oblonga and to review the scientific data including active components and their multi-targeted mechanisms of action against various metabolic syndromes. We also included clinical trials related to this plant in this review. The overview would assist researchers to gather scientific information related to S. oblonga in future.

  14. Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods

    DEFF Research Database (Denmark)

    Jakobsen, Janus Christian; Wetterslev, Jørn; Winkel, Per;

    2014-01-01

    BACKGROUND: Thresholds for statistical significance when assessing meta-analysis results are being insufficiently demonstrated by traditional 95% confidence intervals and P-values. Assessment of intervention effects in systematic reviews with meta-analysis deserves greater rigour. METHODS......: Methodologies for assessing statistical and clinical significance of intervention effects in systematic reviews were considered. Balancing simplicity and comprehensiveness, an operational procedure was developed, based mainly on The Cochrane Collaboration methodology and the Grading of Recommendations...... Assessment, Development, and Evaluation (GRADE) guidelines. RESULTS: We propose an eight-step procedure for better validation of meta-analytic results in systematic reviews (1) Obtain the 95% confidence intervals and the P-values from both fixed-effect and random-effects meta-analyses and report the most...

  15. An Updated Review on the Phytochemistry, Pharmacology, and Clinical Trials of Salacia oblonga

    Science.gov (United States)

    Kushwaha, Priya Singh; Singh, Ashok K.; Keshari, Amit K.; Maity, Siddhartha; Saha, Sudipta

    2016-01-01

    Salacia oblonga (S. oblonga), a perennial herb, has been used for thousands of years in ayurvedic medicine and is closely associated with prevention, treatment, and cure of various human ailments such as obesity and diabetes. A vast and wide range of chemical compounds such as polyphenols, friedelane-type triterpenes, norfriedelane-type triterpenes, eudesmane-type sesquiterpenes including various glycosides had been isolated from this plant. This review is aimed to survey the literature covering the phytochemistry and pharmacology of S. oblonga and to review the scientific data including active components and their multi-targeted mechanisms of action against various metabolic syndromes. We also included clinical trials related to this plant in this review. The overview would assist researchers to gather scientific information related to S. oblonga in future. PMID:28082793

  16. Stress and Primary Headache: Review of the Research and Clinical Management.

    Science.gov (United States)

    Martin, Paul R

    2016-07-01

    This review begins with a discussion of the nature of stress and then presents the functional model of primary headache as a framework for conceptualizing the complex relationship between stress and headaches. Research is reviewed on stress as a trigger of headaches and how stress can play a role in the developmental and psychosocial context of headaches. Clinical management of headaches from a stress perspective is considered both at the level of trials of behavioral interventions that broadly fit into the stress management category and the additional strategies that might be useful for individual cases based on the research demonstrating associations between stress and headaches. The review concludes by suggesting that although some researchers have questioned whether stress can trigger headaches, overall, the literature is still supportive of such a link. Advances in methodology are discussed, the recent emphasis on protective factors is welcomed, and directions for future research suggested.

  17. Review of Clinical Studies of the Treatment of Ulcerative Colitis Using Acupuncture and Moxibustion

    Directory of Open Access Journals (Sweden)

    Jun Ji

    2016-01-01

    Full Text Available Background. Clinical studies suggest that acupuncture and moxibustion therapy in ulcerative colitis (UC can regulate bowel inflammation, and these treatments have the advantages of low rates of adverse reactions and recurrence as well as good long-term efficacy. We reviewed the current status of clinical studies of the treatment. Methods. Randomized controlled trials (RCTs using the therapy as the major intervention for treating UC were included from 1995 to 2015. The extracted data mainly included diagnostic standards, treatment methods, selection of acupoints, treatment times and courses, and efficacy determination criteria. Results. The use of diagnostic standards and efficacy criteria lacked unification and standardization. There were two main groups: acupuncture and moxibustion therapy combined with drug treatment and the use of all types of acupuncture and moxibustion therapy alone or in combination. The acupoint compositions included distal-proximal point combinations, back-shu point and front-mu point combinations, and acupuncture through meridians. The treatment courses in all the clinical trials had large variations. Conclusion. The treatment of UC in the examined articles was mainly based on the classical theory. However, many links of the clinical regimen design were still lacking, which affected the repeatability of the clinical studies and the accuracy of the clinical conclusions.

  18. Aligning strategies for using EEG as a surrogate biomarker: a review of preclinical and clinical research.

    Science.gov (United States)

    Leiser, Steven C; Dunlop, John; Bowlby, Mark R; Devilbiss, David M

    2011-06-15

    Electroencephalography (EEG) and related methodologies offer the promise of predicting the likelihood that novel therapies and compounds will exhibit clinical efficacy early in preclinical development. These analyses, including quantitative EEG (e.g. brain mapping) and evoked/event-related potentials (EP/ERP), can provide a physiological endpoint that may be used to facilitate drug discovery, optimize lead or candidate compound selection, as well as afford patient stratification and Go/No-Go decisions in clinical trials. Currently, the degree to which these different methodologies hold promise for translatability between preclinical models and the clinic have not been well summarized. To address this need, we review well-established and emerging EEG analytic approaches that are currently being integrated into drug discovery programs throughout preclinical development and clinical research. Furthermore, we present the use of EEG in the drug development process in the context of a number of major central nervous system disorders including Alzheimer's disease, schizophrenia, depression, attention deficit hyperactivity disorder, and pain. Lastly, we discuss the requirements necessary to consider EEG technologies as a biomarker. Many of these analyses show considerable translatability between species and are used to predict clinical efficacy from preclinical data. Nonetheless, the next challenge faced is the selection and validation of EEG endpoints that provide a set of robust and translatable biomarkers bridging preclinical and clinical programs.

  19. Assessing mental imagery in clinical psychology: a review of imagery measures and a guiding framework.

    Science.gov (United States)

    Pearson, David G; Deeprose, Catherine; Wallace-Hadrill, Sophie M A; Burnett Heyes, Stephanie; Holmes, Emily A

    2013-02-01

    Mental imagery is an under-explored field in clinical psychology research but presents a topic of potential interest and relevance across many clinical disorders, including social phobia, schizophrenia, depression, and post-traumatic stress disorder. There is currently a lack of a guiding framework from which clinicians may select the domains or associated measures most likely to be of appropriate use in mental imagery research. We adopt an interdisciplinary approach and present a review of studies across experimental psychology and clinical psychology in order to highlight the key domains and measures most likely to be of relevance. This includes a consideration of methods for experimentally assessing the generation, maintenance, inspection and transformation of mental images; as well as subjective measures of characteristics such as image vividness and clarity. We present a guiding framework in which we propose that cognitive, subjective and clinical aspects of imagery should be explored in future research. The guiding framework aims to assist researchers in the selection of measures for assessing those aspects of mental imagery that are of most relevance to clinical psychology. We propose that a greater understanding of the role of mental imagery in clinical disorders will help drive forward advances in both theory and treatment.

  20. Cox-2 expression in ovarian malignancies: a review of the clinical aspects.

    Science.gov (United States)

    Menczer, Joseph

    2009-10-01

    COX-2 is an inducible enzyme expressed only in response to stimuli such as mitogens, cytokines, growth factors or hormones, and is pro-inflammatory. It plays an important role in tumorigenesis. The purpose of the present report is to review the clinical aspects of COX-2 expression in ovarian malignancies. A PubMed (http://www.pubmed.gov/) search of investigations published from July 2001 until August 2008 and containing the term COX-2 in combination with ovarian malignancies was conducted. The clinical aspects of the relevant investigations were reviewed. COX-2 is expressed in ovarian tumors of low malignant potential (LMP), in epithelial ovarian carcinoma (EOC) and primary peritoneal carcinoma (PPC) and apparently plays a role in their carcinogenesis. Its expression seems to be correlated with VEGF that serves as a predictor of poor prognosis in some non-gynecologic malignancies. COX-2 expression is higher in EOC than in LMPs. The results with regard to the association between COX-2 expression and prognostic factors, response to treatment and outcome in ovarian malignancies are inconsistent. Clinical studies dealing with the effect of COX-2 inhibitors on outcome are scarce. The use of COX-2 expression in gynecological malignancies in clinical practice remains to be elucidated.

  1. Economic efficiency of countries' clinical review processes and competitiveness on the market of human experimentation.

    Science.gov (United States)

    Ippoliti, Roberto

    2013-01-01

    Clinical research is a specific phase of pharmaceutical industry's production process in which companies test candidate drugs on patients to collect clinical evidence about safety and effectiveness. Information is essential to obtain manufacturing authorization from the national drug agency and, in this way, make profits on the market. Considering this activity, however, the public stakeholder has to face a conflict of interests. On the one side, there is society's necessity to make advances in medicine and, of course, to promote pharmaceutical companies' investments in this specific phase (new generation). On the other side, there is the duty to protect patients involved in these experimental treatments (old generation). To abide by this moral duty, a protection system was developed through the years, based on two legal institutions: informed consent and institutional review board. How should an efficient protection system that would take human experimentation into account be shaped? Would it be possible for the national protection system of patients' rights to affect the choice of whether to develop a clinical trial in a given country or not? Looking at Europe and considering a protection system that is shaped around institutional review boards, this article is an empirical work that tries to give answers to these open questions. It shows how a protection system that can minimize the time necessary to start a trial can positively affect pharmaceutical clinical research, that is, the choice of pharmaceutical companies to start innovative medical treatments in a given country.

  2. Is Deqi an Indicator of Clinical Efficacy of Acupuncture? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Shuo Zhang

    2013-01-01

    Full Text Available Objective. Despite the systematic literature review of the current evidence, we aim to answer the question “ is Deqi an indicator of clinical effects in acupuncture treatment?” Methods. We systematically searched CNKI, VIP, Wanfang Data, PubMed, Embase, and the CENTRAL for three types of study: (1 empirical research probing into the role of Deqi in acupuncture; (2 mechanism studies examining the effect of Deqi on physiological parameters in animal models and human subjects; (3 clinical studies that compared the outcome of acupuncture with Deqi with that of acupuncture without Deqi. Two reviewers independently extracted data, undertook qualitative or quantitative analysis, and summarized findings. Results. The ancient Chinese acupuncturists valued the role of Deqi as a diagnostic tool, a prognosis predictor, and a necessary part of the therapeutic procedure. Findings from modern experimental research provided preliminary evidence for the physiological mechanism that produced Deqi. Few clinical studies generated conflicting evidence of the comparative effectiveness of acupuncture with Deqi versus acupuncture without Deqi for a variety of conditions. Conclusion. The current evidence base is not solid enough to draw any conclusion regarding the predicative value of natural Deqi for clinical efficacy or the therapeutic value of manipulation-facilitated Deqi.

  3. Characterization of a novel plasmid type and various genetic contexts of bla OXA-58 in Acinetobacter spp. from multiple cities in China.

    Directory of Open Access Journals (Sweden)

    Yiqi Fu

    Full Text Available BACKGROUND/OBJECTIVE: Several studies have described the epidemiological distribution of blaOXA-58-harboring Acinetobacter baumannii in China. However, there is limited data concerning the replicon types of blaOXA-58-carrying plasmids and the genetic context surrounding blaOXA-58 in Acinetobacter spp. in China. METHODOLOGY/PRINCIPAL FINDINGS: Twelve non-duplicated blaOXA-58-harboring Acinetobacter spp. isolates were collected from six hospitals in five different cities between 2005 and 2010. The molecular epidemiology of the isolates was carried out using PFGE and multilocus sequence typing. Carbapenemase-encoding genes and plasmid replicase genes were identified by PCR. The genetic location of blaOXA-58 was analyzed using S1-nuclease method. Plasmid conjugation and electrotransformation were performed to evaluate the transferability of blaOXA-58-harboring plasmids. The genetic structure surrounding blaOXA-58 was determined by cloning experiments. The twelve isolates included two Acinetobacter pittii isolates (belong to one pulsotype, three Acinetobacter nosocomialis isolates (belong to two pulsotypes and seven Acinetobacter baumannii isolates (belong to two pulsotypes/sequence types. A. baumannii ST91 was found to be a potential multidrug resistant risk clone carrying both blaOXA-58 and blaOXA-23. blaOXA-58 located on plasmids varied from ca. 52 kb to ca. 143 kb. All plasmids can be electrotransformed to A. baumannii recipient, but were untypeable by the current replicon typing scheme. A novel plasmid replicase named repAci10 was identified in blaOXA-58-harboring plasmids of two A. pittii isolates, three A. nosocomialis isolates and two A. baumannii isolates. Four kinds of genetic contexts of blaOXA-58 were identified. The transformants of plasmids with structure of IS6 family insertion sequence (ISOur1, IS1008 or IS15-ΔISAba3-like element-blaOXA-58 displayed carbapenem nonsusceptible, while others with structure of intact ISAba3-like element-bla

  4. Poststroke upper extremity rehabilitation: a review of robotic systems and clinical results.

    Science.gov (United States)

    Brewer, Bambi R; McDowell, Sharon K; Worthen-Chaudhari, Lise C

    2007-01-01

    Although the use of robotic devices to address neuromuscular rehabilitative goals represents a promising technological advance in medical care, the large number of systems being developed and varying levels of clinical study of the devices make it difficult to follow and interpret the results in this new field. This article is a review of the current state-of-the-art in robotic applications in poststroke therapy for the upper extremity, written specifically to help clinicians determine the differences between various systems. We concentrate primarily on systems that have been tested clinically. Robotic systems are grouped by rehabilitation application (e.g., gross motor movement, bilateral training, etc.), and, where possible, the neurorehabilitation strategies employed by each system are described. We close with a discussion of the benefits and concerns of using robotics in rehabilitation and an indication of challenges that must be addressed for therapeutic robots to be applied practically in the clinic.

  5. Hypertrophic pachymeningitis: Current criteria for diagnosis and differentiation (Clinical case and review of literature

    Directory of Open Access Journals (Sweden)

    E. G. Mendelevich

    2015-01-01

    Full Text Available The paper describes a 44-year-old male patient with an about 6-year history of hypertrophic pachymeningitis. The major clinical symptoms were characterized by headache, exophthalmos, and blindness in one eye. The data for differential diagnosis of the disease are given. The current literature on the clinical manifestations of hypertrophic pachymeningitis, its differential diagnosis, and the results of magnetic resonance imaging (MRI is reviewed. Diagnostic difficulties at the stage of a clinical observation are due to the nonspecificity of neurological manifestations and the need for a comprehensive examination to detect a somatic disease. MRI can diagnose the disease-specific phenomenon of damage to the meninges, which calls for further careful differentiation. Clinicians must be familiar with alternative differential diagnosis, as a rapid specific therapeutic approach will help avoid long-term or irreversible neurological complications.

  6. Application of maldi-tof mass spectrometry in clinical virology: a review.

    Science.gov (United States)

    Cobo, Fernando

    2013-01-01

    MALDI-TOF mass spectrometry is a diagnostic tool of microbial identification and characterization based on the detection of the mass of molecules. In the majority of clinical laboratories, this technology is currently being used mainly for bacterial diagnosis, but several approaches in the field of virology have been investigated. The introduction of this technology in clinical virology will improve the diagnosis of infections produced by viruses but also the discovery of mutations and variants of these microorganisms as well as the detection of antiviral resistance. This review is focused on the main current applications of MALDI-TOF MS techniques in clinical virology showing the state of the art with respect to this exciting new technology.

  7. Dietary phytochemicals and cancer chemoprevention: a review of the clinical evidence.

    Science.gov (United States)

    Kotecha, Ritesh; Takami, Akiyoshi; Espinoza, J Luis

    2016-08-09

    Cancer chemoprevention involves the use of different natural or biologic agents to inhibit or reverse tumor growth. Epidemiological and pre-clinical data suggest that various natural phytochemicals and dietary compounds possess chemopreventive properties, and in-vitro and animal studies support that these compounds may modulate signaling pathways involved in cell proliferation and apoptosis in transformed cells, enhance the host immune system and sensitize malignant cells to cytotoxic agents. Despite promising results from experimental studies, only a limited number of these compounds have been tested in clinical trials and have shown variable results. In this review, we summarize the data regarding select phytochemicals including curcumin, resveratrol, lycopene, folates and tea polyphenols with emphasis on the clinical evidence supporting the efficacy of these compounds in high-risk populations.

  8. Non-invasive prenatal testing for fetal chromosome abnormalities: review of clinical and ethical issues.

    Science.gov (United States)

    Gekas, Jean; Langlois, Sylvie; Ravitsky, Vardit; Audibert, François; van den Berg, David Gradus; Haidar, Hazar; Rousseau, François

    2016-01-01

    Genomics-based non-invasive prenatal screening using cell-free DNA (cfDNA screening) was proposed to reduce the number of invasive procedures in current prenatal diagnosis for fetal aneuploidies. We review here the clinical and ethical issues of cfDNA screening. To date, it is not clear how cfDNA screening is going to impact the performances of clinical prenatal diagnosis and how it could be incorporated in real life. The direct marketing to users may have facilitated the early introduction of cfDNA screening into clinical practice despite limited evidence-based independent research data supporting this rapid shift. There is a need to address the most important ethical, legal, and social issues before its implementation in a mass setting. Its introduction might worsen current tendencies to neglect the reproductive autonomy of pregnant women.

  9. Chronic lymphocytic leukaemia: contemporary conceptions of etiology, pathogenesis and peculiarities of clinical manifestations (review

    Directory of Open Access Journals (Sweden)

    Chesnokova N.P.

    2011-06-01

    Full Text Available The research work presents an analysis of literature review and results of investigations on the problems of etiology, pathogenesis, classification and peculiarities of clinical manifestations of chronic lymphocytic leukaemia. Special attention is paid to both contemporary conceptions of carcinogenesis, reflecting the role of proto-oncogenes activation, an-tioncogenes and apoptosis genes suppression in mechanisms of neoplasia development and «specific mechanisms» of oncogenic transformation induction of B-lymphocytes and the subsequent development of the stages of promotion, progression and marked clinical manifestations of formation. Possibility of further improvement of use of immune phe-notype character and oncomarkers in diagnostics of chronic lymphocytic leukaemia clinical variants and in evaluation of effectiveness of its therapy has been indicated in the article

  10. The emerge of a new superbug gene blaNDM-1

    Institute of Scientific and Technical Information of China (English)

    Wang Kaiji

    2011-01-01

    @@ NDM-- 1 in detail: NDM-1, which is the abbreviation of 'New Delhi metallo-beta-lactamase', is a recently dis-covered enzyme that is produced by some gram-negative Enterobaeteriaceae such as E coil (Esehe-riehia toll) and Klebsiella pneumonia.It is named after 'New Delhi', which is the capital of India, be-cause the first patient who was diagnosed to be colo-nized by bacteria with blaNDM-1 gene had gone toa hospital in New Delhi for cosmetic surgery not long before he was diagnosed.

  11. Genetic environments of the transferable plasmid-mediated blaCTX-M-3 gene in Serratia marcescens isolates.

    Science.gov (United States)

    Chu, Pei-Yu; Peng, Chien-Fang

    2014-01-01

    In this study, genetic environments of the transferable plasmid-mediated blaCTX-M-3 gene were characterized among 14 isolates of cefotaxime-resistant Serratia marcescens using PCR and BLAST DNA sequence analysis. A total of 3 types of genetic architectures in the regions surrounding this blaCTX-M-3 gene were identified. Type I architecture was characterized by the presence of a complete insertion sequence of tnpA-ISEcp1, identified as interrupting a reverse IS26 sequence in the upstream region of the blaCTX-M-3 gene. A reverse-directional orf477 fragment was located downstream of the blaCTX-M-3 gene, which was in the same direction of the mucA gene. A common region containing the orf513 element was located upstream of the mucA gene. Moreover, a copy of the 3'-CS2 element was located immediately upstream of the orf513 element. A novel complex class 1 integron was characterized by the presence of the dfrA19 gene, which was flanked by two copies of class 1 integrons. This is the first report to describe the dfrA19 gene within a novel complex class 1 integron in S. marcescens isolates from Taiwan. This novel complex class 1 integron structure was located distantly upstream of the blaCTX-M-3 gene.

  12. Clinical guidelines development and usage: a critical insight and literature review: thyroid disease diagnostic algorithms.

    Science.gov (United States)

    Murgić, Jure; Salopek, Daniela; Prpić, Marin; Jukić, Tomislav; Kusić, Zvonko

    2008-12-01

    Clinical guidelines have been increasingly used in medicine. They represent a system of recommendations for the conduction of specific procedures used in fields from public health to different diagnostic and therapeutic procedures in clinical medicine. Guidelines are designed to facilitate to medical practitioners the adoption, evaluation and application of an increasing body of evidence and arising number of expert opinions regarding the presently best treatment and to help in delivering proper decision for the management of a patient or condition. Clinical guidelines represent a part of complementary activity by which research is implemented into praxis, standards are defined and clinical excellence is promoted in all health care fields. There are specific conditions which quality guidelines should meet. First of all, they need to be founded on comprehensive literature review, apart from clinical studies and trials in the target field. Also, there are more systems for analyzing and grading the strength of clinical evidence and the level of recommendation emerging from it. Algorithms are used to organize and summarize guidelines. The algorithm itself has a form of an informatic record and a logical flow. Algorithms, especially in case of clinical uncertainty, must be used for the improvement of health care, increasing it's availability and integration of the newest scientific knowledge. They should have an important role in the health care rationalisation, fight against non-rational diagnostics manifested as diagnostic procedures with no clinical indications, it's unnecessary repetition and wrong sequence. Several diagnostic algorithms used in the field of thyroid diseases are presented, since they have been proved to be of great use.

  13. Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review

    Directory of Open Access Journals (Sweden)

    Patrícia do Carmo Silva Parreira

    2014-03-01

    Full Text Available Questions: Is Kinesio Taping more effective than a sham taping/placebo, no treatment or other interventions in people with musculoskeletal conditions? Is the addition of Kinesio Taping to other interventions more effective than other interventions alone in people with musculoskeletal conditions? Design: Systematic review of randomised trials. Participants: People with musculoskeletal conditions. Intervention: Kinesio Taping was compared with sham taping/placebo, no treatment, exercises, manual therapy and conventional physiotherapy. Outcome measures: Pain intensity, disability, quality of life, return to work, and global impression of recovery. Results: Twelve randomised trials involving 495 participants were included in the review. The effectiveness of the Kinesio Taping was tested in participants with: shoulder pain in two trials; knee pain in three trials; chronic low back pain in two trials; neck pain in three trials; plantar fasciitis in one trial; and multiple musculoskeletal conditions in one trial. The methodological quality of eligible trials was moderate, with a mean of 6.1 points on the 10-point PEDro Scale score. Overall, Kinesio Taping was no better than sham taping/placebo and active comparison groups. In all comparisons where Kinesio Taping was better than an active or a sham control group, the effect sizes were small and probably not clinically significant or the trials were of low quality. Conclusion: This review provides the most updated evidence on the effectiveness of the Kinesio Taping for musculoskeletal conditions. The current evidence does not support the use of this intervention in these clinical populations. PROSPERO registration: CRD42012003436. [Parreira PdCS, Costa LdCM, Hespanhol Junior LC, Lopes AD, Costa LOP (2014 Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review. Journal of Physiotherapy 60: 31–39

  14. Safety reporting in developing country vaccine clinical trials-a systematic review.

    Science.gov (United States)

    Muehlhans, Susann; Richard, Georgina; Ali, Mohammad; Codarini, Gabriela; Elemuwa, Chris; Khamesipour, Ali; Maurer, Wolfgang; Mworozi, Edison; Kochhar, Sonali; Rundblad, Gabriella; Vuitton, Dominique; Rath, Barbara

    2012-05-09

    With more vaccines becoming available worldwide, vaccine research is on the rise in developing countries. To gain a better understanding of safety reporting from vaccine clinical research in developing countries, we conducted a systematic review in Medline and Embase (1989-2011) of published randomized clinical trials (RCTs) reporting safety outcomes with ≥50% developing country participation (PROSPERO systematic review registration number: CRD42012002025). Developing country vaccine RCTs were analyzed with respect to the number of participants, age groups studied, inclusion of safety information, number of reported adverse events following immunization (AEFI), type and duration of safety follow-up, use of standardized AEFI case definitions, grading of AEFI severity, and the reporting of levels of diagnostic certainty for AEFI. The systematic search yielded a total number of 50 randomized vaccine clinical trials investigating 12 different vaccines, most commonly rotavirus and malaria vaccines. In these trials, 94,459 AEFI were reported from 446,908 participants receiving 735,920 vaccine doses. All 50 RCTs mentioned safety outcomes with 70% using definitions for at least one AEFI. The most commonly defined AEFI was fever (27), followed by local (16) and systemic reactions (14). Logistic regression analysis revealed a positive correlation between the implementation of a fever case definition and the reporting rate for fever as an AEFI (p=0.027). Overall, 16 different definitions for fever and 7 different definitions for erythema were applied. Predefined AEFI case definitions by the Brighton Collaboration were used in only two out of 50 RCTs. The search was limited to RCTs published in English or German and may be missing studies published locally. The reported systematic review suggests room for improvement with respect to the harmonization of safety reporting from developing country vaccine clinical trials and the implementation of standardized case definitions.

  15. A Review on Clinical Pharmacokinetics of Tamsulosin in Patients with Benign Prostatic Hyperplasia

    Directory of Open Access Journals (Sweden)

    Tolou Ghamari

    2016-08-01

    Full Text Available Context Benign prostatic hyperplasia (BPH that disturbs aged males is described as the abundant, chronic progressive disorder usually associated with lower urinary tract symptoms. The alpha 1A-adrenergic receptor antagonist, tamsulosin (Flomax®/Omnic®, seems to be an appropriate management from the view point of urological surgeons. The current review aimed to evaluate the clinical pharmacological properties of tamsulosin in prostate disorders. Evidence Acquisition United States national library of medicine (PubMed, NLM were searched from April 1991 to March 2016. The Mesh terms were: tamsulosin, tamsulosin pharmacokinetics in urology, tamsulosin in BPH and clinical pharmacokinetics of tamsulosin in BPH. Published clinical trials and review articles applicable to pharmacotherapy of tamsulosin in BPH were reviewed. Results In patients with mild international prostate symptom score (< 8 to moderate symptoms of BPH, initial treatment with an alpha 1-adrenergic antagonist monotherapy were useful. With a half-life of 9 - 13 hours, the oral bioavailability of drug was reported 100%. The drug is metabolized by liver. Excretion through renal was reported 76%. Initial dose of drug was 0.4 mg/day and the maximum dose was reported 0.8 mg/day. The drug could cause dizziness, sever drowsiness and problems in thinking, driving and many other complications. Other serious adverse reactions could be mentioned as hives, rash, itching, and difficulty in breathing, swelling of face, lips, tongue and throat. Tamsulosin therapy should be stopped in patients who experience hypotension. Conclusions To treat BPH therapeutically, it is necessary to stabilize severities of the patient’s symptoms with potential side effects of the treatment. Tamsulosin blocks alpha 1-receptors in smooth muscles both in the bladder neck and prostate, which leads to relaxation and subsequently less resistance to urinary flow. By advancement of tamsulosin, pharmacotherapy strategies could

  16. Detection of extended-spectrum β-lactamases (blaCTX-M-1 and blaTEM in Escherichia coli, Salmonella spp., and Klebsiella pneumoniae isolated from poultry in North Eastern India

    Directory of Open Access Journals (Sweden)

    H. Lalzampuia

    2014-11-01

    Full Text Available Aim: The present study was conducted to record the association of extended spectrum β-lactamases (ESBLs producing enteric bacteria with diarrhea of poultry birds in Mizoram, India. Materials and Methods: Fecal samples were collected from poultry birds with the history of diarrhea from different parts of Mizoram. Samples were processed for isolation and identification of Escherichia coli, Salmonella, and Klebsiella pneumoniae. All the isolates were subjected to antibiotic sensitivity assays. Phenotypically, ESBLs production ability was determined by double discs synergy test (DDST method. ESBLs producing isolates were subjected to polymerase chain reaction (PCR for detection of ESBLs genes. Plasmids were cured by acridine orange. Transfer of resistance from donor to recipient strains was done by in vitro horizontal method. Results: A total of 134 enteric bacteria was isolated, of which 102 (76.12%, 21 (15.67% and 11 (8.21% were E. coli, Salmonella spp. and K. pneumoniae, respectively. By DDST 7 (5.22% isolates (6 E. coli and 1 K. pneumoniae were ESBLs producer. PCR analysis confirmed 5 (3.73% (4 E. coli and 1 K. pneumoniae isolates harboured blaCTX-M-1 gene and/or blaTEM gene. All the isolates were carrying plasmids ranging between 0.9 kb and ~30 kb. Of the 4 isolates positive for blaCTX-M-1 and/or blaTEM, 2 (1.84% were confirmed for blaCTX-M-1 gene in their plasmid. No blaTEM gene was detected from plasmid. The resistance plasmid could not be transferred to the recipient by in vitro horizontal gene transfer method. Conclusion: ESBLs producing enteric bacteria are circulating in poultry in North Eastern Region of India. As poultry is one of the most common food animals in this region, these organisms may enter in human population through them.

  17. A putative multi-replicon plasmid co-harboring beta-lactamase genes blaKPC-2, blaCTX-M-14 and blaTEM-1 and trimethoprim resistance gene dfrA25 from a Klebsiella pneumoniae sequence type (ST) 11 strain in China

    Science.gov (United States)

    Tang, Yu; Shen, Pinghua; Liang, Wei; Jin, Jialin; Jiang, Xiaofei

    2017-01-01

    The global emergence of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae poses a major public health threat requiring immediate and aggressive action. Some older generation antibiotics, such as trimethoprim, serve as alternatives for treatment of infections. Here, we determined the complete nucleotide sequence of plasmid pHS091147, which co-harbored the carbapenemase (blaKPC-2) and trimethoprim resistance genes (dfrA25) from a Klebsiella pneumoniae sequence type (ST) 11 clone recovered in Shanghai, China. pHS091147 had three replication genes, several plasmid-stability genes and an intact type IV secretion system gene cluster. Besides blaKPC-2 and dfrA25, pHS091147 carried several other resistance genes, including β-lactamase genes blaTEM-1 and blaCTX-M-14, sulphonamide resistance gene sul1, a quinolone resistance gene remnant (ΔqnrB2), and virulence associated gene iroN. Notably, the multidrug-resistance region was a chimeric structure composed of three subregions, which shared strong sequence homology with several plasmids previously assigned in Genbank. To our knowledge, this is the first report of the co-localization of blaKPC-2 and dfrA25 on a novel putative multi-replicon plasmid in a Klebsiella pneumoniae ST11 clone. PMID:28152085

  18. Clinical evidence on titanium-zirconium dental implants: a systematic review and meta-analysis.

    Science.gov (United States)

    Altuna, P; Lucas-Taulé, E; Gargallo-Albiol, J; Figueras-Álvarez, O; Hernández-Alfaro, F; Nart, J

    2016-07-01

    The use of titanium implants is well documented and they have high survival and success rates. However, when used as reduced-diameter implants, the risk of fracture is increased. Narrow diameter implants (NDIs) of titanium-zirconium (Ti-Zr) alloy have recently been developed (Roxolid; Institut Straumann AG). Ti-Zr alloys (two highly biocompatible materials) demonstrate higher tensile strength than commercially pure titanium. The aim of this systematic review was to summarize the existing clinical evidence on dental NDIs made from Ti-Zr. A systematic literature search was performed using the Medline database to find relevant articles on clinical studies published in the English language up to December 2014. Nine clinical studies using Ti-Zr implants were identified. Overall, 607 patients received 922 implants. The mean marginal bone loss was 0.36±0.06mm after 1 year and 0.41±0.09mm after 2 years. The follow-up period ranged from 3 to 36 months. Mean survival and success rates were 98.4% and 97.8% at 1 year after implant placement and 97.7% and 97.3% at 2 years. Narrow diameter Ti-Zr dental implants show survival and success rates comparable to regular diameter titanium implants (>95%) in the short term. Long-term follow-up clinical data are needed to confirm the excellent clinical performance of these implants.

  19. [Clinical characteristics of histoplamosis in 8 patients: case report and literature review].

    Science.gov (United States)

    Zhou, Li; Fan, Songqing; Liang, Qingchun; Peng, Yating; Zong, Dandan; Ouyang, Ruoyun

    2016-06-28

    To explore the clinical characteristics, imaging manifestation, diagnosis and treatment for histoplasmosis and to improve therapeutic level, we retrospectively analyzed the clinical data of 8 patients with biopsy-confirmed histoplasmosis from 2004 to 2014 in the Second Xiangya Hospital of Central South University and reviewed relevant literatures. The main clinical symptoms of histoplasmosis included fever, cough, expectoration, chest pain, blood-stained sputum, lymphadenectasis, etc. The major lung imaging features were mass, node or pneumonia-like performance. No case was diagnosed as histoplasimosis firstly. Four patients whose imaging manifestations were focal pulmonary lesion received lobectomy of lung lesions or wedge resection. Clinical and imaging manifestations in 3 patients, who treated with amphotericin B or its liposomal, itraconazole or fluconazole, were improved. The clinical symptoms and imaging findings of histoplasmosis are nonspecific. It is easy for the physicians to misdiagnose histoplasmosis as bacterial infection, lung cancer, tuberculosis lymphoma, etc. Therefore, it is significant and necessary to carry out multiple biopsies combined with multiple etiological examinations for patients with difficult diagnosis.

  20. Correlation between clinical performance and degree of conversion of resin cements: a literature review

    Science.gov (United States)

    DE SOUZA, Grace; BRAGA, Roberto Ruggiero; CESAR, Paulo Francisco; LOPES, Guilherme Carpena

    2015-01-01

    Resin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC) under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used. PMID:26398507

  1. Review of Clinical Pharmacology of Aloe vera L. in the Treatment of Psoriasis.

    Science.gov (United States)

    Miroddi, Marco; Navarra, Michele; Calapai, Fabrizio; Mancari, Ferdinando; Giofrè, Salvatore Vincenzo; Gangemi, Sebastiano; Calapai, Gioacchino

    2015-05-01

    Aloe vera L., is a plant used worldwide as folk remedy for the treatment of various ailments, including skin disorders. Its gel is present in cosmetics, medicinal products and food supplements. Psoriasis, an immune-mediated chronic inflammatory disease, involving mainly the skin, affects about the 2-3% of general population. Conventional pharmacological treatments for psoriasis can have limited effectiveness and can cause adverse reactions. For this reason often psoriatic patients look for alternative treatments based on natural products containing Aloe vera. We conducted a systematic review of clinical trials assessing effectiveness and safety of aloe for the treatment of psoriasis. Clinical studies published in English were considered; a total of four clinical trials met inclusion criteria. Studies were also evaluated by using the Jadad scale and Consort Statement in Reporting Clinical trials of Herbal Medicine Intervention. Quality and methodological accuracy of considered studies varied considerably, and some crucial information to reproduce clinical results was missing. We conclude that administration of aloe as cutaneous treatment is generally well tolerated, as no serious side effects were reported. Results on the effectiveness of Aloe vera are contradictory; our analysis reveals the presence of methodological gaps preventing to reach final conclusions.

  2. Effectiveness and safety of natalizumab in real-world clinical practice: Review of observational studies.

    Science.gov (United States)

    van Pesch, Vincent; Sindic, Christian J; Fernández, Oscar

    2016-10-01

    Clinical trials have shown that natalizumab is highly effective for treating relapsing forms of multiple sclerosis (MS). The purpose of this analysis was to conduct a targeted review of data from country-specific observational studies and registries of natalizumab-treated patients with relapsing MS in order to more fully investigate the longer-term effectiveness and safety of this disease-modifying therapy in real-world clinical practice settings. A PubMed search was conducted on March 13, 2014, using the terms (natalizumab AND multiple sclerosis) AND (observational OR registry OR post-marketing OR clinical practice). Only English-language papers that reported effectiveness (in terms of effects on relapses, disability progression, and magnetic resonance imaging findings) and/or safety results from studies were included. Data from 22 studies/registries were included. Annualized relapse rates decreased by 73%-94% from baseline across the studies, with improvement maintained for up to 5 years during natalizumab treatment. Natalizumab effectiveness was also demonstrated via assessment of disability progression (Expanded Disability Status Scale), radiological measures, and no-evidence-of-disease-activity measures (clinical, radiological, and overall). Results were similar among patient groups stratified by level of disease activity. Safety outcomes were consistent with natalizumab's known safety profile. Data from country-specific observational studies and registries varying in size and scope support the effectiveness and safety of natalizumab in a broad range of patients in clinical practice.

  3. Correlation between clinical performance and degree of conversion of resin cements: a literature review

    Directory of Open Access Journals (Sweden)

    Grace DE SOUZA

    2015-08-01

    Full Text Available AbstractResin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used.

  4. Correlation between clinical performance and degree of conversion of resin cements: a literature review.

    Science.gov (United States)

    De Souza, Grace; Braga, Roberto Ruggiero; Cesar, Paulo Francisco; Lopes, Guilherme Carpena

    2015-01-01

    Resin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC) under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used.

  5. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review

    Directory of Open Access Journals (Sweden)

    Antonio M. Esquinas

    2014-12-01

    Full Text Available The aim of this article was to review the role of noninvasive ventilation (NIV in acute pulmonary infectious diseases, such as severe acute respiratory syndrome (SARS, H1N1 and tuberculosis, and to assess the risk of disease transmission with the use of NIV from patients to healthcare workers. We performed a clinical review by searching Medline and EMBASE. These databases were searched for articles on ‘‘clinical trials’’ and ‘‘randomised controlled trials’’. The keywords selected were non-invasive ventilation pulmonary infections, influenza-A (H1N1, SARS and tuberculosis. These terms were cross-referenced with the following keywords: health care workers, airborne infections, complications, intensive care unit and pandemic. The members of the International NIV Network examined the major results regarding NIV applications and SARS, H1N1 and tuberculosis. Cross-referencing mechanical ventilation with SARS yielded 76 studies, of which 10 studies involved the use of NIV and five were ultimately selected for inclusion in this review. Cross-referencing with H1N1 yielded 275 studies, of which 27 involved NIV. Of these, 22 were selected for review. Cross-referencing with tuberculosis yielded 285 studies, of which 15 involved NIV and from these seven were selected. In total 34 studies were selected for this review. NIV, when applied early in selected patients with SARS, H1N1 and acute pulmonary tuberculosis infections, can reverse respiratory failure. There are only a few reports of infectious disease transmission among healthcare workers.

  6. Emergence of Acinetobacter baumannii ST730 carrying the bla OXA-72 gene in Brazil

    Science.gov (United States)

    Pagano, Mariana; Rozales, Franciéli P; Bertolini, Diego; Rocha, Lisiane; Sampaio, Jorge LM; Barth, Afonso L; Martins, Andreza F

    2016-01-01

    Over the last decade, Acinetobacter baumannii resistant to carbapenems has emerged in many medical centres and has been commonly associated with high morbimortality. In Brazil, this resistance is mainly attributed to the spread of OXA-23-producing clones and, to a lesser extent, to OXA-143-producing clones. Here, we describe, for the first time, two OXA-72-producing A. baumannii isolates in southern Brazil to a broad spectrum of antibiotics, except polymyxin B and tigecycline. Molecular typing by multilocus sequence typing (MLST) demonstrated that both OXA-72-producing isolates belong to a new sequence type (ST), ST730, which was recently identified in OXA-23-producing A. baumannii isolates in São Paulo, Brazil. We demonstrate that the two A. baumannii ST730 isolates carrying blaOXA-72share a common ancestral origin with the blaOXA-23producers in Brazil. This observation reinforces the importance of strain-typing methods in order to clarify the dynamics of the emergence of new clones in a geographic region. PMID:27653364

  7. Clinical solid waste management practices and its impact on human health and environment--A review.

    Science.gov (United States)

    Hossain, Md Sohrab; Santhanam, Amutha; Nik Norulaini, N A; Omar, A K Mohd

    2011-04-01

    The management of clinical solid waste (CSW) continues to be a major challenge, particularly, in most healthcare facilities of the developing world. Poor conduct and inappropriate disposal methods exercised during handling and disposal of CSW is increasing significant health hazards and environmental pollution due to the infectious nature of the waste. This article summarises a literature review into existing CSW management practices in the healthcare centers. The information gathered in this paper has been derived from the desk study of open literature survey. Numerous researches have been conducted on the management of CSW. Although, significant steps have been taken on matters related to safe handling and disposal of the clinical waste, but improper management practice is evident from the point of initial collection to the final disposal. In most cases, the main reasons of the mismanagement of CSW are the lack of appropriate legislation, lack of specialized clinical staffs, lack of awareness and effective control. Furthermore, most of the healthcare centers of the developing world have faced financial difficulties and therefore looking for cost effective disposal methods of clinical waste. This paper emphasizes to continue the recycle-reuse program of CSW materials after sterilization by using supercritical fluid carbon dioxide (SF-CO2) sterilization technology at the point of initial collection. Emphasis is on the priority to inactivate the infectious micro-organisms in CSW. In that case, waste would not pose any threat to healthcare workers. The recycling-reuse program would be carried out successfully with the non-specialized clinical staffs. Therefore, the adoption of SF-CO2 sterilization technology in management of clinical solid waste can reduce exposure to infectious waste, decrease labor, lower costs, and yield better compliance with regulatory. Thus healthcare facilities can both save money and provide a safe environment for patients, healthcare staffs

  8. Accelerometer measurement of upper extremity movement after stroke: a systematic review of clinical studies.

    Science.gov (United States)

    Noorkõiv, Marika; Rodgers, Helen; Price, Christopher I

    2014-10-09

    The aim of this review was to identify and summarise publications, which have reported clinical applications of upper limb accelerometry for stroke within free-living environments and make recommendations for future studies. Data was searched from MEDLINE, Scopus, IEEExplore and Compendex databases. The final search was 31st October 2013. Any study was included which reported clinical assessments in parallel with accelerometry in a free-living hospital or home setting. Study quality is reflected by participant numbers, methodological approach, technical details of the equipment used, blinding of clinical measures, whether safety and compliance data was collected. First author screened articles for inclusion and inclusion of full text articles and data extraction was confirmed by the third author. Out of 1375 initial abstracts, 8 articles were included. All participants were stroke patients. Accelerometers were worn for either 24 hours or 3 days. Data were collected as summed acceleration counts over a specified time or as the duration of active/inactive periods. Activity in both arms was reported by all studies and the ratio of impaired to unimpaired arm activity was calculated in six studies. The correlation between clinical assessments and accelerometry was tested in five studies and significant correlations were found. The efficacy of a rehabilitation intervention was assessed using accelerometry by three studies: in two studies both accelerometry and clinical test scores detected a post-treatment difference but in one study accelerometry data did not change despite clinical test scores showing motor and functional improvements. Further research is needed to understand the additional value of accelerometry as a measure of upper limb use and function in a clinical context. A simple and easily interpretable accelerometry approach is required.

  9. Escitalopram--translating molecular properties into clinical benefit: reviewing the evidence in major depression.

    LENUS (Irish Health Repository)

    Leonard, Brian

    2010-08-01

    The majority of currently marketed drugs contain a mixture of enantiomers; however, recent evidence suggests that individual enantiomers can have pharmacological properties that differ importantly from enantiomer mixtures. Escitalopram, the S-enantiomer of citalopram, displays markedly different pharmacological activity to the R-enantiomer. This review aims to evaluate whether these differences confer any significant clinical advantage for escitalopram over either citalopram or other frequently used antidepressants. Searches were conducted using PubMed and EMBASE (up to January 2009). Abstracts of the retrieved studies were reviewed independently by both authors for inclusion. Only those studies relating to depression or major depressive disorder were included. The search identified over 250 citations, of which 21 studies and 18 pooled or meta-analyses studies were deemed suitable for inclusion. These studies reveal that escitalopram has some efficacy advantage over citalopram and paroxetine, but no consistent advantage over other selective serotonin reuptake inhibitors. Escitalopram has at least comparable efficacy to available serotonin-norepinephrine reuptake inhibitors, venlafaxine XR and duloxetine, and may offer some tolerability advantages over these agents. This review suggests that the mechanistic advantages of escitalopram over citalopram translate into clinical efficacy advantages. Escitalopram may have a favourable benefit-risk ratio compared with citalopram and possibly with several other antidepressant agents.

  10. Thuja occidentalis (Arbor vitae: A Review of its Pharmaceutical, Pharmacological and Clinical Properties

    Directory of Open Access Journals (Sweden)

    Belal Naser

    2005-01-01

    Full Text Available Arbor vitae (Thuja occidentalis L. is a native European tree widely used in homeopathy and evidence-based phytotherapy. Many reviews and monographs have been published on the herbal substance's description, mode of action and clinical use. However, no comprehensive evidence-based review is available. Therefore, our aim was to search MEDLINE databases and survey manufacturers for further details or unpublished data. This review presents the botany, ethnobotany and phytochemistry, especially the different contents of essential oil (Thujone in relation to different extraction procedures of this medicinal plant. Thuja's antiviral action and immunopharmacological potential, such as stimulatory and co-stimulatory effects on cytokine and antibody production and activation of macrophages and other immunocompetent cells, have been evaluated in numerous in vitro and in vivo investigations. Although no controlled trials have been conducted on Thuja occ alone, many clinical studies have been performed with a herbal medicinal product containing a special extract of Thuja occ and other immunostimulants, demonstrating its therapeutic efficacy and safety in respiratory tract infections.

  11. Acupuncture for Posttraumatic Stress Disorder: A Systematic Review of Randomized Controlled Trials and Prospective Clinical Trials

    Directory of Open Access Journals (Sweden)

    Young-Dae Kim

    2013-01-01

    Full Text Available To evaluate the current evidence for effectiveness of acupuncture for posttraumatic stress disorder (PTSD in the form of a systematic review, a systematic literature search was conducted in 23 electronic databases. Grey literature was also searched. The key search terms were “acupuncture” and “PTSD.” No language restrictions were imposed. We included all randomized or prospective clinical trials that evaluated acupuncture and its variants against a waitlist, sham acupuncture, conventional therapy control for PTSD, or without control. Four randomized controlled trials (RCTs and 2 uncontrolled clinical trials (UCTs out of 136 articles in total were systematically reviewed. One high-quality RCT reported that acupuncture was superior to waitlist control and therapeutic effects of acupuncture and cognitive-behavioral therapy (CBT were similar based on the effect sizes. One RCT showed no statistical difference between acupuncture and selective serotonin reuptake inhibitors (SSRIs. One RCT reported a favorable effect of acupoint stimulation plus CBT against CBT alone. A meta-analysis of acupuncture plus moxibustion versus SSRI favored acupuncture plus moxibustion in three outcomes. This systematic review and meta-analysis suggest that the evidence of effectiveness of acupuncture for PTSD is encouraging but not cogent. Further qualified trials are needed to confirm whether acupuncture is effective for PTSD.

  12. Acupuncture for posttraumatic stress disorder: a systematic review of randomized controlled trials and prospective clinical trials.

    Science.gov (United States)

    Kim, Young-Dae; Heo, In; Shin, Byung-Cheul; Crawford, Cindy; Kang, Hyung-Won; Lim, Jung-Hwa

    2013-01-01

    To evaluate the current evidence for effectiveness of acupuncture for posttraumatic stress disorder (PTSD) in the form of a systematic review, a systematic literature search was conducted in 23 electronic databases. Grey literature was also searched. The key search terms were "acupuncture" and "PTSD." No language restrictions were imposed. We included all randomized or prospective clinical trials that evaluated acupuncture and its variants against a waitlist, sham acupuncture, conventional therapy control for PTSD, or without control. Four randomized controlled trials (RCTs) and 2 uncontrolled clinical trials (UCTs) out of 136 articles in total were systematically reviewed. One high-quality RCT reported that acupuncture was superior to waitlist control and therapeutic effects of acupuncture and cognitive-behavioral therapy (CBT) were similar based on the effect sizes. One RCT showed no statistical difference between acupuncture and selective serotonin reuptake inhibitors (SSRIs). One RCT reported a favorable effect of acupoint stimulation plus CBT against CBT alone. A meta-analysis of acupuncture plus moxibustion versus SSRI favored acupuncture plus moxibustion in three outcomes. This systematic review and meta-analysis suggest that the evidence of effectiveness of acupuncture for PTSD is encouraging but not cogent. Further qualified trials are needed to confirm whether acupuncture is effective for PTSD.

  13. Administration of supplemental L-tyrosine with phenelzine: a clinical literature review

    Directory of Open Access Journals (Sweden)

    Hinz M

    2014-07-01

    Full Text Available Marty Hinz,1 Alvin Stein,2 Ted Cole,3 Patricia Ryan4 1Clinical Research, NeuroResearch Clinics, Inc., Cape Coral, FL, USA; 2Stein Orthopedic Associates, Plantation, FL, USA; 3Cole Center for Healing, Cincinnati, OH, USA; 4Family Wellness Center, Omaha, NE, USA Abstract: The subject of this literature review is the alleged relationship between L-tyrosine, phenelzine, and hypertensive crisis. Phenelzine (Nardil® prescribing information notes: “The potentiation of sympathomimetic substances and related compounds by MAO inhibitors may result in hypertensive crises (see WARNINGS. Therefore, patients being treated with NARDIL should not take […] L-tyrosine […]”. Interest in the scientific foundation of this claim was generated during routine patient care. A comprehensive literature search of Google Scholar and PubMed revealed no reported cases of hypertensive crisis associated with concomitant administration of L-tyrosine and phenelzine. Review of current US Food and Drug Administration nutritional guidelines relating to ongoing phenelzine studies reveals no mention and requires no consideration of L-tyrosine ingestion in combination with phenelzine. This paper is intended to provide an objective review of the science to then allow the reader to formulate the final opinion. Keywords: hypertensive crisis, phenelzine, tyrosine, tyramine, stroke, phenelzine

  14. The 7q11.23 Microduplication Syndrome: A Clinical Report with Review of Literature.

    Science.gov (United States)

    Abbas, Elham; Cox, Devin M; Smith, Teri; Butler, Merlin G

    2016-09-01

    We report a 14-year-old adolescent girl with selective mutism (SM) and a 7q11.23 microduplication detected by chromosomal microarray (CMA) analysis and reviewed the literature from 18 published clinical reports. Our patient had specific phobias, SM, extreme anxiety, obesity, cutis marmorata, and a round appearing face with a short neck and over folded ears. We reviewed the published clinical, cognitive, behavioral, and cytogenetic findings grouped by speech and language delay, growth and development, craniofacial, clinical, and behavior and cognitive features due to the 7q11.23 microduplication. This microduplication syndrome is characterized by speech delay (91%), social anxiety (42%), attention deficit hyperactivity disorder (ADHD, 37%), autism spectrum disorder (29%), and separation anxiety (13%). Other findings include abnormal brain imaging (80%), congenital heart and vascular defects (54%), and mild intellectual disability (38%). We then compared the phenotype with Williams-Beuren syndrome (WBS) which is due to a deletion of the same chromosome region. Both syndromes have abnormal brain imaging, hypotonia, delayed motor development, joint laxity, mild intellectual disability, ADHD, autism, and poor visuospatial skills but opposite or dissimilar findings regarding speech and behavioral patterns, cardiovascular problems, and social interaction. Those with WBS are prone to have hyperverbal speech, lack of stranger anxiety, and supravalvular aortic stenosis while those with the 7q11.23 microduplication have speech delay, SM, social anxiety, and are prone to aortic dilatation.

  15. Assessing Competencies in a Master of Science in Clinical Research Program: The Comprehensive Competency Review.

    Science.gov (United States)

    Robinson, Georgeanna F W B; Moore, Charity G; McTigue, Kathleen M; Rubio, Doris M; Kapoor, Wishwa N

    2015-12-01

    Competencies in Master of Science Clinical Research programs are becoming increasingly common. However, students and programs can only benefit fully from competency-based education if students' competence is formally assessed. Prior to a summative assessment, students must have at least one formative, formal assessment to be sure they are developing competence appropriate for their stage of training. This paper describes the comprehensive competency review (CCR), a milestone for MS students in Clinical Research at the University of Pittsburgh's Institute for Clinical Research Education. The CCR involves metacognitive reflection of the student's learning as a whole, written evidence of each competency, a narrative explaining the choice of evidence for demonstrating competencies, and a meeting in which two faculty members review the evidence and solicit further oral evidence of competence. CCRs allow for individualized feedback at the midpoint in degree programs, providing students with confidence that they will have the means and strategies to develop competence in all areas by the summative assessment of competence at their thesis defense. CCRs have also provided programmatic insight on the need for curricular revisions and additions. These benefits outweigh the time cost on the part of students and faculty in the CCR process.

  16. Clinical tests to diagnose lumbar spondylolysis and spondylolisthesis: A systematic review.

    Science.gov (United States)

    Alqarni, Abdullah M; Schneiders, Anthony G; Cook, Chad E; Hendrick, Paul A

    2015-08-01

    The aim of this paper was to systematically review the diagnostic ability of clinical tests to detect lumbar spondylolysis and spondylolisthesis. A systematic literature search of six databases, with no language restrictions, from 1950 to 2014 was concluded on February 1, 2014. Clinical tests were required to be compared against imaging reference standards and report, or allow computation, of common diagnostic values. The systematic search yielded a total of 5164 articles with 57 retained for full-text examination, from which 4 met the full inclusion criteria for the review. Study heterogeneity precluded a meta-analysis of included studies. Fifteen different clinical tests were evaluated for their ability to diagnose lumbar spondylolisthesis and one test for its ability to diagnose lumbar spondylolysis. The one-legged hyperextension test demonstrated low to moderate sensitivity (50%-73%) and low specificity (17%-32%) to diagnose lumbar spondylolysis, while the lumbar spinous process palpation test was the optimal diagnostic test for lumbar spondylolisthesis; returning high specificity (87%-100%) and moderate to high sensitivity (60-88) values. Lumbar spondylolysis and spondylolisthesis are identifiable causes of LBP in athletes. There appears to be utility to lumbar spinous process palpation for the diagnosis of lumbar spondylolisthesis, however the one-legged hyperextension test has virtually no value in diagnosing patients with spondylolysis.

  17. Combinations of Radiation Therapy and Immunotherapy for Melanoma: A Review of Clinical Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Barker, Christopher A., E-mail: barkerc@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Postow, Michael A. [Department of Medicine, Melanoma and Sarcoma Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-04-01

    Radiation therapy has long played a role in the management of melanoma. Recent advances have also demonstrated the efficacy of immunotherapy in the treatment of melanoma. Preclinical data suggest a biologic interaction between radiation therapy and immunotherapy. Several clinical studies corroborate these findings. This review will summarize the outcomes of studies reporting on patients with melanoma treated with a combination of radiation therapy and immunotherapy. Vaccine therapies often use irradiated melanoma cells, and may be enhanced by radiation therapy. The cytokines interferon-α and interleukin-2 have been combined with radiation therapy in several small studies, with some evidence suggesting increased toxicity and/or efficacy. Ipilimumab, a monoclonal antibody which blocks cytotoxic T-lymphocyte antigen-4, has been combined with radiation therapy in several notable case studies and series. Finally, pilot studies of adoptive cell transfer have suggested that radiation therapy may improve the efficacy of treatment. The review will demonstrate that the combination of radiation therapy and immunotherapy has been reported in several notable case studies, series and clinical trials. These clinical results suggest interaction and the need for further study.

  18. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports

    Science.gov (United States)

    Park, Brian Y.; Wilson, Gary; Berger, Jonathan; Christman, Matthew; Reina, Bryn; Bishop, Frank; Klam, Warren P.; Doan, Andrew P.

    2016-01-01

    Traditional factors that once explained men’s sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography’s unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth. PMID:27527226

  19. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports.

    Science.gov (United States)

    Park, Brian Y; Wilson, Gary; Berger, Jonathan; Christman, Matthew; Reina, Bryn; Bishop, Frank; Klam, Warren P; Doan, Andrew P

    2016-08-05

    Traditional factors that once explained men's sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography's unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.

  20. Sequence and expression of Acinetobacter baumannii blaNDM-1 gene%鲍曼不动杆菌blaNDM-1基因序列分析及表达

    Institute of Scientific and Technical Information of China (English)

    陈硕; 冯书章; 邱少富; 夏力亮; 王中强; 刘军; 柳楠; 祝令伟; 孙洋; 宋宏彬

    2012-01-01

    目的 研究NDM-1鲍曼不动杆菌厦门分离株耐药性产生的分子机制.方法 Vitek32测定耐药谱.根据GenBank发表blaNDM-1基因序列设计合成引物,利用PCR技术扩增NDM-1鲍曼不动杆菌的blaNDM-1结构基因及其上下游调控序列片段,连接T载体,转化至大肠杆菌E.coli DH5α,序列测定并进行BLAST分析比对.测定始发菌株与重组菌株对美洛培南的最小抑菌浓度.结果 药敏试验结果 显示,该菌株对碳青霉烯类及β-内酰胺类抗生素耐药.NDM-1鲍曼不动杆菌厦门分离株blaNDM-1基因与HK-01同源性为100%;与KP-05-506相比,在blaNDM-1和trpF之间有24 bp的插入.美洛培南最小抑菌浓度测定结果 表明,重组菌株E.coli DH5α(pMD18-T::blaNDM-1)MIC值比始发菌株E.coli DH5α升高256倍.结论 获得blaNDM-1基因的大肠杆菌能够表达碳青霉烯酶,该基因是碳青霉烯类抗生素耐药性产生的分子基础,该基因具有跨种水平传播的可能.%The emergence of plasmid-mediated carbapenemases, such as NDM-1 in Enlerobacleriaceae is a major public health issue. The first NDM-1 producing AcineLobacLer baiunannii isolated in Xiamen was characterized. Antibiotic susceptibility was assessed with Vitek32. The A. Baiunannii earring NDM-1 was resistant to carbapenems and |3-lactam antibiotics· And remained susceptible to aminoglycosides and flluoroquinolones. Gene transfer to E. Coli recipient was investigated by using PCR and transformation. Sequence analysis of blaNDM-1 encoding the metallo-fHactamase indicated that the blaNDM-1 of NDM-1 A. Baiunannii was 100% homology with E. Coli HK-01 from Hong Kong. And there was a 24bp insert sequence between blaNDM-1 and LrpF when compared with K. Pneumoniae KP-05-506 from India. Minimum inhibitory concentration (MIC) of the recombination strain E. Coli DH5a (pMD18-T: blaNDM-1 ) was increased 256 times more than E. Coli DH5a to meropenem. The result suggests that the E. Coli acquired the blaNDM-1 could express

  1. Service oriented architecture for clinical decision support: a systematic review and future directions.

    Science.gov (United States)

    Loya, Salvador Rodriguez; Kawamoto, Kensaku; Chatwin, Chris; Huser, Vojtech

    2014-12-01

    The use of a service-oriented architecture (SOA) has been identified as a promising approach for improving health care by facilitating reliable clinical decision support (CDS). A review of the literature through October 2013 identified 44 articles on this topic. The review suggests that SOA related technologies such as Business Process Model and Notation (BPMN) and Service Component Architecture (SCA) have not been generally adopted to impact health IT systems' performance for better care solutions. Additionally, technologies such as Enterprise Service Bus (ESB) and architectural approaches like Service Choreography have not been generally exploited among researchers and developers. Based on the experience of other industries and our observation of the evolution of SOA, we found that the greater use of these approaches have the potential to significantly impact SOA implementations for CDS.

  2. Come fly with me: review of clinically important arboviruses for global travelers.

    Science.gov (United States)

    Cleton, Natalie; Koopmans, Marion; Reimerink, Johan; Godeke, Gert-Jan; Reusken, Chantal

    2012-11-01

    Western tourists are increasingly traveling to exotic locations often located in tropical or subtropical regions of the world. The magnitude of international travel and the constantly changing dynamics of arbovirus diseases across the globe demand up-to-date information about arbovirus threats to travelers and the countries they visit. In this review, the current knowledge on arbovirus threats to global travelers is summarized and prioritized per region. Based on most common clinical syndromes, currently known arboviruses can be grouped to develop diagnostic algorithms to support decision-making in diagnostics. This review systematically combines and structures the current knowledge on medically important travel-related arboviruses and illustrates the necessity of a detailed patient history (travel history, symptoms experienced, vaccination history, engaged activities, tick or mosquito bite and use of repellent and onset of symptoms), to guide the diagnosis.

  3. Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies

    Directory of Open Access Journals (Sweden)

    Sarah Brien

    2004-01-01

    Full Text Available Bromelain, an extract from the pineapple plant, has been demonstrated to show anti-inflammatory and analgesic properties and may provide a safer alternative or adjunctive treatment for osteoarthritis. All previous trials, which have been uncontrolled or comparative studies, indicate its potential use for the treatment of osteoarthritis. This paper reviews the mechanism of its putative therapeutic actions, those clinical trials that have assessed its use in osteoarthritis to date, as well as considering the safety implications of this supplement for osteoarthritis and reviewing the evidence to date regarding the dosage for treating this condition. The data available at present indicate the need for trials to establish the efficacy and optimum dosage for bromelain and the need for adequate prospective adverse event monitoring in such chronic conditions as osteoarthritis.

  4. Clinical characteristics and outcome of patients diagnosed with psychogenic nonepileptic seizures: a 5-year review.

    LENUS (Irish Health Repository)

    O'Sullivan, S S

    2012-02-03

    OBJECTIVE: The goal of this article was to describe the clinical characteristics and outcomes of patients diagnosed with psychogenic nonepileptic seizures (PNES). METHODS: We conducted a retrospective review of patients diagnosed with PNES in a 5-year period. RESULTS: Fifty patients with PNES were identified, giving an estimated incidence of 0.91\\/100,000 per annum. Thirty-eight were included for review, 15 of whom were male (39%). Eighteen patients had been diagnosed with epilepsy as well as PNES (47%). We demonstrated a gender difference in our patients, with males having higher seizure frequencies, more antiepileptic drug use, and a longer interval before diagnosis of PNES. Females were diagnosed with other conversion disorders more often than males. Impaired social function was observed in PNES, as was resistance to psychological interventions with a subsequent poor response to treatments. CONCLUSIONS: PNES remains a difficult condition to treat, and may affect males in proportions higher than those described in previous studies.

  5. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review

    DEFF Research Database (Denmark)

    Sangesland, Anders; Støren, Carl; Vaegter, Henrik B.

    2017-01-01

    Background Pain after surgery is not uncommon with 30% of patients reporting moderate to severe postoperative pain. Early identification of patients prone to postoperative pain may be a step forward towards individualized pain medicine providing a basis for improved clinical management through...... treatment strategies targeting relevant pain mechanisms in each patient. Assessment of pain processing by quantitative sensory testing (QST) prior to surgery has been proposed as a method to identify patients at risk for postoperative pain, although results have been conflicting. Since the last systematic...... review, several studies investigating the association between postoperative pain and more dynamic measures of pain processing like temporal summation of pain and conditioned pain modulation have been conducted. Objectives According to the PRISMA guidelines, the aim of this systematic review...

  6. The Clinical Interview for Depression: A Comprehensive Review of Studies and Clinimetric Properties

    DEFF Research Database (Denmark)

    Guidi, Jenny; Fava, Giovanni A; Bech, Per

    2011-01-01

    . The purpose of this paper is to review the clinimetric characteristics of Paykel's Clinical Interview for Depression (CID) and to examine the results of the studies in which the interview has been used. Methods: Published reports which involved the use of the CID were identified by searching the following......Background: A comprehensive assessment of the wide spectrum of depressive symptomatology, particularly in its subclinical forms, is lacking in standard rating scales. There is also an emerging need for instruments that can detect small differences in therapeutic studies and have good sensitivity...... electronic databases: Medline, PsychINFO, EMBASE, and Web of Science. A manual search of the literature was also performed. Results: The initial strategies yielded 169 published reports for potential inclusion in the review: 98 are discussed here. The CID has been used extensively in a variety of studies...

  7. Comparison of medication reconciliation and medication review: errors and clinical importance

    DEFF Research Database (Denmark)

    Bjeldbak-Olesen, Mette; Danielsen, Anja Gadsbølle; Tomsen, Dorthe Vilstrup

    2013-01-01

    Introduction: The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-re­lated problems (DRPs), denoted errors. Material and methods: This was a retrospective study conducted at the Department...... of Cardiology, Hillerød Hos­pital. Medication reconciliation compared the prescriptions in patient records, an electronic medication system (EMS) and in discharge summaries (DS). The medication review was based on the EMS. The two methods were performed on the same data material. To assess the clinical...... importance of the errors, a four-point scale was applied. Results: A total of 75 patient records were included. In all, 198 discrepancies were identified by medication reconcili­ation, 2.6 per patient. The most frequent discrepancies were omission of a drug in the DS and discrepancy between the drugs noted...

  8. Preparing raw clinical data for publication: guidance for journal editors, authors, and peer reviewers.

    Science.gov (United States)

    Hrynaszkiewicz, Iain; Norton, Melissa L; Vickers, Andrew J; Altman, Douglas G

    2010-01-29

    In recognition of the benefits of transparent reporting, many peer-reviewed journals require that their authors be prepared to share their raw, unprocessed data with other scientists and/or state the availability of raw data in published articles. But little information on how data should be prepared for publication - or sharing - has emerged. In clinical research patient privacy and consent for use of personal health information are key considerations, but agreed-upon definitions of what constitutes anonymised patient information do not appear to have been established. We aim to address this issue by providing practical guidance for those involved in the publication process, by proposing a minimum standard for de-identifying datasets for the purposes of publication in a peer-reviewed biomedical journal, or sharing with other researchers. Basic advice on file preparation is provided along with procedural guidance on prospective and retrospective publication of raw data, with an emphasis on randomised controlled trials.

  9. A Systematic Review and Meta-Analysis of the Clinical Appropriateness of Blood Transfusion in China.

    Science.gov (United States)

    Zhu, Changtai; Gao, Yulu; Li, Zhiqiang; Li, Qinyun; Gao, Zongshuai; Liao, Yanqiu; Deng, Zhifeng

    2015-12-01

    The issue of the clinical appropriateness of blood transfusion has become a focus of transfusion medicine worldwide. In China, irrational uses of blood have often been reported in recent years. However, to date there lacks a systematic review of the rational uses of blood. This study aimed to determine the clinical appropriateness of blood transfusion in China. We searched PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, WanFang Database, and Chinese BioMedical Literature Database, and the retrieval cut-off date was June 31, 2015. SPSS 17.0 and MetaAnalyst 3.13 were employed as the statistics tools in this review. A pooled rate of clinical inappropriateness of transfusion was analyzed by DerSimonian-Laird method. In this study, a total of 39 observational studies were included, which related to 75,132 cases of blood transfusion. According to the meta-analysis results, the overall incidence of clinical inappropriateness of transfusion in China was estimated to be 37.3% (95% confidence interval [CI] [32.1, 42.8]). The subgroup analyses revealed that the pooled rates of clinical inappropriateness of transfusion of plasma, red blood cells (RBCs), cryoprecipitate, and platelets were 56.3% (95% CI [45.8, 66.2]), 30.9% (95% CI [27.1, 35.0]), 25.2% (95% CI [13.2, 42.7]), and 14.1% (95% CI [8.8, 21.9]), respectively. However, the pooled incidence of inappropriateness of transfusion in operative departments was 47.5% (95% CI [36.8, 58.3]), which was significantly higher than that in nonoperative departments, 25.8% (95% CI [18.7, 34.4], P  0.05). In conclusion, China has suffered from a disadvantage in the clinical appropriateness of blood transfusion, especially in plasma and RBC use. In future, comprehensive measures should be implemented in order to improve the clinical appropriateness of blood transfusion.

  10. The usefulness of systematic reviews of animal experiments for the design of preclinical and clinical studies.

    Science.gov (United States)

    de Vries, Rob B M; Wever, Kimberley E; Avey, Marc T; Stephens, Martin L; Sena, Emily S; Leenaars, Marlies

    2014-01-01

    The question of how animal studies should be designed, conducted, and analyzed remains underexposed in societal debates on animal experimentation. This is not only a scientific but also a moral question. After all, if animal experiments are not appropriately designed, conducted, and analyzed, the results produced are unlikely to be reliable and the animals have in effect been wasted. In this article, we focus on one particular method to address this moral question, namely systematic reviews of previously performed animal experiments. We discuss how the design, conduct, and analysis of future (animal and human) experiments may be optimized through such systematic reviews. In particular, we illustrate how these reviews can help improve the methodological quality of animal experiments, make the choice of an animal model and the translation of animal data to the clinic more evidence-based, and implement the 3Rs. Moreover, we discuss which measures are being taken and which need to be taken in the future to ensure that systematic reviews will actually contribute to optimizing experimental design and thereby to meeting a necessary condition for making the use of animals in these experiments justified.

  11. Information systems in clinical pharmacy applied to parenteral nutrition management and traceability: a systematic review

    Directory of Open Access Journals (Sweden)

    Josefa Martínez Gabarrón

    2017-01-01

    Full Text Available Objective: To review the scientific literature on clinical pharmacy information systems applied to parenteral nutrition (PN management and traceability. Method: A systematic review of the documents retrieved from the MEDLINE (PubMed, Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts (IPA and Google Scholar databases up to May, 2016. The terms used, as descriptors and free text, were: “Parenteral Nutrition” and “Drug Information Services”. The quality of the articles was assessed using the STROBE Questionnaire. The search was completed through consultation with experts and the bibliographic review of the articles selected. Results: From the 153 references retrieved in our search, after applying inclusion and exclusion criteria, only 6 articles were selected for review. In three of them, flowcharts or some kind of graphical notation were designed in order to develop standard management systems, while three were based on computer programs. In two of the articles selected, a comprehensive management system had been designed for PN control and traceability. Conclusions: PN must be integrated within a standardized system, to ensure its quality and reduce the risks associated with this therapy. The development of technologies applied to PN would enable to set up management systems that are more complete and easier to apply in a real setting. Therefore, we think it will be necessary to generate new specific articles and developments associated with PN management and traceability, in order to allow their constant monitoring and assessment

  12. Multimodality imaging in cranial blastomycosis, a great mimicker: Case-based illustration with review of clinical and imaging findings

    Directory of Open Access Journals (Sweden)

    Puneet S Kochar

    2016-01-01

    Full Text Available We describe the clinical, laboratory, and imaging data of three patients who are proven cases of blastomycosis with cranial involvement. In this review, we discuss the imaging features of cranial blastomycosis with relevant clinical case examples including computed tomography (CT, magnetic resonance imaging (MRI, and advanced MR imaging techniques like magnetic resonance spectroscopy (MRS and MR perfusion. Literature is reviewed for modern-day diagnosis and treatment of this fatal intracranial infection, if not diagnosed promptly and managed effectively.

  13. [On the clinical applications of logotherapy: a review of Victor Emil Frankl inheritance].

    Science.gov (United States)

    Girmenia, E; Andrissi, L; Tambone, V

    2014-01-01

    The Viktor E. Frankl's thought has found wide application in many areas of the Clinic, not limited to the neuropsychiatric area. If the franklian work is known worldwide for being a theory and a practice within neurotic disorders, we must not forget how logotherapy has been put at the disposal of the sufferer in its broadest sense. Especially in the context of care and care of the chronically and evolutionary ill (cancer, heart disease, degenerative diseases, etc.), the thought and practice logotherapy have made and continue to make a valuable contribution. In this review we will cover in more detail the application of logotherapy in clinical-care, pausing to examine the international literature.

  14. Niemann-Pick disease treatment: a systematic review of clinical trials

    Science.gov (United States)

    Villamandos García, Diana; Sanchis-Gomar, Fabian; Fiuza-Luces, Carmen; Pareja-Galeano, Helios; Garatachea, Nuria; Nogales Gadea, Gisela; Lucia, Alejandro

    2015-01-01

    The aim of this systematic review was to analyse all the published clinical trials assessing treatments for Niemann-Pick (NP) disease. At present there are only trials investigating the treatment of NP disease type C. Furthermore, there is no uniformity among studies in treatment outcomes or in data analysis and presentation of results. Miglustat is able to delay neurodegeneration, with greater benefits in patients with a late onset of the disease and β-cyclodextrin-hydroxypropyl (HBP-CD) can attenuate clinical symptoms. As for cholesterol-lowering drugs, the combination of lovastatin, cholestyramine and nicotinic acid is the most effective one for lowering cholesterolemia. Further research is much needed, and ongoing trials using enzyme replacement therapy might hopefully show promising results in the foreseeable future. PMID:26807415

  15. Lixivaptan – an evidence-based review of its clinical potential in the treatment of hyponatremia

    Directory of Open Access Journals (Sweden)

    Bowman BT

    2013-07-01

    Full Text Available Brendan T Bowman, Mitchell H Rosner Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA Abstract: Hyponatremia is the most common electrolyte abnormality seen in clinical practice. Most cases of euvolemic or hypervolemic hyponatremia involve arginine vasopressin (AVP. AVP leads to a concentrated urine and negative free water clearance. Given this primary role of AVP, antagonizing its effect through blockade of its receptor in the distal tubule is an attractive therapeutic target. Lixivaptan is a newer, non-peptide, vasopressin type 2 receptor antagonist. Recent studies have demonstrated efficacy. This review summarizes the clinical pharmacology and data for this new agent. Keywords: vasopressin, hyponatremia, heart failure, lixivaptan, therapy, outcomes

  16. Review of technology development and clinical trials of transcranial laser therapy for acute ischemic stroke treatment

    Science.gov (United States)

    Catanzaro, Brian E.; Streeter, Jackson; de Taboada, Luis

    2010-02-01

    Stroke is the one of the leading causes of mortality in the United States, claiming 600,000 lives each year. Evidence suggests that near infrared (NIR) illumination has a beneficial effect on a variety of cells when these cells are exposed to adverse conditions. Among these conditions is the hypoxic state produced by acute ischemic stroke (AIS). To demonstrate the impact NIR Transcranial Laser Therapy (TLT) has on AIS in humans, a series of double blind, placebo controlled clinical trials were designed using the NeuroThera(R) System (NTS). The NTS was designed and developed to treat subjects non-invasively using 808 nm NIR illumination. TLT, as it applies to stroke therapy, and the NTS will be described. The results of the two clinical trials: NeuroThera(R) Safety and Efficacy Trial 1 (NEST-1) and NeuroThera(R) Safety and Efficacy Trial 2 (NEST-2) will be reviewed and discussed.

  17. Reducing marginal leakage of posterior composite resin restorations: a review of clinical techniques.

    Science.gov (United States)

    Cheung, G S

    1990-03-01

    It has been well established that composite resin restorations have leakage at the margins. The polymerization shrinkage of the material and its inadequate adhesion to the cavity walls are the primary causes. Unlike silver amalgam restorations, which are self-sealing with age, the gap at the composite-to-tooth interface tends to persist and invite postoperative sensitivity, adverse pulp reactions, and the development of recurrent caries. Many techniques or materials have been advocated to improve the clinical adaptation of this material and to reduce marginal leakage. They limit the effect of polymerization shrinkage and/or enhance the bonding of the composite material to the tooth structure. This article reviews the clinical techniques and materials that have been suggested and are presently available to improve the marginal quality of composite resins, with special reference to posterior restorations.

  18. Melanoma of the oral mucosa. Clinical cases and review of the literature.

    Science.gov (United States)

    González-García, Raúl; Naval-Gías, Luis; Martos, Pedro L; Nam-Cha, Syong Hyun; Rodríguez-Campo, Francisco J; Muñoz-Guerra, Mario F; Sastre-Pérez, Jesús

    2005-01-01

    The appearance of primary melanomas of the oral mucosa is uncommon. The aggressiveness of this entity and the absence of any standardized treatment protocol make the prognostic unfortunate. The difficulty to obtain free surgical margins, the elevated tendency to invade in depth and the early haematogenous metastasis have been referred as features which may explain its bad prognosis, even in comparison with cutaneous melanoma. However, no large clinical series exist and actually, clinical cases are the main source of information. Due to the absence of any treatment modality which may substantially increase long-term survival, we suggest the use of resective surgery with wide margins and early diagnosis by means of biopsy for suspicious melanotic-pigmented lesions. In this work we present 2 new cases of primary melanoma of the oral mucosa, with a follow-up period of 72 and 12 months respectively, and we make a review of the literature in relation with this rare entity.

  19. Aspergillus thyroiditis: a review of the literature to highlight clinical challenges.

    Science.gov (United States)

    Nguyen, J; Manera, R; Minutti, C

    2012-12-01

    Aspergillus involvement of the thyroid is the most commonly reported fungal thyroiditis. Aspergillus thyroiditis (AT) has primarily been a postmortem diagnosis in immunocompromised patients with diagnosed disseminated invasive Aspergillus or high suspicion of fungal infection during life. With better treatment modalities for the comorbidities that place patients at high risk for fungal infections, as well as better antifungal therapies for Aspergillus infections specifically, the spectrum of disease and presentation of AT may be shifting from what was primarily a postmortem finding to an antemortem diagnosis, necessitating a high index of clinical suspicion and timely intervention. We present a review of the literature to better clarify clinical features, diagnostic modalities, and management considerations pertaining to this disease.

  20. A review of the clinical experience in pulsed dose rate brachytherapy.

    Science.gov (United States)

    Balgobind, Brian V; Koedooder, Kees; Ordoñez Zúñiga, Diego; Dávila Fajardo, Raquel; Rasch, Coen R N; Pieters, Bradley R

    2015-01-01

    Pulsed dose rate (PDR) brachytherapy is a treatment modality that combines physical advantages of high dose rate (HDR) brachytherapy with the radiobiological advantages of low dose rate brachytherapy. The aim of this review was to describe the effective clinical use of PDR brachytherapy worldwide in different tumour locations. We found 66 articles reporting on clinical PDR brachytherapy including the treatment procedure and outcome. Moreover, PDR brachytherapy has been applied in almost all tumour sites for which brachytherapy is indicated and with good local control and low toxicity. The main advantage of PDR is, because of the small pulse sizes used, the ability to spare normal tissue. In certain cases, HDR resembles PDR brachytherapy by the use of multifractionated low-fraction dose.

  1. Clinical Outcomes of Specific Immunotherapy in Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Jiang Chen

    2017-01-01

    Full Text Available Specific immunotherapies, including vaccines with autologous tumor cells and tumor antigen-specific monoclonal antibodies, are important treatments for PC patients. To evaluate the clinical outcomes of PC-specific immunotherapy, we performed a systematic review and meta-analysis of the relevant published clinical trials. The effects of specific immunotherapy were compared with those of nonspecific immunotherapy and the meta-analysis was executed with results regarding the overall survival (OS, immune responses data, and serum cancer markers data. The pooled analysis was performed by using the random-effects model. We found that significantly improved OS was noted for PC patients utilizing specific immunotherapy and an improved immune response was also observed. In conclusion, specific immunotherapy was superior in prolonging the survival time and enhancing immunological responses in PC patients.

  2. Chiropractic Treatment for Gastrointestinal Problems: A Systematic Review of Clinical Trials

    Directory of Open Access Journals (Sweden)

    E Ernst

    2011-01-01

    Full Text Available Many chiropractors believe that chiropractic treatments are effective for gastrointestinal disorders. The aim of the present systematic review was to critically evaluate the evidence from controlled clinical trials supporting or not supporting this notion. Six electronic databases were searched for relevant studies. No limits were applied to language or publication date. Prospective, controlled, clinical trials of any type of chiropractic treatment for any type of gastrointestinal problem, except infant colic, were included. Only two trials were found – one was a pilot study, and the other had reached a positive conclusion; however, both had serious methodological flaws. There is no supportive evidence that chiropractic is an effective treatment for gastrointestinal disorders.

  3. Yoga for Health Care in Korea: A Protocol for Systematic Review of Clinical Trials

    Directory of Open Access Journals (Sweden)

    Jiae Choi

    2016-08-01

    Sixteen electronic databases will be searched from the inception of the study until January 2016. All clinical evidences that evaluate any type of yoga and any type of control in individuals with any type of condition will be eligible. The methodological quality will be assessed using the Cochrane risk of bias tool for randomized clinical trials and the Newcastle–Ottawa scale for nonrandomized studies. Two authors will independently assess each study for eligibility and the risk of bias, and then they will extract the data. With its extensive, unbiased search of the Korean literature from various databases without any language restrictions, this systematic review will be useful for both practitioners in the field of yoga research as well as for patients.

  4. Reflexology: an update of a systematic review of randomised clinical trials.

    Science.gov (United States)

    Ernst, E; Posadzki, P; Lee, M S

    2011-02-01

    Reflexology is a popular form of complementary and alternative medicine (CAM). The aim of this update is to critically evaluate the evidence for or against the effectiveness of reflexology in patients with any type of medical condition. Six electronic databases were searched to identify all relevant randomised clinical trials (RCTs). Their methodological quality was assessed independently by the two reviewers using the Jadad score. Overall, 23 studies met all inclusion criteria. They related to a wide range of medical conditions. The methodological quality of the RCTs was often poor. Nine high quality RCTs generated negative findings; and five generated positive findings. Eight RCTs suggested that reflexology is effective for the following conditions: diabetes, premenstrual syndrome, cancer patients, multiple sclerosis, symptomatic idiopathic detrusor over-activity and dementia yet important caveats remain. It is concluded that the best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition.

  5. The clinical significance of circulating tumor cells in non-metastatic colorectal cancer - A review

    DEFF Research Database (Denmark)

    Thorsteinsson, M; Jess, Per

    2011-01-01

    with metastatic disease, but the prognostic role of CTC in non-metastatic colorectal cancer is less clear. The aim of this review is to examine the possible clinical significance of circulating tumor cells in non-metastatic colorectal cancer (TNM-stage I-III) with the primary focus on detection methods......BACKGROUND: Finding a clinical tool to improve the risk stratification and identifying those colorectal cancer patients with an increased risk of recurrence is of great importance. The presence of circulating tumor cells (CTC) in peripheral blood can be a strong marker of poor prognosis in patients...... and prognosis. METHODS: The PubMed and Cochrane database and reference lists of relevant articles were searched for scientific literature published in English from January 2000 to June 2010. We included studies with non-metastatic colorectal cancer (TNM-stage I-III) and CTC detected pre- and/or post...

  6. Pain and placebo in pediatrics: a comprehensive review of laboratory and clinical findings.

    Science.gov (United States)

    Simmons, Kanesha; Ortiz, Robin; Kossowsky, Joe; Krummenacher, Peter; Grillon, Christian; Pine, Daniel; Colloca, Luana

    2014-11-01

    Pain modulation by placebo mechanisms is one of the most robust and best-studied phenomena, yet almost all research investigating the mechanisms and implications of the placebo analgesia are based on adult research. After highlighting crucial aspects that need to be considered in studying pain modulation in children, this comprehensive review examines studies related to pain modulation with an emphasis on factors such as age, neural development and pain measures. We critically discuss psychological mechanisms underlying placebo effects, including (1) verbally induced expectations, (2) conditioning and learning mechanisms, and (3) child-parent-physician interactions. Taken together, research suggests that placebo mechanisms can affect therapeutic outcomes and potentially be exploited clinically to improve clinical outcomes in pediatric population. Recommendations for further investigating the mechanistic bases and harnessing placebo effects for supportive therapeutic applications are given.

  7. Chikungunya virus in Colombia: Clinical and epidemiological aspects, and literature review

    Directory of Open Access Journals (Sweden)

    Zuluaga Gómez, Mateo

    2016-01-01

    Full Text Available In recent years, with the movement of populations and with globalization, some infections and diseases have changed from endemic to epidemic in certain regions. Such is the case of chikungunya virus (CHIKV, a re-emerging arbovirus that has triggered global alarm. According to the Center for Disease Control and Prevention (CDC, until January 2015, there had been case reports from 42 countries in the Caribbean, and Central, South, and North America, with more than one million suspected cases and about thirty thousand laboratory-confirmed cases. The latest report in Colombia by Instituto Nacional de Salud refers to a total of 231.392 clinically confirmed cases (suggestive symptoms associated with CHIKV, 1.528 cases confirmed by laboratory, and 3.848 suspected cases, for an overall total of 236.768. In this review, the following aspects of CHIKV infection are included: virology, transmission by vector, pathogenesis, epidemiology, clinical manifestations, laboratory tests, preventive measures and future prospects.

  8. Chronic Inflammatory Demyelinating Polyneuropathy in Children: A Review of Clinical Characteristics and Recommendations for Treatment

    Directory of Open Access Journals (Sweden)

    Narges Karimi

    2015-07-01

    Full Text Available Context: Chronic inflammatory demyelinating polyradiculopathy (CIDP is an acquired and autoimmune neuropathy, characterized by a chronic, rapidly progressive, symmetric weakness. In children, abnormal gait is as a first symptom of muscle weakness. Evidence Acquisition: The diagnosis of CIDP is on the basis of clinical characteristics, electrodiagnostic that shows the severity of the disease, lumbar puncture and spine magnetic resonance imaging (MRI. Results: The first-line treatments in childhood CIDP are intravenous immunoglobulin (IVIG, corticosteroids, and plasmapheresis. Response to first-line therapies is usually satisfactory; nevertheless, recommendations regarding the choice of second-line therapy can only be prepared on the basis of the existing practice described in some of the case reports. Conclusions: This review demonstrated the clinical presentation, diagnosis, and treatment of childhood CIDP.

  9. Lipoedema: from clinical presentation to therapy. A review of the literature.

    Science.gov (United States)

    Langendoen, S I; Habbema, L; Nijsten, T E C; Neumann, H A M

    2009-11-01

    Lipoedema is an infrequently recognized disorder in women. Lipoedema is characterized by bilateral enlargement of the legs due to abnormal depositions of subcutaneous fat associated with often mild oedema. There is substantial variability in disease severity. The diagnosis should be made as early as possible to prevent complications of the disorder, which is associated with increasing functional and cosmetic morbidity. This review describes clinical manifestations, pathogenesis, technical investigations, management and therapies of lipoedema, with the aim of optimizing management and care of patients with lipoedema.

  10. [EEG coherence analysis in depressive disorders and its possible use in clinical practice: a literature review].

    Science.gov (United States)

    Varlamov, A A; Strelets, V B

    2013-01-01

    Recent reviews and meta-analyses of clinical data have revealed that there is a clear need in objective biomarkers of mental disorders and, in particular, of depression. There is a lot of evidence that EEG coherence can be an important marker of depressive disorders, and can predict response to different antidepressants. The most consistent finding is a decrease of frontal interhemispheric EEG coherence which is observed for most disorders related to depression. Methodological issues are discussed with a particular emphasis on use of statistical classifiers and on coupling EEG coherence with other methods of EEG analysis.

  11. Incretin-based therapies– review of the physiology, pharmacology and emerging clinical experience

    DEFF Research Database (Denmark)

    Martin, JH; Deacon, Carolyn F.; Gorrell, MD

    2011-01-01

    primarily in response to oral nutrient ingestion. They have various effects, but those most relevant to metabolic dysfunction include stimulation of insulin and suppression of glucagon secretion, with resultant reduction in fasting and postprandial glucose. Incretin secretion and/or action is impaired......-resistant peptides that bind to and activate the glucagon-like peptide-1 receptor. In this review, we address aspects of incretin biology and pharmacotherapy with a view to highlighting potentially clinically relevant issues and areas of basic research that may impinge on these....

  12. Developing evidence-based dentistry skills: how to interpret randomized clinical trials and systematic reviews.

    Science.gov (United States)

    Kiriakou, Juliana; Pandis, Nikolaos; Madianos, Phoebus; Polychronopoulou, Argy

    2014-10-30

    Decision-making based on reliable evidence is more likely to lead to effective and efficient treatments. Evidence-based dentistry was developed, similarly to evidence-based medicine, to help clinicians apply current and valid research findings into their own clinical practice. Interpreting and appraising the literature is fundamental and involves the development of evidence-based dentistry (EBD) skills. Systematic reviews (SRs) of randomized controlled trials (RCTs) are considered to be evidence of the highest level in evaluating the effectiveness of interventions. Furthermore, the assessment of the report of a RCT, as well as a SR, can lead to an estimation of how the study was designed and conducted.

  13. A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases.

    Science.gov (United States)

    Goodwin, C Rory; Sankey, Eric W; Liu, Ann; Elder, Benjamin D; Kosztowski, Thomas; Lo, Sheng-Fu L; Fisher, Charles G; Clarke, Michelle J; Gokaslan, Ziya L; Sciubba, Daniel M

    2016-05-01

    OBJECT Surgical procedures and/or adjuvant therapies are effective modalities for the treatment of symptomatic spinal metastases. However, clinical results specific to the skin cancer spinal metastasis cohort are generally lacking. The purpose of this study was to systematically review the literature for treatments, clinical outcomes, and survival following the diagnosis of a skin cancer spinal metastasis and evaluate prognostic factors in the context of spinal skin cancer metastases stratified by tumor subtype. METHODS The authors performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles since 1950 that reported survival, clinical outcomes, and/or prognostic factors for the skin cancer patient population with spinal metastases. The methodological quality of reviews was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) tool. RESULTS Sixty-five studies met the preset criteria and were included in the analysis. Of these studies, a total of 25, 40, 25, and 12 studies included patients who underwent some form of surgery, radiotherapy, chemotherapy, or observation alone, respectively. Sixty-three of the 65 included studies were retrospective in nature (Class of Evidence [CoE] IV), and the 2 prospective studies were CoE II. Based on the studies analyzed, the median overall survival for a patient with a spinal metastasis from a primary skin malignancy is 4.0 months; survival by tumor subtype is 12.5 months for patients with basal cell carcinoma (BCC), 4.0 months for those with melanoma, 4.0 months for those with squamous cell carcinoma, 3.0 months for those with pilomatrix carcinoma, and 1.5 months for those with Merkel cell carcinoma (p cancer lesion was 3.5% (n = 21/608, range 0.2%-100.0%), and the rate of known spine metastasis recurrence despite treatment for all skin malignancies was 2.8% (n = 17/608, range 0.0%-33.3%). Age greater than 65 years, sacral spinal involvement, presence

  14. Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.

    Directory of Open Access Journals (Sweden)

    Maria B Ospina

    Full Text Available BACKGROUND: Much controversy exists regarding the clinical efficacy of behavioural and developmental interventions for improving the core symptoms of autism spectrum disorders (ASD. We conducted a systematic review to summarize the evidence on the effectiveness of behavioural and developmental interventions for ASD. METHODS AND FINDINGS: Comprehensive searches were conducted in 22 electronic databases through May 2007. Further information was obtained through hand searching journals, searching reference lists, databases of theses and dissertations, and contacting experts in the field. Experimental and observational analytic studies were included if they were written in English and reported the efficacy of any behavioural or developmental intervention for individuals with ASD. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively and, where possible, meta-analyses of the study results were conducted. One-hundred-and-one studies at predominantly high risk of bias that reported inconsistent results across various interventions were included in the review. Meta-analyses of three controlled clinical trials showed that Lovaas treatment was superior to special education on measures of adaptive behaviour, communication and interaction, comprehensive language, daily living skills, expressive language, overall intellectual functioning and socialization. High-intensity Lovaas was superior to low-intensity Lovaas on measures of intellectual functioning in two retrospective cohort studies. Pooling the results of two randomized controlled trials favoured developmental approaches based on initiative interaction compared to contingency interaction in the amount of time spent in stereotyped behaviours and distal social behaviour, but the effect sizes were not clinically significant. No statistically significant differences were found for: Lovaas versus special

  15. The clinical significance of breast cancer stem cells (review of literature

    Directory of Open Access Journals (Sweden)

    I. B. Schepotin

    2014-01-01

    Full Text Available For a long time, in oncology dominated the stochastic theory of onset and progression of tumors, which postulated that any cell malignanttumor has tumorogenesis properties. However, currently there are more data indicating that the malignant tumors like normal tissues consistof several subpopulations of cells of various degree of differentiation, including stem. Thus, the alternative stochastic theory became a hierarchical theory of carcinogenesis. Like normal stem cells, cancer stem cells have natural resistance to radiation and systemic drug therapy, and may become the reason of occurrence of relapses and metastases. In this review analysed data regarding the clinical significance of breast cancer stem cells.

  16. [Resource activation in clinical psychology and psychotherapy: review of theoretical issues and current research].

    Science.gov (United States)

    Groß, L J; Stemmler, M; de Zwaan, M

    2012-08-01

    This review summarises theoretical issues and current research on working with clients' resources and strengths in clinical psychology and psychotherapy. Resource activation is considered as an important common factor in psychotherapy. In general, resource activation means an explicit focus on resources, strengths and potentials of the clients. After defining the term resources, considerations with regard to therapeutic attitude, principles of resource activation, approaches to resource diagnostics and different research strategies are presented. Current research focuses especially on the relation between resource activation and process variables in out-patient treatment.

  17. Clinical value of prognosis gene expression signatures in colorectal cancer: a systematic review.

    Directory of Open Access Journals (Sweden)

    Rebeca Sanz-Pamplona

    Full Text Available INTRODUCTION: The traditional staging system is inadequate to identify those patients with stage II colorectal cancer (CRC at high risk of recurrence or with stage III CRC at low risk. A number of gene expression signatures to predict CRC prognosis have been proposed, but none is routinely used in the clinic. The aim of this work was to assess the prediction ability and potential clinical usefulness of these signatures in a series of independent datasets. METHODS: A literature review identified 31 gene expression signatures that used gene expression data to predict prognosis in CRC tissue. The search was based on the PubMed database and was restricted to papers published from January 2004 to December 2011. Eleven CRC gene expression datasets with outcome information were identified and downloaded from public repositories. Random Forest classifier was used to build predictors from the gene lists. Matthews correlation coefficient was chosen as a measure of classification accuracy and its associated p-value was used to assess association with prognosis. For clinical usefulness evaluation, positive and negative post-tests probabilities were computed in stage II and III samples. RESULTS: Five gene signatures showed significant association with prognosis and provided reasonable prediction accuracy in their own training datasets. Nevertheless, all signatures showed low reproducibility in independent data. Stratified analyses by stage or microsatellite instability status showed significant association but limited discrimination ability, especially in stage II tumors. From a clinical perspective, the most predictive signatures showed a minor but significant improvement over the classical staging system. CONCLUSIONS: The published signatures show low prediction accuracy but moderate clinical usefulness. Although gene expression data may inform prognosis, better strategies for signature validation are needed to encourage their widespread use in the clinic.

  18. Assumptions and advice: mothers and Queensland well-baby clinics. A review.

    Science.gov (United States)

    Thorley, Virginia

    2014-03-01

    In 20th century Australia, free well-baby clinics were run by maternal and child health nurses, although the funding and organisational structure varied from state to state. It was assumed that women who attended followed the advice assiduously; yet attendance did not necessarily equate to practice. In Queensland, the state government's free Maternal and Child Welfare Service (MCW) advised mothers on infant feeding and care through well-baby clinics throughout the state, a correspondence section for mothers in remote areas and a railcar clinic to some western towns, under the state government's policy of covering every mother and baby in Queensland. Women in Queensland, as in other states, were exposed to other influences on how to feed babies and often exercised agency in making their own decisions according to their circumstances and their own judgment. This review will place research from Queensland on women's reasons for attending the clinics and adherence to the advice provided, during the period 1920-1965, within a wider context. This includes research on barriers to following advice, counselling versus imparting information and the mother's self-efficacy. The message for today is that adherence to advice still cannot be assumed and mothers' own circumstances need to be factored in.

  19. Clinical trials for authorized biosimilars in the European Union: a systematic review

    Science.gov (United States)

    Mielke, Johanna; Koenig, Franz; Jones, Byron

    2016-01-01

    Aim In 2006, Omnitrope (by Sandoz) was the first approved biosimilar in Europe. To date, 21 biosimilars for seven different biologics are on the market. The present study compared the clinical trials undertaken to obtain market authorization. Methods We summarized the findings of a comprehensive review of all clinical trials up to market authorization of approved biosimilars, using the European public assessment reports (EPARs) published by the European Medicines Agency (EMA). The features compared were, among others, the number of patients enrolled, the number of trials, the types of trial design, choice of endpoints and equivalence margins for pharmacokinetic (PK)/pharmacodynamic (PD) and phase III trials. Results The variability between the clinical development strategies is high. Some differences are explainable by the characteristics of the product; if, for example, the PD marker can be assumed to predict the clinical outcome, no efficacy trials might be necessary. However, even for products with the same reference product, the sample size, endpoints and statistical models are not always the same. Conclusions There seems to be flexibility for sponsors regarding the decision as to how best to prove biosimilarity. PMID:27580073

  20. Intracranial Hypertension Syndrome in Systemic Lupus Erythema-tosus:Clinical Analysis and Review of the Literature

    Institute of Scientific and Technical Information of China (English)

    Zheng XUE; Xuezhen WANG; Fei LIU; Shaoxian HU; Suiqiang ZHU; Suming ZHANG; Bitao BU

    2009-01-01

    In order to better understand the clinical manifestation of systemic lupus erythematosus (SLE) with intracranial hypertension syndrome (IHS),we analyzed the clinical features and treatment of a typical SLE patient with IHS.SLE is one of the most unpredictable autoimmune diseases in-volving multiple organ systems that is defined clinically and associated with antibodies directed against cell nuclei.IHS is an uncommon manifestation of neuropsychiatric SLE (NPSLE) and is characterized by an elevated intracranial pressure,papilledema,and headache with occasional ab-ducens nerve paresis,absence of a space-occupying lesion or ventricular enlargement,and normal cerebrospinal fluid chemical and hematological constituents.IHS has been reported in a few sporadic cases in patients with SLE worldwide,but rarely has been reported in China.In this study,a 34-year-old female SLE patient with IHS was.reported and pertinent literature reviewed.The clinical presentation,image logical features,and investigatory findings were discussed.