Use Of Medical Treatment Research Articles

Socio-cultural determinants of timely and delayed treatment of Buruli ulcer: implications for disease control

IntroductionPublic health programmes recommend timely medical treatment for Buruli ulcer (BU) infection to prevent pre-ulcer conditions from progressing to ulcers, to minimise surgery, disabilities and the socio-economic impact of BU. Clarifying the role of socio-cultural determinants of timely medical treatment may assist in guiding public health programmes to improve treatment outcomes. This study clarified the role of socio-cultural determinants and health system factors affecting timely medical treatment for BU in an endemic area in Ghana.MethodsA semi-structured explanatory model interview based on the explanatory model interview catalogue (EMIC) was administered to 178 BU-affected persons. Based on research evidence, respondents were classified as timely treatment (use of medical treatment 3 months from awareness of disease) and delayed treatment (medical treatment 3 months after onset of disease and failure to use medical treatment). The outcome variable, timely treatment was analysed with cultural epidemiological variables for categories of distress, perceived causes of BU, outside-help and reasons for medical treatment in logistic regression models. The median time for the onset of symptoms to treatment was computed in days. Qualitative phenomenological analysis of respondents’ narratives clarified the meaning, context and dynamic features of the relationship of explanatory variables with timely medical treatment.ResultsThe median time for initiating treatment was 25 days for pre-ulcers, and 204 days for ulcers. Income loss and use of herbalists showed significantly negative associations with timely treatment. Respondents’ use of herbalists was often motivated by the desire for quick recovery in order to continue with work and because herbalists were relatives and easily accessible. However, drinking unclean water was significantly associated with timely treatment and access to health services encouraged timely treatment (OR 8.5, p = 0.012). Findings show that health system factors of access are responsible for non-compliance to treatment regimes.ConclusionsFindings highlight the importance of an integrated approach to BU control and management considering the social and economic features that influence delayed treatment and factors that encourage timely medical treatment. This approach should consider periodic screening for early case-detection, collaboration with private practitioners and traditional healers, use of mobile services to improve access, adherence and treatment outcomes.

Medications for Adolescents and Young Adults With Autism Spectrum Disorders: A Systematic Review

Although many treatments have been studied in children with autism spectrum disorders (ASDs), less attention has focused on interventions that may be helpful in adolescents and young adults with ASD. The goal of this study was to systematically review evidence regarding medication treatments for individuals between the ages of 13 and 30 years with ASD. The Medline, PsycINFO, and ERIC databases were searched (1980-December 2011), as were reference lists of included articles. Two investigators independently assessed studies against predetermined inclusion/exclusion criteria. Two investigators independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength of evidence ratings on the basis of predetermined criteria. Eight studies of medications were identified that focused on 13- to 30-year-olds with ASD; 4 of the studies were of fair quality. The strength of evidence was insufficient for all outcomes associated with medications tested in this population; however, the 2 available studies of the atypical antipsychotic medication risperidone in this age range were consistent with the moderate evidence in children with ASD for treating problem behavior, including aggression, and high strength of evidence for adverse events, including sedation and weight gain. There is a marked lack of data on use of medication treatments for adolescents and young adults with ASD. The evidence on the use of risperidone in this age range is insufficient when considered alone but is consistent with the data in the population of children with ASD.

How Strongly Does Trehalose Interact with Lysozyme in the Solid State? Insights from Molecular Dynamics Simulation and Inelastic Neutron Scattering

Therapeutic proteins are usually conserved in glassy matrixes composed of stabilizing excipients and a small amount of water, which both control their long-term stability, and thus their potential use in medical treatments. To shed some light on the protein-matrix interactions in such systems, we performed molecular dynamics (MD) simulations on matrixes of (i) the model globular protein lysozyme (L), (ii) the well-known bioprotectant trehalose (T), and (iii) the 1:1 (in weight) lysozyme/trehalose mixture (LT), at hydration levels h of 0.0, 0.075, and 0.15 (in g of water/g of protein or sugar). We also supplemented these simulations with complementary inelastic neutron scattering (INS) experiments on the L, T, and LT lyophilized (freeze-dried) samples. The densities and free volume distributions indicate that trehalose improves the molecular packing of the LT glass with respect to the L one. Accordingly, the low-frequency vibrational densities of states (VDOS) and the mean square displacements (MSDs) of lysozyme reveal that it is less flexible-and thus less likely to unfold-in the presence of trehalose. Furthermore, at low contents (h = 0.075), water systematically stiffens the vibrational motions of lysozyme and trehalose, whereas it increases their MSDs on the nanosecond (ns) time scale. This stems from the hydrogen bonds (HBs) that lysozyme and trehalose form with water, which, interestingly, are stronger than the ones they form with each other but which, nonetheless, relax faster on the ns time scale, given the larger mobility of water. Moreover, lysozyme interacts preferentially with water in the hydrated LT mixtures, and trehalose appears to slow down significantly the relaxation of lysozyme-water HBs. Overall, our results suggest that the stabilizing efficiency of trehalose arises from its ability to (i) increase the number of HBs formed by proteins in the dry state and (ii) make the HBs formed by water with proteins stable on long (>ns) time scales.

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THE VALUE OF BODILY MATERIAL: ACQUIRING AND ALLOCATING HUMAN GAMETES

The UK is facing increasing demand for sperm and eggs for use in medical treatment and research. The disparity between supply and demand has led a number of UK bodies to recommend the adoption of a national donation system, at least with regard to gamete donation for treatment. This article argues that a national gamete donation system would have benefits beyond those articulated by bodies such as the Human Fertilisation and Embryology Authority, the British Fertility Society, and the Nuffield Council on Bioethics, because a system of this type could facilitate the legal and ethical implementation of donor incentives. Three types of incentive are explored and it is argued that a national donation system could and should be utilised to implement a mirror exchange scheme or, preferably, an indirect mirror exchange scheme.

Newsmakers

This week's Newsmakers are controversial bioethicist Glenn McGee, who resigned last week from a Texas company that banks adult stem cells for use in medical treatments, and cell biologists Howard Green of Harvard Medical School and Elaine Fuchs of the Rockefeller University, winners of the March of Dimes Prize in Developmental Biology.

Conventional and emerging treatments in the management of acute primary angle closure

The management of acute primary angle closure is directed at lowering the intraocular pressure and relieving pupil block. Conventional treatment involves the use of medical treatment and laser peripheral iridotomy, respectively, as a means for achieving these aims. Newer therapeutic strategies have been described that are potentially useful adjuncts or alternatives to conventional treatment. Emerging strategies that lower intraocular pressure include anterior chamber paracentesis, as well as laser procedures such as iridoplasty and pupilloplasty. A possible alternative to relieving pupil block is lens extraction, and may be combined with adjunctive measures such as goniosynechiolysis and viscogoniosynechiolysis. Trabeculectomy has a limited role in the acute setting. This review paper reviews the current evidence regarding conventional and newer treatment modalities for acute primary angle closure.

Ambiguous diagnosis, futile treatments and temporary recovery: Meanings of medical treatment among HIV/AIDS family caregivers providing care without ARVs

The capacity of countries with high HIV and AIDS prevalence to provide antiretroviral treatment and care for all people who need support remains a public health challenge. In Lesotho, there are improvements in this area but the high proportion of people who need ART yet they do not receive treatment suggests that many HIV-infected people continue to depend on medicines that treat opportunistic infections. The objective of the article is to explore caregivers' experiences with diagnostic procedures and outcomes, prescriptions and treatment outcomes when ARVs were unavailable. A phenomenological design using in-depth face-to-face interviews was used to obtain the experiences of 21 family caregivers about caregiving, including access to and use of medical treatments. Caregivers' experiences indicate that most of the consulted health professionals provided vague and inconsistent diagnoses while the medication they prescribed failed to treat most of the symptoms. Unavailability of medicines that control pain and symptoms effectively continues to be a prominent feature of HIV and AIDS home-based caregiving in Lesotho. It is recommended that health professionals should facilitate disclosure of HIV diagnosis to family caregivers to assist them to understand unstable treatment outcomes; and policy makers should strengthen home-based care by developing policies that integrate palliative care into HIV and AIDS care.

The Consistency Between Treatments Provided to Nursing Facility Residents and Orders on the Physician Orders for Life-Sustaining Treatment Form

To evaluate the consistency between treatments provided and Physician Orders for Life-Sustaining Treatment (POLST) orders. Retrospective chart abstraction. Stratified, random sample of 90 nursing facilities in Oregon, Wisconsin, and West Virginia. Eight hundred seventy living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. Chart data about POLST form orders and related treatments over a 60-day period were abstracted. Decision rules were created to determine whether the rationale for each treatment was consistent with POLST orders. Most residents (85.2%) had the same POLST form in place during the review period. A majority of treatments provided to residents with orders for comfort measures only (74.3%) and limited antibiotics (83.3%) were consistent with POLST orders because they were primarily comfort focused rather than life-prolonging, but antibiotics were provided to 32.1% of residents with orders for no antibiotics. Overall consistency rates between treatments and POLST orders were high for resuscitation (98%), medical interventions (91.1%), and antibiotics (92.9%) and modest for feeding tubes (63.6%). In all, POLST orders were consistent with treatments provided 94.0% of the time. With the exception of feeding tubes and antibiotic use in residents with orders for no antibiotics, the use of medical treatments was nearly always consistent with POLST orders to provide or withhold life-sustaining interventions. The POLST program is a useful tool for ensuring that the treatment preferences of nursing facility residents are honored.

Usefulness of heart rate turbulence for predicting cardiac events in patients with nonischemic dilated cardiomyopathy

BackgroundFew studies have described the clinical value of heart rate turbulence (HRT), an autonomic risk stratification index, in stratifying patients with nonischemic dilated cardiomyopathy (NIDCM). We prospectively assessed the utility of HRT for cardiac events in patients with NIDCM. MethodsWe enrolled 134 consecutive patients with NIDCM. Heart rate turbulence was automatically measured using an algorithm based on 24-hour Holter electrocardiograms. In addition to HRT, other risk indices such as a reduced left ventricular ejection fraction of 30% or less, the presence of nonsustained ventricular tachycardia (VT), the use of medical treatment, and so on were assessed as well. The primary end point was defined as cardiac mortality and sustained VTs. ResultsOf the patients enrolled, 106 (79%) were used for HRT assessment. Heart rate turbulence was determined as positive in 26 patients (25%) and negative in 80 patients (75%). During a follow-up of 445 ± 216 days, 23 patients (23%) reached the primary end point. Among indices, documented presence of nonsustained VT and an HRT-positive outcome had significant values with the primary end point (P = .02 and P = .0001, respectively). On multivariate analysis, an HRT-positive outcome was the most significant predictor, with a hazard ratio of 4.5 (95% confidence interval, 2.0-10.4; P = .0004). ConclusionsHeart rate turbulence is a powerful risk stratification index for cardiac events defined as cardiac mortality and sustained VTs in patients with NIDCM.

Gene expression profile in cultured human umbilical vein endothelial cells exposed to a 300 mT static magnetic field

In a previous investigation we reported that exposure to a moderate (300 mT) static magnetic field (SMF) causes transient DNA damage and promotes mitochondrial biogenesis in human umbilical vein endothelial cells (HUVECs). To better understand the response of HUVECs to the 300 mT SMF, a high-quality subtracted cDNA library representative of genes induced in cells after 4 h of static magnetic exposure was constructed. The global gene expression profile showed that several genes were induced after the SMF exposure. The characterized clones are involved in cell metabolism, energy, cell growth/division, transcription, protein synthesis, destination and storage, membrane injury, DNA damage/repair, and oxidative stress response. Quantitative real-time polymerase chain reaction (qRT-PCR) experiments were performed at 4 and 24 h on four selected genes. Their expression profiles suggest that HUVEC's response to SMF exposure is transient. Furthermore, compared to control cells, an up-regulation of several genes involved in cell growth and division was observed. This up-regulation is likely to be the cause of the slight, but significant, increase in cell proliferation at 12 h post-treatment. These results provide additional support to the notion that SMFs may be harmless to human health, and could support the rationale for their possible use in medical treatments.

Resultados a largo plazo de la microdiscectomía lumbar en una población laboralmente activa

In the treatment of the lumbar disc herniaton (LDH) microdiscectomy constitutes one of the standard procedures. In the present study we have analyzed the clinical outcome of the lumbar microdis- cectomy in a series of worker patients who underwent surgery in our service. Retrospective analysis and a 5-year follow up, of a series of 142 patients operated on by means of lumbar microdiscectomy in the 2004-2005 period. The clinical outcome was analyzed according to the "Herron and Turner" outline: pain reduction, use of medical treatment, restriction in the ability to perform physical activities, and return to work. 116 men and 26 women, with an average age of 37.9 and 45.4 years respectively, underwent surgery because of LDH. In the clinical aspect, sciatica was predominant over low back pain in a ratio of three to one. The L5-S1 discal level was operated on in 68.3% of the cases. It was considered that occupational activities gave rise to damage in 107 patients (75.3%). Besides a symptomatic disc, there was an additional injured disc in 44.3% of the cases. An initial unfavourable outcome was seen in 42 patients (33%), 15 of which recovered from in an interval of 3 months, and another fifteen within a one year period. A re-operation was necessa ry in 16 patients because of recurrent lumbar disc herniation (11%). Work reintegration was achieved in 83.3% (119/142) of the cases. After a 5-year follow up, we stated the consistency of the clinical result. We analyzed the intervertebral disc behaviour as regards sex, age, variety of discal herniation, additional disc, outcome and re-operation variables. After the analysis of the type of discal herniation and additional disc we defined three disc injury patterns. We consider microdiscectomy as the technique of choosing for the treatment of recurrence disc herniation. Between the working class, discal injury predominates in young men, as a consequence of the annulus breakage, or an annulus plus posterior longitudinal ligament breakage (traumatic herniae). Frequently it was observed that more than one disc was involved, and a left lateralization.

Recent results about antioxidant and immunomodulatory effects of sulphurous water

The purpose of this study was to gather the most significant articles that highlight the antioxidant and immunomodulatory role of sulphurous mineral water (SMW), also validating scientifically its use in medical treatment.

Recent results about antioxidant and immunomodulatory effects of sulphurous water

The purpose of this study was to gather the most significant articles that highlight the antioxidant and immunomodulatory role of sulphurous mineral water (SMW), also validating scientifically its use in medical treatment.

The long-term trajectory of depression among Latinos in primary care and its relationship to depression care disparities

Objective Lower use of medication treatment, poorer doctor–patient communication (DPC) and depression stigma are key contributors to mental healthcare disparities among Latinos with depression. The current study investigated the relationship between these key variables and the long-term trajectory of depression in primary care among Latinos. Method Participants ( N=220) were Latinos presenting to primary care who screened positive for depression. A repeated measures design was used to assess participants at baseline and 6, 25 and 30 months. Repeated measures included depression (Patient Health Questionnaire-9), self-reported quality of DPC and stigma pertaining to antidepressants. Using growth curve modeling, participants' depressive symptom trajectories were examined for a 30-month period. Self-reported utilization of antidepressants, DPC and antidepressant stigma were examined as predictors of the depressive symptom trajectory. In addition, rates of depression improvement/remission and recurrence/relapse were examined. Results Improvement/remission was experienced by 69.4% of participants during a 30-month period. Among those who improved/remitted at 6 or 25 months, 63.4% maintained that improvement/remission by 30 months. The long-term trajectory of depressive symptoms demonstrated a significant positive association with antidepressant stigma and significant negative associations with use of antidepressant treatment and quality DPC. Conclusions While relapse/recurrence is common, most Latinos in this study experienced improvement in depression over 30 months. For many, there is a considerable time to reach improvement/remission. Also, these findings confirm the significance of antidepressant underutilization, DPC and stigma in the long-term outcome of depression among Latinos in primary care.

Self-reported adherence to medical treatment prior to and during pregnancy among women with ulcerative colitis

Adherence to medical treatment among women with ulcerative colitis (UC) prior to and during pregnancy has never been investigated. The aim was to examine predictors for and prevalence rates of nonadherence to maintenance treatment among women with UC prior to and during pregnancy. We identified 115 women with UC having given birth during 2000-2005 within a population of 1.6 million. They received a questionnaire about predictors and adherence and relapses were registered. We retrieved information on medical treatment from prescription databases and used logistic regression to estimate prevalence odds ratios (POR) for nonadherence by different predictors. Among 93 (81%) respondents, 63 (68%) reported taking medication, 53 of whom had filled prescriptions for relevant medication, yielding a positive predictive value of self-reported use of medical treatment of 84.1% (95% confidence interval [CI] 72.7-92.1). Approximately 60% reported adhering to medical treatment. Those who received counseling regarding medical treatment were less likely to be nonadherent compared with no counseling, especially during pregnancy (POR 0.2, 95% CI 0.04-0.94). Of those who were nonadherent, fear of a negative effect on fertility/fetus was stated as the reason by 23% prior to and by 50% during pregnancy. Notably, 40.3% reported an episode of relapse during the pregnancy period, compared with 13.6% in the period 6 months prior to pregnancy. Adherence was high despite fear of a negative effect on fertility or the fetus. Counseling predicted higher adherence. This may be important because our study suggests an increase in UC activity during pregnancy.

X선 고전압장치의 전파 및 배전압 정류방식에 따른 X선 출력 및 선질 비교

X-ray systems for medical treatment use noninvasive procedures. Being capable of locally inspecting the inside of the body, X-ray systems are routinely used for basic diagnosis. X-ray systems to be used for medical purposes were originally made with a gas filled tube inside an induction coil in the initial stages of development but with this approach it becomes difficult to take a satisfactory picture through thick body sections, non invasively. However continued development made it possible to take non-invasive pictures of breasts, blood vessels and other body parts through thick body sections. Recently, high-voltage X-ray generators of more compact size, increased generation efficiency, and sophisticated output control have become possible. All of these features are made possible by the use of a high-frequency output from an inverter and a fast switching semiconductor device. In this paper, we describe a new X-ray generator operating with a resonant inverter in order to reduce switching loss and high frequency noise. In addition, in order to identify the differences amongst types of rectification, we have compared output and the quality of X-ray pictures obtained with full-wave rectification and dual-voltage rectification methods.

Validation of the American Association of Poison Control Centers out of hospital guideline for pediatric diphenhydramine ingestions

Context. In 2006, the American Association of Poison Control Centers (AAPCC) published an out of hospital guideline for diphenhydramine overdoses in children. This guideline has not been validated. Objective. Our objective was to determine the incidence of serious clinical effects or use of medical treatments after unintentional diphenhydramine ingestions in children. We sought to determine if patients with less than 7.5 mg/kg ingestions developed medical complications of diphenhydramine toxicity. Materials and methods. In our observational case series, we searched 7 years of data (2000–2006) in the Texas Poison Center Network for diphenhydramine using the AAPCC generic codes. We included only acute, single ingestions of diphenhydramine in children under 6 years old. We included only patients with a recorded weight, known amount of ingestant, and known follow-up. We defined “serious clinical effects” as hallucinations, seizure, wide QRS on electrocardiogram, wide complex dysrhythmia, any conduction block, hypotension, hypertension, rhabdomyolysis, pyrexia, dystonia, coma, respiratory depression, or death. One trained abstractor reviewed the data and entered it into an electronic data collection form. Twenty percent of the charts were audited for abstractor agreement. Results. Our search resulted in 928 cases. Of these, 305 were included in our study. Of the patients who ingested doses less than 7.5 mg/kg, 99.7% (299/300) did not require critical treatments or were without serious clinical effects. One child was admitted. Five children ingested doses of more than 7.5 mg/kg. All five were observed in the emergency department and discharged home. Two patients had serious clinical effects of hallucinations, one of which ingested more than 7.5 mg/kg. No child required critical treatments. Our agreement on chart review for 20% of the cases was very good for “serious clinical effects” (kappa, 0.79; 95% CI, 0.39–1.0) and excellent for “critical treatments” (kappa, 1.0). Conclusion. Based on our observational case series, 99.6% of patients who reportedly ingested doses less than 7.5 mg/kg did not develop serious clinical effects or require admission. Pediatric ingestions over 7.5 mg/kg were uncommon in our study population. Serious clinical effects, critical treatments, and admission from diphenhydramine were rare in children under 6 years old.

Biochemical and Biological Characterization of a New Oxidized Avidin with Enhanced Tissue Binding Properties

Chicken avidin and bacterial streptavidin are widely employed in vitro for their capacity to bind biotin, but their pharmacokinetics and immunological properties are not always optimal, thereby limiting their use in medical treatments. Here we investigate the biochemical and biological properties of a new modified avidin, obtained by ligand-assisted sodium periodate oxidation of avidin. This method allows protection of biotin-binding sites of avidin from inactivation caused by the oxidation step and delay of avidin clearance from injected tissue by generation of aldehyde groups from avidin carbohydrate moieties. Oxidized avidin shows spectroscopic properties similar to that of native avidin, indicating that tryptophan residues are spared from oxidation damage. In strict agreement with these results, circular dichroism and isothermal titration calorimetry analyses confirm that the ligand-assisted oxidation preserves the avidin protein structure and its biotin binding capacity. In vitro cell binding and in vivo tissue residence experiments demonstrate that aldehyde groups provide oxidized avidin the property to bind cellular and interstitial protein amino groups through Schiff's base formation, resulting in a tissue half-life of 2 weeks, compared with 2 h of native avidin. In addition, the efficient uptake of the intravenously injected (111)In-BiotinDOTA (ST2210) in the site previously treated with modified avidin underlines that tissue-bound oxidized avidin retains its biotin binding capacity in vivo. The results presented here indicate that oxidized avidin could be employed to create a stable artificial receptor in diseased tissues for the targeting of biotinylated therapeutics.

Obesity paradox in Korean patients undergoing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

The effect of body mass index (BMI) on outcomes after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is not well known. In patients registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between November 2005 and November 2007, 3824 STEMI patients who arrived at hospital within 12h after onset of chest pain and underwent primary PCI were analyzed, and divided into four groups according to their BMI: underweight (BMI<18.5 kg/m(2), n=129); normal weight (18.5 < or =BMI <23.0 kg/m(2), n=1253); overweight (23.0 < or =BMI <27.5 kg/m(2), n=1959); and obese (BMI > or =27.5 kg/m(2), n=483). In-hospital mortality, revascularization in 1 year, mortality in 1 year, and overall mortality were compared between groups. Overweight and obese group were significantly younger, had normal left ventricular ejection fraction, and were more likely to be men with a higher incidence of hypertension, diabetes, and hyperlipidemia. There were no significant differences in symptom-to-door time and door-to-balloon time between groups. Obese patients had significantly lower in-hospital and overall mortalities. Major adverse cardiac events showed a bimodal pattern. Obese STEMI patients treated with primary PCI were associated with lower mortality, which may be explained by better use of medical treatment, hemodynamic stability, and younger age.