bluuebunny/crossref_metadata_2025 huggingface dataset:
Family members' experience of intensive care unit support group: qualitative analysis of intervention
Authors: Kirshbaum‐Moriah Dvora , Harel Chaya , Benbenishty Julie
Published: December 2016

Background

Family members of intensive care unit patients develop anxiety, depression and/or symptoms suggestive of risk for post‐traumatic stress. Nurse‐led support groups have been recommended and used in a variety of settings as a mechanism to help meet family needs and overcome challenges. These groups have been reported to increase the members' understanding of complex medical issues involved in their situations and to be helpful in identifying practical coping mechanisms.

Aim

To investigate the experiences of family members participating in a nurse‐social worker led support group in the intensive care unit.

Method

Study design: prospective collection of family narratives during support group meetings. A qualitative analysis was done of the narratives of weekly routine nurse‐social worker led support group for family members of intensive care unit patients. The meeting contents are documented and related in the nursing notes.

Setting: level 1 trauma centre, at a university hospital, with 13‐bed intensive care unit. During the past 3 years this family support group has been providing routine intervention with the purpose of calming the families of intensive care unit patients during crisis situations by utilizing nurse, social worker and group dynamics.

Results

A qualitative analysis was performed on the content of support group dynamics. The principal themes found were Behavioural, Perceptual, Emotional and Supportive.

Conclusions

The family support group provides the participants with a ‘tool box’ of coping mechanisms, which they can choose from in this current unfamiliar crisis event. The group provides a supportive environment, mutuality, a sense of belonging, needs of community, unconditional acceptance and information provision for the participants in the group.

Relevance to clinical practice

In order to provide support for several families, nurses can use the family support group intervention as an effective technique in reaching as many families as possible. Narratives from family members during group meetings may be a good information source providing insights for nursing guidance and patient/family education.
JAZ2 controls stomata dynamics during bacterial invasion
Authors: Gimenez‐Ibanez Selena , Boter Marta , Ortigosa Andrés , García‐Casado Gloria , Chini Andrea , Lewsey Mathew G. , Ecker Joseph R. , Ntoukakis Vardis , Solano Roberto
Published: December 2016

Coronatine (COR) facilitates entry of bacteria into the plant apoplast by stimulating stomata opening. COR‐induced signaling events at stomata remain unclear. We found that the COR and jasmonate isoleucine (JA‐Ile) co‐receptor JAZ2 is constitutively expressed in guard cells and modulates stomatal dynamics during bacterial invasion

We analyzed tissue expression patterns of AtJAZ genes and measured stomata opening and pathogen resistance in loss‐ and gain‐of‐function mutants.

Arabidopsis jaz2 mutants are partially impaired in pathogen‐induced stomatal closing and more susceptible to Pseudomonas. Gain‐of‐function mutations in JAZ2 prevent stomatal reopening by COR and are highly resistant to bacterial penetration. The JAZ2 targets MYC2, MYC3 and MYC4 directly regulate the expression of ANAC19, ANAC55 and ANAC72 to modulate stomata aperture. Due to the antagonistic interactions between the salicylic acid (SA) and JA defense pathways, efforts to increase resistance to biotrophs result in enhanced susceptibility to necrotrophs, and vice versa. Remarkably, dominant jaz2Δjas mutants are resistant to Pseudomonas syringae but retain unaltered resistance against necrotrophs.

Our results demonstrate the existence of a COI1‐JAZ2‐MYC2,3,4‐ANAC19,55,72 module responsible for the regulation of stomatal aperture that is hijacked by bacterial COR to promote infection. They also provide novel strategies for crop protection against biotrophs without compromising resistance to necrotrophs.
Validation of an instrument to measure moral distress within the Australian residential and community care environments
Authors: Burston Adam , Eley Robert , Parker Deborah , Tuckett Anthony
Published: December 2016

Aim and objectives

The aim of this study was to gain insight into the experience of moral distress within the aged care workforce. The objective of this study was to use and validate an existing instrument to measure moral distress within the aged care setting.

Background

Moral distress, a phenomenon associated with worker satisfaction and retention, is common within nursing. Instruments to measure moral distress exist; however, there are no validated instruments to measure moral distress within an aged care setting.

Design and method

An existing instrument, the Moral Distress Scale (Revised) was identified and amended. Amendments were subject to expert review for face and content validity. Data were collected from aged care nurses working in residential and community aged care, in Australia. Reliability was assessed using Cronbach's alpha with exploratory factor analysis undertaken for construct validity.

Results

106 participants completed the survey, 93 (87.7%) identified as female and 13 (12.3%) male. Participants ranged in age from 21 to 73 years, with a mean time working in nursing of 20.6 years. The frequency component of the instrument demonstrated an alpha of 0.89, the intensity component 0.95 and the instrument as a whole 0.94. Three factors were identified and labelled as: Quality of Care, Capacity of Team and Professional Practice. Mean scores indicate a low occurrence of moral distress, but this distress, when experienced, was felt with a moderate level of intensity. Primary causes of moral distress were insufficient staff competency levels, poor quality care because of poor communication and delays in implementing palliation.

Conclusion

The instrument demonstrates validity and reliability within the Australian aged care setting. Further analysis with larger populations is required to support these findings.

Implications for practice

Australian aged care workers do experience moral distress. They suffer adverse consequences of this distress and quality of care is negatively impacted. This newly validated instrument can be used to quantify the occurrence of moral distress and to inform targeted interventions to reduce the occurrence and intensity of the experience.
Predicting outcomes of restored Everglades high flow: a model system for scientifically managed floodplains
Authors: Choi Jay , Harvey Jud W.
Published: December 2016

Restoration of higher flows through the Everglades is intended to reestablish sheetflow to rebuild a well‐functioning ridge and slough landscape that supports a productive and diverse ecosystem. Our objective of the study was to use hydrologic simulations and biophysical analysis to predict restoration outcomes for five major subbasins of the Everglades. Five different scenarios of restoration were examined, and for each we predicted an outcome based on metrics describing the present‐day condition of the landscape and additional metrics determined by modeling the hydrologic changes accompanying restoration. Restoration scenarios spanned from a baseline case with average annual flows of about 52% of the predrainage flow to the most aggressive scenario that permits 91% of the predrainage flow. Our predictions indicated that all restoration scenarios could benefit the functionality of the ridge‐slough ecosystem. However, the difference between any single restoration scenario and the “no restoration” baseline was far greater than was the difference between any two levels of restoration. Interestingly, our analysis suggested that the most extensive (and highest cost) restoration scenarios are not likely to improve ridge and slough function more than less extensive restoration options. However, the value of more aggressive restoration may lie in factors not considered directly in our analysis. For example, an important reason to implement the more aggressive restoration scenarios could be additional flexibility that permitting greater flow allows for adaptively managing the ecosystem while also serving water needs for southeastern Florida in what could be a drier Everglades in the coming decades.
Intraocular sarcoma associated with lens capsule rupture and persistent hyperplastic primary vitreous in a dog
Authors: Graham Kathleen L. , Krockenberger Mark B. , Billson F. Mark
Published: December 2016

This case report describes the clinical findings and ocular pathology in an adult Golden Retriever diagnosed with an intraocular sarcoma. Nineteen s prior to diagnosis with a lens capsule rupture and intraocular sarcoma, the dog was diagnosed with persistent hyperplastic primary vitreous and uveitis based on clinical signs and the ultrasonographic appearance of the eye. Two years after enucleation, there was no evidence of metastatic spread of the sarcoma. The immunohistochemical characteristics of the tumor as well as the limitations and supportive evidence used in attempting to identify the histogenesis of the tumor are outlined.
RADIOGRAPHIC APPEARANCE OF PRESUMED NONCARDIOGENIC PULMONARY EDEMA AND CORRELATION WITH THE UNDERLYING CAUSE IN DOGS AND CATS
Authors: Bouyssou Sarah , Specchi Swan , Desquilbet Loïc , Pey Pascaline
Published: December 2016

Noncardiogenic pulmonary edema is an important cause of respiratory disease in dogs and cats but few reports describe its radiographic appearance. The purpose of this retrospective case series study was to describe radiographic findings in a large cohort of dogs and cats with presumed noncardiogenic pulmonary edema and to test associations among radiographic findings versus cause of edema. Medical records were retrieved for dogs and cats with presumed noncardiogenic edema based on history, radiographic findings, and outcome. Radiographs were reviewed to assess lung pattern and distribution of the edema. Correlation with the cause of noncardiogenic pulmonary edema was evaluated with a Fisher's exact test. A total of 49 dogs and 11 cats were included. Causes for the noncardiogenic edema were airway obstruction (n= 23), direct pulmonary injury (n= 13), severe neurologic stimulation (n= 12), systemic disease (n= 6), near‐drowning (n= 3), anaphylaxis (n= 2) and blood transfusion (n= 1). Mixed, symmetric, peripheral, multifocal, bilateral, and dorsal lung patterns were observed in 44 (73.3%), 46 (76.7%), 55 (91.7%), 46 (76.7%), 46 (76.7%), and 34 (57.6%) of 60 animals, respectively. When the distribution was unilateral, pulmonary infiltration involved mainly the right lung lobes (12 of 14, 85.7%). Increased pulmonary opacity was more often asymmetric, unilateral, and dorsal for postobstructive pulmonary edema compared to other types of noncardiogenic pulmonary edema, but no other significant correlations could be identified. In conclusion, noncardiogenic pulmonary edema may present with a quite variable radiographic appearance in dogs and cats.
Primary immunodeficiencies suggest redundancy within the human immune system
Authors: Fischer Alain , Rausell Antonio
Published: December 2016

The frequency of innate immune mutations in primary immunodeficiencies suggests redundancy in infection response.
Activities of Omadacycline and Comparator Agents against Staphylococcus aureus Isolates from a Surveillance Program Conducted in North America and Europe
Authors: Pfaller Michael A. , Rhomberg Paul R. , Huband Michael D. , Flamm Robert K.
Published: December 2016

Omadacycline is a new broad-spectrum aminomethylcycline in late-stage clinical development for acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia as a once-daily formulation taken orally or intravenously. In this study, omadacycline and comparator agents were tested against 502 isolates of
Staphylococcus aureus
selected from a 2014 global surveillance program, and the results were compared with those for 7,740 isolates from a 2010 surveillance program. For the 2014 isolates, testing was completed on 252 isolates from Europe and 250 isolates from North America. Each set of isolates was composed of ∼100 hospital-acquired methicillin-resistant
Staphylococcus aureus
(HA-MRSA) isolates (isolated >48 h after hospital admission), 100 community-acquired MRSA (CA-MRSA) isolates (isolated <48 h after hospital admission), and 50 methicillin-susceptible
S. aureus
(MSSA) isolates. The omadacycline MIC
50
and MIC
90
for all
S. aureus
collected during 2014 was 0.12 and 0.12 μg/ml, respectively. The MIC
90
values were identical for MRSA, HA-MRSA, and CA-MRSA (0.12 μg/ml). The MIC
90
values for isolates from 2010 for
S. aureus
, MRSA, and CA-MRSA were 0.25 μg/ml (0.5 μg/ml for HA-MRSA; 87.8% were at ≤0.25 μg/ml). All 2014 and 2010 MRSA isolates were susceptible to vancomycin, and ≥99.8% were susceptible to daptomycin, linezolid, and tigecycline. The activity of omadacycline was similar for North American and European isolates, including MRSA (CA-MRSA or HA-MRSA). There was no evidence for emerging resistance to omadacycline between 2010 and 2014. The potent activity of omadacycline against
S. aureus
indicates that omadacycline merits further study in serious infections where multidrug resistance may be a concern.
Imaging of Borrelia turicatae Producing the Green Fluorescent Protein Reveals Persistent Colonization of the Ornithodoros turicata Midgut and Salivary Glands from Nymphal Acquisition through Transmission
Authors: Krishnavajhala Aparna , Wilder Hannah K. , Boyle William K. , Damania Ashish , Thornton Justin A. , Pérez de León Adalberto A. , Teel Pete D. , Lopez Job E.
Published: December 2016

Relapsing fever (RF) spirochetes colonize and are transmitted to mammals primarily by
Ornithodoros
ticks, and little is known regarding the pathogen's life cycle in the vector. To further understand vector colonization and transmission of RF spirochetes,
Borrelia turicatae
expressing a green fluorescent protein (GFP) marker (
B. turicatae-gfp
) was generated. The transformants were evaluated during the tick-mammal infectious cycle, from the third nymphal instar to adult stage.
B. turicatae-gfp
remained viable for at least 18 months in starved fourth-stage nymphal ticks, and the studies indicated that spirochete populations persistently colonized the tick midgut and salivary glands. Our generation of
B. turicatae-gfp
also revealed that within the salivary glands, spirochetes are localized in the ducts and lumen of acini, and after tick feeding, the tissues remained populated with spirochetes. The
B. turicatae-gfp
generated in this study is an important tool to further understand and define the mechanisms of vector colonization and transmission.

IMPORTANCE
In order to interrupt the infectious cycle of tick-borne relapsing fever spirochetes, it is important to enhance our understanding of vector colonization and transmission. Toward this, we generated a strain of
Borrelia turicatae
that constitutively produced the green fluorescent protein, and we evaluated fluorescing spirochetes during the entire infectious cycle. We determined that the midgut and salivary glands of
Ornithodoros turicata
ticks maintain the pathogens throughout the vector's life cycle and remain colonized with the spirochetes for at least 18 months. We also determined that the tick's salivary glands were not depleted after a transmission blood feeding. These findings set the framework to further understand the mechanisms of midgut and salivary gland colonization.
Novel Observations in 11 Heteroresistant Vancomycin-Intermediate Methicillin-Resistant Staphylococcus aureus Strains from South India
Authors: Bakthavatchalam Yamuna Devi , Veeraraghavan Balaji , Peter John Victor , Rajinikanth Janakiraman , Inbanathan Francis Yesurajan , Devanga Ragupathi Naveen Kumar , Rajamani Sekar Suresh Kumar
Published: December 2016

We report here the draft genome sequences of 11 heteroresistant vancomycin-intermediate
Staphylococcus aureus
(hVISA) strains from bloodstream infection. All strains harbor mutations in
vraSR
,
graSR
,
walKR
, and/or
tcaRAB
and are often implicated as the frequently mutated candidate genes in hVISA phenotypes.
Conserved ABC Transport System Regulated by the General Stress Response Pathways of Alpha- and Gammaproteobacteria
Authors: Herrou Julien , Willett Jonathan W. , Czyż Daniel M. , Babnigg Gyorgy , Kim Youngchang , Crosson Sean
Published: December 2016

Brucella abortus
σ
E1
is an EcfG family sigma factor that regulates the transcription of dozens of genes in response to diverse stress conditions and is required for maintenance of chronic infection in a mouse model. A putative ATP-binding cassette transporter operon,
bab1_0223-bab1_0226
, is among the most highly activated gene sets in the σ
E1
regulon. The proteins encoded by the operon resemble quaternary ammonium-compatible solute importers but are most similar in sequence to the broadly conserved YehZYXW system, which remains largely uncharacterized. Transcription of
yehZYXW
is activated by the general stress sigma factor σ
S
in
Enterobacteriaceae
, which suggests a functional role for this transport system in bacterial stress response across the classes
Alphaproteobacteria
and
Gammaproteobacteria
. We present evidence that
B. abortus
YehZYXW does not function as an importer of known compatible solutes under physiological conditions and does not contribute to the virulence defect of a σ
E1
-null strain. The sole
in vitro
phenotype associated with genetic disruption of this putative transport system is reduced growth in the presence of high Li
+
ion concentrations. A crystal structure of
B. abortus
YehZ revealed a class II periplasmic binding protein fold with significant structural homology to
Archaeoglobus fulgidus
ProX, which binds glycine betaine. However, the structure of the YehZ ligand-binding pocket is incompatible with high-affinity binding to glycine betaine. This is consistent with weak measured binding of YehZ to glycine betaine and related compatible solutes. We conclude that YehZYXW is a conserved, stress-regulated transport system that is phylogenetically and functionally distinct from quaternary ammonium-compatible solute importers.

IMPORTANCE
Brucella abortus
σ
E1
regulates transcription in response to stressors encountered in its mammalian host and is necessary for maintenance of chronic infection in a mouse model. The functions of the majority of genes regulated by σ
E1
remain undefined. We present a functional/structural analysis of a conserved putative membrane transport system (YehZYXW) whose expression is strongly activated by σ
E1
. Though annotated as a quaternary ammonium osmolyte uptake system, experimental physiological studies and measured ligand-binding properties of the periplasmic binding protein (PBP), YehZ, are inconsistent with this function. A crystal structure of
B. abortus
YehZ provides molecular insight into differences between bona fide quaternary ammonium osmolyte importers and YehZ-related proteins, which form a distinct phylogenetic and functional group of PBPs.
Does increased duration of consultant presence affect length of hospital stay for unplanned admissions in acute paediatrics?: an observational before-and-after analysis using administrative healthcare data
Authors: Cromb Daniel , Carter Chris , Lemer Claire , Cheung C Ronny
Published: December 2016

Objectives

This study aims to review whether implementation of increased duration of consultant presence is associated with reduction in length of hospital stay (LoS) in children with an unplanned admission to hospital.

Method (design/setting/participants/interventions/outcome measures)

An observational before-and-after study of all unplanned general paediatric admissions to a UK hospital between 1 September 2012 and 31 August 2015, comparing LoS and readmission rates before and after implementation of a policy mandating consultant review within 12 hours of unplanned hospital admission.

Results

5367 inpatient admissions were analysed: 3386 prior to implementation of the policy and 1981 afterwards. There was no significant difference in median LoS between the two groups or in readmission rates at 24 hours, 48 hours or 7 days. However, among children who stayed in hospital for under 24 hours, and those who were discharged with a diagnosis of acute gastroenteritis, consultant review within 12 hours of admission was associated with a shorter LoS—respectively, 16 hours 23 min versus 15 hours 45 min (p=0.01) and 28 hours 46 min versus 19 hours 41 m (p<0.01).

Conclusions

Increased duration of consultant presence was not associated with significant impact on LoS, other than in admissions of brief duration and in gastroenteritis, where diagnosis is based on clinical judgement in the absence of objective diagnostic thresholds. Future studies should focus on whether these results are generalisable across other settings, and other measures of cost-effectiveness of early consultant review, given the major implications on resource and workforce planning of such policies.
Peripheral osteoma in an unusual location on the mandible
Authors: Kucukkurt Sercan , Özle Murat , Baris Emre
Published: December 2016

Osteoma is a benign, slow-growing, painless, discrete lesion which is characterised with the proliferation of a compact or cancellous bone. Osteomas are rare on the jaws. Lesions of the mandible developed most often in the condyle, angle and margin. Osteoma developed on the genial tubercle area had only been reported in one case. A 50-year-old female patient has been admitted to our department with the symptom of a hard mass under the chin area. In extra-oral and radiographic examinations, a 1×1 cm size, round, palpable, immobile, radiopaque mass has been determined on the genial tubercle area. The lesion has been completely removed under local anaesthesia by extra-oral approach. Her recovery period was uneventful. Osteoma diagnosis was confirmed with histopathological examination. There is no recurrence at 3-year follow-up. The purpose of this case report is to present a peripheral osteoma case that occurred in the genial tubercle area which is an unusual place.
Missing the point: self-inflicted traumatic brain injury in psychosis
Authors: Maruca-Sullivan Phelan E , Goldenberg Matthew N , Cone David C , Ciarleglio Justine
Published: December 2016

A 36-year-old man was brought to the emergency department by emergency medical services after being found acting unusually at a gas station with blood on his head and clothing. He presented acutely psychotic and reported that he had a pen in his head. Medical evaluation was notable for a superficial puncture wound to the right temple, and he was medically cleared for psychiatric evaluation. After he developed nausea and headache later that evening, the CT scan revealed a temporal bone fracture, pneumocephalus, intraparenchymal haemorrhage and the presence of a metal pen tip lodged in the brain parenchyma. The full nature of the injury went undiscovered in the emergency department for 16 hours due to the superficial appearance of the injury and his acute psychosis with prominent delusional thought content and disorganisation. He underwent craniotomy with removal of the pen and subsequent hospitalisation for intravenous antibiotics, followed by a prolonged psychiatric hospitalisation for psychosis.
Prenatal intestinal volvulus: look for cystic fibrosis
Authors: Chouikh Taieb , Mottet Nicolas , Cabrol Christelle , Chaussy Yann
Published: December 2016

Intestinal volvulus is a life-threatening emergency requiring prompt surgical management. Prenatal intestinal volvulus is rare, and most are secondary to intestinal atresia, mesenteric defect or without any underlying cause. Cystic fibrosis (CF) is known to cause digestive tract disorders. After birth, 10–15% of newborns with CF may develop intestinal obstruction within a few days of birth because of meconial ileus.1This obstruction is a result of dehydrated thickened meconium obstructing the intestinal lumen. We report two cases of fetuses with prenatal diagnosis of segmental volvulus in whom CF was diagnosed.
Large bowel perforation secondary to CMV colitis: an unusual primary presentation of HIV infection
Authors: Barling Daniel Richard , Tucker Simon , Varia Haren , Isaacs Peter
Published: December 2016

We report a case of HIV-associatedCytomegaloviruscolitis complicated by large bowel perforation. A 62-year-old man of same-sex relationship was not known to have HIV, but a diagnosis of inflammatory bowel disease was made early in his admission, with steroid treatment initiated. He was later confirmed to be HIV positive, and found to have multiple microperforations of the bowel necessitating ileocecectomy and Hartmann's procedures.
Sweet syndrome: a painful reality
Authors: Khan Uqba , Rizvi Humaira , Ali Farman , Lebovic Daniel
Published: December 2016

Sweet syndrome is a rare disorder that is manifested by constellation of clinical features, including fever, neutrophilic leucocytosis, raised painful plaques on skin and dermal infiltration by neutrophils. Numerous aetiological associations have been reported in the literature, including various haematological malignancies and drugs. Our case was peculiar because of association of capecitabine and Sweet syndrome in rectal cancer. We describe a case of a woman aged 57 years, with recently diagnosed stage III rectal cancer, developed painful erythematous rash over her face along with fever and headache. Skin biopsy was performed which revealed typical findings of Sweet syndrome. She was successfully treated with systemic steroids. Our case was an unusual presentation of Sweet syndrome in a patient with rectal adenocarcinoma treated with neoadjuvant capecitabine.
Melanoderma: uncommon presentation of a common condition
Authors: Gunaseelan Priyadarshini , Narasingarajan Sarveswari , Mahadevan Shriraam
Published: December 2016

A 64-year-old man presented with blackish pigmentation of skin and tongue for more than 2 years that did not improve with local remedies. He had no history of comorbid medical or surgical illnesses. General examination showed severe hyperpigmentation of skin and mucosa and also showed anaemia. Systemic examination was unremarkable except for Romberg sign and mild hyperreflexia. Adrenal insufficiency was ruled out by normal cortisol levels and haemogram showed macrocytosis with hypersegmented neutrophils suggestive of severe vitamin B12 deficiency which confirmed by low serum B12 levels. After 3 months of parenteral vitamin B12 treatment, the pigmentation and anaemia improved significantly. The mechanism of hyperpigmentation due to B12 deficiency is postulated to be increased melanin deposition in the basal layer of the epidermis. Since vitamin B12 deficiency is not uncommonly encountered in general practice, atypical presentation of this easily diagnosable and treatable condition is emphasised.
Rare case of losartan-induced cough complicated by rectus sheath haematoma: in a patient on rivaroxaban therapy
Authors: Talari Goutham , Talari Preetham , Sweigart Joseph , Ahmed Sadiq
Published: December 2016

Spontaneous rectus sheath haematomas and cough secondary to losartan are individually rare conditions. Abdominal wall haematomas present with abdominal pain and abdominal mass. Most patients are managed conservatively; Surgery or embolisation is indicated for shock, infection, rupture into the peritoneum or intractable pain. This is a man aged 65 years presented with dry cough and right-sided abdominal pain. He started losartan a few weeks prior to the onset of cough and had been on rivaroxaban for prior deep venous thrombosis. The right side of his abdomen was distended, bruised and tender. His haemoglobin dropped from 13.3to 9.5 g/dL. CT abdomen/pelvis showed a large 14.5×9.1×4.5 cm haematoma within the right lateral rectus muscle. His only risk factor for developing rectus sheath haematoma was cough in the setting of anticoagulation. Dry cough due to angiotensin receptor blockers is rare, but can have very serious consequences.
Idiopathic myelofibrosis with disseminated hepatosplenic, mesenteric, renal and pulmonary extramedullary haematopoeisis, portal hypertension and tuberculosis: initial presentation and 2 years follow-up
Authors: Panda Ananya , Chandrashekhara Sheragaru Hanumanthappa , Nambirajan Aruna , Mishra Pravas
Published: December 2016

A 35-year-old man with a 12-year history of idiopathic myelofibrosis (IMF) presented in 2014 with fatigue and abdominal distension. CT scan revealed massive hepatosplenomegaly with focal splenic lesions, soft tissue around renal pelvis, mesenteric masses compressing bowel loops and perilymphatic nodules in lungs. There was portal hypertension, ascites, pleural effusion, bilateral psoas abscesses and necrotic retroperitoneal lymphadenopathy. MRI additionally revealed hypointense periportal infiltrative lesions in liver, not seen on CT scan. None of these lesions showed diffusion restriction. Biopsy from mesenteric masses revealed extramedullary haematopoeisis. Aspiration from psoas abscess confirmed tuberculosis. Follow-up after 6 weeks of ruxolitinib (JAK2 tyrosine kinase inhibitor) and 9 months of antitubercular therapy revealed resolution of psoas abscesses and lymph nodes. Mild reduction was noted in mesenteric masses and ascites while perirenal soft tissue had increased. Follow-up imaging after another 1 year of ruloxitinib showed new-onset bilateral paravertebral and presacral foci of extramedullary haematopoeisis.
Expectoration of an inferior vena cava filter strut
Authors: Mehanni Stephen , Higley Meghan , Schenning Ryan C
Published: December 2016

Inferior vena cava (IVC) filter use is widespread in patients with venous thromboembolism (VTE) and temporary contraindication to anticoagulation, though timely removal is often not performed. We report the case of an expectoration of an IVC filter strut. Review of the patient's prior imaging confirmed an infrarenal Bard G2 filter with an absent strut, which was visualised in the left lung base. The strut was presumed to have embolised to a pulmonary artery branch and eroded into an adjacent bronchus. Subsequent fluoroscopically guided filter retrieval was successful. The incidence of IVC filter fractures increases with longer dwell times. Filter fragment embolisation has resulted in major adverse events, including sudden death and cardiac tamponade. Recent evidence has suggested that retrieval of IVC filters with prolonged dwell times is feasible and safe. This report brings awareness to the range of complications with indwelling IVC filters, and highlights the importance of timely removal.
Acute oxygenator failure: a new presentation of heparin-induced thrombocytopenia in a patient undergoing venovenous extracorporeal membrane oxygenation support
Authors: Ratzlaff Robert A , Ripoll Juan G , Kassab Lena L , Diaz-Gomez Jose L
Published: December 2016

A 58-year-old man with medical history of thrombocytopenia was admitted to an outside hospital for a 6-day history of worsening dyspnoea requiring mechanical ventilator support. He was transferred to our institution for extracorporeal membrane oxygenation (ECMO) given his refractory hypoxaemia. On arrival, H1N1 influenza virus was confirmed and all measures to improve oxygenation were ineffective. Thus, the decision was made to start venovenous (VV)-ECMO. Although a low baseline platelet count was recognised (60–70×109/L), a sudden further decrease occurred (30×109/L) and platelet transfusion was initiated. A substantial increase in the pressure across the ECMO oxygenator was identified, and the diagnosis of type II heparin-induced thrombocytopenia was suspected and confirmed. Heparin was discontinued, the oxygenator was exchanged and argatroban was used for anticoagulation. After 28 days on VV-ECMO support, the decision was made to withdraw organ support in conjunction with the patient and family wishes.
Shape of the association between income and mortality: a cohort study of Denmark, Finland, Norway and Sweden in 1995 and 2003
Authors: Mortensen Laust H , Rehnberg Johan , Dahl Espen , Diderichsen Finn , Elstad Jon Ivar , Martikainen Pekka , Rehkopf David , Tarkiainen Lasse , Fritzell Johan
Published: December 2016

Objectives

Prior work has examined the shape of the income–mortality association, but work has not compared gradients between countries. In this study, we focus on changes over time in the shape of income–mortality gradients for 4 Nordic countries during a period of rising income inequality. Context and time differentials in shape imply that the relationship between income and mortality is not fixed.

Setting

Population-based cohort study of Denmark, Finland, Norway and Sweden.

Participants

We collected data on individuals aged 25 or more in 1995 (n=12.98 million individuals, 0.84 million deaths) and 2003 (n=13.08 million individuals, 0.90 million deaths). We then examined the household size equivalised disposable income at the baseline year in relation to the rate of mortality in the following 5 years.

Results

A steep income gradient in mortality in men and women across all age groups except the oldest old in Denmark, Finland, Norway and Sweden. From the 1990s to 2000s mortality dropped, but generally more so in the upper part of the income distribution than in the lower part. As a consequence, the shape of the income gradient in mortality changed. The shift in the shape of the association was similar in all 4 countries.

Conclusions

A non-linear gradient exists between income and mortality in most cases and because of a more rapid mortality decline among those with high income the income gradient has become steeper over time.
Introduction of standard measles vaccination in an urban African community in 1979 and overall child survival: a reanalysis of data from a cohort study
Authors: Mogensen Søren Wengel , Aaby Peter , Smedman Lars , Martins Cesário L , Rodrigues Amabelia , Benn Christine S , Ravn Henrik
Published: December 2016

Objective

To examine the effect of the first introduction of measles vaccine (MV) in Guinea-Bissau in 1979.

Setting

Urban community study of the anthropometric status of all children under 6 years of age.

Participants

The study cohort included 1451 children in December 1978; 82% took part in the anthropometric survey. The cohort was followed for 2 years.

Intervention

In December 1979, the children were re-examined anthropometrically. The participating children, aged 6 months to 6 years, were offered MV if they did not have a history of measles infection. There were no routine vaccinations in 1979–1980.

Primary and secondary outcome measures

Age-adjusted mortality rate ratios (MRRs) for measles vaccinated and not vaccinated children; changes in nutritional status.

Results

The nutritional status deteriorated significantly from 1978 to 1979. Nonetheless, children who received MV at the December 1979 examination had significantly lower mortality in the following year (1980) compared with the children who had been present in the December 1978 examination but were not measles vaccinated. Among children still living in the community in December 1979, measles-vaccinated children aged 6–71 months had a mortality rate of 18/1000 person-years during the following year compared with 51/1000 person-years for absent children who were not measles vaccinated (MRR=0.30 (0.12–0.73)). The effect of MV was not explained by prevention of measles infection as the unvaccinated children did not die of measles infection.

Conclusions

MV may have beneficial non-specific effects on child survival not related to the prevention of measles infection.
Validity of three asthma-specific quality of life questionnaires: the patients' perspective
Authors: Apfelbacher Christian J , Jones Christina J , Frew Anthony , Smith Helen
Published: December 2016

Objectives

It is not known which of the many asthma-specific quality of life (QoL) questionnaires best capture the lived experience of people with asthma. The objective of this study was to explore patients' views of three commonly used asthma-specific QoL questionnaires.

Design

Qualitative study using semistructured interviews.

Setting

Primary and secondary care in Brighton and Hove, UK.

Participants

30 adult people with a physician-diagnosis of asthma who were asked to complete the Juniper Asthma Quality of Life Questionnaire (AQLQ-J), the Sydney Asthma Quality of Life Questionnaire (AQLQ-S) and the Living with Asthma Questionnaire (LWAQ) to elicit their views on the content validity of these.

Results

Thematic content analysis revealed a lack of congruence between the concerns of people with asthma and the questionnaire content in terms of missing (eg, allergies) and irrelevant (eg, smoky restaurants) content. The AQLQ-J was perceived as a ‘narrow’, ‘medical’ questionnaire focused on symptoms, the environment and functional ability. In contrast, the LWAQ and the AQLQ-S were perceived to be ‘non-medical’. The LWAQ was described as a ‘test’ and as a wide-ranging, embracing and holistic questionnaire. Its strong emotional focus was irritating to some. The AQLQ-S was described as a simple, quick and easy questionnaire, although there was a perception that it was lacking in depth.

Conclusions

Patient interviews highlighted strengths and shortcomings in the content validity of these three asthma-specific questionnaires. For patients, the AQLQ-S content seemed to be the most pertinent in its adequacy of coverage of medical, social and emotional aspects of health-related QoL in asthma.
Nationwide cross-sectional study of the impact of chronic pain on an individual’s employment: relationship with the family and the social support
Authors: de Sola Helena , Salazar Alejandro , Dueñas María , Ojeda Begoña , Failde Inmaculada
Published: December 2016

Objectives

To determine the prevalence and the factors related to sick leave and job loss among individuals suffering from chronic pain (CP), and to analyse specifically the effect of family and social support on the individual's employment.

Design

Observational cross-sectional study.

Setting

Data were collected using structured computer-assisted telephone interviews between February and June 2011.

Participants

A nationwide study of 1543 Spanish adults of working age (<65), 213 of whom suffered from CP (pain suffered at least 4 or 5 days a week during the past 3 months, according to the criteria of the International Association for the Study of Pain (IASP)).

Main outcome measure

Information was collected regarding the individual's sociodemographic status, pain characteristics, healthcare use and satisfaction, limitations in daily activities, mood status, perception of the impact of pain on their families, and their satisfaction with the family and social support. To identify factors associated with sick leave and job loss among those suffering CP, 2 logistic regression models were generated.

Results

The prevalence of sick leave due to CP in the general Spanish population was 4.21% (95% CI 3.2% to 5.2%). Sick leave were more likely for individuals who considered their family were affected by their pain (OR=2.18), needed help to dressing and grooming (OR=2.98), taking medication (OR=2.18), had a shorter pain duration (OR=0.99) and higher educational level. The prevalence of job loss due to CP was 1.8% (95% CI 1.1% to 2.5%). It was related to feelings of sadness (OR=4.25), being unsatisfied with the care provided by health professionals (OR=2.60) and consulting a doctor more often due to CP (OR=1.09).

Conclusions

CP is negatively associated with an individual's employment. This detrimental effect could be ameliorated if the factors related to sick leave and job loss provoked by CP are identified, especially those related to the effect of CP on the family and social environment.
Efficacy and safety of Wuling San for treatment of breast-cancer-related upper extremity lymphoedema: study protocol for a pilot trial
Authors: Zhu Huiru , Peng Zheng , Dai Meiyu , Zou Yan , Qin Fengxian , Chen Jifei , Song Liuying , He Baoyu , Lv Xiaolan , Dai Shengming
Published: December 2016

Introduction

Breast-cancer-related upper extremity lymphoedema (BCUL), a common complication of mastectomy, can cause physical discomfort, psychological distress, cosmetic defects, functional disability and chronic recurrent erysipelas in the affected arm(s). It is a challenge to physicians involved in the management of these patients. Wuling San, a classic prescription in Traditional Chinese Medicine used in treating oedema for thousands of years, is reported by many Chinese journals to perform well in BCUL. Therefore, the aim of this study is to verify its efficacy and evaluate its safety using rigorous methodological designs in patients with BCUL.

Methods and analysis

To verify the efficacy and assess the safety of Wuling San over a placebo, this double-blind, randomised, placebo-controlled, multicentre trial will be carried out in three hospitals. A total of 200 eligible patients with BCUL will be randomly allocated, in a ratio of 1:1, to either the experimental medicine group or the placebo group. The primary outcome measure will be the proportion of absolute reduced limb volume, as measured by perometry. The second outcome measure will be the number of participants with adverse events. The assessment will be carried out at the following time points: before enrolment (baseline) and 2, 4, 6 and 8 weeks after treatment.

Ethics and dissemination

This trial will be conducted in accordance with the Declaration of Helsinki and supervised by the institutional review board of the Fourth Affiliated Hospital of Guangxi Medical University (approval number PJK2016088). All patients will receive information about the trial in verbal and written forms and will give informed consent before enrolment. This trial will help to demonstrate whether Wuling San is effective in the treatment of patients with BCUL. The results will be published in peer-reviewed journals or disseminated through conference presentations.

Trial registration number

NCT02726477; Pre-results.
Randomised, double-blind, placebo-controlled study investigating the effects of inorganic nitrate on vascular function, platelet reactivity and restenosis in stable angina: protocol of the NITRATE-OCT study
Authors: Rathod Krishnaraj S , Jones Daniel A , Van-Eijl T J A , Tsang Hilda , Warren Helen , Hamshere Stephen M , Kapil Vikas , Jain Ajay K , Deaner Andrew , Poulter Neil , Caulfield Mark J , Mathur Anthony , Ahluwalia Amrita
Published: December 2016

Introduction

The mainstay treatment for reducing the symptoms of angina and long-term risk of heart attacks in patients with heart disease is stent implantation in the diseased coronary artery. While this procedure has revolutionised treatment, the incidence of secondary events remains a concern. These repeat events are thought to be due, in part, to continued enhanced platelet reactivity, endothelial dysfunction and ultimately restenosis of the stented artery. In this study, we will investigate whether a once a day inorganic nitrate administration might favourably modulate platelet reactivity and endothelial function leading to a decrease in restenosis.

Methods and design

NITRATE-OCT is a double-blind, randomised, single-centre, placebo-controlled phase II trial that will enrol 246 patients with stable angina due to have elective percutaneous coronary intervention procedure with stent implantation. Patients will be randomised to receive 6 months of a once a day dose of either nitrate-rich beetroot juice or nitrate-deplete beetroot juice (placebo) starting up to 1 week before their procedure. The primary outcome is reduction of in-stent late loss assessed by quantitative coronary angiography and optical coherence tomography at 6 months. The study is powered to detect a 0.22±0.55 mm reduction in late loss in the treatment group compared with the placebo group. Secondary end points include change from baseline assessment of endothelial function measured using flow-mediated dilation at 6 months, target vessel revascularisation (TVR), restenosis rate (diameter>50%) and in-segment late loss at 6 months, markers of inflammation and platelet reactivity and major adverse cardiac events (ie, myocardial infarction, death, cerebrovascular accident, TVR) at 12 and 24 months.

Ethics and dissemination

The study was approved by the Local Ethics Committee (15/LO/0555). Trial results will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals.

Trial registration numbers

NCT02529189andISRCTN17373946, Pre-results.
Relationship of social and economic factors to mental disorders among population-based samples of Jamaicans and Guyanese
Authors: Lacey Krim K , Powell Sears Karen , Crawford Tazhmoye V , Matusko Niki , Jackson James S
Published: December 2016

Background

There have been growing concerns about increasing mental health problems in the Caribbean region. This study explores rates and factors associated with selected mental health disorders within 2 Caribbean countries: Jamaica and Guyana.

Methods

Probability samples of 1218 Jamaicans and 2068 Guyanese participants were used. A modified version of the WHO Composite International Diagnostic Interview (WHO CIDI) defined by the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) was administered in order to assess lifetime mental disorders. Descriptive statistics, χ2and hierarchical regression analytic procedures were used to examine rates and factors associated with mental disorders.

Results

Rates of mental health conditions were different across contexts and were generally higher for Guyanese compared with Jamaicans for alcohol abuse (3.6% vs 2.2%), drug abuse (1.4% vs 1.3%), substance abuse (4.7% vs 2.7%) and mania (0.4% vs 0.1%). The rate of depression, however, was higher among Jamaicans than Guyanese (7.4% vs 4.1%). There were also noticeable differences in rates in both countries, due to social and economic factors, with social factors playing a larger contributory role in the mental health status of individuals across countries.

Conclusions

The results of this study suggest the need for more indepth analyses of factors contributing to mental health conditions of peoples within the Caribbean region, including the influence of additional sources of stress, quality of care and help-seeking behaviours of individuals.