Comparative scanning electron microscopy of bullous diseases

The purpose of this study is to compare scanning electron microscopy findings of the blister roof in three distinct bullous diseases: one intraepidermal acantholytic (pemphigus foliaceus); one due to hemidesmosomal dysfunction (bullous pemphigoid); and one secondary to anchoring fibril dysfunction - type VII collagen (dystrophic epidermolysis bullosa). In pemphigus foliaceus, acantholytic phenomena were readily demonstrated. In bullous pemphigoid, the epidermis had a solid aspect. In dystrophic epidermolysis bullosa a net was seen in the blister roof.     

Is the present cut-point to define type 2 diabetes appropriate in Latin-Americans?

The diagnosis of diabetes mellitus type 2 (DM2) is based either on increased plasma glucose or Glycated hemoglobin levels. Since these measures are the only means for diagnosis of DM2, they must be well adapted to each population according to their metabolic characteristics, given that these may vary in each population. The World Health Organization (WHO) determined the cut-points of plasma glucose levels for the diagnosis of DM2 by associating hyperglycemia with the risk of a specific microvascular complication-retinopathy. Cardiovascular diseases are however the principal causes of mortality in patients with DM2 and we reported that in the Colombo-Ecuadorian population impaired fasting glucose and impaired glucose tolerance are both risk markers for myocardial infarction. We propose that the current cut-points accepted by the WHO need to be revaluated in populations such as Latin America and that there should be lower cut points for glycaemia in this population, to reduce the prevalence of cardiovascular complications associated with DM2.     

Detection and source tracking of Escherichia coli,harboring intimin and Shiga toxin genes,isolated from the Little Bighorn River,Montana

The Little Bighorn River flows through the Crow Indian Reservation in Montana. In 2008, Escherichia coli concentrations as high as 7179 MPN/100 ml were detected in the river at the Crow Agency Water Treatment Plant intake site. During 2008, 2009, and 2012, 10 different serotypes of E. coli, including O157:H7, harboring both intimin and Shiga toxin genes were isolated from a popular swim site of the Little Bighorn River in Crow Agency. As part of a microbial source tracking study, E. coli strains were isolated from river samples as well as from manure collected from a large cattle feeding operation in the upper Little Bighorn River watershed; 23% of 167 isolates of E. coli obtained from the manure tested positive for the intimin gene. Among these manure isolates, 19 were identified as O156:H8, matching the serotype of an isolate collected from a river sampling site close to the cattle feeding area.     

Metabolic disorders of the liver

Metabolic diseases could be inherited as inborn errors of metabolism or acquired. In this review we discuss some of the metabolic disorders likely to present in the adult population and in which liver biopsy could be indicated as part of diagnosis or treatment. These include iron overload/hemochromatosis, Wilson's disease, alpha-1-antitrypsin deficiency, Niemann–Pick's disease and Gaucher's disease with emphasis on characteristic or helpful histopathologic features. In this era of molecular and other non-invasive analyses, the role of liver biopsy for primary diagnosis has decreased but is still an important tool for supplementing clinical/molecular diagnosis, staging disease and as a guide to management. In addition to qualitative assessment, quantitative measurements of iron and copper per unit dry weight of liver tissue can be performed on paraffin-embedded blocks and should be considered in patients being treated for iron overload or being worked up for possible Wilson's disease respectively. Gaucher's disease and Niemann–Pick's disease are examples of lysosomal storage diseases that could present outside of the pediatric population; these diseases have fairly distinguishing features that could be used to triage which patients need additional enzyme or other assays for definitive diagnoses. While non-alcoholic steatohepatitis remains the commonest metabolic liver disease in adult population, the pathologist should also be aware of these other entities discussed in this review.     

Cronicidad y complejidad: nuevos roles en Enfermería. Enfermeras de Práctica Avanzada y paciente crónico

The increase in chronic diseases and the progressive ageing of the population is a source of concern for the different agencies with responsibility for health care. This has led to the creation of many documents focused on the analysis of the current situation and care of chronic diseases, including the WHO recommendations intended to assist countries and health services design and implement strategies that will address the existing demand, control and prevention of chronic diseases.In addition, there is a need to respond to the demand generated by chronic diseases in every sense, and from the different systems it is becoming more difficult to get enough support from multidisciplinary teams where the nurse has a central importance. While chronic diseases are becoming a threat due to the costs they generate, it is also an opportunity for nursing to be at the forefront for advanced care requirements, performed by professionals with recognized advanced clinical skills and ability for case management while monitoring and controlling complex chronic patients. The different services of the National Health System have introduced nurses that play different roles (cases managers, liaison nurses, advanced practice nurses and so on). However, it could be argued that they are not being trained to a desirable development level.It is therefore time for health care authorities to determine the role of the advanced practice nurse in relation to functional positions, and allow them to make an advance in the development of unified skills for the whole National Health System. From our experience we have learned that the advanced practice nurse is a resource that helps in the sustainability of services, thanks to the efficiency shown in the results obtained from the care given to both chronic and complex chronic patients.     

杨国华治疗疑难杂症医案2则

疑难杂症是临床中处理颇为棘手的病证,每一位从事临床工作的中医大夫都可能遇到这类病例,而且随着临床实践水平的不断增多,接触此类病例的机会也相应增多。乳糜胸是威胁生命的严重疾病,发生率低,诊治有一定困难;同种异体脱钙骨移植术后免疫排斥反应大多是轻微,亦有少见高热病例。二者均属临床中疑难杂症。中国中医科学院望京医院心内科杨国华主任医师治疗此类病症从中医学整体观念出发,细于观察,详于辨证,善于分析,终以药而胜病,文章详细介绍了杨国华治疗疑难杂症的2则医案。     

Personal Values that Support and Counteract Utilization of a Screening Test for Prostate Cancer

The main aim of the current research was to discover the personal values that may support men's prostate cancer screening decisions in the future. We asked for participants’ past behavior and future behavioral intentions, and also considered their real-life behavior. The sample consisted of 371 men, of which 93 were first-time patients at the Andrology Unit. The results show that Security value was related to past participation, while Achievement, Stimulation, and Traditions counteracted this. Present prostate-testing behavior was related only to higher Security values. Predictors of future behavioral intentions were Security, Self-direction, and Benevolence, which described 21% of the total variability. Considering informed decision-making processes, our results suggest that men who hold Security, Self-direction, and Benevolence values are more likely to participate in office-based initial screening. The study indicates the need to offer office-based initial screening to those age-eligible men whose values do not support participation.     

mHealth: Using Mobile Technology to Support Healthcare

Adherence to long-term therapy in outpatient setting is required to reduce the prevalence of chronic diseases such as HIV/AIDS, Diabetes, Tuberculosis and Malaria. This paper presents a mobile technology-based medical alert system for outpatient adherence in Nigeria. The system makes use of the SMS and voice features of mobile phones. The system has the potential of improving adherence to medication in outpatient setting by reminding patients of dosing schedules and attendance to scheduled appointments through SMS and voice calls. It will also inform patients of benefits and risks associated with adherence. Interventions aimed at improving adherence would provide significant positive return on investment through primary prevention (of risk factors) and secondary prevention of adverse health outcomes.