Anaemia, iron index status and acute phase proteins in malaria (Abidjan, Côte d'Ivoire)

Clinical signs of malaria are the combined expression of several biological mechanisms. During this parasite infection, anaemia can be the consequence of several different pathogenic mechanisms. It can be an acute haemolytic anaemia due to a mechanical and immune action of the parasite or an inflammation. Besides, in Africa malaria matches with iron deficiency area. So, malarial anaemia in tropical area can be a characteristic of iron deficiency The purpose of this survey was to define the features of malarial anaemia and elucidate the link of all biological processes involved. A black population living in tropical urban areas, with fever and diagnosed Plasmodium-infection was assessed. Parasitaemia, haemoglobin, hematocrit, average corpuscular volume and average corpuscular haemoglobin were determined. For each patient, iron index status and acute phase protein were assessed with the plasmatic iron, ferritin, haptoglobin, transferrin and C-reactive protein. Regardless of gender and age, the characteristics of malarial anaemia are microcythaemia and hypochromia. Anaemia occurs as frequently as parasitaemia is high. When parasitaemia is low anaemia gets a haemolytic feature. When parasitaemia is high, anaemia gets haemolytic and inflammatory features. Anaemia occurs more often with a good iron index status.     

Primitive, and protective, our cellular oxygenation status?

The primitive atmosphere where aerobic life started on earth was hypoxic and hypercapnic. Remarkably, an adaptation strategy whereby O2 partial pressure, PO2, in the arterial blood is maintained within a low and narrow range of 1-3 kPa, largely independent of inspired PO2, has also been reported in modern water-breathers. In mammalian tissues, including brain, the most frequently measured PO2 is also in the same low range. Based on the postulate that basic cellular machinery has been established since the early stages of evolution, we propose that this similarity in oxygenation status is the consequence of an early adaptation strategy which, subsequently, throughout the course of evolution, maintained cellular oxygenation in the same low and primitive range independent of environmental changes. Specialized enzymes aimed at protecting cells against O2 toxicity are thought to have appeared very early in evolution but we suggest that preventing high PO2's is also the simplest and most efficient tool for limiting reactive oxygen species (ROS) production. It could be a cue mechanism to widen our understanding of the ageing process.     

Nutritional status and height,weight and BMI centiles of school-aged children and adolescents of 6–18-years from Kinshasa (DRC)

Background: The last study to establish centiles of main anthropometric measurements in Kinshasa was conducted over 60 years ago, which questions its current adequacy to describe or monitor growth in this population.

Aim: To assess the nutritional status of school-aged children and adolescents and to estimate centile curves of height, weight and body mass index (BMI).

Subjects and methods: A representative sample of 7541 school-aged children and adolescents (48% boys) aged 6–18 years was measured between 2010–2013. Smooth centiles of height, weight and BMI-for-age were estimated with the LMS method and compared with the WHO 2007 reference. Nutritional status was assessed by comparing measurements of height and BMI against the appropriate WHO cut-offs.

Results: Compared to the WHO reference, percentiles of height and BMI were generally lower. This difference was larger in boys than in girls and increased as they approached adolescence. The prevalence of short stature (?1 SD) was higher in girls (8.6%) than in boys (4.5%).

Conclusion: Children from Kinshasa fall below WHO centile references. This study established up-to-date centile curves for height, weight and BMI by age in children and adolescents. These reference curves describe the current status of these anthropometric markers and can be used as a basis for comparison in future studies.     

Immigrant status, antenatal depressive symptoms, and frequency and source of violence: what's the relationship?

This study describes the prevalence of violence during pregnancy and examines the association between the experience of violence since the beginning of pregnancy and the prevalence of antenatal depressive symptoms while taking into account immigrant status. Cross-sectional study including 5,162 pregnant women attending Montreal hospitals for antenatal care was conducted, with 1,400 being born outside of Canada. CES-D scale was used to evaluate depression at 24-26?weeks of pregnancy. The Abuse Assessment Screen scale was used to determine the frequency and severity of violence since the beginning of pregnancy. Relationship with abuser was also considered. All modeling was done using logistic regressions. Threats were the most frequent type of violence, with 63?% happening more than once. Long-term immigrant women reported the highest prevalence of all types of violence (7.7?%). Intimate partner violence (IPV) (15?%) was most frequently reported among the poorest pregnant women. Strong associations exist between more than one episode of abuse and depression (POR?=?5.21 [3.73; 7.23], and IPV and depression [POR?=?5.81 [4.19; 8.08]. Immigrant status did not change the associations between violence and depression. Violence against pregnant women is not rare in Canada, and it is associated with antenatal depressive symptoms. These findings support future development of perinatal screening for violence, follow-up, and a culturally sensitive referral system.     

Humble doctors,healthy patients? Exploring the relationships between clinician humility and patient satisfaction,trust, and health status

ObjectiveIn medicine, numerous commentaries implore clinicians (e.g., physicians, physician assistants, nurse practitioners) to display more humility. However, given the complex power dynamics between patients and clinicians, one should not presume that patients desire and appreciate humble clinicians. This paper examines the relationship between clinician humility and patient outcomes, and aims to provide empirical evidence for the significance of clinician humility.MethodsIn two studies, patients (N = 497) recalled their most recent visit to a clinician through an online survey platform (Qualtrics). Patients rated their clinician’s humility, satisfaction and trust with their clinician, and health status. They also provided demographic information (e.g., gender, race, subjective SES), details about their clinician (e.g., gender, race, professional status) and information about their last medical visit with this clinician (e.g., purpose of visit, wait time during visit).ResultsThrough hierarchical multiple regression, we demonstrated that clinician humility positively predicted patient satisfaction, trust, and self-report health (only in Study 2) above and beyond patient, clinician, and visit characteristics.ConclusionThe results demonstrated that clinician humility can predict important patient outcomes above and beyond objective characteristics of the medical interaction.Practice ImplicationsThese findings may shape clinician-patient interactions by validating the pursuit of humility during medical encounters.     

When activation changes,what else changes? the relationship between change in patient activation measure (PAM) and employees’ health status and health behaviors

Objective

To test whether changes in the patient activation measure (PAM) are related to changes in health status and healthy behaviors.

Methods

Data for this secondary analysis were taken from a group-randomized, controlled trial comparing a traditional health promotion program for employees with an activated consumer program and a control program. The study population included 320 employees (with and without chronic disease) from two U.S. companies: a large, integrated health care system and a national airline. Survey and biometric data were collected in Spring 2005 (baseline) and Spring 2007 (follow-up).

Results

Change in PAM was associated with changes in health behaviors at every level (1–4), especially at level 4. Changes related to overall risk score and many of its components: aerobic exercise, safety, cancer risk, stress and mental health. Other changes included frequency of eating breakfast and the likelihood of knowing about health plans and how they compare.

Conclusion

Level 4 of patient activation is not an end-point. People are capable of continuing to make significant change within this level.

Practice implications

Interventions should be designed to encourage movement from lower to higher levels of activation. Even people at the most activated level improve health behaviors.     

Relative abundance and gonotrophic status of Aedes albifasciatus (Diptera: Culicidae) during the autumn-winter period in Córdoba Province, Argentina

Variations in the abundance of larvae and females of Aedes albifasciatus (Macquart) were monitored biweekly during the autumn-winter periods of 1996 and 1997 on the southern edge of the Mar Chiquita Lake in Córdoba Province. The degree of development of the primary ovarian follicles also was determined in host-seeking females. Abundance of the larvae and the females were noticeably different during the 2 yr of the study and matched changes in the pattern of precipitation. Although most females had ovarian follicles in Christophers stages Ib-IIa, 14% and 4% in 1996 and 1997, respectively, were in stages III-V (i.e., exhibited gonotrophic discordance). Females appeared to continue taking blood meals and laying eggs even during the autumn-winter period.     

Does marital status and marital status change predict physical health in older adults?

BACKGROUND: Evidence for the effects of marital status and marital status change on physical health is equivocal. METHOD: Structural equation models examined whether marital status predicted physical health. Six groups were examined simultaneously: married (M); widowed (W); divorced (D); never married (NM); newly widowed (NW); and newly divorced (ND). There were four annual measures (T1-T4). Both NW and ND were married at T1, but had lost their partners by T2. Four physical health variables were examined: Problems, Limitations, Service use, and Self-rated health (SRH). Age and gender were included. RESULTS: Previous health predicted future for all measures and for all groups. However, the specific strengths and time-courses varied between marital status groups and between health measures. The most marked patterns were associated with marital status change. Service use was influenced most strongly by NW, whilst Limitations was influenced by ND. Problems distinguished NW and ND from stable marital status groups but also from each other. SRH was influenced by W and not by recent marital status change. The effects of age and gender were modest and restricted to specific health variables and specific marital statuses. CONCLUSIONS: The results demonstrate that marital status and marital status change, in particular, influence health longitudinally. The impact of a change to divorced or to widowed status is not the same. No two health variables responded in the same way, suggesting that marital status has a differential effect on health.     

Maleimide Functionalized Poly(ε-caprolactone)-b-poly(ethylene glycol) (PCL-PEG-MAL): Synthesis, Nanoparticle Formation, and Thiol Conjugation

Carboxylic acid terminated poly(ε-caprolactone)s (PCL-COOHs) with narrow polydispersity were synthesized and coupled with poly(ethylene glycol) (HO-PEG-OH) to afford PCL-PEG-OH copolymers. The hydroxyl groups in the PCL-PEG-OHs were then converted to maleimide groups to afford maleimide terminated PCL-PEG-MALs that contained 70-90% maleimide functionality. Nanoparticles with maleimide functionality on their surfaces were prepared by impingement mixing. Particle sizes and size distributions were determined by dynamic light scattering. Conjugation of reduced glutathione with model maleimides and two MAL-functional nanoparticles was also demonstrated. The amount of accessible maleimide on the particle surface was measured using Ellman's reagent to range between ~51-67%.     

Fast-track knee arthroplasty – status and future challenges

BackgroundFast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee arthroplasty.MethodBoth authors searched the contemporary literature on minimally invasive knee arthroplasty and review articles on fast-track surgery aiming to summarize recent developments.ResultsLength of stay after knee arthroplasty is influenced by preoperative risk factors, anaesthetic and surgical techniques, pain, orthostatic intolerance, cognitive function, sleep disturbances, bleeding and anaemia and finally muscle function and rehabilitation.ConclusionsFast-track surgery reduces the length of stay and the morbidity after knee arthroplasty.Clinical relevanceOptimisation of pre-, per- and postoperative pathway for knee arthroplasty reduces morbidity after this type of surgery and results in shorter length of stay.     

Meningococcal Quadrivalent (Serogroups A, C,W135, and Y) Conjugate Vaccine (Menveo®)

Menveo® is a quadrivalent meningococcal polysaccharide conjugate vaccine containing the four Neisseria meningitidis capsular polysaccharides, A, C, W135, and Y, each conjugated to the mutant diphtheria toxin, known as crossreactive material 197 (CRM₁₉₇). Administration of a single dose of the Menveo® vaccine elicited a strong immune response against all four vaccine serogroups in adolescents and adults in randomized, single- or multicenter, phase II or III trials. In adolescents, Menveo® was generally more immunogenic against vaccine serogroups than the polysaccharide conjugate vaccine Menactra® or the unconjugated polysaccharide vaccine Menomune®, in terms of seroresponse and/or seroprotection rates and geometric mean titers (GMTs) 1 month post-vaccination in two phase II or III studies. In two phase III trials in adults aged 19–55 years, the immunogenicity of Menveo® was generally noninferior or superior to that of Menactra® against all four vaccine serogroups, with regard to seroresponse/seroprotection rates, and GMTs 1 month after vaccination. Moreover, an exploratory arm of one of these studies suggested Menveo® was at least as immunogenic as Menomune® in adults aged 56–65 years. Longer term, the immunogenicity of Menveo® persisted for 12–22 months post-vaccination in the adolescent studies, with the vaccine generally remaining at least as immunogenic as Menactra® or Menomune®. Coadministration of Menveo® with a combined tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine or Tdap and human papillomavirus vaccines generally did not affect the immunogenicity of these vaccines in adolescents and young adults in two additional randomized, single- or multicenter, phase III studies. The tolerability profile of Menveo® was generally similar to that of the comparator vaccines Menactra® or Menomune® in adults and adolescents, and few Menveo® recipients experienced serious adverse events within 30 days or 6 months post-vaccination.     

Synthesis and characterization of injectable, thermosensitive, and biocompatible acellular bone matrix/poly(ethylene glycol)-poly (ε-caprolactone)-poly(ethylene glycol) hydrogel composite

In orthopedic tissue engineering, the extensively applied acellular bone matrix (ABM) can seldom be prefabricated just right to mold the cavity of the diverse defects, might induce severe inflammation on account of the migration of small granules and usually bring the patients great pain in the treatment. In this study, a new injectable thermosensitive ABM/PECE composite with good biocompatibility was designed and prepared by adding the ABM granules into the triblock copolymer poly(ethylene eglycol)-poly(ε-caprolactone)-poly(ethylene eglycol) (PEG-PCL-PEG, PECE). The PECE was synthesized by ring-opening copolymerization and characterized by 1H NMR. The ABM was prepared by acellular treatment of natural bone and ground to fine granules. The obtained ABM/PECE composite showed the most important absorption bands of ABM and PECE copolymer in FT-IR spectroscopy and underwent sol-gel phage transition from solution to nonflowing hydrogel at 37°C. SEM results indicated that the ABM/PECE composite with different ABM contents all presented similar porous 3D structure. ABM/PECE composite presented mild cytotoxicity to rat MSCs in vitro and good biocompatibility in the BALB/c mice subcutis up to 4 weeks. In conclusion, all the results confirmed that the injectable thermosensitive ABM/PECE composite was a promising candidate for orthopedic tissue engineering in a minimally-invasive way.     

Biodegradation, biocompatibility, and drug delivery in poly(ω-pentadecalactone-co-p-dioxanone) copolyesters

Poly(ω-pentadecalactone-co-p-dioxanone) [poly(PDL-co-DO)] copolyesters are copolymers of an isodimorphic system, which remain semicrystalline over the whole range of compositions. Here, we evaluated enzymatically synthesized poly(PDL-co-DO) copolymers as new materials for biomedical applications. In vivo experiments using mice, showed that the copolyesters are well tolerated, with tissue responses that are comparable to poly(p-dioxanone). In addition, the copolymers were found to degrade hydrolytically at controlled rates over a period of several months under physiological conditions. The poly(PDL-co-DO) copolymers with up to 69 mol% DO units were successfully transformed to free-standing nanoparticles that are capable of encapsulating an anticancer drug, doxorubicin, or a polynucleotide, siRNA. Drug- or siRNA-loaded nanoparticles exhibited controlled and continuous release of agent over many weeks. In addition, siLUC-encapsulated poly(PDL-co-DO) nanoparticles were active in inhibiting luciferase gene expression in LUC-RKO cells. Because of substantial differences in structure and hydrophobicity between PDL and DO units, poly(PDL-co-DO) biodegradation rate and physical properties can be tuned over a wide range depending on the copolymer composition. Our results demonstrate that the semicrystalline and biodegradable poly(PDL-co-DO) copolyesters are promising biomaterials to serve as drug carriers, as well as potential raw materials for constructing bioabsorbable sutures and other medical devices.     

Characterization of the hepatic and splenic immune status and immunoglobulin synthesis in aged male mice lacking the peroxisome proliferator-activated receptor-alpha (PPARα)

It is now well established that the nuclear receptor peroxisome proliferator-activated receptor-alpha (PPARα) is expressed in different types of immune cells and plays a pivotal role in the regulation of age-related production of inflammatory cytokines. However, the role(s) of this receptor in the regulation of immune cell homoeostasis in ageing non-lymphoid and lymphoid organs has not yet been resolved. We examine this issue here by evaluating the hepatic and splenic immune status and immunoglobulin (Ig) production in male PPARα-null mice and their wild-type littermates at one and 2 years of age. In comparison with the age-matched control animals, PPARα-null mice exhibited age-related elevations in the numbers of total, as well as of phenotypically distinct subpopulations of intrahepatic immune cells (IHIC) and splenocytes. Moreover, at 2 years of age, these alterations in hepatic immune cells were accompanied by significant increases in hepatic levels of the pro-inflammatory cytokines tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and interferon-gamma (IFN-γ), in combination with the development of hepatic inflammatory loci containing mixtures of leucocytes. Alterations in splenocytes of old PPARα-null mice were also accompanied by increases in cellularity of both white and red pulps of the spleen. Furthermore, these same animals exhibited pronounced increases in the numbers of splenic plasma cells and enhanced production of Ig of different isotypes, including IgG1, IgG2a and IgE. Thus, our findings indicate that upon ageing, PPARα plays a crucial role in regulating the total numbers, compositions and functions of immune cells in both lymphoid and non-lymphoid immune organs of mice.     

Users and non-users of web-based health advice service among Finnish university students – chronic conditions and self-reported health status (a cross-sectional study)

Background

Discrepancies between the conclusions of different meta-analyses (quantitative syntheses of systematic reviews) are often ascribed to methodological differences. The objective of this study was to determine the discordance in interpretations when meta-analysts are presented with identical data.

Methods

We searched the literature for all randomized clinical trials (RCT) and review articles on the efficacy of intravenous magnesium in the early post-myocardial infarction period. We organized the articles chronologically and grouped them in packages. The first package included the first RCT, and a summary of the review articles published prior to first RCT. The second package contained the second and third RCT, a meta-analysis based on the data, and a summary of all review articles published prior to the third RCT. Similar packages were created for the 5^th RCT, 10^th RCT, 20^th RCT and 23^rd RCT (all articles). We presented the packages one at a time to eight different reviewers and asked them to answer three clinical questions after each package based solely on the information provided. The clinical questions included whether 1) they believed magnesium is now proven beneficial, 2) they believed magnesium will eventually be proven to be beneficial, and 3) they would recommend its use at this time.

Results

There was considerable disagreement among the reviewers for each package, and for each question. The discrepancies increased when the heterogeneity of the data increased. In addition, some reviewers became more sceptical of the effectiveness of magnesium over time, and some reviewers became less sceptical.

Conclusion

The interpretation of the results of systematic reviews with meta-analyses includes a subjective component that can lead to discordant conclusions that are independent of the methodology used to obtain or analyse the data.