Human bio-monitoring study--toxic elements in blood of women

The article describes bio-monitoring study concerning recent and long-term exposure of Czech women to toxic metals. Blood cadmium, mercury and lead levels were measured in groups of women with various life styles, etc., to have comparable results in the course of a long study period; a strong emphasis was laid on the quality control of the whole process during the study. Higher cadmium level was found in smokers compared to non-smokers, lower mercury level was found in the group of women who never eat fish. A slight increase of blood lead level with age was observed. No significant differences were found between localities in a given period. Our results do not differ from those gained in other European countries.     

Acute visual loss after preoperative embolization of an ethmoidal metastasis

An unintentional embolization of retinal arteries is rare and has been documented as a complication after embolization of arteries supplying head and neck tumors. However, occlusion of the central retinal artery with severe loss of vision has never been reported to be a complication from embolization of tumor-supplying ethmoidal branches of the ophthalmic artery. A 40 year-old male patient with a history of right nephrectomy for renal cell carcinoma underwent preoperative radiological embolization of an ethmoidal metastasis after having experienced a life-threatening sinus bleeding. Repeated probing of the ophthalmic artery with an endovascular microcatheter for particle embolization of the tumor-supplying arteries was performed under anticoagulation with heparin. Postoperatively, a standard ophthalmological examination including extended vascular evaluation by angiography was performed. After extended probing of the ophthalmic artery a marked reduction in its blood flow occurred. Despite post-interventional imaging showing persisting perfusion of the central retinal and ciliary arteries, the patient developed complete loss of vision on this side four days later. At this time fundoscopy and fluorescein angiography revealed a recanalized central artery occlusion, while indocyanin angiography showed infarctions of the choroid. Radiological intervention via the ophthalmic artery can result in complete loss of vision, even after limited and transient obstruction of the vessel.     

The incidence of biopsy-proven transformation in follicular lymphoma in the rituximab era. A retrospective analysis from the Czech Lymphoma Study Group (CLSG) database

The aim of this study is to assess the incidence, risk factors, and outcome of biopsy-proven transformation in follicular lymphoma (FL) patients in the rituximab era. Transformation was analyzed in 1233 patients with initially diagnosed FL grades 1–3A, identified between 2002 and 2012 in the prospectively maintained Czech Lymphoma Study Group database. Only patients with histologically proven transformation (HT) were included. HT occurred in 58 cases at a median of 3.0 years from the initial FL diagnosis; the HT rate was 4% at 5 years. Transformation occurred most frequently at the first relapse (84% patients). Median OS from the HT was 2.5 years (95% CI 0.4–4.6) and 6-year OS with HT was shorter compared to all FLs (60 vs. 83.9%; 95% CI). A bulky tumor (≥?10 cm), increased lactate dehydrogenase, age ≥?60 years, and International Prognostic Index (intermediate/high risk), but not Follicular Lymphoma International Prognostic Index, were associated with transformation (p?<?0.05). In the first line, 70% of patients received rituximab (including 36% rituximab maintenance), 57% CHOP-like regimens, and 2.6% of patients were treated with fludarabine-based therapy, whereas 11% of patients were watched only. The patients treated with R-CHOP in the first line (n?=?591) showed the transformation rate at 5 years of 4.23% (95% CI 2.52–5.93); subsequent rituximab maintenance (n?=?276) vs. observation (n?=?153) was associated with a lower transformation rate (p.033; HR 3.29; CI 1.10–9.82). The transformation rate seems to be lower than in previous series, which may be influenced by broad use of rituximab, but prognosis of HT developed during therapy continues to be poor.     

Pressure Ulcers and Malnutrition: Results from a Snapshot Sampling in a University Hospital

Objective

We aimed to ascertain the factors potentially contributing to the manifestation of pressure ulcers (PU) due to poor nutritional status in a nonselected hospitalized population.

Subjects and Methods

This is a prospective cohort study of 471 adult inpatients treated at our university hospital. Study parameters included anthropometric data, demographics, medical history, mood status, diet-related factors and self-perception of health status. For each participant, the body mass index (BMI) was calculated, and a malnutrition universal screening tool (MUST) was used to screen for nutritional deficiencies, with the presence of PU constituting the outcome of interest. An independent-samples t test, χ² analysis and logistic regression analysis were performed.

Results

The overall prevalence of PU in our cohort was 14.2%. Advanced age, low BMI, poor health status by self-assessment, serious mood disorders, malnutrition, abnormal appetite status, a quantity of food intake half of normal, an artificial diet, limited or no autonomy in everyday activities (p < 0.01 for all) and recent weight loss (p < 0.05) were identified as important determinants for the manifestation of PU. Multivariate analysis highlighted limited autonomy in everyday activities (OR 6.456 and 95% CI 3.212-12.973; p = 0.000), MUST score (OR 3.825 and 95% CI 1.730-8.455; p = 0.001) and artificial diet (OR 1.869 and 95% CI 1.247-2.802; p = 0.018) as the most powerful predictors of PU development.

Conclusion

Poor nutritional status, limited autonomy in everyday activities and artificial nutrition seemed to confer noteworthy prognostic value regarding PU development in the acute-care setting.Key Words: Pressure ulcers, Nutritional status, Malnutrition universal screening tool     

Cannabis and Schizophrenia

Background: Many people with schizophrenia smoke cannabis, and it is unclear why a large proportion do so and if the effects are harmful or beneficial. It is also unclear what the best method is to allow people with schizophrenia to alter their cannabis intake. Objectives: To assess the effects of specific psychological treatments for cannabis reduction in people with schizophrenia. To assess the effects of antipsychotics for cannabis reduction in people with schizophrenia. To assess the effects of cannabinoids (cannabis-related chemical compounds derived from cannabis or manufactured) for symptom reduction in people with schizophrenia. Search Methods: We searched the Cochrane Schizophrenia Group Trials Register (August 2013) and all references of articles selected for further relevant trials. We contacted the first author of included studies for unpublished trials or data. Selection Criteria: We included all randomized controlled trials involving cannabinoids and schizophrenia/schizophrenia-like illnesses, which assessed: (1) treatments to reduce cannabis use in people with schizophrenia and (2) the effects of cannabinoids on people with schizophrenia. Conclusions: Results are limited and inconclusive due to the small number and size of randomized controlled trials available and quality of data reporting within these trials. Currently, there is no evidence to demonstrate that one type of adjunct psychological therapy or one type of drug therapy is more effective than another. There is also insufficient evidence to show that cannabidiol has an antipsychotic effect.