Iron regulation by hepcidin

Hepcidin is a key hormone that is involved in the control of iron homeostasis in the body. Physiologically, hepcidin is controlled by iron stores, inflammation, hypoxia, and erythropoiesis. The regulation of hepcidin expression by iron is a complex process that requires the coordination of multiple proteins, including hemojuvelin, bone morphogenetic protein 6 (BMP6), hereditary hemochromatosis protein, transferrin receptor 2, matriptase-2, neogenin, BMP receptors, and transferrin. Misregulation of hepcidin is found in many disease states, such as the anemia of chronic disease, iron refractory iron deficiency anemia, cancer, hereditary hemochromatosis, and ineffective erythropoiesis, such as β-thalassemia. Thus, the regulation of hepcidin is the subject of interest for the amelioration of the detrimental effects of either iron deficiency or overload.     

Development and reliability of a Motivational Interviewing Scenarios Tool for Eating Disorders (MIST-ED) using a skills-based intervention among caregivers

The aims of this study were to develop an eating disorder scenarios tool to assess the motivational interviewing (MI) skills of caregivers and evaluate the coding reliability of the instrument, and to test the sensitivity to change through a pre/post/follow-up design. The resulting Motivational Interview Scenarios Tool for Eating Disorders (MIST-ED) was administered to caregivers (n = 66) who were asked to provide oral and written responses before and after a skills-based intervention, and at a 3-month follow-up. Raters achieved excellent inter-rater reliability (intra-class correlations of 91.8% on MI adherent and 86.1% for MI non-adherent statements for written scenarios and 89.2%, and 85.3% for oral scenarios). Following the intervention, MI adherent statements increased (baseline = 9.4%, post = 61.5% and follow-up 47.2%) and non-MI adherent statements decreased (baseline = 90.6%, post = 38.5% and follow-up = 52.8%). This instrument can be used as a simple method to measure the acquisition of MI skills to improve coping and both response methods are adequate. The tool shows good sensitivity to improved skills.     

Postoperative management

The outpatient model for elective hemorrhoidectomy has become firmly established, however postoperative ambulatory management continues to be challenging, and scientific evidence guiding decision making remains limited. Several good analgesic options exist, including NSAIDS, long-acting local anesthesia, and opioids, and there is evidence available to suggest that combination therapy, incorporating two or more of these agents together, results in more effective symptom relief. Strong evidence also exists that judicious use of operative intravenous fluids is capable of reducing urinary retention, a commonly encountered postoperative difficulty. Other adjuvant modalities, including topical antibiotics and ointments, remain available with some evidence to support their use; however, overall popularity remains limited.     

Pain,Psychosocial, Sexual,and Psychophysical Characteristics of Women with Primary vs. Secondary Provoked Vestibulodynia

IntroductionWomen with provoked vestibulodynia (PVD), a common cause of dyspareunia, are typically considered a homogeneous group. However, research suggests that differences on some factors (e.g., medical history, pain characteristics, psychological functioning, treatment response) exist based upon whether the pain was present at first intercourse (primary PVD: PVD1) or developed at some later point (secondary PVD: PVD2).AimsThe purpose of this study was to examine differences in demographic variables, pain characteristics, psychosocial and psychosexual adjustment, and pain sensitivity between women with PVD1 and PVD2.MethodsTwenty-six women suffering from PVD (13 with PVD1 and 13 with PVD2) completed a screening assessment, a standardized gynecological examination, an interview, questionnaires, and a quantitative sensory testing session.Main Outcome MeasuresThese included pain ratings during the gynecological examination and interview, scores on measures of psychosocial/sexual functioning (e.g., Short Form-36 [SF-36] Health Survey, Female Sexual Function Index), and thresholds and pain ratings during thermal sensory testing over the dominant forearm and vulvar vestibule.ResultsThe women with PVD1 were more likely to be nulliparous, but they were not significantly different from the women with PVD2 on other demographic variables or in their pain ratings during the gynecological examination. The women with PVD1 reported lower levels of social and emotional functioning and heightened anxiety surrounding body exposure during sexual activity, and they also displayed lower heat pain tolerance over the forearm and lower heat detection and pain thresholds at the vulvar vestibule than the women with PVD2.ConclusionsThe findings from this study support previous research indicating that women with PVD1 and PVD2 differ in a number of domains. Further research is needed to confirm and elaborate on these findings. Sutton KS, Pukall C, and Chamberlain S. Pain, psychosocial, sexual, and psychophysical characteristics of women with primary vs. secondary provoked vestibulodynia.     

The 4‐mg intravenous dexamethasone suppression test in the diagnosis of Cushing’s syndrome

Objective Optimal diagnostic criteria for the 4‐mg intravenous dexamethasone suppression test (IVDST) in patients with Cushing’s syndrome (CS), compared with normal subjects, have not been established. We evaluated the performance of the 4‐mg IVDST for differentiating CS from normal subjects and to define the responses in CS of various aetiologies. Design, subjects, measurements Thirty‐two control subjects [normal and overweight/obese participants with or without type 2 diabetes) were prospectively studied, and data from 66 patients with Cushing’s disease (CD), three with ectopic ACTH syndrome (EAS), 14 with adrenal Cushing’s (AC)] and 15 with low probability of CS (LPC) from three tertiary hospitals were retrospectively evaluated. Dexamethasone was infused at 1 mg/h for 4 h. Plasma cortisol and ACTH were measured at ?60 min (baseline), ?5 min, +3 h, +4 h, +5 h and at +23 and +23·5 h on Day 2. Results Control subjects (including those with type 2 diabetes) exhibited a marked suppression of cortisol which was maintained until Day 2. Two of 15 patients with LPC had Day 2 cortisol results that overlapped with CS. Patients with CD demonstrated partial suppression, with rebound hypercortisolism on Day 2. Patients with AC and EAS did not suppress cortisol levels. Day 2 cortisol level of >130 nmol/l (or >20% of the baseline) diagnosed CS with 100% sensitivity and 96% specificity. Conclusion While the IVDST allowed complete discrimination between control subjects and CS, 13% of LPC overlapped with CS. Given the small number of EAS, no conclusion can be drawn regarding the utility of this test in the differential diagnosis of CS.     

The experience of being 30–45 years of age and depending on haemodialysis treatment: a phenomenological study

Scand J Caring Sci; 2010; 24; 693–699
The experience of being 30–45 years of age and depending on haemodialysis treatment: a phenomenological study The aim of this study was to describe how haemodialysis (HD) patients, between 30 and 45 years of age, experience their dependence on HD treatment. Nine patients undergoing HD treatment were interviewed. The transcribed texts were analysed according to Giorgi′s four basic principles. Being between 30 and 45 years of age and needing HD treatment meant experiencing a total lack of freedom, which was illuminated through the sub‐themes: a sense of fear, dependency on caregivers, time lost in dialysis, feelings of loneliness and the stress of being on the waiting list for a new kidney. The participants felt that being dependent on HD treatment was ‘not a real life’ and that they were experiencing a double life of sorts: the life of dialysis versus their ordinary life outside treatment. The dependency on HD treatment was also expressed as a feeling that life ‘stood still.’ The results also indicate that the participants expected to encounter competent healthcare professionals, and they emphasised the importance of providing support for younger HD patients by focusing on their ability to cope with their life situation.