Evaluation of alternative diagnostic techniques for diagnosis of cerebral malaria in a tertiary referral hospital in Bangladesh

Five alternative techniques for diagnosis of malaria were evaluated in 124 clinically diagnosed cerebral malaria cases admitted in a tertiary hospital in Bangladesh. Clinical diagnosis of cerebral malaria was done by WHO criteria. The tests were conventional routine malaria microscopy; prolonged microscopy; dipstick antigen capture assay (Para Sight TM-F test); pigments in peripheral leucocytes and routine microscopy repeated at 12 hours interval. First four tests were done at 0 hours of hospital admission and repeat routine microscopy was added at 12 hours interval. Diagnostic capability of the test was 64%, 65%, 69%, 27% and 63% respectively. None of the tests except pigments in peripheral leucocytes was superior at initial evaluation. Only the dipstick test added 5% more diagnostic possibility compared with routine microscopy as standard. Stratification of diagnostic capability in different ways improved diagnosis 15% and 11% in smear negative cases by dipstick and prolonged microscopy respectively. It was increased by 50% (5/10 patients) with dipstick test in the smear negative patients with history of anti-malarials prior to hospital admission.     

The management and clinical knowledge of headache disorders among general practitioners in Norway: a questionnaire survey

BackgroundGeneral practitioners (GPs) diagnose and manage a majority of headache patients seeking health care. With the aim to understand the potential for clinical improvement and educational needs, we performed a study to investigate Norwegian GPs knowledge about headache and its clinical management.MethodsWe invited GPs from a random sample of 130 Norwegian continuous medical education (CME) groups to respond to an anonymous questionnaire survey.Results367 GPs responded to the survey (73% of invited CME groups, 7.6% of all GPs in Norway). Mean age was 46 (SD 11) years, with an average of 18 (SD 10) years of clinical experience. In general the national treatment recommendations were followed, while the International Classification of Headache Disorders and other international guidelines were rarely used. Overall, 80% (n = 292) of the GPs suggested adequate prophylactic medication for frequent episodic migraine, while 28% (n = 101) suggested adequate prophylactic medication for chronic tension-type headache (CTTH). Half (52%, n = 191)) of the respondents were aware that different types of acute headache medication can lead to medication-overuse headache (MOH), and 59% (n = 217) knew that prophylactic headache medication does not lead to MOH. GPs often used MRI in the diagnostic work-up. GPs reported that lack of good treatment options was a main barrier to more optimized treatment of headache patients.ConclusionThe knowledge of management of CTTH and MOH was moderate compared to migraine among Norwegian GPs.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-021-01350-3.     

Nanocellulose: a bioadsorbent for chemical contaminant remediation

Chemical contaminants such as heavy metals, dyes, and organic oils seriously affect the environment and threaten human health. About 2 million tons of waste is released every day into the water system. Heavy metals are the largest contributor which cover about 31% of the total composition of water contaminants. Every day, approximately 14 000 people die due to environmental exposure to selected chemicals. Removal of these contaminants down to safe levels is expensive, high energy and unsustainable by current approaches such as oxidation, biodegradation, photocatalysis, precipitation, reverse osmosis and adsorption. A combination of biosorption and nanotechnology offers a new way to remediate these chemical contaminants. Nanostructured materials are proven to have higher adsorption capacities than the same material in its larger-scale form. Nanocellulose is very promising as a high-performance bioadsorbent due to its interesting characteristics of high adsorption capacity, high mechanical strength, hydrophilic surface chemistry, renewability and biodegradability. It has been proven to have higher adsorption capacity and better binding affinity than other similar materials at the macroscale. The high specific surface area and abundance of hydroxyl groups within lead to the possible functionalization of this material for decontamination purposes. Several research papers have shown the effectiveness of nanocellulose in the remediation of chemical contaminants. This review aims to provide an overview of the most recent developments regarding nanocellulose as an adsorbent for chemical contamination remediation. Recent advancements regarding the modification of nanocellulose to enhance its adsorption efficiency towards heavy metals, dyes and organic oils were highlighted. Moreover, the desorption capability and environmental issue related to every developed nanocellulose-based adsorbent were also tackled.

The adsorption and desorption of contaminants by nanocellulose.     

Biofeedback in patients with ileoanal pouch dysfunction: a specialist centre experience

Objectives: To report outcomes following biofeedback for functional problems associated with an ileoanal pouch. Incontinence and evacuatory disorders associated with the ileoanal pouch can be particularly problematic and difficult to treat using conventional therapies. Biofeedback therapy is a behavioural treatment that offers a non-surgical approach as an alternative or adjunct for patients.

Materials and methods: This was a retrospective single centre study. We reviewed the notes of all patients attending for biofeedback at our institution between January 2012 and October 2017 and identified all those that did so for ileoanal pouch related problems. We recorded patient reported subjective improvements following biofeedback. The validated International Consultation on Incontinence Questionnaire was used to assess improvement in incontinent symptoms and the evacuatory disorder questionnaire was used to assess improvement in evacuatory disorders.

Results: Twenty-six patients with ileoanal pouch related problems underwent biofeedback. Based on patients’ feedback at next clinical encounter following biofeedback, nine reported much improvement, 11 reported some improvement and six reported no improvement. In the group treated for incontinence, quality of life improved significantly from a median pre-treatment score of 80 to a post-treatment score of 41 (p?=?.01). Biofeedback reduced pain, bloating straining and laxative use in patients with evacuatory disorders.

Conclusions: Biofeedback may be associated with significant improvement in quality of life as well as possible improvements in symptoms related to both incontinence and evacuatory disorders. It is probably an underused service. Further larger prospective studies are required to properly assess the efficacy of biofeedback in ileoanal pouch related dysfunction.     

Stroke incidence in the young: evidence from a Norwegian register study

Journal of Neurology - While there is a general agreement that stroke incidence among the elderly is declining in the developed world, there is a concern that it may be increasing among the young....