Struma cordis in young male—a rare entity with excellent prognosis

During embryogenesis, defective movement of thyroid tissue from the floor of the primitive foregut to the pre-tracheal region leads to ectopic thyroid, most commonly found around the course of the thyroglossal duct or sometimes laterally in the neck. Very rarely, ectopic thyroid at distant sites, e.g., in the thorax (mediastinal, lung, heart) or in the abdomen (ovary, adrenal, duodenal, pancreas, and intestine) are reported. Thyroid function in all these cases has been reported to vary from euthyroid, hypothyroid to hyperthyroid. We are here presenting a rare case of ectopic thyroid in the heart (Struma cordis), within the right ventricular cavity attached to the interventricular septum at the right ventricular outflow tract (RVOT), i.e., on the tricuspid valve and adjacent intraventricular septum in a male subject (male to female ratio as M/F 1:6). This case is worth reporting because of the rarity regarding the location, male sex, and the involvement of the tricuspid valve.     

Lymphoplasmacytic lymphoma/Waldenström macroglobulinemia with inv(16)(p13q22) as a sole genetic abnormality

Abnormal expression of bone morphogenic proteins (BMP) has been reported in prostate cancer as compared to benign prostatic tissue. Since aberrations in gene expression often result from alterations in gene copy number, we have investigated this possibility in patients with early prostate cancer. Probes for fluorescence in situ hybridization for the BMP, BMP5, BMP7, and UC28 gene loci were developed and applied to archival sections with areas of adjacent benign epithelium, high-grade prostatic intraepithelial neoplasia, and prostate carcinoma. Two hundred nuclei from each region were evaluated. No deletions of the gene loci examined were observed, but gain of BMP2, BMP5, BMP7, and UC28 occurred in 58, 50, 50, and 67% of tumor foci, respectively. These aberrations in copy number may be caused by early events in tumor development because they were also present in 10-30% of high-grade prostatic intraepithelial hyperplasia foci. In addition, one tumor demonstrated a tandem amplification of the UC28 gene locus. Approximately half of the prostate tumors displayed increased copy numbers of the BMP2, BMP5, BMP7, and UC28 gene loci, which may account for their abnormal gene expression patterns in neoplastic prostate tissue.     

Children's skin conductance level and reactivity: Are these measures stable over time and across tasks?

The stability of children's skin conductance level during baselines (SCL-B) and SCL reactivity (SCL-R) were examined longitudinally. During two laboratory sessions (T1 and T2), 2 years apart, children participated in procedures during which they were exposed to two stressors namely exposure to an audiotaped conflict between two adults, and a problem solving task. Children ranged in age between 6 and 13 years at T1. Measures of SCL-B and SCL-R during the two stressors were obtained. Findings illustrated the temporal stability of SCL-B and SCL-R to the star-tracing task over 2 years. Results also indicated stability in SCL-R to the two stressors (argument and problem-solving) examined within the same session at either T1 or T2. These results support the proposition that SCL-B and SCL-R constitute stable individual differences at the ages examined, and build on the scant longitudinal literature on psychophysiological development in children.     

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available.

Objectives: This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC.

Methods: Data were collected during a workshop at the WONCA East Mediterranean Regional Conference in 2017. Academic family physicians (FP) presented their country, using the WONCA framework of 11 PowerPoint slides with queries of the country demographics, main health challenges, and the position of PHC in the health system.

Results: All six countries have improved the health of their populations, but currently face challenges of non-communicable diseases, aging populations and increasing costs. Main concerns were a lack of trained FPs in community settings, underuse of prevention and of equitable access to care. Countries differed in the extent to which this had resulted in coherent policy.

Conclusion: Priorities were (i) advocacy for community-based PHC to policymakers, including the importance of coordination of healthcare at the community level, and UHC to respond to the needs of populations; (ii) collaboration with universities to include PHC as a core component of every medical curriculum; (iii) collaboration with communities to improve public understanding of PHC; (iv) engagement with the private sector to focus on PHC and UHC.     

Fabrication of hybrid scaffold based on hydroxyapatite-biodegradable nanofibers incorporated with liposomal formulation of BMP-2 peptide for bone tissue engineering

In the present study, we fabricated an efficient, simple biomimetic scaffold to stimulate osteogenic differentiation of mesenchymal stem cells (MSCs). Electrospun poly L-lactic acid nanofibers were employed to mimic the nanofibrillar structure of bone proteins and coated with hydroxyapatite nanoparticles to simulate bone minerals. Thereafter, we regulated the release pattern of BMP-2 peptide through covalent attachment of an optimized liposomal formulation to the scaffold. The fabricated platform provided a sustained release profile of BMP-2 peptide up to 21?days while supporting cellular attachment and proliferation without cytotoxicity. In-vitro results confirmed the superiority of the scaffold containing liposomes through enhancement of growth and differentiation of MSCs. Ectopic bone formation model exhibited significant localized initiation of bone formation of liposome incorporated scaffold. Consequently, these findings demonstrated that our designed platform with modified release properties of BMP-2 peptide considerably promoted osteogenic differentiation of MSCs making it a unique candidate for bone regeneration therapeutics.     

Breastfeeding and Exposure to Past,Current, and Neighborhood Violence

Objectives Breastfeeding has short- and long-term health benefits for children and mothers, but US breastfeeding rates are suboptimal. Exposure to violence may contribute to these low rates, which vary by race/ethnicity. We studied: (1) whether patterns of violence exposure differ by race/ethnicity and (2) whether these patterns are associated with breastfeeding outcomes. Methods We conducted a secondary analysis of data drawn from self-report surveys completed by a convenience sample of low-income postpartum women (n?=?760) in upstate New York. Latent class analysis was used to identify groups of women with similar responses to seven violence measures, including childhood physical and/or sexual violence, experience of partner violence during or just after pregnancy (physical, emotional, verbal), and neighborhood violence (perceived or by ZIP code). Logistic regression and survival analysis were utilized to determine if classes were associated with breastfeeding initiation, duration, and exclusivity, controlling for demographics. Results Exposure to at least one form of violence was high in this sample (87%). We identified 4 classes defined by violence exposure (combining current and historical exposures). Violence exposure patterns differed between racial/ethnic groups, but patterns were inconsistently associated with breastfeeding plans or outcomes. For White women, history of violence exposure increased the likelihood of earlier breastfeeding cessation. By contrast, among Black women, history of violence exposure increased the likelihood of having a breastfeeding plan and initiating breastfeeding. Conclusions for Practice Some differences between violence exposure classes are likely due to the correlation between race/ethnicity and socioeconomic status in the community studied. Additional studies are warranted to better understand how exposure to violence is related to breastfeeding and how best to support women making decisions about intention, initiation, and duration of breastfeeding.     

How do Swedish day center attendees with psychiatric disabilities view their worker role? A structural equation modeling study

Abstract

Aim: To investigate how day center attendees with psychiatric disabilities perceived their worker role and the importance of current work situation and personal factors in that respect.

Methods: Two-hundred attendees completed the Worker Role Self-assessment and questionnaires addressing possible predictors of the worker role: current employment situation, satisfaction with that situation, and a personal factor (encompassing self-esteem, self-mastery and engagement). Structural equation modeling was used.

Results: A model indicated two worker role factors; belief in a future worker role (WR1) and current capacities and routines (WR2). WR1 was positively influenced by having a job, younger age and the personal factor. Satisfaction with current work situation (usually unemployment) was negatively associated with WR1. The personal factor was single predictor of WR2. The attendees rated WR2 more positively than WR1.

Conclusions: The personal factor was crucial for both WR1 and WR2. Work-related factors were only important for WR1. The more negative rating of belief in a future worker role may be interpreted as mistrust in the services. The attendees’ positive ratings of capacities indicate, however, that they had a rehabilitation potential to develop. Enhancing self-esteem, mastery and engagement may be an avenue for staff in efforts to support the attendee’s worker role.     

Augmented reality–assisted craniofacial reconstruction in skull base lesions — an innovative technique for single-step resection and cranioplasty in neurosurgery

Neurosurgical Review - Defects of the cranial vault often require cosmetic reconstruction with patient-specific implants, particularly in cases of craniofacial involvement. However, fabrication...     

A system dynamics model for national drug policy

Background

Data modeling techniques can create a virtual world to analyze decision systems. National drug authorities can use such techniques to take care of their deficiencies in decision making processes. This study was designed to build a system dynamics model to simulate the effects of market mix variables (5 P’s) on the national drug policy (NDP) indicators including availability, affordability, quality, and rationality. This was aimed to investigate how to increase the rationality of decision making, evaluate different alternatives, reduce the costs and identify the system obstacles.System dynamics is a computer-based approach for analyzing and designing complex systems over time. In this study the cognitive casualty map was developed to make a concept about the system then the stock-flow model was set up based on the market demand and supply concept.

Results

The model demonstrates the interdependencies between the NDP variables through four cognitive maps. Some issues in availability, willingness to pay, rational use and quality of medicines are pointed in the model. The stock-flow diagram shows how the demand for a medicine is formed and how it is responded through NDP objectives. The effects of changing variables on the other NDP variables can be studied after running the stock-flow model.

Conclusion

The model can initiate a fundamental structure for analyzing NDP. The conceptual model made a cognitive map to show many causes’ and effects’ trees and reveals some relations between NDP variables that are usually forgotten in the medicines affairs. The model also provides an opportunity to be expanded with more details on a specific disease for better policy making about medication.