Point-of-Care Ultrasound and the Rapid Response System

Over the years, the use of ultrasound has moved solely from the domain of the radiologist to that of the intensivist and emergentologist for use in acute care settings. By virtue of its ease of use and rapid learning curve to proficiency, we are now seeing an increased desire by internists to learn the modality and apply it at the patient's bedside. The rapid response system represents a rational starting point for the introduction of point-of-care ultrasound to the inpatient ward setting.     

Update on Mental Health of Infants and Children of Parents Affected With Mental Health Issues

This paper highlights the most recent publications, in the field of psychiatry, on offspring of patients with psychiatric illnesses such as schizophrenia and bipolar disorder, and then summarizes what we know about the progeny of adults with mood disorders, the most prevalent of parental disorders. Studies examining personality disorders and contextual factors such as stress and trauma are examined with a focus on the crucial question of development and attachment status in children. Findings converge to reveal that offspring of parents (generally mothers) with most major psychiatric disorders present a higher risk for all mental disorders, and a wide range of disorders are also found in children, adolescent, and finally adult offspring of mothers with mood and anxiety disorders. Developmental psychopathology and infant and child psychiatry have focused on early relationship formation through social interaction and attachment patterns as pathways affected by vulnerability or resilience factors. First year of life longitudinal studies following mothers and infants has shown that maternal psychopathology is positively correlated with higher risk of attachment issues. It would seem that pathology appears when adaptation to real-life contexts becomes difficult in association with an accumulation of negative individual characteristics and environmental circumstances. We suggest that in order to move forward psychiatry should embrace a developmental cascade model, which posits a cumulative pathway for the emergence of psychopathology in the developing child. We propose that we have sufficient knowledge today to start implementing multilevel approaches to enhance the health and mental health of the next generation.     

Comparison of Radiocephalic Fistulas Placed in the Proximal Forearm and in the Wrist

Non‐maturation is a common problem in patients receiving an arteriovenous fistula. The first vascular access choice is a distal radiocephalic fistula (dRCF) at the wrist. Patients with a failed dRCF or with vessels unsuitable for dRCF, the recommendation is to place a brachiocephalic fistula in the upper arm. Proximal forearm radiocephalic fistulas (pRCF) are created infrequently, but may permit a second forearm fistula before proceeding to the upper arm. The goal of the present study was to compare the outcomes of them. We retrospectively analyzed a computerized access database to compare the outcomes of 19 RCF and 39 dRCF placed during a 6‐month period. The baseline characteristics were similar, except those with a pRCF were more likely to have previous access and be male. Primary failure (non‐maturation) was lower for pRCF than dRCF (32 vs. 59%, p = 0.05); and excluding secondary failures, cumulative fistula survival was similar (92 vs. 86% at 1 year and 74 vs. 76% at 2 years, p = 0.56). pRCF may be an attractive alternative to a brachiocephalic fistula in patients who cannot receive a dRCF. pRCF has a lower non‐maturation rate than that of a dRCF, and a comparable cumulative survival once it is used successfully for dialysis.     

Registered blindness in Kuwait – 15 years of dynamic changes

Purpose: Incidence rate of registered blindness and low vision (IR) among the Kuwaitis from 2005 to 2014 and longitudinal changes since 2000.

Methods: Data of newly certified Kuwaitis with best-corrected visual acuity 0.1 or less or visual field constriction to 20 ° or less in their better eye, aggregated in intervals from 2005 to 2009 and 2010 to 2014 and presented as IR per 100 000 person years of observation by age, gender, severity and leading cause.

Results: Delayed certification resulted in rise of IR from 2005. IR of males declined since 2010, whereas among the females it continued rising at a slower rate. After 2010 IR of patients from 40 to 59 years expanded significantly and declined in the group over 60 years. Retinitis pigmentosa was the leading cause driven by high prevalence of consanguineous marriages; the large difference between the males and females is due mainly to cultural factors. Diabetic complications escalated from 2005 affecting patients over 40 years. Glaucoma became the leading cause in the age over 60 years after 2005 and while the male patients decreased after 2010 by 18%, disabled females grew by further 35%.

Conclusions: Demographic, social and behavioral factors had impact on the structure and time trends of registered blindness among the Kuwaitis. High prevalence of diabetes and aging of the population resulted in rise of certification from diabetic complications and glaucoma in the last 10 years.     

Breast cancer therapy affects the expression of antineonatal Nav1.5 antibodies in the serum of patients with breast cancer

Neonatal Nav1.5 (nNav1.5) is the alternative splice variant of Nav1.5 and it has been widely associated with the progression of breast cancer. The immunological context of nNav1.5 with respect to breast cancer metastases remains unexplored. The presence of antibodies against nNav1.5 may highlight the immunogenicity of nNav1.5. Hence, the aim of the present study was to detect the presence of antineonatal Nav1.5 antibodies (antinNav1.5-Ab) in the serum of patients with breast cancer and to elucidate the effects of breast cancer therapy on its expression. A total of 32 healthy female volunteers and 64 patients with breast cancer were randomly recruited into the present study as the control and breast cancer group, respectively. Patients with breast cancer were divided equally based on their pre- and ongoing-treatment status. Serum samples were tested with in-house indirect enzyme-linked immunosorbent assay (ELISA) to detect antinNav1.5-Ab, CD25 (T regulatory cell marker) using an ELISA kit and Luminex assay to detect the expression of metastasis-associated cytokines, such as vascular endothelial growth factor (VEGF), interleukin (IL)-6, IL-10, IL-8, chemokine (C-C motif) ligand 2 and tumor necrosis factor-alpha (TNF-α) The mean difference in the expression of antinNav1.5-Ab among the three groups (control, pretreatment and ongoing-treatment) was significant (P=0.0005) and the pretreatment breast cancer group exhibited the highest expression. The concentration of CD25 was highest in the pretreatment breast cancer group compared with the control and ongoing-treatment groups. There was a significant positive correlation between antinNav1.5-Ab and IL-6 in the pretreatment group (r=0.7260; P=0.0210) and a significant negative correlation between antinNav1.5-Ab and VEGF in the ongoing-treatment group (r=−0.842; P-value=0.0040). The high expression of antinNav1.5-Ab in the pretreatment group was in accordance with the uninterrupted presence of metastasis and highlighted the immunogenicity of nNav1.5 whereas the low expression of antinNav1.5-Ab in the ongoing-treatment group reflected the efficacy of breast cancer therapy in eliminating metastases. The augmented manifestation of T regulatory cells in the pretreatment group highlighted the functional role of nNav1.5 in promoting metastasis. The parallel expression of antinNav1.5-Ab with the imbalanced expression of cytokines promoting metastasis (IL-8, IL-6 and TNF-α) and cytokines that prevent metastasis (IL-10) indicated the role of nNav1.5 in breast cancer growth. The expression of antinNav1.5-Ab in accordance to the metastatic microenvironment indicates the immunogenicity of the protein and highlights the influence of breast cancer therapy on its expression level.