Relative lung deposition of salbutamol following inhalation from a spacer and a Sidestream jet nebulizer following an acute exacerbation

Background

Studies comparing inhalation methods in acute exacerbations have not assessed lung deposition.

Methods

Five 100-μg salbutamol doses were inhaled from a metered dose inhaler plus spacer (MDI + SP) and 5 mg was nebulized (NEB) following acute exacerbation hospitalization. Urinary salbutamol excretion was determined at 30 min (USAL0.5) and over 24 h (USAL24) postinhalation together with forced expiratory volume in 1 s (FEV₁).

Results

The USAL0.5 mean ratio (90% confidence interval) post MDI + SP and NEB [n = 19 asthma, 11 chronic obstructive pulmonary disease (COPD)] was 1.01 (0.81, 1.26). USAL24 was less (P < 0.001) following MDI + SP, whereas FEV₁ was similar. Only a small difference between asthmatics and COPD patients was observed for the MDI + SP in that the USAL0.5 was higher in the asthmatics for the spacer method.

Conclusion

The relative lung deposition after inhaling 500 μg salbutamol from MDI + SP is similar to 5 mg from a Sidestream nebulizer following an acute exacerbation.

What is already known about this subject

• Studies have shown that a large volume spacer attached to a metered dose inhaler provides similar bronchodilator effects to nebulized dosing during the management of patients following an acute exacerbation.
• Due to the high doses used, these effects could be measured at the top of the dose–response relationship and the response limited due to the patient''s exacerbation.
• Although clinical end-points are the gold standard to show comparability, some indication of similar lung deposition is useful to consolidate any claims.

What this study adds

• The urinary pharmacokinetic method we have used postinhalation provides an index of lung deposition for inhalation methods that can be incorporated into the routine management of patients with an acute exacerbation.
• This is the first study to identify and compare lung deposition and systemic delivery for inhalation methods within the setting of the routine management of asthma and chronic obstructive pulmonary disease patients following hospitalization due to an acute exacerbation.
• The study highlights the comparability of the doses for the two inhalation methods evaluated with respect to lung deposition, systemic delivery and bronchodilator response.

     

An effective method for videorecording the nasal–dorsal part of a rhinoplasty – a multiple case study

Rhinoplasty is a difficult procedure to record for several reasons which include the narrow, dark and deep surgical field cluttered with many instruments, and the heads and hands of the surgical team often blocking the view. This study discusses 13 rhinoplasty cases that were recorded using the authors’ technique. A three-minute, unedited segment was extracted from the mid-portion of each surgical case, and that footage was evaluated by three specialist examiners. Results indicate that the authors’ technique can offer a effective solution in the video recording of the nasal–dorsal part of a rhinoplasty.     

Real-time Medical Emergency Response System: Exploiting IoT and Big Data for Public Health

Healthy people are important for any nation’s development. Use of the Internet of Things (IoT)-based body area networks (BANs) is increasing for continuous monitoring and medical healthcare in order to perform real-time actions in case of emergencies. However, in the case of monitoring the health of all citizens or people in a country, the millions of sensors attached to human bodies generate massive volume of heterogeneous data, called “Big Data.” Processing Big Data and performing real-time actions in critical situations is a challenging task. Therefore, in order to address such issues, we propose a Real-time Medical Emergency Response System that involves IoT-based medical sensors deployed on the human body. Moreover, the proposed system consists of the data analysis building, called “Intelligent Building,” depicted by the proposed layered architecture and implementation model, and it is responsible for analysis and decision-making. The data collected from millions of body-attached sensors is forwarded to Intelligent Building for processing and for performing necessary actions using various units such as collection, Hadoop Processing (HPU), and analysis and decision. The feasibility and efficiency of the proposed system are evaluated by implementing the system on Hadoop using an UBUNTU 14.04 LTS coreTMi5 machine. Various medical sensory datasets and real-time network traffic are considered for evaluating the efficiency of the system. The results show that the proposed system has the capability of efficiently processing WBAN sensory data from millions of users in order to perform real-time responses in case of emergencies.     

Knowledge and Attitudes of Saudi Dental Undergraduates on Oral Cancer

Oral cancer awareness among future dental practitioners may have an impact on the early detection and prevention of oral cancer. A cross-sectional survey was undertaken to assess the current knowledge of future Saudi dentists on oral cancer and their opinions on oral cancer prevention. A pretested questionnaire was sent to 550 undergraduate dental students in the fourth, fifth, and sixth year of the Al-Farabi College for Dentistry and Nursing, Riyadh, Saudi Arabia. Questions relating to knowledge of oral cancer, risk factors, and opinions on oral cancer prevention and practices were posed. Four hundred seventy-nine students returned the questionnaire (87.1 %). Eighty-one percent of respondents correctly answered questions relating to oral cancer awareness. Eighty-seven percent of respondents felt confident in performing a systematic oral examination to detect changes consistent with oral malignancy. Interestingly, 57 % of respondents had seen the use of oral cancer diagnostics aids. Thirty-seven percent of respondents felt inadequately trained to provide tobacco and alcohol cessation advice. There is a need to reinforce the undergraduate dental curriculum with regards to oral cancer education; particularly in its prevention and early detection. Incorporating the use of oral cancer diagnostic aids should be made mandatory.     

Laser speckle imaging in the spatial frequency domain

Laser Speckle Imaging (LSI) images interference patterns produced by coherent addition of scattered laser light to map subsurface tissue perfusion. However, the effect of longer path length photons is typically unknown and poses a limitation towards absolute quantification. In this work, LSI is integrated with spatial frequency domain imaging (SFDI) to suppress multiple scattering and absorption effects. First, depth sensitive speckle contrast is shown in phantoms by separating a deep source (4 mm) from a shallow source (2 mm) of speckle contrast by using a high spatial frequency of illumination (0.24 mm(-1)). We develop an SFD adapted correlation diffusion model and show that with high frequency (0.24 mm(-1)) illumination, doubling of absorption contrast results in only a 1% change in speckle contrast versus 25% change using a planar unmodulated (0 mm(-1)) illumination. Similar absorption change is mimicked in vivo imaging a finger occlusion and the relative speckle contrast change from baseline is 10% at 0.26 mm(-1) versus 60% at 0 mm(-1) during a finger occlusion. These results underscore the importance of path length and optical properties in determining speckle contrast. They provide an integrated approach for simultaneous mapping of blood flow (speckle contrast) and oxygenation (optical properties) which can be used to inform tissue metabolism.     

Thiazolides as novel antiviral agents. 2. Inhibition of hepatitis C virus replication

We report the activities of a number of thiazolides [2-hydroxyaroyl-N-(thiazol-2-yl)amides] against hepatitis C virus (HCV) genotypes IA and IB, using replicon assays. The structure-activity relationships (SARs) of thiazolides against HCV are less predictable than against hepatitis B virus (HBV), though an electron-withdrawing group at C(5') generally correlates with potency. Among the related salicyloylanilides, the m-fluorophenyl analogue was most promising; niclosamide and close analogues suffered from very low solubility and bioavailability. Nitazoxanide (NTZ) 1 has performed well in clinical trials against HCV. We show here that the 5'-Cl analogue 4 has closely comparable in vitro activity and a good cell safety index. By use of support vector analysis, a quantitative structure-activity relationship (QSAR) model was obtained, showing good predictive models for cell safety. We conclude by updating the mode of action of the thiazolides and explain the candidate selection that has led to compound 4 entering preclinical development.     

Assessment of therapeutic response in patients with brain abscess using diffusion tensor imaging

BackgroundAccurate assessment of therapeutic response in patients with brain abscess (BA) is essential to direct appropriate therapy. This study was performed with an aim to see the treatment-induced changes in diffusion tensor imaging (DTI) indices (ie, fractional anisotropy [FA] and mean diffusivity [MD]) in follow-up patients with BA after treatment.MethodsTwenty patients with BA were prospectively studied in this study. Diffusion tensor imaging in first follow-up was done in all after 1 week and in 6 at 4 weeks of the initial study.ResultsThe mean FA and MD values in first, second, and third studies were 0.28 ± 0.03 and (0.81 ± 0.07) × 10^?3 mm²/s, 0.18 ± 0.09 and (1.08 ± 0.09) × 10^?3 mm²/s, and 0.13 ± 0.04 and (0.99 ± 0.13) × 10^?3 mm²/s, respectively. The FA value was significantly (P < .01) decreased along with no significant change in MD value (P = .08) for 3 study periods. The mean volume (in milliliter) of the abscesses was 2.14 ± 1.04, 1.34 ± 0.45, and 0.77 ± 0.14 in first, second, and third studies, respectively.ConclusionsWe conclude that the reduction in FA value reflects the down-regulation of the neuroinflammatory molecules in response to treatment in patient with BA and may be used to assess therapeutic response in these patients in future.     

Laparoscopic Nephrectomy in Patients Undergoing Hemodialysis Treatment

Background and Objectives:

To report our experience with laparoscopic nephrectomy (LN) in patients undergoing hemodialysis compared with normal counterparts.

Methods:

Seventeen patients (20 renal units, Group 1) undergoing hemodialysis underwent LN, which was indicated due to nonfunctioning kidney in 17 and suspected malignancy in 3 renal units. Radical nephrectomy (RN), simple nephrectomy (SN), and simple nephroureterectomy (SNU) were performed in 3, 9, and 8 cases, respectively. For comparison, 101 patients (Group 2) without CRF (chronic renal failure) who had undergone LN were evaluated. In this group, RN, SN, SNU and radical nephroureterectomy (RNU) were performed in 48, 41, 8, and 4 patients, respectively.

Results:

The mean age (36.9±13.1 vs. 48.7±19.4yr, P=0.002) and BMI (22.1±4.8 vs. 26.2±5.1kg/m², P=0.001) were lower in Group 1, whereas ASA (physical status score of American Society of Anesthesiologists) score (2.8±0.4 vs. 1.5±0.7, P<0.001) was lower in Group 2. The estimated blood loss (111±114 vs. 184±335mL, P=0.34) was higher in Group 2. Both groups were comparable in regard to mean operative time (133±79 vs. 119±45, P=0.70), hematocrit drop (4.69±3.9 vs. 3.86±3.0, P=0.29) and hospital stay (3.6±3.3 vs. 3.3±2.4 days, P=0.34). Meanwhile, when only patients undergoing SN and SNU in the study cohort (n=17 in Group 1 and n=49 in Group 2) are taken into consideration, no significant difference was observed between the 2 groups in terms of any kind of above-mentioned perioperative parameters. No case in Group 1 was converted to open surgery due to metabolic problems.

Conclusions:

LN in patients undergoing hemodialysis may be performed safely by an experienced laparoscopy team.     

Central pontine myelinolysis after orthotopic liver transplant-a rare complication

Central pontine myelinolysis is a rare but devastating cause of morbidity and mortality after orthotopic liver transplant. The exact cause of central pontine myelinolysis is uncertain. However, rapid correction of hyponatremia has been described as a major factor. We describe a patient with central pontine myelinolysis after orthotopic liver transplant in the absence of significant hyponatremia. Although rapid correction of hypernatremia has been reported in association with central pontine myelinolysis, to our knowledge, in this case, where the serum sodium went from normal to hypernatremic, later diagnosis of central pontine myelinolysis in a postliver transplant setting is unique. We also discuss factors that may contribute to the development of central pontine myelinolysis after orthotopic liver transplant and its pathophysiology.