Management of tandem occlusions in patients who receive rtPA

Journal of Thrombosis and Thrombolysis - Tandem occlusions exist in 17–32% of large vessel occlusion (LVO) strokes. A significant concern is bleeding when carotid stenting is performed in...     

T-cell characterization in chronic allergic eye disease

Chronic allergic eye disease encompasses several disorders, but it is vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) that have sight-threatening sequelae. T cells, eosinophils, and mast cells are all found in the conjunctiva, and are thought to play a role in disease pathogenesis. Recently, the conjunctival epithelium has also been considered to play a key role. New and effective therapeutic strategies for the future for these patients depend on achieving a greater understanding of the roles and interactions of the cell populations in these sight-threatening disorders.     

Congenital arteriovenous fistula between an intercostal artery and the left brachiocephalic vein

Congenital arteriovenous fistulas between the thoracic arteries and the systemic veins are rare, and in clinical terms may mimic patency of the arterial duct. We present a neonate with a large arteriovenous fistula between the left sixth intercostal artery and the left brachiocephalic vein, to the best of our knowledge a unique site of drainage. To our knowledge, ours is also the earliest presentation and treatment of a thoracic arteriovenous fistula.     

Cutaneous reactions due to diltiazem and cross reactivity with other calcium channel blockers

BackgroundThe spectrum of cutaneous eruptions in association with calcium channel blockers is extensive, varying from exanthemas to severe adverse events. Reactions due to diltiazem occur more frequently than with other calcium channel blockers. Patch testing has been used as confirmatory testing in patients with extensive cutaneous reactions. Cross-reactivity among these drugs have not been established.MaterialWe present 3 patients: 1) A 54-year-old man developed a generalized eythema-multiformelike reaction followed by erythrodermia and exfoliative dermatitis 6-7 days after starting on diltiazem. The drug was stopped and remission was obtained with emollients and systemic corticosteroids and antihistamines within 12 days. 2) A 80-year-old woman experienced a pruritic exanthematous eruption on her trunk which evolved to generalized erythrodermia and superficial desquamation. This reaction appeared 10 days after taking diltiazem, and gradually improved in 10-12 days after discontinuation of this drug.3) A 79-year-old man presented with erythema and pruritus initially on the back, and then affecting thorax, extremities and face. He had started treatment with diltiazem three days before. Diltiazem was stopped and steroid and antihistamine therapy was given. His skin condition improved, but 3 days later the patient received verapamil with worsening of previous situation. He recovered within 7 days.Methods and resultsTwo to six months after the reaction, we carried out epicutaneous tests with calcium channel blockers from different groups. Diltiazem proved positive (at 48 and 96 hours) in the three patients; nifedipine was also positive in patient 2, and verapamil in patient 3. Controlled administration of verapamil was well tolerated in patient 2 after the reaction, and the patient 1 has taken nifedipine without problems.Conclusions1) We report 3 cases of cutaneous reactions due to diltiazem. 2) Epicutaneous tests have been useful for diagnosis. 3) As one of patients had positive patch tests to diltiazem and nifedipine, and other one with diltiazem and verapamil, more studies are needed to demonstrate cross reactions among calcium channel blockers.     

Failure of endoscopic therapy in upper gastrointestinal hemorrhage due to duodenal ulcers.

OBJECTIVES: to evaluate the efficacy of endoscopic treatment in patients with upper gastrointestinal (UGIH) due to duodenal ulcer with high risk of persistent or recurrent bleeding and to determine the associated failure factors of this procedure. PATIENTS AND METHOD: three hundred and thirty-six patients with UGIH due to duodenal ulcer requiring endoscopic treatment were analyzed between January 1992 and December 2001. The patients were classified according to the endoscopic findings: a) patients with limited bleeding; and b) patients with persistent and/or recurrent bleeding due to therapeutic failure. The clinical guidelines followed in patients with endoscopic treatment failure were previously established in the internal protocol. The variables that obtained statistical significance in the univariate analysis were included in the logistic regression model to identify those with an independent predictive value for failure of the endoscopic treatment. RESULTS: mean age of the patients was 60 +/- 17 years, 271 (81%) were male. Bleeding with severe hemodynamic affectation was detected in 82 patients (24%). The most common location of the duodenal ulcer was on the anterosuperior part of the duodenal bulb (227 patients, 68%). In 43 patients (13%) the ulcer was larger than 2 cm. The bleeding stigmata were classified as: Forrest I in 125 (38%) and Forrest II in 211 (62%). It was initially reached in 297 patients (88%). Twenty-two patients required emergency surgery (6,5%) and the global mortality rate was 3%. Severe hemodynamic affectation at admission (OR 11.8, p>0.001), ulcers exceeding 2 cm (OR 6.95, p = 0.019) and the presence of active bleeding during endoscopy (Forrest I) (OR 3.55, p = 0.08) were the variables included in the multivariate analysis independently associated to endoscopic therapy failure. CONCLUSION: endoscopic therapy is an efficient treatment of upper gastrointestinal bleeding due to duodenal ulcer. By means of a clinical variable, the hemodynamic status and two endoscopies, bleeding stigmata and the size of the ulcer, a group of patients with high risk of endoscopic treatment failure can be selected.     

An insight into recent consanguinity within the Basque area in Spain. Effects of autochthony,industrialization and demographic changes

Background: The importance of studying the genetic kinship of those human groups characterized by a deeply rooted ethnicity has traditionally been and still is an interesting goal of anthropological and population genetic studies. However, only a few surveys have aimed to learn about the impact of industrial development on the consanguinity of these populations and even those have concentrated on industrialized regions. This approach is worth analysing in Spain, where industrialization was late in relation to other western European countries.

Aim: In this work we analyse the characteristics of inbreeding in Guipúzcoa from 1951 to 1995. This Basque province underwent industrial and tourist development earlier than other Spanish regions. It has the highest density of Basque speakers and has always occupied a central position within the map of distribution of the Basque language. Guipúzcoa is geographically placed in the core of the Basque area.

Subjects and methods: Data on consanguineous marriages recorded in the province of Guipúzcoa between 1951 and 1995 were taken from Roman Catholic dispensations stored in the Diocesan Archives of San Sebastián, the province's capital city. Over the whole time period, a total of 1152 consanguineous marriages were registered.

Results: The high frequencies of first cousin (M22) (F = 1/16) and uncle-niece/aunt-nephew (M12) (F = 1/8) consanguineous marriages distinguish Guipúzcoa from the rest of Iberian populations. The M22/M33 ratio (with M33 being second cousins) has never dropped below 0.67, which represents a significant deviation from the expectation value of 0.25. When consanguineous marriages are classified according to marriage partner birthplaces interesting results emerge. Provincial endogamy shows the highest consanguinity rates (57%) and the proportion of M22/M33 is also rather high (0.63). However, a major contribution to the consanguinity levels and mean inbreeding coefficient recorded in Guipúzcoa over recent decades has been made by immigrant relative groups coming from other geographical areas of Spain. In this segment of population the observed M22/M33 rates are 1.44.

Conclusions: This study shows again how important preferentiality (or avoidance) is in human consanguinity, and also how human groups, in spite of being spatially settled in the same territory, present differential attitudes for given consanguinity patterns.

Hintergrund: Die Analyse genetischer Verwandtschaftsgrade zwischen jenen menschlichen Gruppen, welche ethnisch tief verwurzelt sind, ist traditionell und noch heute ein interessantes Ziel anthropologischer und populationsgenetischer Studien Allerdings haben nur einige Studien darauf abgezielt, die Auswirkung der industriellen Entwicklung auf die Verwandtschaft dieser Populationen zu untersuchen und selbst diese haben sich auf industrialisierte Regionen konzentriert. Es lohnt sich, dies am Beispiel Spaniens zu untersuchen, wo die Industrialisierung im Vergleich zu anderen westeuropäischen Ländern spät stattgefunden hat. Ziel: In dieser Arbeit werden die Charakteristiken von Consangunität in Guipúzcoa von 1951 bis 1995 analysiert. In dieser baskischen Provinz fand die industrielle und touristische Entwicklung früher als in anderen spanischen Regionen statt. Diese Provinz hat die höchste Konzentration von Angehörigen der baskischen Sprachgruppe und hat immer eine zentrale Stellung innerhalb der Verteilung der baskischen Sprache eingenommen. Guipúzcoa befindet sich geographisch im Kern des Baskenlandes. Material und Methoden: Die dieser Arbeit zugrunde liegenden Daten bezüglich von Ehen zwischen Blutsverwandten, welche in der Provinz von Guipúzcoa zwischen 1951 und 1995 geschlossen wurden, stammen aus den römisch-katholischen Archiven der Diözese von San Sebastián, der Provinzhauptstadt. In diesem gesamten Zeitraum wurden insgesamt 1152 Verwandtenehen registriert. Ergebnisse: Die große Häufigkeiten von Verwandtenehen zwischen ersten Cousins (M22) (F = 1/16) und Onkel-Nichte/Tante-Neffe (M12) (F = 1/8) unterscheiden Guipúzcoa vom Rest der iberischen Population. Das Verhältnis M22/M33 (wobei M33 der zweite Cousin ist) liegt nie unter 0,67. Dies stellt eine deutliche Abweichung vom Erwartungswert von 0,25 dar. Wenn Verwandtenehen entsprechend den Geburtsorten der Ehepartner eingestuft werden, zeigen sich interessante Resultate. Bei provinzieller Endogamie ist die Verwandtschaftsrate am höchsten (57%) und der Anteil M22/M33 ist auch ziemlich hoch (0,63). Die Verwandtschaftsrate und der mittlere Consangunitäts-Koeffizienten, welcher in Guipúzcoa in den letzten Jahrzehnten registriert wurde, wird jedoch wesentlich von Verwandtengruppen, welche aus anderen Regionen Spaniens eingewandert sind, bestimmt. In dieser Bevölkerungsgruppe beträgt die M22/M33-Rate 1,44. Schlußfolgerungen: Diese Studie zeigt wieder, wie wichtig Sympathien (oder Antipathien) in der chlichen Verwandtschaft sind, und auch, wie menschliche Gruppen trotz räumlicher Trennung innerhalb eines Landes, unterschiedliche Einstellungen zu existierenden Verwandtschaftsbeziehungen haben.

Arrière-plan: l'étude de la consanguinité des groupes humains caractérisés par une identité ethnique anciennement formée, est une vocation traditionnelle mais toujours valide de l'anthropobiologie et de la génétique des populations. Cependant, peu de travaux ont cherché à évaluer l'impact du développement industriel sur la consanguinité de telles populations. Cette approche vaut la peine d'être analysée en Espagne, où l'industrialisation s'est produite tardivement par rapport aux autres nations ouest-européennes. But: ce travail étudie les caractéristiques de la consanguinité en Guipúzcoa de 1951 à 1995. Cette province basque a connu un développement touristique et industriel antérieurement aux autres régions espagnoles. Elle a la plus forte densité de locuteurs basques et a toujours occupé une position centrale dans la carte de répartition de la langue basque. La Guipúzcoa est au cur géographique de l'aire basque. Sujets et méthodes: pour l'ensemble de la période étudiée (1951 à 1995), on a relevé les données de 1152 mariages consanguins dans les archives des dispenses de mariage de l'église Catholique Romaine, conservées dans les Archives Diocésaines de Saint Sébastien, la capitale de la province. Résultats: les fréquences élevées de mariage consanguins entre cousins germains (M22) (F = 1/16) et oncle-nièce/tante-neveu (M12) (F = 1/8), distinguent la Guipúzcoa des autres populations ibériques. Le rapport M22/M33 (M33 étant les cousins issus de germains) n'est jamais tombé au-dessous de 0,67, ce qui représente une déviation significative par rapport à la valeur attendue de 0,25. Lorsque les mariages consanguins sont ordonnés en fonction des lieux de naissance des intéressés, apparaît un résultat intéressant. L'endogamie provinciale est associée aux plus niveaux de consanguinité (57%) et la proportion de M22/M33 est aussi plutôt élevée (0,63). Une contribution majeure aux taux de consanguinité et coefficient moyen de consanguinité observés en Guipúzcoa au cours des décennies récentes, provient cependant des groupes d'immigrants apparentés provenant d'autres régions d'Espagne. Dans ce segment de population, le rapport M22/M33 est 1,44. Conclusions: cette étude montre encore l'importance des préférences ou de l'évitement dans la consanguinité humaine et aussi comment les groupes humains présentent des attitudes différentielles pour certains modèles de consanguinité en dépit du fait qu'ils occupent les mêmes territoires géographiques.     

Depression or resilience? A participatory study to identify an appropriate assessment tool with Kanien’kéha (Mohawk) and Inuit in Quebec

Purpose

We present a study on selection of a psychometric scale to be clinically used among Indigenous people with depression. Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec.

Methods

We selected three depression scales and three protective factor scales based on: strong validity for psychometric properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity, and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory committees, and carried out a thematic analysis of the information.

Results

The advisory groups considered the measurement scales to be unsafe. The major components that hindered their acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person and the practitioner.

Conclusion

This project provides valuable information about the perspectives of local Indigenous peoples regarding mental health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could be used in psychological and psychiatric intervention as well as in social and community services.

     

Leuprolide acetate induces structural and functional recovery of injured spinal cord in rats

Gonadotropin-releasing hormone (GnRH) and its synthetic analog leuprolide acetate, a GnRH agonist, have neurotrophic properties. This study was designed to determine whether administration of leuprolide acetate can improve locomotor behavior, gait, micturition reflex, spinal cord morphology and the amount of microglia in the lesion epicenter after spinal cord injury in rats. Rats with spinal cord compression injury were administered leuprolide acetate or saline solution for 5 weeks. At the 5^th week, leuprolide acetate-treated rats showed locomotor activity recovery by 38%, had improvement in kinematic gait and exhibited voiding reflex recovery by 60%, as compared with the 1^st week. By contrast, saline solution-treated rats showed locomotor activity recovery only by 7%, but voiding reflex did not recover. More importantly, leuprolide acetate treatment reduced microglial immunological reaction and induced a trend towards greater area of white and gray matter in the spinal cord. Therefore, leuprolide acetate has great potential to repair spinal cord injury.