Obstructive sleep apnoea and snoring - is examination necessary?

This article outlines two cases of snoring and obstructive sleep apnoea (OSA) secondary to parapharyngeal space tumours. Both patients were referred to a specialist sleep clinic where oropharyngeal masses were seen and biopsied. Both underwent surgery and this was curative of both their snoring and their OSA. Parapharyngeal space tumours are an extremely rare cause of OSA and snoring. However, all patients with OSA and snoring should have a full head and neck examination before referral; in rare cases this could enable early detection of a parapharyngeal space tumour.     

Assessment of Knowledge,Readiness and Barriers,Female Secondary School Teachers and Staff Regarding Adolescent Mental Health in Riyadh,Saudi Arabia

School Mental Health - Mental health is a major component of overall health and is considered a contributor to the significant levels of disability in Saudi Arabia. Levels of mental health...     

Phytochemical composition,anti-inflammatory activity and cytotoxic effects of essential oils from three Pinus spp.

Context: Inflammation and cell differentiation lead to a number of severe diseases. In the recent years, various studies focused on the anti-inflammatory and anticancer activity of essential oils (EOs) of numerous plants, including different Pinus species.

Objective: The phytochemical composition, anti-inflammatory and cytotoxic activity of EOs from needles and twigs of Pinus heldreichii Christ (Pinaceae) and P. peuce Griseb., and from needles, twigs and cones of P. mugo Turra were determined.

Materials and methods: For separation and identification of the EOs, gas chromatography/flame ion detector (GC/FID) and GC/mass spectrometry were performed. The amount of secreted IL-6 in a lipopolysaccharide (LPS)-stimulated macrophage model was quantified (concentration of oils: 0.0001–0.2%, 3?h incubation). Cytotoxicity on the cancer cell lines HeLa, CaCo-2 and MCF-7 were determined using a MTT (Thiazolyl Blue Tetrazolium Bromide) assay (concentration of oils: 0.001–0.1%, 24?h incubation).

Results: The most prominent members in the oils include: δ-3-carene, α-pinene and linalool-acetate (P. mugo); α-pinene, β-phellandrene and β-pinene (P. peuce); limonene, α-pinene and (E)-caryophyllene (P. heldreichii). EOs showed significant cytotoxic effects on cancer cell lines (IC₅₀ 0.007 to >0.1%), with a reduction in cell viability with up to 90% at a concentration of 0.1%, and anti-inflammatory activity (IC₅₀ 0.0008–0.02%) with a reduction of IL-6 secretion with up to 60% at a concentration of 0.01%.

Discussion and conclusion: The EOs of needles and twigs from P. peuce and P. heldreichii as well as of needles, twigs and cones of P. mugo can be considered as promising agents for anticancer and anti-inflammatory drugs.     

Pediatric and adult H3 K27M-mutant diffuse midline glioma treated with the selective DRD2 antagonist ONC201

Journal of Neuro-Oncology - Smoking is agreed to be a major health risk factor, but it is debated whether it has an influence on perioperative adverse events (AEs) in elective cranial tumor...     

The feasibility of task-sharing the identification,emergency treatment,and referral for women with pre-eclampsia by community health workers in India

Background

Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy.

Methods

This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software.

Results

There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy.

Conclusion

Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.

     

Single versus multi‐drug antimicrobial surgical infection prophylaxis for left ventricular assist devices: A systematic review and meta‐analysis

Infection remains the Achilles heel of left ventricular assist device (LVAD) therapy. However, an optimal antimicrobial surgical infection prophylaxis (SIP) regimen has not been established. This study evaluated the efficacy of a single‐drug SIP compared to a multi‐drug SIP on clinical outcomes in patients undergoing continuous‐flow LVAD (CF‐LVAD) and pulsatile LVAD (P‐LVAD) implantation. An electronic search was performed to identify studies in the English literature on SIP regimens in patients undergoing LVAD implantation. Identified articles were assessed for inclusion and exclusion criteria. Fourteen articles with 1,311 (CF‐LVAD: 888; P‐LVAD: 423) patients were analyzed. Overall, 501 (38.0%) patients received single‐drug SIP, whereas 810 (62.0%) received multi‐drug SIP. Time to infection was comparable between groups. There was no significant difference in overall incidence of LVAD‐specific infections [single‐drug: 18.7% vs. multi‐drug: 24.8%, P = 0.49] including driveline infections [single‐drug: 14.1% vs. multi‐drug: 20.8%, P = 0.37]. Compared to single‐drug SIP, patients who received multi‐drug SIP had a significantly lower survival rate [single‐drug: 90.0% vs. multi‐drug: 76.0%, P = 0.01] and infection‐free survival rate [single‐drug: 88.4% vs. multi‐drug: 77.3%, P = 0.04] at 90 days. However, there were no significant differences in 1‐year survival and 1‐year infection‐free survival between groups. No survival differences were observed in the CF‐LVAD subset as well. This study demonstrated no additional advantage of a multi‐drug compared to a single‐drug regimen for SIP. Although there was a modest advantage in early survival among CF‐LVAD and P‐LVAD patients who received single‐drug SIP, there were no significant differences in the 1‐year survival and 1‐year infection‐free survival.     

Development of sustained release antipsychotic tablets using novel polysaccharide isolated from Delonix regia seeds and its pharmacokinetic studies

A natural polysaccharide was isolated from the seeds of Delonix regia. The isolated polysaccharide could maintain aqueous equilibrium between the dosage form and the surrounding medium due to its massive competence of water absorption (80.72%) and swelling index (266.7%). The Scanning Electron Micrograph of a polysaccharide exhibits rough surface with pores and crevices, hence, the drug release will be retarded because of the drug particles entrapment in the pores and crevices. Further, the surface tension of polysaccharide is higher than that of water, which may facilitate sustained release of drugs from dosage forms. An antipsychotic drug, quetiapine fumarate has a short half-life of 6 h and administered multiple times per day. Hence the quetiapine fumarate oral sustained release tablets were formulated using this polysaccharide in the concentration of 5–30% to avoid the side effects and increase patient compliance. Dissolution of the developed tablets with 25% polysaccharide content showed a better release profile than the other batches (5–20%) at the end of 12 h. The strong matrix complex has low solubility in water, it does not dissolve rapidly and the drug continues to diffuse through the gel layer at a consistent rate. Drug release from the matrix tablets follows matrix type except F-4 and F-5 which follow first order and Hix.crow type. The bioavailability study was carried out using healthy male New Zealand white rabbits that show the AUC_(0–inf) value for developed SR tablets is 1.44 times higher than the reference thus, indicating more efficient and sustained drug delivery capable of maintaining plasma drug levels better.     

Modulation of Wnt/β-catenin signaling pathway by bioactive food components

The Wnt/β-catenin signaling pathway, one of the most conserved intercellular signaling cascade, is a known regulator of cellular functions related to tumor initiation and progression, cell proliferation, differentiation, survival and adhesion. Because aberrant Wnt/β-catenin signaling has been observed in a variety of human cancers including a majority of colorectal cancers, about half of prostate cancers and a third of melanomas, inhibitors of its complex signaling pathways are being investigated for therapy as well as chemoprevention of these cancers. During the last decade, several naturally occurring dietary agents have been shown to target intermediates in the Wnt/β-catenin signaling pathway. In this review, we highlight the current understanding of the Wnt/β-catenin signaling pathway and present an analysis of the key findings from laboratory studies on the effects of a panel of dietary agents against a variety of cancers. Promise of these agents for treating and preventing human cancer is then discussed.