Recurrent abdominal pain in children: a clinical approach

The term ‘recurrent abdominal pain’, or RAP, refers mainly to the duration of painful period and frequency of pain. The commonly accepted duration is at least three months in the preceding period, and over this three-month period, there are at least three episodes of pain that are severe enough to affect the daily activities of the affected patients. Over the years, with advances in medical technology and better understanding of the pathophysiology of abdominal pain, more and more organic causes have been identified. However, the most common cause of RAP in children is still functional in origin.     

Carers’ concern for older people falling at home: an integrative review

Falls, the leading cause of injury and death among older people, can have a significant psychosocial impact on carers. Carers play a crucial role in caring for older persons at home and in fall prevention. This review, which included 15 studies, aimed to identify carers’ concern about older people falling and its impact. We identified that most carers had concerns about repeated falls in older people, unknown consequences of falls and care recipients’ non-adherence to fall prevention advice. These concerns, in turn, affect carers’ physical and psychological health, lifestyle, caregiving burden and use of fall prevention strategies. This paper highlights the importance of recognising carers’ fall concern so as to identify carers’ needs and awareness of fall prevention in older people living at home. Greater insight into carers’ fall concern could facilitate the implementation of new strategies to manage older people’s fall risk as well as improve carers’ well-being.     

The efficacy of hepatitis B treatments in achieving HBsAg seroclearance: A systematic review and meta‐analysis

Current therapies for chronic hepatitis B (CHB) include nucleos(t)ide analogues (NAs) and interferon (IFN), but their relative efficacy as monotherapy or in combination has not been examined systematically for HBsAg loss (functional cure). Hence, we systematically reviewed the evidence for HBsAg loss in CHB patients treated with IFN, NA or the combination. We searched PubMed, EMBASE and abstracts from EASL, Asia Pacific Association for study of the Liver and American Association for the Study of Liver Disease for randomized controlled trials of CHB patients, comparing NA, IFN or the combination. The Cochrane Risk of Bias tool v2.0 and GRADE method were used. Analyses were stratified by NA genetic barrier, cirrhosis, type of combination therapy, HBeAg, treatment naivety, IFN dosage/duration and outcome duration. Sensitivity analysis was performed for selected strata, and HBsAg loss was measured at the end‐of‐study (EOS), end‐of‐treatment (EOT) or end‐of‐follow‐up (EOF). Effects were reported as risk differences (RD) with 95% confidence intervals (CI) using a random‐effects model. Forty‐five studies were included, all with low risk of bias. For HBsAg loss at EOS, when comparing combination vs IFN, RD = 1%, 95%CI‐1%, 2%; combination vs NA, RD = 5%, 95%CI 3%,7%; IFN vs NA, RD = 3%, 95%CI 2%,5%. Subgroup analysis showed a significant effect of standard IFN dose vs nonstandard; IFN duration ≥48 weeks vs <48 weeks, and loss of efficacy >2 years of follow‐up. Similar findings were seen in HBsAg seroconversion, but only three studies reported HBsAg seroreversion. In conclusion, IFN monotherapy/combination had a small but significant increase in HBsAg loss over NA, associated with standard dose of IFN and ≥48 weeks of therapy, although this effect faded over time.     

Safety and Efficacy of Oral Transmucosal Fentanyl Citrate Compared to Morphine Sulphate Immediate Release Tablet in Management of Breakthrough Cancer Pain

Aim:

To compare the efficacy and safety of oral transmucosal fentanyl citrate (OTFC) and oral morphine in Indian patients with breakthrough episodes of cancer pain.

Materials and Methods:

In this randomized, open label, active controlled, clinical study, total 186 patients who regularly experienced 1-4 episodes of breakthrough cancer pain (BTCP) daily, over the persistent pain controlled by taking oral morphine 60 mg/day or its equivalent were randomized to receive either OTFC 200 mcg or oral morphine 10 mg for the treatment of BTCP for 3 days. Improvement in pain as determined by numerical rating scale (NRS) at 5, 15, 30, and 60 minutes of drug administration and percentage of BTCP episodes showing reduction in pain intensity by >33% at 15 minutes were primary efficacy endpoints. Secondary efficacy endpoints were requirement for rescue analgesia and global assessment by physician and patient. Data of both treatment groups were analysed by appropriate statistical test using software, STATISTICA, version 11.

Results:

Patients treated with OTFC experienced significantly greater improvement in pain intensity of breakthrough episodes compared to those treated with oral morphine at all assessment time points (P < 0.0001). 56% of breakthrough pain episodes treated with OTFC showed a greater than 33% reduction in pain intensity from baseline at 15 minutes compared to 39% episodes treated with oral morphine (P < 0.0001). Patient''s and physician''s global assessment favoured OTFC than oral morphine (P < 0.0001). Requirement of rescue analgesia in both the study groups was similar (P > 0.05). Both study drugs were well tolerated.

Conclusions:

OTFC was found to provide faster onset of analgesic effect than immediate release oral morphine in management of breakthrough cancer pain.     

A one-pot synthesis of N2,6-diaryl-5,6-dihydro-1,3,5-triazine-2,4-diamines and systematic evaluation of their ability to host ethanol in crystals

A convenient one-pot method for the preparation of N²,6-diaryl-5,6-dihydro-1,3,5-triazine-2,4-diamines was developed using a three-component synthesis of 1,6-diaryl-1,6-dihydro-1,3,5-triazine-2,4-diamines followed by their Dimroth rearrangement to the desired products. The prepared compounds crystallized from ethanol as ethanol clathrates (1 : 1). X-ray crystallography on several products confirmed the adoption of 5,6-dihydro-tautomer. The thermal analysis and powder X-ray diffraction experiments on selected compounds suggested that thermal desolvation of crystals was irreversible.

One-pot synthesis and analysis of stable dihydrotriazine-EtOH clathrates.     

《英国非酒精性脂肪性肝炎肝移植指南》导读

非酒精性脂肪性肝炎（non—alcoholicsteatohepatitis,NASH）现已成为肝移植愈来愈重要的基础肝病。鉴于晚期NASH患者常并存多种影响肝移植转归的临床问题,而至今尚无针对NASH患者进行肝移植的评估和治疗指南,为此英国移植学会（British Transplant Society,BTS）邀请相关专家制定了指南,以指导肝移植前后NASH患者的处理。     

Limited knowledge of chronic kidney disease among primary care patients – a cross-sectional survey

Background

Kidney disease is the 9th leading cause of death in Singapore. While preventive effects have focused on early detection and education, little is known about the knowledge level of chronic kidney disease (CKD) locally. We seek to evaluate the knowledge of CKD among primary care patients.

Methods

We conducted a cross-sectional survey of a convenience sample of 1520 patients from 3 primary care centers. Those with existing CKD or on dialysis were excluded. Knowledge was assessed based on 7 questions on CKD in the self-administered questionnaire. One point was given for each correct answer with a maximum of 7 points.

Results

1435 completed all 7 questions on CKD. Mean age was 48.9 ±15.0 (SD) years. 50.9% were male. 62.3% had a secondary and below education and 52.4% had a monthly household income of????$2000. 43.7% had chronic diseases. Mean score was 3.44?±?1.53 (out of a maximum of 7). Median score was 4. In multivariate logistic regression, being older {>60?years [Odds Ratio (OR) 0.50, 95% Confidence Interval (CI) 0.32-0.79]; 40?C60?years (OR 0.62, 95% CI 0.43,0.89)}, less educated [up to primary education (OR 0.33, 95% CI 0.22-0.49)], having a lower monthly household income [<S$2000 (OR 0.41, 95% CI 0.26-0.66); S$2000-4999 (OR 0.53, 95%CI, 0.33-0.83)], and being non-professionals [OR 0.66, 95% CI 0.43-0.99] (all p?<?0.05)] were likely to score less.

Conclusion

This suggests that CKD education should be targeted at older patients with lower education and lower socioeconomic status.     

Synergetic treatment of dye contaminated wastewater using microparticles functionalized with carbon nanotubes/titanium dioxide nanocomposites

The highly efficient treatment of azo dye contaminated wastewater from the textile industry is an important but challenging problem. Herein, polydimethylsiloxane (PDMS) microparticles, incorporating multiple-walled carbon nanotubes/titanium dioxide (MWCNTs/TiO₂) nanocomposites, were successfully synthesized to treat wastewater containing Rhodamine B (RhB) dyes in a synergetic approach, by combining sorption and photocatalytic degradation. The surfactant wrapping sol–gel method was applied to synthesize MWCNTs/TiO₂ nanocomposites with TiO₂ nanoparticles evenly distributed on the surface of the MWCNTs. The PDMS microparticles were fabricated with an oil-in-water (O/W) single emulsion template, using needle-based microfluidic devices. MWCNTs/TiO₂ nanocomposites (at a weight ratio of 1%, and 2%, respectively) were mixed with the PDMS precursor as the dispersed phase, and an aqueous solution of polyvinyl alcohol (PVA) was used as the continuous phase. Highly monodispersed microparticles, with average diameters of 692.7 μm (Coefficient of Variation, CV = 0.74%) and 678.3 μm (CV = 1.04%), were formed at an applied flow rate of the dispersed and continuous phase of 30 and 200 μL min⁻¹, respectively. The fabricated hybrid microparticles were employed for the treatment of RhB, involving a dark equilibrium for 5 hours and UV irradiation for 3 hours. The experimental conditions of applied PDMS type, mass loading amount, treatment duration, photodegradation kinetics, initial concentration of pollutants and environmental pH values were investigated in this work. The PDMS microparticles with 2 wt% MWCNTs/TiO₂ nanocomposites can exhibit a removal efficiency of 85%. Remarkably, an efficiency of 70% can be retained after the microparticles have been recycled and reused for 3 cycles. The PDMS–MWCNTs/TiO₂ microparticles possess a superior performance over conventional treatment approaches for dye contaminated wastewater, especially in recyclability and the prevention of secondary pollution. This work provides a feasible and eco-friendly route for developing an efficient and low-cost microfluidic method for treating complicated water environmental systems.

PDMS–MWCNTs/TiO₂ microparticles made by microfluidics can achieve 85% removal efficiency of RhB pollutant in wastewater via synergetic treatment.