Cycles of abuse nurtured by concealment: A clinical report

At present, health care staff do not seem to have sufficient knowledge about their patients' abusive experiences. The aim of the present study is to analyze and discuss what the implications might be for the encounter between patients and health care professionals, when experiences of abuse are concealed. The methodology of this article is varied: a personal narrative, medical records, sociological theoretical literature and empirical evidence. From the narrative we learn that concealment of abuse was devastating for the patient. She was “treated” in vain as a correct diagnosis was not made, while abuse by her father continued. Health care staff also violated her, which she told her therapist, but her protests were not acknowledged. Ten years of treatment thus made her even more sick. This case story focuses on the mechanisms which nurture concealment of a patient's history of abuse, such as structural and symbolic violence. We also suggest ways to break “cycles of abuse”. Help the patient to stop concealing also means that she/he leaves a victim role, gets in charge of the situation and takes a first step towards empowerment. In this way, health care settings can become enabling and empowering environments.     

Changing Spectrum of Retinopathy of Prematurity (ROP) and Variations Among Siblings of Multiple Gestation

Objective  

To assess the changing spectrum of ROP, and to compare the siblings of multiple gestations with regard to incidence and severity of ROP.     

Does insulin-like growth factor 1 genotype influence muscle power response to strength training in older men and women?

The CA-repeat polymorphism in the insulin-like growth factor 1 (IGF1) gene promoter region has been associated with strength and circulating IGF-I protein levels. The purpose of the study was to determine if the IGF1 CA-repeat polymorphism influences muscle power at baseline and in response to ST in older adults. Knee extensor peak power (PP) was measured at 50, 60, and 70% of 1-RM strength before and after 10 weeks of unilateral knee extensor ST in older adults, aged 50–85 years, to determine the changes in absolute and relative PP with ST. Subjects (N = 114) were genotyped for the IGF1 CA-repeat polymorphism and grouped as homozygous for the 192 allele, heterozygous, or non-carriers of the 192 allele. The 192 homozygotes had significantly lower baseline PP at 50, 60, and 70% of 1-RM strength than the non-carriers when age, sex, and baseline fat-free mass were covaried (all P < 0.05). This same relationship was observed when the highest PP within these ranges was compared (e.g., 317.6 ± 13.5 for 192 homozygotes and 380.2 ± 16.3 for non-carriers of the 192 allele, P < 0.05). Both absolute and relative PP increased significantly with ST in all genotype groups as expected, but there were no significant relationships among IGF1 genotypes and any of the PP changes. Despite a significant relationship between IGF1 genotype and knee extensor peak power at baseline, IGF1 genotype does not appear to influence changes in knee extensor peak power with ST.     

Combining Cep290 and Mkks ciliopathy alleles in mice rescues sensory defects and restores ciliogenesis

Cilia are highly specialized microtubule-based organelles that have pivotal roles in numerous biological processes, including transducing sensory signals. Defects in cilia biogenesis and transport cause pleiotropic human ciliopathies. Mutations in over 30 different genes can lead to cilia defects, and complex interactions exist among ciliopathy-associated proteins. Mutations of the centrosomal protein 290 kDa (CEP290) lead to distinct clinical manifestations, including Leber congenital amaurosis (LCA), a hereditary cause of blindness due to photoreceptor degeneration. Mice homozygous for a mutant Cep290 allele (Cep290rd16 mice) exhibit LCA-like early-onset retinal degeneration that is caused by an in-frame deletion in the CEP290 protein. Here, we show that the domain deleted in the protein encoded by the Cep290rd16 allele directly interacts with another ciliopathy protein, MKKS. MKKS mutations identified in patients with the ciliopathy Bardet-Biedl syndrome disrupted this interaction. In zebrafish embryos, combined subminimal knockdown of mkks and cep290 produced sensory defects in the eye and inner ear. Intriguingly, combinations of Cep290rd16 and Mkksko alleles in mice led to improved ciliogenesis and sensory functions compared with those of either mutant alone. We propose that altered association of CEP290 and MKKS affects the integrity of multiprotein complexes at the cilia transition zone and basal body. Amelioration of the sensory phenotypes caused by specific mutations in one protein by removal of an interacting domain/protein suggests a possible novel approach for treating human ciliopathies.     

A professional development model for medical laboratory scientists working in the microbiology laboratory

The University of Texas M.D. Anderson Cancer Center, Division of Pathology and Laboratory Medicine is committed to providing the best pathology and medicine through: state-of-the art techniques, progressive ground-breaking research, education and training for the clinical diagnosis and research of cancer and related diseases. After surveying the laboratory staff and other hospital professionals, the Department administrators and Human Resource generalists developed a professional development model for Microbiology to support laboratory skills, behavior, certification, and continual education within its staff. This model sets high standards for the laboratory professionals to allow the labs to work at their fullest potential; it provides organization to training technologists based on complete laboratory needs instead of training technologists in individual areas in which more training is required if the laboratory needs them to work in other areas. This model is a working example for all microbiology based laboratories who want to set high standards and want their staff to be acknowledged for demonstrated excellence and professional development in the laboratory. The PDM model is designed to focus on the needs of the laboratory as well as the laboratory professionals.     

Deep Learning–Based Diabetic Retinopathy Severity Grading System Employing Quadrant Ensemble Model

The diabetic retinopathy accounts in the deterioration of retinal blood vessels leading to a serious compilation affecting the eyes. The automated DR diagnosis frameworks are critically important for the early identification and detection of these eye-related problems, helping the ophthalmic experts in providing the second opinion for effectual treatment. The deep learning techniques have evolved as an improvement over the conventional approaches, which are dependent on the handcrafted feature extraction. To address the issue of proficient DR discrimination, the authors have proposed a quadrant ensemble automated DR grading approach by implementing InceptionResnet-V2 deep neural network framework. The presented model incorporates histogram equalization, optical disc localization, and quadrant cropping along with the data augmentation step for improving the network performance. A superior accuracy performance of 93.33% is observed for the proposed framework, and a significant reduction of 0.325 is noticed in the cross-entropy loss function for MESSIDOR benchmark dataset; however, its validation utilizing the latest IDRiD dataset establishes its generalization ability. The accuracy improvement of 13.58% is observed when the proposed QEIRV-2 model is compared with the classical Inception-V3 CNN model. To justify the viability of the proposed framework, its performance is compared with the existing state-of-the-art approaches and 25.23% of accuracy improvement is observed.     

Sublingual Misoprostol to Reduce Blood Loss at Cesarean Delivery

Objective

This prospective randomized controlled study was carried out with the purpose of assessing the efficacy of sublingual misoprostol in decreasing intraoperative blood loss and the need for additional uterotonic agents at cesarean delivery.

Methods

One hundred seventy-four women undergoing elective or emergency cesarean delivery were assigned randomly to receive either 400 μg misoprostol or placebo sublingually at the time of cord clamping. An intravenous infusion of 20 units of oxytocin was started in all women at the same time. The primary outcome measures were intraoperative blood loss, need for additional uterotonic agents, and perioperative hemoglobin (Hb) fall.

Results

The maternal demographic factors, indications for cesarean delivery, and high-risk factors were similar between the two groups. Mean intraoperative blood loss was significantly less in misoprostol group as compared with placebo group (595 ± 108 vs. 651 ± 118 ml, P = 0.025). Fewer women needed additional uterotonic agents in misoprostol group (22.2 vs. 42.8 %; P = 0.0035; RR 0.52, 95 % CI 0.33–0.82). Perioperative Hb fall was significantly less in misoprostol group (0.87 ± 0.29 vs. 1.01 ± 0.26 g, P = 0.0018).

Conclusion

Sublingual misoprostol decreases intraoperative blood loss and the need for additional uterotonic agents at cesarean delivery.