Effect of mucosal thickening near gastric carcinoma on the endoscopic diagnosis of malignancy

Gastric mucosal thickening of variable degree occurs in the vicinity of gastric carcinomas and is possibly related to simultaneous tumor expression of epidermal growth factor and its receptor. Seventeen cases in which both endoscopic biopsy and subsequent resection for gastric carcinoma had been performed were studied to see if putative tumor-related mucosal thickening had an effect on endoscopic biopsy sensitivity. Biopsy fragment positivity rate was greater in cases with exophytic, protruding tumor masses (46.8± 8.5%) than in all other cases (17.0± 4.7%; P=0.02). Thickness of nontumorous mucosa adjacent to carcinomas did not significantly affect the biopsy fragment positivity rate in cases with exophytic masses (thin subgroup, 51.0±16.2%; thick subgroup, 44.0±10.8%; P=0.7) but did reduce the positivity rate significantly (P=0.05) in ulcerative or infiltrative tumors without exophytic components (thin subgroup, 23.3±4.1%; thick subgroup, 8.4±2.1%). This reduction in biopsy sensitivity related to mucosal thickening occurring adjacent to nonprotuberant lesions may explain, at least in part, the variable rates of positive biopsies observed with gastric cancers.Supported in part by a grant (AM07130) from the United States Public Health Service.     

Pharmacists’ contributions to the delivery of pharmaceutical care to patients with type 2 diabetes in Kuwait

This study was designed to identify pharmacists’ potential contributions to the delivery of pharmaceutical care to patients with type 2 diabetes in Kuwait, and to identify and explore barriers that were preventing them from providing care to this specific group. A pretested self-administered questionnaire was distributed to all pharmacists registered in the Kuwait Pharmaceutical Association’s email registry (N?=?250). Invitations to a focus group interview were then sent to all pharmacists (N?=?50) who had responded to the questionnaire. Seven pharmacists accepted the invitation and participated in the focus group interview. Of the 50 respondents to the questionnaire, 31 (62.0 %; 95 % CI: 47.2–75.4) indicated that they were “comfortable” and “extremely comfortable” in discussing patient’s blood pressure target and annual screening with physicians rather than discussing smoking cessation advice or specific medication-related care issues. More than 75 % of the respondents were “comfortable” and “extremely comfortable” in sharing and verifying the patient’s drug history, blood pressure, cholesterol and stability of blood glucose with the healthcare team, and to maintain a pharmaceutical care plan for patients with diabetes. Overall, pharmacists indicated that they were more comfortable in undertaking clinical activities than discussing care issues with physicians. The focus group interview identified issues related to pharmacist-physician interaction, pharmacists’ confidence, pharmacists’ image by patients and physicians and barriers to implementing pharmaceutical care. This study shows that pharmacists in Kuwait perceive that their contribution to the delivery of pharmaceutical care could develop further with increased partnership between pharmacists and physicians and provision of further education, training and continuing professional development support.     

Enhanced Recovery After Bariatric Surgery (ERABS): Clinical Outcomes from a Tertiary Referral Bariatric Centre

There is paucity of data on Enhanced Recovery After Bariatric Surgery (ERABS) protocols. This feasibility study reports outcomes of this protocol utilized within a tertiary-referral bariatric centre. Data on consecutive primary procedures (laparoscopic gastric bypasses, sleeve gastrectomies and gastric bands) performed over 9 months within an ERABS protocol were prospectively recorded. Interventions utilized included shortened preoperative fasts, intra-operative humidification, early mobilization and feeding, avoidance of fluid overload, incentive spirometry, use of prokinetics and laxatives. Data collected included demographics, co-morbidities, morbidity, mortality, length of stay (LOS) and re-admissions. A total of 226 procedures (age [mean ± SD], 45?±?11 years, median [interquartile range] BMI 44.9 [41.0–49.0] kg/m²) were undertaken: 150 (66 %) bypasses, 47 (21 %) sleeves and 29 (13 %) bands. Hypertension, diabetes mellitus, sleep apnea and limited mobility were present in 40 %, 34 %, 24 % and 9 % of patients, respectively. No anastomotic or staple line leaks/bleeds were encountered. Ten (4.4 %) patients developed postoperative morbidity (mainly respiratory complications). One death occurred from massive pulmonary embolus in a high-risk patient (despite insertion of preoperative-IVC filter). Respective mean ± SD LOS for bypasses, sleeves and bands were 1.88?±?1.12, 2.30?±?1.69 and 0.69?±?0.81 days. Successful discharge on the first postoperative day was achieved in 37 % and 28 % of bypasses and sleeves, respectively. Day-case gastric bands were performed in 48 %. Thirty-day hospital re-admission occurred in six (2.7 %) patients. Applying an ERABS protocol was feasible, safe, associated with low morbidity, acceptable LOS and low 30-day re-admission rates. The presence of multiple medical co-morbidities should not preclude use of an ERABS protocol within bariatric patients.     

Metastatic Osteosarcoma to the Interventricular Septum: An Unusual Presentation in a Child

Whereas primary cardiac tumors are reported in only 0.17 % of pediatric patients, malignant cardiac tumors are even less common in children. This report presents a 10-year-old child with relapsed osteosarcoma manifesting as metastatic lesions to the interventricular septum.     

Metal-free functionalized carbonized cotton for efficient solar steam generation and wastewater treatment

Water desalination via solar steam generation is one of the most important technologies to address the increasingly pressing global water scarcity. Materials for solar photothermal energy conversion are highly sought after for their cost savings, environmental friendliness and broad utility in many applications including domestic water heating and solar-driven desalination. Herein, we report the successful development of metal-free, low weight and cost effective functionalized carbonized cotton (CC) fibers for efficient solar water desalination and wastewater treatment. The CC fibers with nearly full solar spectrum absorption, efficient photo-thermal conversion and low-cost could provide excellent alternatives to the high-cost plasmonic-based materials for solar water desalination. We also report on a novel and simple device to mitigate the issues associated with conductive heat loss by utilizing the economically viable carbonized cotton materials as an irradiation surface placed on a low-density polyethylene foam that floats on the surface of seawater. The CC solar steam generation device exhibits average water evaporation rates of 0.9, 6.4 and 10.9 kg m⁻² h⁻¹ with impressive solar-to-vapor efficiencies of 59.2, 88.7 and 94.9% under 1, 5 and 8 sun illumination, respectively. Moreover, the device displays excellent durability showing stable evaporation rates over 10 steam generation cycles under 5 sun of solar intensity. Furthermore, the applicability of the CC device for the removal of organic dyes from contaminated water through solar steam generation is also demonstrated. The low-cost, simple design, high solar thermal evaporation efficiency, excellent stability and long-term durability make this CC device a perfect candidate for applications in seawater desalination and wastewater treatment by solar steam generation.

Water desalination via solar steam generation is one of the most important technologies to address the increasingly pressing global water scarcity.