Role of estrogen treatment in the management of schizophrenia

Increasing evidence from epidemiological, preclinical and clinical studies suggests that estrogens may exert psychoprotective effects in schizophrenia. Observations of gender differences in the onset and course of schizophrenia have prompted exploration of the effects of estrogen on the CNS. The aim of this paper is to provide an overview of different applications of adjunctive estrogen as a possible treatment for symptoms of schizophrenia in both men and women. Recent trials have suggested that estrogen augmentation therapy may be able to enhance the management of schizophrenia; however, the clinical application of estrogen as a treatment has been limited by potential side effects, the most worrying being breast and uterine cancer in women, and feminization in men. Selective estrogen receptor modulators (SERMs), however, may offer therapeutic benefits for both men and women with schizophrenia without posing threat to breast and uterine tissue and without feminizing effects. The use of estrogen opens up new possibilities for both men and women in the treatment of severe mental illnesses such as schizophrenia. With further preclinical and clinical research, it is hoped that this promising field of hormone modulation can continue to evolve and eventually be translated into real therapeutic potential.     

A new tool to assess bleeding severity in patients with chemotherapy‐induced thrombocytopenia (CME)

BACKGROUND: Current scales to measure bleeding in clinical trials are inadequate. The aim of this study was to develop a simple, valid, and reliable measurement tool to categorize the severity of bleeding in patients with chemotherapy‐induced thrombocytopenia (CIT). STUDY DESIGN AND METHODS: Measurement theory was used to develop the Bleeding Severity Measurement Scale (BSMS) in four steps: 1) identification of the patient population, 2) item generation and reduction, 3) reviewing the items and formatting the scale, and 4) evaluation of psychometric properties. Feasibility was tested in a pilot study. Content and face validity were assessed by expert review. Psychometric evaluation included determination of intra‐ and interrater reliability and construct and criterion validity. RESULTS: The final BSMS defined two grades of bleeding: not clinically significant (Grade 1) and clinically significant (Grade 2). Grade 2 bleeds were defined as bleeds resulting in morbidity, requiring interventions, or directly causing death. The BSMS had excellent interrater (intraclass correlation coefficient [ICC], 0.80) and intrarater (ICC, 1.0) reliability and good construct and criterion validity. The BSMS distinguished between patients with different bleeding severities. CONCLUSION: Using rigorous methods, we designed a simple bleeding assessment tool with excellent psychometric properties for patients with CIT. Use of this scale in clinical trials should provide valid and reliable assessments of bleeding.     

Medicinal use of potato-derived products: conclusions of a rapid versus full systematic review

Vlachojannis et al reported a systematic review on the medicinal use of potato-derived products. The authors identified five trials for inclusion in the review, including one study on the treatment of burns. Based on this RCT the review authors concluded that potato peel is not recommended for burns. As the authors of a rapid review on the use of potato peels for burns, we read this systematic review with great interest. Although the concept of rapid review is rising, accelerating the review process might introduce bias and its conclusions may be subject to change once a systematic review is available. Since this rapid and systematic review were done at similar times, we explored if the results were consistent. We identified three trials on the use of potato peels. Two of these trials were not mentioned in the systematic review. The evidence indicates that sterile potato peel dressings are better than gauze alone during the healing phase.While there is no evidence of an antibacterial effect, we concluded that potato peels promote healing. Potato peel dressings might be the best available dressing in resource poor countries. Because systematic reviews have a major impact it is crucial that systematic reviews meet specified quality criteria. Therefore we draw attention to adherance to the PRISMA statement.     

The association between urinary kidney injury molecule 1 and urinary cadmium in elderly during long-term, low-dose cadmium exposure: a pilot study

In recent years there has been a major change on the part of funders, particularly in North America, so that data sharing is now considered to be the norm rather than the exception. We believe that data sharing is a good idea. However, we also believe that it is inappropriate to prescribe exactly when or how researchers should preserve and share data, since these issues are highly specific to each study, the nature of the data collected, who is requesting it, and what they intend to do with it. The level of ethical concern will vary according to the nature of the information, and the way in which it is collected - analyses of anonymised hospital admission records may carry a quite different ethical burden than analyses of potentially identifiable health information collected directly from the study participants. It is striking that most discussions about data sharing focus almost exclusively on issues of ownership (by the researchers or the funders) and efficiency (on the part of the funders). There is usually little discussion of the ethical issues involved in data sharing, and its implications for the study participants. Obtaining prior informed consent from the participants does not solve this problem, unless the informed consent process makes it completely clear what is being proposed, in which case most study participants would not agree. Thus, the undoubted benefits of data sharing does not remove the obligations and responsibilities that the original investigators hold for the people they invited to participate in the study.     

Strength Profiles of Shoulder Rotators in Healthy Sport Climbers and Nonclimbers

Objective:

To establish the isokinetic strength profiles and work ratios of the shoulder internal and external rotators in sport climbers and to compare them with these profiles and ratios in nonclimbers. We hypothesized that the strength profiles of the shoulder rotators were different between sport climbers and nonclimbers.

Design:

Cross-sectional study.

Setting:

Exercise science laboratory.

Patients or Other Participants:

Thirty-one experienced sport climbers and 27 nonclimbers.

Main Outcome Measure(s):

We tested all participants by measuring the isokinetic concentric and eccentric work output of their shoulder rotators in the middle 110° of shoulder rotation. We measured mean conventional work ratios of concentric external rotation (ER) to internal rotation (IR) (con ER:IR) and eccentric ER to IR (ecc ER:IR), and we measured mean functional work ratios of eccentric ER to concentric IR (ecc ER:con IR) and eccentric IR to concentric ER (ecc IR:con ER).

Results:

All work ratios were different between the 2 groups (P < .001). In the climbers, the conventional work ratios were smaller than 1 for con ER:IR (0.79) and ecc ER:IR (0.88), whereas for the nonclimbers, the ratios were 1.03 and 1.13, respectively. The functional work ratio of ecc ER:con IR was smaller for the climbers (1.05) than for the nonclimbers (1.30), but the functional work ratio of ecc IR:con ER was larger for the climbers (1.58) than for the nonclimbers (1.17).

Conclusions:

The difference in work ratios of the shoulder rotators between participant groups might be due to training-induced changes in the shoulder rotation muscles of sport climbers. The clinical implication of this strength difference in shoulder IR and ER in climbers has yet to be examined.     

Descemet stripping endothelial keratoplasty: effect of the surgical procedure on corneal optics

PURPOSE: To determine the changes in corneal optical performance after posterior lamellar corneal transplantation. DESIGN: Retrospective case series. METHODS: The anterior segment in four eyes of four patients who underwent Descemet stripping endothelial keratoplasty (DSEK) with cataract extraction and intraocular lens (IOL) implantation were imaged with the Visante anterior segment optical coherence tomography [OCT] (Carl Zeiss Meditec, Dublin, California, USA). The curvature of the posterior surface of the donor graft was compared with that of the host cornea, and corneal thickness was measured. RESULTS: All eyes had a hyperopic refractive error after surgery. The posterior corneal curvature after surgery was more than that before surgery. Average preoperative keratometry was 43.4 diopters (D), and after surgery, it was 42.8 D using keratometry. However, when the postsurgical corneal power was calculated using the Gaussian optics method, the average value was 40.8 D. CONCLUSIONS: The addition of a donor corneal graft to the posterior surface of decompensated corneas may lessen the effective optical power of the cornea and may have implications for IOL power calculations in these eyes.     

Rational and design of SATRACD study: detecting subclinical anthracycline therapy related cardiac dysfunction in low income country

BackgroundAnthracycline therapy-related cardiac dysfunction (ATRCD) is the most notorious adverse side-effect of chemotherapy. It has become a significant cardiovascular health concern for long-term cancer survivors. With the emerging concept of subclinical ATRCD and newer diagnostictools (Speckle Tracking Echocardiography (STE) and biomarkers), detecting anthracycline cardiac toxicity at an early stage has become an important step to prevent severe cardiac dysfunction and improve the cardiovascular outcome in cancer survivors. Despite the increasing population at risk in sub-Saharan Africa (SSA), there is no contemporary data in Uganda to address the burden, pathogenesis and risk factors of subclinical ATRCD. This big gap in knowledge has led to a lack of local guidelines for monitoring and management of ATRCD.MethodsSATRACD (Detecting Subclinical Anthracycline Therapy Related Cardiac Dysfunction In Low Income Country) study is an observational prospective cohort study. Three hundred and fifty-three anthracycline naïve cancer patients will be recruited at baseline. Patients are followed up on completion of anthracycline-based chemotherapy and at 6 months after completion of anthracycline therapy. Data on demographics, cancer profile and clinical presentation will be collected at baseline. Comprehensive cardiac assessment will be performed at each visit, including electrocardiogram, conventional echocardiography, STE, cardiac and oxidative stress markers. We will be able to determine the incidence of subclinical and clinical ATRCD at 6 months after completion of anthracycline therapy, determine whether hypertension is a major risk factor for ATRCD, evaluate the role of conventional echocardiography parameters, and biomarkers for detecting subclinical ATRCD.ConclusionThis SATRACD study will provide contemporary data on Ugandan cancer patients who have subclinical and clinical ATRCD, help in the development of local strategies to prevent and manage ATRCD, and improve cardiovascular outcome for Ugandan cancer survivors.