Effect of different activations of silver nanoparticle irrigants on the elimination of Enterococcus faecalis

Clinical Oral Investigations - This study aimed to compare the efficacy of silver nanoparticles (AgNPs) irrigating solution alone and following activation with photon-induced photoacoustic...     

High Frequency of Acquired ADAMTS13 Deficiency After Hemolysis in Hemiscorpius Lepturus (Scorpion) Stung Children

Objective

To estimate the frequency of acquired ADAMTS13 deficiency in severe cases of Hemiscorpius lepturus stung patients and the frequency of acute kidney injury (AKI) in these patients.

Methods

Sixty scorpion stung children who were referred with severe hemolysis and hemoglobinuria were studied. None of them had received blood products and no one had a past medical history of renal failure.

Results

Plasma levels of ADAMTS13 and ADAMTS13 antibody (IgG) were measured using ELISA. ADAMTS13 was decreased in 91.7 % of patients and the anti-ADAMTS13 antibody (Ab) was increased in 98.3 %. ADAMTS13 decreased in all of the patients with acute kidney injury and none of those with normal levels of ADAMTS13 developed renal failure; all patients with AKI had also increased levels of ADAMTS13Ab. Acute kidney injury was found in 23.3 % and had significant association with severe anemia, thrombocytopenia, pyuria, hematuria and considerable proteinuria (p?<?0.001). Disseminated intravascular coagulation (DIC) and Hemolytic uremic syndrome (HUS) developed in 6.7 % and 10 % respectively.

Conclusions

The index findings demonstrate that Hemiscorpius lepturus sting is usually associated with ADAMTS13 deficiency, and increased ADAMTS13 autoantibody. These combined mechanisms may contribute to scorpion sting-induced coagulopathies and may predispose patients to develop DIC and HUS.     

Is Venous Foot Pump Effective In Prevention of Thromboembolic Disease After Joint Arthroplasty: A Meta-Analysis

The goal of this meta-analysis was to evaluate the efficacy of venous foot pumps in prevention of venous thromboembolism following joint arthroplasty. Using different databases, we found 13 prospective clinical trials published meeting our inclusion criteria. In total, 1514 patients were included in the final analysis. Venous foot pump devices are effective in prevention of venous thromboembolic disease after total hip and knee arthroplasty compared to chemoprophylaxis. This was especially significant in prevention of major deep vein thrombosis and pulmonary emboli rate. The use of mechanical devices like venous calf or foot pump, either alone or in combination with less potent chemical prophylaxis, on the other hand can reduce the rate of venous thromboembolism and complications of potent chemoprophylaxis like wound hematoma.     

The effect of 810-nm low-level laser therapy on pain caused by orthodontic elastomeric separators

The purpose of this study was to assess the effect of 810-nm (DMC Equipamentos, Sao Carlos, Brazil) continuous wave low-level laser therapy (LLLT) on the pain caused by orthodontic elastomeric separators. Thirty-seven orthodontic patients (12 male and 25 female, aged 11–32 years, mean age?=?24.97 years) participated in the study, including 20 subjects aged 18 years or more, and 17 under 18 years of age. Four elastomeric separators (Dentarum, Springen, Germany) were placed for the first permanent molars (distal and mesial), either for maxillary (22 patients) or mandibular (15 patients) arches; one quadrant was randomly selected and used as a placebo group (received no laser irradiation). After separator placement for each quadrant, patients received 10 doses (2 J/cm², 100 mW, 20 s) of laser irradiation on the buccal side (at the cervical third of the roots), for distal and mesial of the second premolars and first permanent molars, as well as distal of second permanent molars (five doses). The same procedure was repeated for the lingual or palatal side (five doses). After 24 h, patients returned to the clinic and received another 10 doses of laser irradiation on the same quadrant. Postseparation pain level recorded on a 10-cm visual analog scale for both jaws immediately (hour?0), and after 6, 24, 30 h, as well as on days?3, 4, 5, 6, and 7. Significant differences in the pain perception (PP) were found between the laser and placebo groups at 6, 24, 30 h, and day?3 of the experiment (P?<?0.05). Friedman’s test of multiple comparisons revealed significant differences in the PP among various time intervals for laser (chi-square?=?173.407, P?=?0.000) and placebo (chi-square?=?184.712, P?=?0.000) groups. In both groups, pain was highest at 6 and 30 h after placing elastomeric separators. No gender differences were observed in both groups. More pain was recorded in the mandible (P?<?0.05) at 24 (laser group) and 30 h (both groups) after starting the experiment. The PP was significantly higher (P?<?0.05) for the group aged 18 years or more, only at days?3 [both groups] and 4 [laser group only] of the experiment. The 810-nm continuous wave LLLT significantly reduced the PP in the first 3 days after orthodontic separation. However, the mean postseparation PP in both groups was low and wide ranges of PP scores were observed.     

Efficacy and safety of Romosozumab in treatment for low bone mineral density: a systematic review and meta-analysis

Clinical Rheumatology - Osteoporosis is a chronic skeletal disease with an increasing prevalence. Romosozumab, as a monoclonal anti-sclerostin antibody with a dual function, has been produced. In...     

Mozart's movements and behaviour: a case of Tourette's syndrome?

In this review, we intend to explore the often asked question: “Did Mozart have Tourette''s syndrome?” Although there are numerous reports attributing Mozart''s peculiar personality and behaviour to a spectrum of neurobehavioural disorders such as Tourette''s syndrome, autistic disorder, Asperger''s syndrome, attention deficit hyperactivity disorder, obsessive–compulsive disorder and paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, the evidence for any of these disorders is lacking. Whether Mozart''s behaviour was nothing more than a reflection of his unique personality or a more complex neurological disorder, aggravated later in life by enormous demands by his father and society, his behaviour has been the subject of many biographies. It will also remain unknown to what extent his accomplishments and failures were shaped by his childhood experiences, pressured lifestyle, and his innate genius and extraordinary talent. Lessons from his life may have important implications for other gifted individuals and savants whose special attributes may lead them to succeed or, on the other hand, suppress their emotional growth and make them more vulnerable to stress and failure.The 250th anniversary of the birth of one of the greatest musical geniuses of all times, Wolfgang Amadeus Mozart (1756–1791), provides an opportunity not only to reflect on his immeasurable contributions to the world of classical music, but also to examine him as a man of exceptional creative power. Mozart''s biographical accounts often comment on his peculiar behaviour which has been interpreted by some as a manifestation of an underlying neurobehavioural disorder, such as Tourette syndrome (TS). Once considered a rare psychiatric curiosity, TS is now recognised as a relatively complex neurobehavioural disorder, affecting approximately 2% of the general population.^1,2 Some studies have suggested that TS affects up to 3.8% of children, and two‐thirds of them have coexistent attention deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD) or other behavioural comorbidities.³ Although learning disabilities have been suggested to be present in some patients with TS,^4,5 most reach their full potential without any residual psychiatric or neurological handicap. Many notable figures, such as Dr Samuel Johnson, have made extraordinary contributions to the arts and sciences despite, or perhaps because of, their TS.⁶ Several reports have drawn attention to the observation that some TS patients possess unique talents and skills, similar to individuals with autism and savant syndrome.^7,8 Various structural and functional imaging studies of brains of musicians have found that in contrast with non‐musicians, the musicians'' brains tend to have increased gray matter in Broca''s area and in certain portions of the auditory cortex, such as the Heschl''s gyrus and planum temporale.^9,10 Studies of developmental and acquired disorders of musical listening and interpretation have shown that brain plasticity is involved in musical perceptions and integration with cognitive and emotional responses,¹¹ and that music could have both evocative and suppressive effects on some patients with movement disorders such as TS and parkinsonism.¹²Although many individuals with unique talents have been carefully studied, no unified theory has emerged to explain the neurological basis of such exceptional creative or interpretive abilities, as demonstrated by some people with autism or some savant artists. It is beyond the scope of this review to discuss the neurobiology of savant and the reader is referred to other sources,^13,14 but the brain mechanisms giving rise to savant‐like features may be relevant to the understanding of the neurobiology of a genius mind, such as that of Mozart. Whether savant is more frequently observed in patients with TS or whether some savant cases manifest features of TS, such as tics and OCD, has not been systematically studied.Insanity and exceptional musical talent have often been thought to be linked, but the mechanism of this relationship is unknown.¹⁵ As an example, David Helfgott, a prodigious pianist featured in the movie “Shine,” has been thought to suffer from a mild form of schizophrenia with positive symptoms. He grunts, mutters, sings, talks to himself very loudly and exhibits other tic‐like mannerisms as he plays.¹⁶ Creativity has often been associated with bipolar disorder and some composers, artists, authors and other creative geniuses of the past have observed loss of their creative talents with pharmacological treatment of their bipolar disorder. Vincent van Gogh, who committed suicide at the age of 37 years, in the last few years of his life suffered from episodes of mania and depression. Despite the mood swings and mental torment, he completed more than 300 of his best paintings, suggesting that his manic state may have facilitated his creativity.¹⁷ There is a lengthy list of other famous figures such as Ludwig von Beethoven, Robert Schumann, Peter Ilyich Tchaikovsky, Sergei Rachmaninoff, Ernest Hemingway, Leo Tolstoy, Jonathan Swift, Oliver Cromwell, Abraham Lincoln, Theodore Roosevelt, John Nash, Nikolai Gogol, Edgar Allan Poe and many more who have suffered from a variety of mental or personality disorders.^15,18,19 Besides Samuel Johnson and Mozart, many celebrities such as Howard Hughes, Marc Summers, David Beckham, Tim Howard, Jim Eisenreich, Chris Jackson (Mahmoud Abdul‐Raul), David Aldridge, Michael Wolff, Dan Ackroyd, Howie Abdul‐Rauf Mandel and Mel Gibson are among those thought to manifest some features of TS and its comorbidities, particularly OCD.^16,20,21     

Demographic and clinical determinants of having do not resuscitate orders in the intensive care unit of a comprehensive cancer center

To understand the needs of patients and family members as physicians communicate their expectations about patients admitted to the intensive care unit (ICU), we evaluated the demographic and clinical determinants of having a Do Not Resuscitate (DNR) order for adults with cancer. Patients included were admitted from June 16, 2008-August 16, 2008, to the ICU in a comprehensive cancer center. We conducted a prospective chart review and collected data on patient demographics, length of stay, advance directives, clinical characteristics, and DNR orders. A total of 362 patients met the inclusion criteria; only 15.2% had DNR orders before ICU discharge. In the multivariate analysis, we found that medical admission was an independent predictor of having a DNR order during the ICU stay (odds ratio = 3.65; 95% confidence interval, 1.44-9.28); we also found a significant two-way interaction between race/ethnicity and type of admission (medical vs. surgical) with having a DNR order (p =?.04). Although medical admissions were associated with significantly more DNR orders than were surgical admissions, we observed that the subgroup of non-white patients admitted for medical reasons was significantly less likely to have DNR orders. This finding could reflect different preferences for aggressive care by race/ethnicity in patients with cancer, and deserves further investigation.