Variants of SLE--a statistical approach for discrimination of a group of SLE cases into different subgroups sharing symptomatology. A pilot study.

Symptoms of two groups of Systemic lupus erythematosus (SLE) (Group 1 constituted 65 patients examined from 1975 to 1981; Group 2 constituted 104 patients examined from 1980 to 1988), which were diagnosed according to the American Rheumatism Association (ARA) preliminary criteria, were statistically analyzed with the use of a package of statistical programs which included computation of a matrix of correlation and cluster analysis. In both groups similar frequency and associations of SLE symptoms were seen. Hence, there was a positive correlation between kidney involvement and hematological abnormalities with nDNA Abs what was a hallmark of a severe SLE. In contrast, the symptoms of severe SLE disease was rarely seen in cases with Raynaud's phenomenon and discoid lesions. Our cluster analysis further distinguished groups on the basis of renal involvement, skin symptomatology, and polyserositis. These results also were similar in both groups of patients. That gave further credence to our results and continued to support the concept of SLE variants being distinguished on the basis of the clinical picture.     

The effectiveness of interventions to reduce the household economic burden of illness and injury: a systematic review

Objective

To determine the nature, scope and effectiveness of interventions to reduce the household economic burden of illness or injury.

Methods

We systematically reviewed reports published on or before 31 January 2014 that we found in the CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE and PsycINFO databases. We extracted data from prospective controlled trials and assessed the risk of bias. We narratively synthesized evidence.

Findings

Nine of the 4330 studies checked met our inclusion criteria – seven had evaluated changes to existing health-insurance programmes and two had evaluated different modes of delivering information. The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population. However, the reductions only represented marginal changes in the total expenditures of patients. We found no studies that had been effective in addressing broader household economic impacts – such as catastrophic health expenditure – in the disease populations investigated.

Conclusion

In general, interventions designed to reduce the complex household economic burden of illness and injury appear to have had little impact on household economies. We only found a few relevant studies using rigorous study designs that were conducted in defined patient populations. The studies were limited in the range of interventions tested and they evaluated only a narrow range of household economic outcomes. There is a need for method development to advance the measurement of the household economic consequences of illness and injury and facilitate the development of innovative interventions to supplement the strategies based on health insurance.     

Considering pharmacy workflow in the context of Australian community pharmacy: A pilot time and motion study

Background

Given time pressures on primary care physicians, utilising pharmacists for chronic disease management is of great interest. However, limited data are available on the current workflow in community pharmacies to guide these discussions.

Oral modifications during menopause

The menopause, a physiological process specific to elderly women (>50 years) is defined by various involutive phenomena occurred at general level and particularly in the stomatognatic system elements. The authors followed the influence of the oral contraceptives in changes of oral tissues during menopause. The study was carried on 148 elderly women during menopause split in two groups: group I (study group) who have used oral contraceptives in earlier years, group II (control group) without contraceptive therapy. The evaluation of the results was made using clinical exams and complementary investigations (X-ray, cytological, histopathological, mycological, salivary rate exams) and index quantification. The results showed the importance of the apparition of changes in to the oral tissues during menopause increased in comparison to the control group. Corresponding prevention strategies are the basis of oral health management in women at menopause.     

A rare cause of non-Q myocardial infarction--acute carbon monoxide poisoning

Myocardial infarction is a rarely reported complication of acute carbon monoxide (CO) poisoning. We report the case of a 77 years old woman who presented to our emergency department with altered consciousness as a consequence of exposure to CO. The patient didn't experience any chest pain, but the electrocardiogram showed a non-Q-wave antero-septal acute myocardial infarction, with typical elevation in troponin T and creatine-phosphokinase MB levels. The patient recovered completely after specific treatment of poisoning with no major cardiac complication. We consider that careful electrocardiographic and enzymatic monitoring of all patients, especially elderly patients, in the first hours after CO exposure is important for early diagnosis and treatment of this rare complication of CO poisoning, and can improve the outcome of these patients.     

Flavonoids from Dalbergia louvelii and their antiplasmodial activity

Four new flavonoids (1-4), along with 13 known compounds, were isolated from the heartwood of Dalbergia louvelii by following their potential to inhibit in vitro the growth of Plasmodium falciparum. Of the isolated compounds, four known compounds showed antiplasmodial activity with IC(50) values ranging from 5.8 to 8.7 microM, namely, (R)-4' '-methoxydalbergione (5), obtusafuran (6), 7,4'-dihydroxy-3'-methoxyisoflavone (7), and isoliquiritigenin (8). The structures of the new compounds were determined using spectroscopic techniques as 1-(3-hydroxyphenyl)-3-(4-hydroxy-2,5-dimethoxyphenyl)propane (1), spirolouveline (2), (3R)-7,2'-dihydroxy-4',5'-dimethoxyisoflavanone (3), and 3-(2,4-dihydroxy-5-methoxy)phenyl-7-hydroxycoumarin (4), respectively.     

Exertional heat stroke in a young man with a documented rise in troponin I

Heat stroke is a medical emergency that requires immediate attention to prevent multiorgan dysfunction. It is vital that, as emergency physicians, we aim for early diagnosis and aggressive treatment of this condition to prevent the high morbidity and mortality that is associated with it. The case history is presented of a 21-year-old man who presented with exertional heat stroke with a raised troponin I level 24 h after admission which subsequently normalised. To our knowledge, there are no case reports in the literature of a patient with a raised troponin level following exertional heat stroke.     

Research Productivity of Canadian Radiation Oncology Residents: A Time-Trend Analysis

(1) Background: Research productivity is a mandatory component of Canadian radiation oncology (RO) resident training. To our knowledge, Canadian RO resident research publication productivity has not previously been analysed. (2) Methods: We compiled a 12-year database of RO residents in Canadian training programs who completed residency between June 2005 and June 2016. Resident names and dates of training were abstracted from provincial databases and department websites and were used to abstract data from PubMed, including training program, publication year, journal, type of research, topic and authorship position. Residents were divided into four time periods and the linear trend test evaluated publication rates over time. Univariable and multivariable logistic regression analyses were performed to identify authorship predictors. (3) Results: 227 RO residents representing 363 publications were identified. The majority were first-author publications (56%) and original research (77%). Overall, 82% of first-author, and 80% of any-author articles were published in resident year 4 or higher. Mean number of publications for first-author and any-author positions increased significantly over time (p = 0.016 and p = 0.039, respectively). After adjusting for gender and time period, large institutions (> 3 residents per year) trended toward associations with more first-author publications (odds ratio (OR): 2.44; p = 0.066) and more any-author publications (OR: 2.49; p = 0.052). No significant differences were observed by gender. (4) Conclusions: Canadian RO resident publication productivity nearly doubled over a 12-year period. The majority of publications are released in the last 2 years of residency, and larger residency programs may be associated with more publications. These findings serve as a baseline as programs transition to Competency Based Medical Education (CBME).     

Occurrence of erectile dysfunction, testosterone deficiency syndrome and metabolic syndrome in patients with abdominal obesity. Where is a sufficient level of testosterone?

Aim

The aim of this study was to determine the prevalence of erectile dysfunction (ED), testosterone deficiency syndrome (TDS), and metabolic syndrome in patients with abdominal obesity (AO) and the prevalence of morbidity at different levels of testosterone (TST).

Background

Male sex hormones play an important role in ED and variety of TDS and may have influence on the development of metabolic syndrome. The number of men with AO which constitutes a serious health risk is continuously growing. Currently, there are different views that TST levels are already insufficient, and the patient should benefit from treatment.

Objectives

This study examined the association between ED, testosterone level and metabolic syndrome in men with AO.

Design, setting, and participants

The study was carried out in an outpatient urology center of Urology Clinic and Obesity Center of the Clinic of Internal Medicine. There were 167 participants??men with AO which were examined as part of preventive examination.

Methods

Hormonal, a complete urological and internal evaluation was carried out in every patient.

Results and limitations

We found some degree of ED in 73% (122/167) in men with AO. The TST levels below 14?nmol/l had of these 122 patients 84 patients (68.9%) and 49 patients (40.2%) below 10?nmol/l. In this group of patients, we found 103/167 patients (61.7%) with metabolic syndrome. When we compared TST level and morbidity, we found significantly more patients with diabetes mellitus (DM), hypertension and dyslipidemia in group with TST below 10?nmol/l. We also found difference in the levels of HDL cholesterol and triglycerides in the group of patients with TST 10?C14 and over 14?nmol/l.

Conclusion

Patients over 40?years of age with AO and ED should also be examined for TDS and metabolic syndrome. In this group of patients we found that 113/167 patients (67.6%) had total TST below 14?nmol/l, and sufficient level of TST seems to be above this level.