Attitudes of general practitioners in New Zealand to pharmaceutical representatives.

BACKGROUND. Pharmaceutical representatives are a vital component of the marketing of pharmaceutical products and an important source of prescribing information for general practitioners. AIM. A study was undertaken to explore the attitudes of New Zealand general practitioners to pharmaceutical representatives. METHOD. A questionnaire survey of 100 general practitioners was undertaken to which 67 general practitioners responded. RESULTS. The provision of practical prescribing advice by representatives and gifts relevant to medicine were seen as desirable activities by many respondents. However, gifts of value considerably greater than suggested acceptable in recent guidelines for general practitioners were also highly favoured by some practitioners. CONCLUSION. Current ethical guidelines setting out the relationship between pharmaceutical representatives and medical practitioners are inadequate and should be based on the need for the general practitioner to become an unbiased promoter of patient health.     

Meta-Analysis and Systematic Review of Micro- and Macro-Nutrient Intakes and Trajectories of Macro-Nutrient Supply in the Eastern Mediterranean Region

The Eastern Mediterranean Region (EMR) is experiencing a nutrition transition, characterized by the emergence of overnutrition and micro-nutrient deficiencies. No previous study has comparatively examined nutrient intake in adults across countries in the EMR. This review examined the adequacy of nutrients in adults living in the EMR. Moreover, it analyzed the food balance sheets (FBS) for 1961–2018 to identify the trajectory of energy supply from macro-nutrients in the EMR. A systematic search was conducted from January 2012 to September 2020. Only observational studies were retained with a random sampling design. An assessment of the methodological quality was conducted. Levels of nutrient daily intake and their adequacy compared to the daily reference intake of the Institute of Medicine were reported across the region. No studies were identified for half of the region’s countries. Although nutrient energy intake was satisfactory overall, fat and carbohydrate intake were high. Intake of vitamin D, calcium, potassium, zinc, and magnesium were below that recommended. The analysis of the FBS data allowed for the identification of four linear patterns of trajectories, with countries in the EMR best fitting the ‘high-energy-supply from carbohydrate’ group. This systematic review warrants multi-sectorial commitment to optimize nutrient intake.     

Novel airway findings in a patient with 1p36 deletion syndrome

1p36 deletion syndrome comprises a phenotypic presentation that includes central nervous system, cardiac, and craniofacial anomalies. There has been no report of associated airway anomalies with this syndrome. We present here a case report and literature review. Prenatally, amniocentesis for chromosomal analysis was performed on our patient, with results consistent with 1p36 deletion syndrome. Respiratory distress and unsuccessful attempts at intubation prompted transfer to Children's Hospital of Colorado. Microlaryngoscopy was subsequently performed, revealing a persistent buccopharyngeal membrane and unidentifiable larynx. Emergent tracheostomy was then performed to secure the airway. Airway anomalies may be associated with 1p36 deletion syndrome.     

Practical considerations for the application of ear simulators in the calibration of audiometers in the extended high frequency region

Objective: Calibration service providers for audiometric equipment often encounter impracticalities in fully implementing the International Electrotechnical Commission (IEC) guidelines for the extended high frequency region. This report evaluates some of the work-around solutions sometimes employed in practice and the implications these have for audiometer calibration results and uncertainties. Design: The impact of using four different microphone configurations on the ear simulator calibration in the frequency range 125?Hz to 20?kHz, and especially in the extended high frequency range from 10?kHz to 20?kHz, was investigated, at a range of temperatures. Results: Variations in the response of the ear simulator of up to 6?dB were observed with the different microphone configurations. In addition, using the microphone without its protection grid produced a dip in the high frequency response of approximately 15?dB. Conclusion: While deviation from the practices required in IEC standards is not recommended, replacing the microphone protection grid with a specially fabricated collar (essentially a grid with the top removed) was found to constrain deviations in response to within ±2?dB. It was also concluded that simply removing the microphone protection grid resulted in a wholly unsatisfactory performance.     

Application of artificial intelligence using a novel EUS-based convolutional neural network model to identify and distinguish benign and malignant hepatic masses

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The Olfactory Strip and Its Preservation in Endoscopic Pituitary Surgery Maintains Smell and Sinonasal Function

Background The return of olfaction and of sinonasal function are important end points after pituitary surgery. Opinions differ on the impact of surgery because techniques vary greatly. A modified preservation of the so-called olfactory strip is described that utilizes a small nasoseptal flap and wide exposure. Methods A cohort of patients undergoing pituitary surgery and endoscopic sinonasal tumor surgery were assessed. Patient-reported outcomes (Sino-Nasal Outcome Test [SNOT22] and Nasal Symptom Score [NSS]) were recorded. A global score of sinonasal function and the impact on smell and taste were obtained. Objective smell discrimination testing was performed in the pituitary group with the Smell Identification Test. Outcomes were assessed at baseline and at 6 months. Results Ninety-eight patients, n = 40 pituitary (50.95 ± 15.31 years; 47.5% female) and n = 58 tumor (52.35 ± 18.51 years; 52.5% female) were assessed. For pituitary patients, NSSs were not significantly different pre- and postsurgery (2.75 ± 3.40 versus 3.05 ± 3.03; p = 0.53). SNOT22 scores improved postsurgery (1.02 ± 0.80 versus 0.83 ± 0.70; p = 0.046). Objective smell discrimination scores between baseline and 6 months were similar (31.63 ± 3.49 versus 31.35 ± 4.61; p = 0.68). No difference in change of olfaction was seen compared with controls (Kendall tau-b p = 0.46). Conclusions Preservation of the olfactory strip can provide a low morbidity approach without adversely affecting olfaction and maintaining reconstruction options.     

C3 exoenzyme lacks effects on peripheral axon regeneration in vivo

Peripheral nerve injury triggers the activation of the small GTPase RhoA in spinal motor and peripheral sensory neurons. C3 transferase, an exoenzyme produced by Clostridium botulinum that inactivates RhoA by ADP‐ribosylation, has been successfully applied in central nervous system (CNS) lesion models to facilitate regeneration functionally and morphologically. Until now it has not been demonstrated if C3_bot exerts positive effects on peripheral axon regeneration as well. In organotypic spinal cord preparations, C3_bot reduced axonal growth of motoneurons, while no effect on sensory axon outgrowth from dorsal root ganglia (DRG) explants was observed. Enzymatically inactive C3_E174Q was ineffective in both culture models. Spinal cord slices exhibited a significant increase in microglia/macrophages after treatment with C3_bot suggesting an inflammatory component in the inhibition of axon growth. C3_bot or C3_E174Q were then applied into conduits implanted after transection of the sciatic nerve in rats. Functional evaluation by electrophysiology, nociception, and walking track tests did not show any significant difference between groups with active or mutant C3_E174Q. Transmission electron microscopy of the regenerated nerves revealed no significant differences in the number of myelinated and unmyelinated axons 6 weeks after surgery. Compared to the CNS, the functional significance of RhoA may be limited during nerve regeneration in a growth‐promoting environment.