Helium Neon laser therapy for post mastectomy lymphedema and shoulder mobility

The aim of this work was to evaluate the efficacy of Helium Neon (He–Ne) laser therapy on post mastectomy lymphedema and shoulder mobility. Thirty female patients with axillary lymph node dissection (ALND), with or without radiotherapy had been participated in this study. The patients were randomly divided into two groups of equal numbers. Group A received He–Ne laser therapy and decongestive lymphatic therapy. Group B received placebo laser therapy in addition to decongestive lymphatic therapy. Measurements of limb volume and shoulder mobility (by tape measurement and standard goniometer) were collected before treatment and after six months of treatment. The mean values of limb volume and Shoulder mobility after 6 months of treatment showed a significant improvement (p< 0.05) for the two groups of the study with a greater improvement for patients in group A. Conclusion: Helium Neon laser therapy has a positive effect in reducing post mastectomy lymphedema and increasing range of motion of shoulder joint.Keywords: Helium Neon laser; Lymphedema; Mastectomy; Shoulder mobilityThe Egyptian Journal of Medical Human Genetics (2013) 14, 195–19

Solute channels of the outer membrane: from bacteria to chloroplasts

Chloroplasts, unique organelles of plants, originated from endosymbiosis of an ancestor of today's cyanobacteria with a mitochondria-containing host cell. It is assumed that the outer envelope membrane, which delimits the chloroplast from the surrounding cytosol, was thus inherited from its Gram-negative bacterial ancestor. This plastid-specific membrane is thus equipped with elements of prokaryotic and eukaryotic origin. In particular, the membrane-intrinsic outer envelope proteins (OEPs) form solute channels with properties reminiscent of porins and channels in the bacterial outer membrane. OEP channels are characterised by distinct specificities for metabolites and a quite peculiar expression pattern in specialised plant organs and plastids, thus disproving the assumption that the outer envelope is a non-specific molecular sieve. The same is true for the outer membrane of Gram-negative bacteria, which functions as a permeability barrier in addition to the cytoplasmic membrane, and embeds different classes of channel pores. The channels of these prokaryotic prototype proteins, ranging from unspecific porins to specific channels to ligand-gated receptors, are exclusively built of P-barrels. Although most of the OEP channels are formed by P-strands as well, phylogeny based on sequence homology alone is not feasible. Thus, the comparison of structural and functional properties of chloroplast outer envelope and bacterial outer membrane channels is required to pinpoint the ancestral OEP `portrait gallery'

Prognostic Evaluation of Vimentin Expression in Correlation with Ki67 and CD44 in Surgically Resected Pancreatic Ductal Adenocarcinoma

Purpose: Radical surgical resection with adjuvant chemotherapy or chemo-radiotherapy is the most effective treatment for pancreatic ductal adenocarcinoma (PDAC). However, relatively few studies investigate the prognostic significance of biological markers in PDAC. This study aims to look into the expressions of vimentin, Ki67, and CD44 in PDAC surgical specimens and their potential prognostic implications in survival. / Method: The study was designed as retrospective, and vimentin, Ki67, and CD44 expressions were evaluated by immunohistochemistry in 53 pancreatic ductal adenocarcinoma cases. Overall survival was assessed by the Kaplan–Meier method. / Results: Patients’ median age was 68 years. The median survival was 18 months. The tumors were T3-4 in 40/53 (75.5%), and metastases in lymph nodes were found in 42 out of 53 (79.2%) cases. On multivariate analysis, the size of primary tumor (p < 0 001), the surgical resection margin status (p = 0 042), and vimentin expression (p = 0 011) were independently correlated with overall survival. / Conclusions: Long-term survival after resection of PDAC is still about 15%. Vimentin expression is a potential independent adverse prognostic molecular marker and should be included in histopathological reports. Also, CD44 expression correlates with high Ki67, vimentin positivity, and N stage and may represent a potential target of novel therapeutic modalities in pancreatic adenocarcinoma patients

Prise en charge des complications des fistules artério-veineuses pour hémodialyse chronique

La fistule artério-veineuse native est l'accès vasculaire de choix pour  l'hémodialyse chronique en raison de sa longévité, son taux faible de complication et de mortalité par rapport aux pontages artério-veineux et aux cathéters. Cependant, il arrive assez souvent que l'on assiste à des complications qui sont dominées par la sténose et la thrombose. C'est une étude rétrospective des complications ayants survenues pour 31 fistules artério-veineuses pour hémodialyse chronique des 200 fistules réalisées chez 200 patients au sein du service de chirurgie vasculaire du CHU Hassan II de Fès sur une période de trois ans, étendue de Janvier 2007 à  Décembre 2009. Ces complications ont été présentés par les thrombosesdans 14 cas soit 45,15% de l'ensemble des complications, les sténoses dans 4 cas (12,90%,) les anévrismes dans 4 cas (12,90%), les  complications ischémiques dans 3 cas (9,67%), l'infection dans 3 cas (9,67%), l'hémorragie dans 2 cas (6,45%) et l' hyperdébit dans un seul cas soit 3,22%. On a pu conserver 22 fistules soit 70,96% par traitement chirurgical ou endovasculaire, on a confectionné une nouvelle fistule dans 8cas soit 25,80%, et on a adressé une patiente (3,22%) pour pose d'un cathéter veineux tunnelisé permanent. Les complications des fistules artério-veineuses pour l'hémodialyse chronique sont la principale cause de morbidité chez les patients hémodialysés, il est donc important de s'impliquer lors de leur création, et de donner un maximum d'attention quand ils sont manipulés. Ceci suggère la mise en place d'un programme de surveillance de ces fistules en raison de l'impact des complications sur la morbi-mortalité du patient hémodialysé et sur le plan financier

Prognostic evaluation of CD44 expression in correlation with bcl-2 and p53 in colorectal cancer

To investigate the expression of CD44 in colorectal cancer and examine its association with clinicopathological features, bcl-2, p53 and long-term outcome, paraffin-embedded tumour specimens from 61 patients with Dukes stage B (AJCC/UICC stage I) and 39 patients with Dukes stage C (AJCC/UICC stage III) colorectal adenocarcinoma were assessed by immunohistochemistry. The expression of CD44, bcl-2 and p53 were correlated with 5-year follow-up. Low CD44 expression was present in 30%, moderate in 30% and extensive in 40% of cases. It was not related to patient sex and age but was related to tumour differentiation, stage and tumour site. No association was demonstrated between CD44 and bcl-2. However, there was significant evidence of an association between CD44 and p53 in 66 cases in which p53 was previously assessed. There was a trend towards increased survival in patients whose tumours expressed lower levels of CD44 protein. When entered into multivariate analysis model, which also included bcl-2 and p53, CD44 staining emerged as an indicator of poor prognosis in colorectal cancer patients

Diagnostic importance of platelet parameters in patients with acute coronary syndrome admitted to a tertiary care hospital in southwest region, Saudi Arabia

AbstractObjectiveIdentifying risk factors for acute coronary syndrome (ACS) is important for both diagnostic and prognostic purposes. Abnormal platelet parameters, mainly platelet count (PC), mean platelet volume (MPV) and platelet distribution width (PDW) are thought to be among these risk factors. In this study, the associations between PC, MPV and PDW and ACS were investigated in patients admitted to the tertiary care hospital in the south west region of Saudi Arabia.Materials and methodsA retrospective cohort of 212 patients with the diagnosis of ACS admitted to Aseer Central Hospital during the period extending from February 1, 2008 to October 31, 2008 were included. The control group consisted of 49 matched subjects who were admitted for chest pain investigation and subsequently found to be non-cardiac chest pain after performing relevant investigations. Blood samples were taken at the time of admission for platelet parameters. Statistical analysis was made using SPSS software and P-values were considered significant if <0.05.ResultsA total of 212 patients with acute coronary syndrome (80 patients with MI and 132 patients with UA) and 49 matched controls were studied. The PC was not statistically different among the three groups (283.3±94.8×109L−1 for MI cases, 262±60.8×109L−1 for UA cases and 275.8±58.9×109L−1 for controls). The MPV was significantly larger in MI cases compared to controls (8.99±1.5fl vs. 8.38±0.51fl, respectively, P<0.009), similarly, the MPV was significantly larger in UA cases compared to controls (9.23±1.19fl vs. 8.38±0.51fl, respectively, P<0.001). The PDW was significantly higher in MI cases compared to controls (15.88±1.5fl vs. 11.96±1.8fl, respectively, P<0.001), similarly, the PDW as also significantly larger in UA cases compared to controls (18.1±18fl vs. 11.96±1.8fl, respectively, P<0.019).ConclusionPlatelet parameters mainly MPV and PDW are readily available and relatively simple and inexpensive laboratory tests which we detected to be significantly raised in patients who have suffered an acute coronary syndrome compared with controls

Diuretic activity of carob (Ceratonia silique L.) Honey: comparison with furosemide

Background: Honey has wide range of biological activities. It has effect on renal function, and urinary nitric oxide and prostaglandins level. The present study was conducted to evaluate diuretic potential of carob honey, collected from Morocco, in normal rats and the results were compared with use of furosemide.Materials and methods: Adult male Wister rats weighing between 230 and 278 g were used. The animals were divided into three groups; group 1 received oral administration of distilled water (10 ml/kg BW), and served as control group, group 2 received oral administration of furosemide (10 mg/kg BW), and group 3 was treated with oral administration of carob honey (100 mg/kg BW). Urine volume, and urine and plasma sodium and potassium were measured after single dose of the interventions and after daily administrations of the interventions.Results: After the single dose of carob honey, urine output was significantly increased at all time intervals (1-6 hrs and at 24 hrs after administration). The daily dose of carob honey for nine days significantly increased urine volume as compared to control group. Carob honey increased urinary levels of sodium and potassium, and did not cause hypokalemia, while furosemide increased urinary sodium and potassium and caused hypokalemia.Conclusion: Carob honey has diuretic, natriuretic and kaliuretic activity without side effects of hypokalemia that was observed with use of furosemide.Key words: Carob honey, furosemide, diuresis, sodium, potassium, creatinine clearanc

Daily illumination exposure and melatonin: influence of ophthalmic dysfunction and sleep duration

BACKGROUND: Ocular pathology lessens light's efficacy to maintain optimal circadian entrainment. We examined whether ophthalmic dysfunction explains unique variance in melatonin excretion of older adults over and above the variance explained by daily illumination, medical, and sociodemographic factors. We also examined whether ophthalmic dysfunction influences relationships between ambient illumination and melatonin. METHODS: Thirty older adults (mean age = 69 years; Blacks = 42% and Whites = 58%) of both genders participated in the study. Demographic and health data were collected at baseline. Participants underwent eye exams at SUNY Downstate Medical Center, wore an actigraph to monitor illumination and sleep, and collected urine specimens to estimate aMT6s concentrations. RESULTS: Hierarchical regression analysis showed that illumination factors explained 29% of the variance in aMT6s mesor. The proportion of variance explained by ophthalmic factors, sleep duration, and race was 10%, 2%, and 2%, respectively. Illumination factors explained 19% of the variance in aMT6s acrophase. The proportion of variance explained by ophthalmic factors, sleep duration, and race was 11%; 17%; and 2%, respectively. Controlling for sleep duration and race reduced the correlations between illumination and melatonin, whereas controlling for ophthalmic factors did not. CONCLUSION: Ophthalmic exams showed that elevated intraocular pressure and large cup-to-disk ratios were independently associated with earlier melatonin timing. Lower illumination exposure also had independent associations with earlier melatonin timing. Conceivably, ophthalmic and illumination factors might have an additive effect on the timing of melatonin excretion, which in turn might predispose individuals to experience early morning awakenings

Resistant Hypertension and Obstructive Sleep Apnea in the Primary-Care Setting

We ascertained the prevalence of resistant hypertension (RH) among blacks and determined whether RH patients are at greater risk for obstructive sleep apnea (OSA) than hypertensives. Method. Data emanated from Metabolic Syndrome Outcome Study (MetSO), a study investigating metabolic syndrome among blacks in the primary-care setting. Sample of 200 patients (mean age = 63 ± 13 years; female = 61%) with a diagnosis of hypertension provided subjective and clinical data. RH was defined using the JNC 7and European Society guidelines. We assessed OSA risk using the Apnea Risk Evaluation System ARES), defining high risk as a total ARES score ≥6. Results. Overall, 26% met criteria for RH and 40% were at high OSA risk. Logistic regression analysis, adjusting for effects of age, gender, and medical co morbidities, showed that patients with RH were nearly 2.5 times more likely to be at high OSA risk, relative to those with hypertension (OR = 2.46, 95% CI: 1.03–5.88, P < .05). Conclusion. Our findings show that the prevalence of RH among blacks fell within the range of RH for the general hypertensive population (3–29%). However, patients with RH were at significantly greater risk of OSA compared to patients with hypertension

Preventing dispensing errors by alerting for drug confusions in the pharmacy information system—A survey of users

Introduction Drug confusion is thought to be the most common type of dispensing error. Several strategies can be implemented to reduce the risk of medication errors. One of these are alerts in the pharmacy information system. Objective To evaluate the experiences of pharmacists and pharmacy technicians with alerts for drug name and strength confusion. Methods In May 2017, a cross-sectional survey of pharmacists and pharmacy technicians was performed in community pharmacies in the Netherlands using an online questionnaire. Results Of the 269 respondents, 86% (n = 230) had noticed the alert for drug name confusion, and 26% (n = 67) for drug strength confusion. Of those 230, 9% (n = 20) had experienced that the alert had prevented dispensing the wrong drug. For drug strength confusion, this proportion was 12% (n = 8). Respondents preferred to have an alert for drug name and strength confusion in the pharmacy information system. ‘Alert fatigue’ was an important issue, so alerts should only be introduced for frequent confusions or confusions with serious consequences. Conclusion Pharmacists and pharmacy technicians were positive about having alerts for drug confusions in their pharmacy information system and experienced that alerts contributed to the prevention of dispensing errors. To prevent alert fatigue, it was considered important not to include all possible confusions as a new alert: the potential contribution to the prevention of drug confusion should be weighed against the risk of alert fatigue