Kirurgisk behandling av degenerative meniskskader

Degenerativ meniskskade er en vanlig skade i befolkningen. Flere og flere opplever plager av dette ettersom befolkningen blir stadig eldre. De siste årene har det blitt publisert flere studier som tyder på at effekten av kirurgi ikke er statistisk signifikant i forhold til konservativ behandling, verken når det kommer til smerter eller funksjon. ”Rapport om dagkirurgi i Norge 2011-2013” viser at meniskoperasjoner er ulikt fordelt blant befolkningen i Norge. Enkelte deler av landet utfører fire ganger flere inngrep per 100 000 innbyggere enn andre boområder. Målsetningen med oppgaven vår er derfor å redusere antall unødvendige meniskoperasjoner. En systematisk oversikt og metaanalyse fra 2014 danner kunnskapsgrunnlaget for oppgaven vår. Denne studien inkluderer syv enkeltstudier, deriblant et enkeltstudium der man sammenlignet kirurgi med såkalt sham-kirurgi. Resultatene viste en bedring i funksjon etter 6 måneder, men det var ingen bedring etter 12 måneder. Det var ingen bedring i smerter verken på kort eller lang sikt. En undersøkelse av dagens praksis ved fire sykehus i ulike deler av Norge viser til dels ulik framgangsmåte mtp. vurdering av pasientene og indikasjoner for kirurgi. Ved tre av sykehusene mangler det skriftlige retningslinjer for vurdering. Vi foreslår derfor å utarbeide nasjonale skriftlige retningslinjer som et tiltak for å redusere antall operasjoner. Dette arbeidet bør ledes av en bredt sammensatt ekspertgruppe med mandat fra Helsedirektoratet. Vi ønsker også at fastlegene får tilgang til standardisert informasjon til hjelp ved spørsmål om videre henvisning. I tillegg ser vi for oss at helsemyndighetene også styrer dette via økonomiske incentiver. For å måle effekten av tiltakene våre vil vi blant annet telle antall operasjoner pr 100 000 innbyggere, telle antall henvisninger fra fastlegene og forsøke å måle den økonomiske effekten av tiltakene. Siden det ikke finnes overordnede retningslinjer for behandling av degenerative meniskskader har vi valgt å dele implementering av tiltakene våre i to: Den første delen beskriver hvordan vi ser for oss å organisere dette på overordnet nivå, mens del to beskriver hvordan vi ser for oss at tiltakene kan implementeres i et klinisk mikrosystem. Vi har valgt å bruke PDSA-sirkelen som et verktøy for implementering av tiltakene. Målet om å redusere antall operasjoner krever etablering av nasjonale retningslinjer og andre tiltak på nasjonalt og lokalt nivå. Vi har gjennom denne oppgaven forsøkt å lage en plan for endring av dagens praksis til en mer restriktiv tilnærming

Anemia, diet and therapeutic iron among children living with HIV: a prospective cohort study

BACKGROUND: Children living with HIV have higher-than-normal prevalence of anemia. The beneficial effect of therapeutic iron has been questioned in the setting of high prevalence of infections. This study examines anemia prevalence and effect of standard therapeutic iron on HIV disease progression among children. METHODS: Perinatally-infected children aged 2–12 years were enrolled at three sites in southern India, and were followed for 1 year with clinical assessments, dietary recall and anthropometry. Laboratory parameters included iron markers (ferritin, soluble transferrin receptor) and other micronutrient levels (vitamin A, B(12), folate). Iron was given to anemic children based on WHO guidelines. Statistical analyses including frequency distributions, chi square tests and multivariate logistic regression were performed using Stata v13.0. RESULTS: Among 240 children enrolled (mean age 7.7 years, 54.6 % males), median CD4 was 25 %, 19.2 % had advanced disease, 45.5 % had malnutrition, and 43.3 % were on antiretroviral treatment (ART) at baseline. Anemia was prevalent in 47.1 % (113/240) children. Iron deficiency was present in 65.5 %; vitamin A and vitamin B(12) deficiency in 26.6 % and 8.0 % respectively; and anemia of inflammation in 58.4 %. Independent risk factors for anemia were stunting, CD4 < 25 %, detectable viral load ≥400 copies/ml and vitamin A deficiency. Inadequate dietary iron was prominent; 77.9 % obtained less than two-thirds of recommended daily iron. Among clinically anemic children who took iron, overall adherence to iron therapy was good, and only minor self-limiting adverse events were reported. Median hemoglobin rose from 10.4 g/dl to 10.9 mg/dl among those who took iron for 3 months, and peaked at 11.3 mg/dl with iron taken for up to 6 months. Iron was also associated with a greater fall in clinical severity of HIV stage; however when adjusted for use of ART, was not associated with improvement in growth, inflammatory and CD4 parameters. CONCLUSIONS: Children living with HIV in India have a high prevalence of anemia mediated by iron deficiency, vitamin A deficiency and chronic inflammation. The use of therapeutic iron for durations up to 6 months appears to be safe in this setting, and is associated with beneficial effects on anemia, iron deficiency and HIV disease progression

Neural correlates of religious and spiritual experiences

ABSTRACT A literature review was undertaken with the aim of understanding the relationship between human brain and religious and spiritual experiences (RSEs). The most common features ascribed to RSEs include a sense of having encountered ultimate reality , a sense of unity or totality , a state of no mind – pure consciousness and a state of bliss , which may be experienced during a wide range of spiritual practices such as prayer, yoga and meditation. Scientists previously believed that RSEs were artifacts of temporal lobe function, thus the temporal lobe was thought to be the only part of the brain involved in those experiences. Can RSEs predominantly be related to a single region of the brain? Or are there many parts of the brain involved simultaneously during RSEs? A search was conducted using the PubMed database to retrieve articles related to neural (anatomical) correlates of RSEs that were investigated using functional neuroimaging techniques, such as SPECT, PET and fMRI. Search terms included brain, religion, spirituality and neurotheology. 11 relevant articles were reviewed. Perhaps the most striking finding observed in these studies is that there exists no single specific neural correlate of RSEs. This finding should not come as a surprise, given that these experiences, like many other higher cortical functions, are complex and multidimensional, combining perception, cognition and emotion. Accordingly, RSEs are not merely irrational or delusions, they are rather based in the observable functions of the brain. The studies have also revealed some discrepancies, which are predominantly attributed to the diversity of meditative practices included in the studies. Still, there are some consistent findings within the frontal lobes, parietal lobes, basal ganglia and limbic system, which appears to be frequently related in a network associated with RSEs. However, these findings are only correlative in nature, they tell us nothing about cause and effect. In other words, it is not clear whether a change in regional brain activity caused that experience or responded to that experience

Utilisation of community-based rehabilitation services for incurably blind persons in a rural population of southern India

Purpose: To identify barriers in utilisation of community based rehabilitation (CBR) services for incurably blind persons in rural South India. Methods: A community-based rehabilitation programme for incurably blind persons was initiated in Theni district of southern Tamil Nadu in south India. After door-to-door enumeration and preliminary ocular screening by trained workers at the village, identified blind persons were categorised as either curable or incurable by an ophthalmologist. Trained workers provided rehabilitation, including mobility training (OM), training to perform activities of daily living (ADL), and economic rehabilitation for the incurably blind in their respective villages. Results: Of the 460,984 persons surveyed, 400 (0.09&#x0025;) were certified as incurably blind including 156 (39.00&#x0025;) persons blind from birth. Social rehabilitation was provided for 268 (67.00&#x0025;) incurably blind persons. Economic rehabilitation was provided to 96 persons, and integrated education to 22 children. Nearly one-fifth (n=68,17.00&#x0025;) of incurably blind persons refused the services provided. The major reasons for refusal included old age and other illnesses (41.18&#x0025;), and multiple handicaps (19.12&#x0025;). Twenty-seven (6.75&#x0025;) persons had either migrated or died, and 29 (7.25&#x0025;) persons were already able to function independently. Conclusion: Although CBR programmes provide useful services to the incurably blind, a better understanding of barriers is required to improve service utilisation. Developing a standardised data collection format for every CBR programme can result in the creation of a national database of ophthalmic diseases

Graphene oxide synthesis from agro waste

A new method of graphene oxide (GO) synthesis via single-step reforming of sugarcane bagasse agricultural waste by oxidation under muffled atmosphere conditions is reported. The strong and sharp X-ray diffraction peak at 2θ = 11.6° corresponds to an interlayer distance of 0.788 nm (d002) for the AB stacked GOs. High-resolution transmission electron microscopy (HRTEM) and selected-area electron diffraction (SAED) confirm the formation of the GO layer structure and the hexagonal framework. This is a promising method for fast and effective synthesis of GO from sugarcane bagasse intended for a variety of energy and environmental application

Development of Ce³⁺/Eu³⁺ Dual-Substituted Hydroxyapatite Coating on Surgical Grade Stainless Steel for Improved Antimicrobial and Bioactive Properties

The research goal of this experiment is a successful electrodeposition of cerium/europium substituted hydroxyapatite (Ce/Eu-HAP) on borate-passivated 316L stainless steel (SS). The surface characteristics of the resultant coatings were evaluated by Fourier transform infrared spectroscopy, X-ray diffractometry, scanning electron microscopy, and energy dispersive X-ray analysis. The electrochemical characterization of all the coatings was studied in Ringer’s solution, in which Ce/Eu-HAP coating exhibited better anticorrosion property than the other developed coatings. The metal ion release from the coatings was studied by inductively coupled plasma atomic emission spectrometry. With regards to antimicrobial activity against <i>E. coli</i>, the Ce/Eu-HAP coating exhibited high resistivity compared with the other developed coatings. The resultant coatings exhibited lower cytotoxicity against human osteosarcoma MG63 cells at various incubation days, which evidence the better bioactive nature of the coatings. Thus, the dual-minerals-substituted HAP coating can play a significant role in biomedical applications

Green synthesis, characterization of silver nanoparticles using aqueous leaf extracts of Solanum melongena and in vitro evaluation of antibacterial, pesticidal and anticancer activity in human MDA-MB-231 breast cancer cell lines

The present study validated the green synthesis and characterization of AgNPs using the leaf extracts of Solanum melongena (SM-AgNPs). The efficiency of the phytocompounds in the leaf extract in reducing Ag+ to Ag0 ions was studied. The synthesized SM-AgNPs were characterized by spectroscopic methods and standard methods were adopted for the antioxidant activity, HPTLC, cytotoxicity and antimicrobial assays and pesticidal activity as well. The synthesised nanoparticle was measured to be 20.54 nm which was confirmed by the characterization. The total phenolic content was 5.98 ± 0. GAE/g which indicated potent antioxidant activity. HPTLC profile showed thirteen peaks corresponding to the phenolic compounds with Rf values ranging from 0.05 to 0.95. The average particle size and zeta potential was 75.14 nm-19.8 mV respectively. Cytotoxicity assay of the synthesized AgNP’s showed viability percentage of 50.23 at 100 mg/mL. Treatment of MDA-MB-231 cell lines with the SM-AgNPs induced early apoptosis in a greater number of cells. The synthesizedAgNPs were effective against the bacterial isolates Escherichia coli, Pseudomonas aeruginosa, Shigella flexneri, Proteus vulgaris, Klebsiella pneumoniae and Staphylococcus aureus. High mortality of Bemisiatabaci was observed in the100 µg/mL of the SM-AgNPs treated concentrations. The study demonstrated the efficiency of SM-AgNPs against cancer cell lines, microbial isolates and insect pests

Supporting adherence to antiretroviral therapy with mobile phone reminders: results from a cohort in South India.

BACKGROUND: Adherence is central to the success of antiretroviral therapy. Supporting adherence has gained importance in HIV care in many national treatment programs. The ubiquity of mobile phones, even in resource-constrained settings, has provided an opportunity to utilize an inexpensive, contextually feasible technology for adherence support in HIV in these settings. We aimed to assess the influence of mobile phone reminders on adherence to antiretroviral therapy in South India. Participant experiences with the intervention were also studied. This is the first report of such an intervention for antiretroviral adherence from India, a country with over 800 million mobile connections. METHODS: STUDY DESIGN: Quasi-experimental cohort study involving 150 HIV-infected individuals from Bangalore, India, who were on antiretroviral therapy between April and July 2010. The intervention: All participants received two types of adherence reminders on their mobile phones, (i) an automated interactive voice response (IVR) call and (ii) A non-interactive neutral picture short messaging service (SMS), once a week for 6 months. Adherence measured by pill count, was assessed at study recruitment and at months one, three, six, nine and twelve. Participant experiences were assessed at the end of the intervention period. RESULTS: The mean age of the participants was 38 years, 27% were female and 90% urban. Overall, 3,895 IVRs and 3,073 SMSs were sent to the participants over 6 months. Complete case analysis revealed that the proportion of participants with optimal adherence increased from 85% to 91% patients during the intervention period, an effect that was maintained 6 months after the intervention was discontinued (p = 0.016). Both, IVR calls and SMS reminders were considered non-intrusive and not a threat to privacy. A significantly higher proportion agreed that the IVR was helpful compared to the SMS (p<0.001). CONCLUSION: Mobile phone reminders may improve medication adherence in HIV infected individuals in this setting, the effect of which was found to persist for at least 6 months after cessation of the intervention

Two novel phages PSPa and APPa inhibit planktonic, sessile and persister populations of Pseudomonas aeruginosa, and mitigate its virulence in Zebrafish model

Abstract The present study explores the avenue of phage therapy as an alternative antimicrobial therapeutic approach to counter multidrug-resistant (MDR) Pseudomonas aeruginosa infection. Our study investigated two novel virulent phages PSPa and APPa, specific to P. aeruginosa, in which in vitro evaluations were carried out to assess the therapeutic potential of phages. Both the identified phages exhibited host specificity by showing antagonistic activity of about 96.43% (27/28) and 92.85% (26/28) towards the 28 MDR clinical isolates of P. aeruginosa. The PSPa phage was found to have linear dsDNA with a sequence length of 66,368 bp and 92 ORFs, of which 32 were encoded for known functions of the phage life cycle and the remaining 60 were hypothetical functions. The APPa phage was found to have linear dsDNA with 59,591 bp of genome length and 79 ORFs, of which 15 were found to have known phage functions and the remaining 64 were found to be hypothetical proteins. Notably, the genome of both the phages lacks genes coding for tRNA, rRNA, and tmRNA. The phylogenetic analysis revealed that PSPa and APPa share > 95% sequence similarity with previously sequenced Pseudomonas viruses of their respective families. Further, the in vivo efficacy evaluation using the zebrafish model revealed that the treatment with PSPa and APPa has remarkably improved the survival rate of bacterial-infected zebrafish, reinforcing the anti-infective potential of the isolated phages PSPa and APPa against P. aeruginosa infection