Ocular Refraction at Birth and Its Development During the First Year of Life in a Large Cohort of Babies in a Single Center in Northern Italy

The purpose of this study was to investigate refraction at birth and during the first year of life in a large cohort of babies born in a single center in Northern Italy. We also aimed to analyze refractive errors in relation to the gestational age at birth. An observational ophthalmological assessment was performed within 24 h of birth on 12,427 newborns. Refraction was examined using streak retinoscopy after the administration of tropicamide (1%). Values in the range of between +0.50 ≤ D ≤ +4.00 were defined as physiological refraction at birth. Newborns with refraction values outside of the physiological range were followed up during the first year of life. Comparative analyses were conducted in a subgroup of babies with known gestational ages. The following distribution of refraction at birth was recorded: 88.03% of the babies had physiological refraction, 5.03% had moderate hyperopia, 2.14% had severe hyperopia, 3.4%, had emmetropia, 0.45%, had myopia, 0.94% had astigmatism, and 0.01% had anisometropia. By the end of the first year of life, we observed reductions in hyperopia and astigmatism, and stabilization of myopia. Preterm babies had a four-fold higher risk of congenital myopia and a three-fold higher risk of congenital emmetropia as compared to term babies. Refraction profiles obtained at birth changed during the first year of life, leading to a normalization of the refraction values. Gestational age at birth affected the incidence of refractive errors and amblyopia

The incorporation of stress management programming into family medicine residencies-results of a national survey of residency directors: a CERA study

BACKGROUND AND OBJECTIVES: Residents\u27 stress and burnout is a concern among family medicine residency programs. Our objective is to assess stress management options available to family medicine residents. METHODS: In 2012, the Council of Academic Family Medicine Educational Research Alliance (CERA) e-mailed a survey to US residency directors. Questions were asked on four types of stress management programming (SMP): (1) access to counselors, social workers, or mental health providers, (2) residency support or Balint groups, (3) stress management lectures or workshops, and (4) residency retreats. We assessed how many programs contained all four types of SMP and their relationship to the following topics: stress management techniques for patients, spirituality, mind/body techniques, and self-care for residents. RESULTS: Of the 212 responses, 29% reported having all four types of SMP. Eighty-three percent reported stress management lectures or workshops, and 79% reported residency retreats. Smaller and mid-size residencies (36%) and residencies in the West (36%) were more likely to have all four types of SMP. There was a correlation between having didactics, clinical rotations, and electives on stress management techniques for patient care and having stress management lectures or workshops for residents. There was statistical significance between having resident self-care curriculum and (1) having retreats and (2) stress management lectures or workshops. CONCLUSIONS: It is necessary to evaluate whether residency programs are providing appropriate stress management skills for residents that will improve physician wellness and patient outcomes

Adrenoreceptors and nitric oxide in the cardiovascular system

Nitric Oxide (NO) is a small molecule that continues to attract much attention from the scientific community. Since its discovery, it has been evident that NO has a crucial role in the modulation of vascular tone. Moreover, NO is involved in multiple signal transduction pathways thus contributing to the regulation of many cellular functions. NO effects can be either dependent or independent on cGMP, and rely also upon several mechanisms such as the amount of NO, the compartmentalization of the enzymes responsible for its biosynthesis (NOS), and the local redox conditions. Several evidences highlighted the correlation among adrenoreceptors activity, vascular redox status and NO bioavailability. It was suggested a possible crosstalk between NO and oxidative stress hallmarks in the endothelium function and adaptation, and in sympathetic vasoconstriction control. Adrenergic vasoconstriction is a balance between a direct vasoconstrictive effect on smooth muscle and an indirect vasorelaxant action caused by α2- and β-adrenergic endothelial receptor-triggered NO release. An increased oxidative stress and a reduction of NO bioavailability shifts this equilibrium causing the enhanced vascular adrenergic responsiveness observed in hypertension. The activity of NOS contributes to manage the adrenergic pathway, thus supporting the idea that the endothelium might control or facilitate β-adrenergic effects on the vessels and the polymorphic variants in β2-receptors and NOS isoforms could influence aging, some pathological conditions and individual responses to drugs. This seems to be dependent, almost in part, on differences in the control of vascular tone exerted by NO. Given its involvement in such important mechanisms, the NO pathway is implicated in aging process and in both cardiovascular and non-cardiovascular conditions. Thus, it is essential to pinpoint NO involvement in the regulation of vascular tone for the effective clinical/therapeutic management of cardiovascular diseases (CVD). © 2013 Conti, Russomanno, Corbi, Izzo, Vecchione and Filippelli

Medication and Dietary Supplement Interactions among a Low-Income, Hospitalized Patient Population Who Take Cardiac Medications

Purpose. To identify characteristics associated with the use of potentially harmful combinations of dietary supplements (DS) and cardiac prescription medications in an urban, underserved, inpatient population. Methods. Cardiac prescription medication users were identified to assess the prevalence and risk factors of potentially harmful dietary supplement-prescription medication interactions (PHDS-PMI). We examined sociodemographic and clinical characteristics for crude (χ2 or t-tests) and adjusted multivariable logistic regression associations with the outcome. Results. Among 558 patients, there were 121 who also used a DS. Of the 110 participants having a PHDS-PMI, 25% were asked about their DS use at admission, 75% had documentation of DS in their chart, and 21% reported the intention to continue DS use after discharge. A multivariable logistic regression model noted that for every additional medication or DS taken the odds of having a PHDS-PMI increase and that those with a high school education are significantly less likely to have a PHDS-PMI than those with a college education. Conclusion. Inpatients at an urban safety net hospital taking a combination of cardiac prescription medications and DS are at a high risk of harmful supplement-drug interactions. Providers must ask about DS use and should consider the potential for interactions when having patient discussions about cardiac medications and DS

Persistent itching associated to silodosin in an elderly patient: Implications for drug-drug interactions and pharmacogenetics

Itching is a complaint affecting especially the elderly, in whom comorbidities and polypharmacy increase the risk of adverse drug reactions. We reported the case of an 83-year-old man with a generalized itching lasting more than 3 years underwent to our attention during his enrollment in a clinical study at University Hospital of Salerno, Italy where he was planned for a thromboendoarteriectomy because of left internal carotid artery stenosis. His medical history included arterial hypertension, ischemic heart disease, chronic cerebrovasculopathy, dyslipidaemia and prostatic hyperplasia. His therapy was olmesartan medoxomil 10 mg/die, nebivolol 5 mg x 1/2/die, acetylsalicylic acid 100 mg/die, omeprazole 20 mg/die, atorvastatin 20 mg/die, supplements contain ing EPA and DHA, vitamins K2, B6, B12 and folic acid (vit B9) and silodosin 8 mg/die. The patient’s demographic clinic, laboratory data and a pharmacological anamnesis were collected. Screening of two ABCB1 polymorphisms associated to a decrease of P-glycoprotein (P-gp) activity was performed by realtime PCR. An iatrogenic cause of the itching was suspected and the Naranjo algorithm was applied, revealing possible association between such an adverse reaction and all used drugs. Because the patient reported the beginning of the itching in concomitance with the aspirin assumption, this agent was discontinued but without improvement. Then, because silodosin-atorvastatin interaction may increase the silodosin plasma concentration, this drug was switched to doxazosin and the itching disappeared. This clinical case stresses the potential misleading based on the patients’ beliefs and the importance to consider all the patients’ available information to ascertain the cause of adverse drug reactions

Argas (Persicargas) persicus (Oken, 1818) (Ixodida: Argasidae) in Sicily with considerations about its Italian and West-Mediterranean distribution.

Recently, in the province of Trapani (Western Sicily), some overwintering specimens of the argasid tick Argas (Persicargas) persicus (Oken, 1818) were observed and collected. Morphological and genetic analysis were utilized in order to reach a definitive identification. The species was found in two semi-natural sites where, having been found repeatedly, its presence does not appear accidental. Moreover the characteristics of the Sicilian findings seem to exclude a human-induced spread. This record, the first regarding Sicily and South Italy, is discussed together with the previous doubtful citations for Italy. These findings revalue not only all the old citations for Italy but also the hypothesis that the Mediterranean distribution of this argasid is of a natural origin

A systematic review of the reporting of adverse events associated with medical herb use among children

PURPOSE: Information about the safety of herbal medicine often comes from case reports published in the medical literature, thus necessitating good quality reporting of these adverse events. The purpose of this study was to perform a systematic review of the comprehensiveness of reporting of published case reports of adverse events associated with herb use in the pediatric population. METHODS: Electronic literature search included 7 databases and a manual search of retrieved articles from inception through 2010. We included published case reports and case series that reported an adverse event associated with exposure to an herbal product by children under the age of 18 years old. We used descriptive statistics. Based on the International Society of Epidemiology\u27s Guidelines for Submitting Adverse Events Reports for Publication, we developed and assigned a guideline adherence score (0-17) to each case report. RESULTS: Ninety-six unique journal papers were identified and represented 128 cases. Of the 128 cases, 37% occurred in children under 2 years old, 38% between the ages of 2 and 8 years old, and 23% between the ages of 9 and 18 years old. Twenty-nine percent of cases were the result of an intentional ingestion while 36% were from an unintentional ingestion. Fifty-two percent of cases documented the Latin binomial of the herb ingredients; 41% documented plant part. Thirty-two percent of the cases reported laboratory testing of the herb, 20% documented the manufacturer of the product, and 22% percent included an assessment of the potential concomitant therapies that could have been influential in the adverse events. Mean guideline adherence score was 12.5 (range 6-17). CONCLUSIONS: There is considerable need for improvement in reporting adverse events in children following herb use. Without better quality reporting, adverse event reports cannot be interpreted reliably and do not contribute in a meaningful way to guiding recommendations for medicinal herb use

Corneal epithelial wound healing promoted by verbascoside-based liposomal eyedrops

Different liposomal formulations were prepared to identify those capable of forming eyedrops for corneal diseases. Liposomes with neutral or slightly positive surface charge interact very well with the cornea. Then these formulations were loaded with verbascoside to heal a burn of corneal epithelium induced by alkali. The cornea surface affected involved in wound was monitored as a function of time. Experimental results were modeled by balance equation between the rate of healing, due to the flow of phenylpropanoid, and growth of the wound. The results indicate a latency time of only three hours and furthermore the corneal epithelium heals in 48 hours.Thus, the topical administration of verbascoside appears to reduce the action time of cells, as verified by histochemical and immunofluorescence assays

Platelet aggregation is affected by nitrosothiols in patients with chronic hepatitis: in vivo and in vitro studies

AIM: To investigate the relationship among the number of platelets and plasma levels of S-nitrosothiols (S-NO), nitrite, total non-protein SH (NPSH), glutathione (GSH), cysteine (CYS), malondialdehyde (MDA), 4-hydroxininenal (4HNE), tumor necrosis factor-alpha (TNFalpha) and interleukin (IL)-6 in patients with chronic hepatitis C (CH). METHODS: In vitro the aggregation of platelets derived from controls and CH patients was evaluated before and after the addition of adenosine diphosphate (ADP) and collagen, both in basal conditions and after incubation with nitrosoglutathione (GSNO). RESULTS: In vivo, S-NO plasma levels increased significantly in CH patients and they were significantly directly correlated with platelet numbers. Patients with platelet counts 150000/microL. In vitro, the ADP and collagen aggregation time was increased in platelets from patients and not from controls; in addition, platelets from CH patients but not from controls also showed a latency time after exposure to collagen