Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery.

BACKGROUND: Stroke is the major cause of adult disability. Selective serotonin reuptake inhibitors (SSRIs) have been used for many years to manage depression. Recently, small trials have demonstrated that SSRIs might improve recovery after stroke, even in people who are not depressed. Systematic reviews and meta-analyses are the least biased way to bring together data from several trials. Given the promising effect of SSRIs on stroke recovery seen in small trials, a systematic review and meta-analysis is needed. OBJECTIVES: To determine whether SSRIs improve recovery after stroke, and whether treatment with SSRIs was associated with adverse effects. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (August 2011), Cochrane Depression Anxiety and Neurosis Group Trials Register (November 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 8), MEDLINE (from 1948 to August 2011), EMBASE (from 1980 to August 2011), CINAHL (from 1982 to August 2011), AMED (Allied and Complementary Medicine) (from 1985 to August 2011), PsycINFO (from 1967 to August 2011) and PsycBITE (Pyschological Database for Brain Impairment Treatment Efficacy) (March 2012). To identify further published, unpublished and ongoing trials we searched trials registers, pharmaceutical websites, reference lists, contacted experts and performed citation tracking of included studies. SELECTION CRITERIA: We included randomised controlled trials that recruited stroke survivors (ischaemic or haemorrhagic) at any time within the first year. The intervention was any SSRI, given at any dose, for any period. We excluded drugs with mixed pharmacological effects. The comparator was usual care or placebo. In order to be included, trials had to collect data on at least one of our primary (dependence and disability) or secondary (impairments, depression, anxiety, quality of life, fatigue, healthcare cost, death, adverse events and leaving the trial early) outcomes. DATA COLLECTION AND ANALYSIS: We extracted data on demographics, type of stroke, time since stroke, our primary and secondary outcomes, and sources of bias. For trials in English, two review authors independently extracted data. For Chinese papers, one review author extracted data. We used standardised mean differences (SMD) to estimate treatment effects for continuous variables, and risk ratios (RR) for dichotomous effects, with their 95% confidence intervals (CIs). MAIN RESULTS: We identified 56 completed trials of SSRI versus control, of which 52 trials (4059 participants) provided data for meta-analysis. There were statistically significant benefits of SSRI on both of the primary outcomes: RR for reducing dependency at the end of treatment was 0.81 (95% CI 0.68 to 0.97) based on one trial, and for disability score, the SMD was 0.91 (95% CI 0.60 to 1.22) (22 trials involving 1343 participants) with high heterogeneity between trials (I(2) = 87%; P < 0.0001). For neurological deficit, depression and anxiety, there were statistically significant benefits of SSRIs. For neurological deficit score, the SMD was -1.00 (95% CI -1.26 to -0.75) (29 trials involving 2011 participants) with high heterogeneity between trials (I(2) = 86%; P < 0.00001). For dichotomous depression scores, the RR was 0.43 (95% CI 0.24 to 0.77) (eight trials involving 771 participants) with high heterogeneity between trials (I(2) = 77%; P < 0.0001). For continuous depression scores, the SMD was -1.91 (95% CI -2.34 to -1.48) (39 trials involving 2728 participants) with high heterogeneity between trials (I(2) = 95%; P < 0.00001). For anxiety, the SMD was -0.77 (95% CI -1.52 to -0.02) (eight trials involving 413 participants) with high heterogeneity between trials (I(2) = 92%; P < 0.00001). There was no statistically significant benefit of SSRI on cognition, death, motor deficits and leaving the trial early. For cognition, the SMD was 0.32 (95% CI -0.23 to 0.86), (seven trials involving 425 participants) with high heterogeneity between trials (I(2) = 86%; P < 0.00001). The RR for death was 0.76 (95% CI 0.34 to 1.70) (46 trials involving 3344 participants) with no heterogeneity between trials (I(2) = 0%; P = 0.85). For motor deficits, the SMD was -0.33 (95% CI -1.22 to 0.56) (two trials involving 145 participants). The RR for leaving the trial early was 1.02 (95% CI 0.86 to 1.21) in favour of control, with no heterogeneity between trials. There was a non-significant excess of seizures (RR 2.67; 95% CI 0.61 to 11.63) (seven trials involving 444 participants), a non-significant excess of gastrointestinal side effects (RR 1.90; 95% CI 0.94 to 3.85) (14 trials involving 902 participants) and a non-significant excess of bleeding (RR 1.63; 95% CI 0.20 to 13.05) (two trials involving 249 participants) in those allocated SSRIs. Data were not available on quality of life, fatigue or healthcare costs.There was no clear evidence from subgroup analyses that one SSRI was consistently superior to another, or that time since stroke or depression at baseline had a major influence on effect sizes. Sensitivity analyses suggested that effect sizes were smaller when we excluded trials at high or unclear risk of bias.Only eight trials provided data on outcomes after treatment had been completed; the effect sizes were generally in favour of SSRIs but CIs were wide. AUTHORS' CONCLUSIONS: SSRIs appeared to improve dependence, disability, neurological impairment, anxiety and depression after stroke, but there was heterogeneity between trials and methodological limitations in a substantial proportion of the trials. Large, well-designed trials are now needed to determine whether SSRIs should be given routinely to patients with stroke

Analisis Pengaruh Aksesibilitas Ruas Jalan Yos Sudarso, Jalan Jendral Sudirman, dan Jalan Mulawarman terhadap Nilai Jual Lahan di Kota Tarakan

One of the steps that&nbsp; taken by the Government of Tarakan City in supporting the development of the city is by the way of developing transportation of infrastructure in the form of a road network that aims to provide accessibility,&nbsp; for making it easier for people to do the movement. This study aims to find out the sale value of land for connection with the accessibility of the road and to know the accessibility factor of the road that has the most influence on the sale value of land in the city of Tarakan. Sampling was conducted on three streets namely, Yos Sudarso road, Mulawarman road, and&nbsp;&nbsp; Sudirman road as the location of this research. From the data that obtained were analyzed by using statistical analysis that using by multiple regression. For&nbsp; this analysis shows that the results of 70.6% of the variable sale value of land can be explained by the intensity variable of city transportation. The most influential accessibility factor of the sale value of land is the intensity of city transportation, which every addition of public transportation 8 vehicle / hour will increase the sale value of land amounted to Rp. 394,527.40 per m²

Representing Onomatopoeias in the Asterix: Asterix in Britain Comic and Their Translations in Indonesian

This study tried to reveal the issue of onomatopoeias found in Asterix in Britain comic and their translations in Indonesian. There were three basic problem formulations: what types of onomatopoeias were found in the Asterix in Britain comic, how they were translated into Indonesian as found in Indonesian version, how their natural features and arbitrariness impacted the techniques of translation applied. The method used was a descriptive-qualitative method. 103 words are identified as onomatopoeic words. It is categorized into miscellaneous sounds (74,8%), human sounds (19,4%), animal sounds (3,9%), and nature sounds (1,9%). All are based on Rozmej and Drabikowska's classification. In term of translation techniques, the most applied technique is adaptation about 72,8%, and the least applied is compensation with only 0,9%. The other techniques found are naturalized borrowing, pure borrowing, and amplification. These techniques affect the results of translation that the forms of translated onomatopoeia are constantly maintained, changed, or removed

How Do Energy Prices, and Labor and Environmental Regulations Affect Local Manufacturing Employment Dynamics? A Regression Discontinuity Approach

Manufacturing industries differ with respect to their energy intensity, labor-to-capital ratio and their pollution intensity. Across the United States, there is significant variation in electricity prices and labor and environmental regulation. This paper uses a regression discontinuity approach to examine whether the basic logic of comparative advantage can explain the geographical clustering of U.S. manufacturing. Using a unified empirical framework, we document that energy-intensive industries concentrate in low electricity price counties, labor-intensive industries avoid pro-union counties, and pollution-intensive industries locate in counties featuring relatively lax Clean Air Act regulation. We use our estimates to predict the likely jobs impacts of regional carbon mitigation efforts.

The Roles of Nanoparticle in the Treatment and Diagnosis of Ovarian Cancer

Ovarian cancer is the most common type of cancer worldwide among women, and it is usually diagnosed at an advanced stage. The initial treatment for ovarian cancer is surgical debulking, but this is only effective in the treatment of early stage disease. Surgery alone is insufficient for treatment of advanced disease and systemic therapies, in particular chemotherapies, are indicated. The main aim of this book chapter is to review the role of nano-therapy in treatment of advance ovarian cancer, in comparison to the use of traditional chemotherapies. Nano-therapies are thought to have advantages in terms of improving drug stability in the human body, chemotherapy toxicity profile, and drug delivery to the target cells thus enhancing drug penetration into the cancer cells. This book chapter also covers the development of nano-therapy and also the type of potential cargos. In summary, the types of nanocarrier, and their roles ovarian cancer diagnosis and treatment will be discussed

Interventions for post-stroke fatigue

BACKGROUND: Post-stroke fatigue (PSF) is a common and distressing problem after stroke. The best ways to prevent or treat PSF are uncertain. Several different interventions can be argued to have a rational basis. OBJECTIVES: To determine whether, among people with stroke, any intervention reduces the proportion of people with fatigue, fatigue severity, or both; and to determine the effect of intervention on health-related quality of life, disability, dependency and death, and whether such intervention is cost effective. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (last searched May 2014), Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014, Issue 4), MEDLINE (1950 to May 2014), EMBASE (1980 to May 2014), CINAHL (1982 to May 2014), AMED (1985 to May 2014), PsycINFO (1967 to May 2014), Digital Dissertations (1861 to May 2014), British Nursing Index (1985 to May 2014), PEDro (searched May 2014) and PsycBITE (searched May 2014). We also searched four ongoing trials registries, scanned reference lists, performed citation tracking of included trials and contacted experts. SELECTION CRITERIA: Two review authors independently scrutinised all titles and abstracts and excluded obviously irrelevant studies. We obtained the full texts for potentially relevant studies and three review authors independently applied the inclusion criteria. We included randomised controlled trials (RCTs) that compared an intervention with a control, or compared different interventions for PSF. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias for each included trial. The primary outcomes were severity of fatigue, or proportion of people with fatigue after treatment. We performed separate analyses for trials investigating efficacy in treating PSF, trials investigating efficacy in preventing PSF and trials not primarily investigating efficacy in PSF but which reported fatigue as an outcome. We pooled results from trials that had a control arm. For trials that compared different potentially active interventions without a control arm, we performed analyses for individual trials without pooling.We calculated standardised mean difference (SMD) as the effect size for continuous outcomes and risk ratio (RR) for dichotomous outcomes. We pooled the results using a random-effects model and assessed heterogeneity using the I(2) statistic. We performed separate subgroup analyses for pharmacological and non-pharmacological interventions. We also performed sensitivity analyses to assess the influence of methodological quality. MAIN RESULTS: We retrieved 12,490 citations, obtained full texts for 58 studies and included 12 trials (three from the 2008 search and nine from the 2014 search) with 703 participants. Eight trials primarily investigated the efficacy in treating PSF, of which six trials with seven comparisons provided data suitable for meta-analysis (five pharmacological interventions: fluoxetine, enerion, (-)-OSU6162, citicoline and a combination of Chinese herbs; and two non-pharmacological interventions: a fatigue education programme and a mindfulness-based stress reduction programme). The fatigue severity was lower in the intervention groups than in the control groups (244 participants, pooled SMD -1.07, 95% confidence interval (CI) -1.93 to -0.21), with significant heterogeneity between trials (I(2) = 87%, degrees of freedom (df) = 6, P value &#60; 0.00001). The beneficial effect was not seen in trials that had used adequate allocation concealment (two trials, 89 participants, SMD -0.38, 95% CI -0.80 to 0.04) or trials that had used adequate blinding of outcome assessors (four trials, 198 participants, SMD -1.10, 95% CI -2.31 to 0.11).No trial primarily investigated the efficacy in preventing PSF.Four trials (248 participants) did not primarily investigate the efficacy on fatigue but other symptoms after stroke. None of these interventions showed any benefit on reducing PSF, which included tirilazad mesylate, continuous positive airway pressure for sleep apnoea, antidepressants and a self management programme for recovery from chronic diseases. AUTHORS' CONCLUSIONS: There was insufficient evidence on the efficacy of any intervention to treat or prevent fatigue after stroke. Trials to date have been small and heterogeneous, and some have had a high risk of bias. Some of the interventions described were feasible in people with stroke, but their efficacy should be investigated in RCTs with a more robust study design and adequate sample sizes

Ciclo ribosomal en bacterias : Terminación de la síntesis proteica

Fil: Azzam, Mansur E.. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina

Outcome of cataract surgery in Nigeria: visual acuity, autorefraction, and optimal intraocular lens powers--results from the Nigeria national survey.

OBJECTIVE: To describe presenting and corrected visual acuities after cataract surgery in a nationally representative sample of adults. Another objective was to describe refractive errors in operated eyes and to determine the optimal range of intraocular lens (IOL) powers for this population. DESIGN: Cross-sectional, population-based survey. PARTICIPANTS: Adults aged 40 years and more were selected using multistage stratified sampling and proportional to size procedures. A sample size of 15027 was calculated, and clusters were selected from all states. METHODS: Individuals who had undergone cataract surgery were identified from interview and examination. All had their presenting visual acuity (VA) measured using a reduced logarithm of the minimum angle of resolution chart and underwent autorefraction. Corrected VAs were assessed using the autorefraction results in a trial set. An ophthalmologist conducted all examinations, including slit-lamp and dilated fundus examination. Causes of visual loss were determined for all eyes with a presenting VA <6/12 using the World Health Organization recommendations. Biometry data were derived from 20449 phakic eyes using the SRK-T formula after excluding those with poor VA or corneal opacities. MAIN OUTCOME MEASURES: Presenting and corrected visual acuities in pseudo/aphakic individuals and autorefraction findings; biometry profile of Nigerian adults. RESULTS: Data from 288 eyes of 217 participants were analyzed. Only 39.5% of eyes had undergone IOL implantation at surgery. Only 29.9% of eyes had a good outcome (i.e., ≥6/18) at presentation, increasing to 55.9% with correction. Use of an IOL was the only factor associated with a good outcome at presentation (odds ratio 9.0; 95% confidence interval, 4.3-18.9; P=0.001). Eyes undergoing cataract surgery had a higher prevalence and degree of astigmatism than phakic eyes. Biometry data reveal that posterior chamber IOL powers of 20, 21, and 22 diopters (D) (A constant 118.0) will give a postoperative refraction range of -2.0 D to emmetropia in 71.4% of eyes, which increases to 82.6% if 19 D is also included. CONCLUSIONS: Postoperative astigmatism needs to be reduced through better surgical techniques and training, and use of biometry should be standard of care

Prevalence, causes, and risk factors for functional low vision in Nigeria: results from the national survey of blindness and visual impairment.

PURPOSE: To estimate prevalence and describe causes of functional low vision (FLV) among a nationally representative sample of Nigerian adults, assess socioeconomic risk factors, and estimate the number of adults in Nigeria who might benefit from low vision assessment or rehabilitation services. METHODS: Multistage, stratified, cluster random sampling with probability proportional to size procedures were used to identify a nationally representative sample of 15,027 persons aged 40 years or older. Distance vision was measured using a reduced logMAR tumbling E-chart. All participants with presenting acuity of <6/12 in one or both eyes had their corrected acuity measured and underwent detailed clinical examination to determine the cause. FLV was defined as best corrected vision <6/18 in the better eye, after excluding those with no light perception in both eyes and those with treatable causes. Analysis took account of the clustered design. RESULTS: In all, 13,591 individuals were examined in 305 clusters (response rate, 89.9%). The crude prevalence of FLV was 3.5% (95% confidence interval, 3.1-3.9%). This was lower than the prevalence of blindness, which was 4.2%. Glaucoma was the most common cause and age the most important risk factor. There are estimated to be approximately 5000 adults with FLV per million population and 340 who are totally blind. Only 9.3% of those with FLV were of working age and literate. CONCLUSIONS: These are the first data on the prevalence, causes, and risk factors for FLV from Africa. Results support studies from Asia that the prevalence of FLV is lower than previously thought. Because the majority of adults with FLV in Nigeria live in rural areas and are elderly and not literate, further research is required to assess the nature of the interventions required and who might best deliver them