Outcomes after urgent thyroidectomy following rapid control of thyrotoxicosis in Graves’ disease are similar to those after elective surgery in well-controlled disease

Background Surgery for Graves’ disease (GD) is usually performed after adequate control with medical treatment. Occasionally, rapid pre-operative optimization is required. The primary objective was to compare the outcomes of patients undergoing elective surgery for well-controlled GD with those undergoing rapid pre-operative treatment. We also propose a formal treatment protocol for future use. Methods A retrospective cohort study in a tertiary referral centre included 247 patients with well-controlled GD undergoing elective surgery and 19 patients with poorly controlled disease undergoing surgery after rapid optimization. The latter group did not respond well to thionamides (carbimazole and/or propylthiouracil) or had intolerance or side effects to thionamides and were treated with a range of non-thionamide drugs, including Lugol’s iodine, cholestyramine, beta blockers and steroids (with or without thionamides), and closely monitored for 1–2 weeks before surgery. Outcome measures included thyroid storm, hypoparathyroidism and recurrent laryngeal nerve palsy. Results In total, 266 patients with male-to-female ratio of 1:6 and median (interquartile range) age of 39 (31–51) were included. Overall, long-term recurrent laryngeal palsy and hypoparathyroidism occurred in 1 (0.38%) and 13 (4.9%) patients, respectively. No patient had thyroid storm. There was no significant difference in hypoparathyroidism (p = 1), vocal cord palsy (p = 0.803) and post-operative bleeding (p = 0.362), between elective surgery and rapid optimization groups. Conclusion Rapid pre-operative treatment is effective, safe and is associated with similar outcomes compared to usual treatment. A rapid pre-operative optimization protocol is proposed

Ethnopharmacological survey of Samburu district, Kenya

<p>Abstract</p> <p>Background</p> <p>Ethnobotanical pharmacopoeia is confidently used in disease intervention and there is need for documentation and preservation of traditional medical knowledge to bolster the discovery of novel drugs. The objective of the present study was to document the indigenous medicinal plant utilization, management and their extinction threats in Samburu District, Kenya.</p> <p>Methods</p> <p>Field research was conducted in six divisions of Samburu District in Kenya. We randomly sampled 100 consented interviewees stratified by age, gender, occupation and level of education. We collected plant use data through semi-structured questionnaires; transect walks, oral interviews and focus groups discussions. Voucher specimens of all cited botanic species were collected and deposited at University of Nairobi's botany herbarium.</p> <p>Results</p> <p>Data on plant use from the informants yielded 990 citations on 56 medicinal plant species, which are used to treat 54 different animal and human diseases including; malaria, digestive disorders, respiratory syndromes and ectoparasites.</p> <p>Conclusion</p> <p>The ethnomedicinal use of plant species was documented in the study area for treatment of both human and veterinary diseases. The local population has high ethnobotanical knowledge and has adopted sound management conservation practices. The major threatening factors reported were anthropogenic and natural. Ethnomedical documentation and sustainable plant utilization can support drug discovery efforts in developing countries.</p

Ceramides bind VDAC2 to trigger mitochondrial apoptosis

Ceramides draw wide attention as tumor suppressor lipids that act directly on mitochondria to trigger apoptotic cell death. However, molecular details of the underlying mechanism are largely unknown. Using a photoactivatable ceramide probe, we here identify the voltage-dependent anion channels VDAC1 and VDAC2 as mitochondrial ceramide binding proteins. Coarse-grain molecular dynamics simulations reveal that both channels harbor a ceramide binding site on one side of the barrel wall. This site includes a membrane-buried glutamate that mediates direct contact with the ceramide head group. Substitution or chemical modification of this residue abolishes photolabeling of both channels with the ceramide probe. Unlike VDAC1 removal, loss of VDAC2 or replacing its membrane-facing glutamate with glutamine renders human colon cancer cells largely resistant to ceramide-induced apoptosis. Collectively, our data support a role of VDAC2 as direct effector of ceramide-mediated cell death, providing a molecular framework for how ceramides exert their anti-neoplastic activity

A review of trisomy X (47,XXX)

Trisomy X is a sex chromosome anomaly with a variable phenotype caused by the presence of an extra X chromosome in females (47,XXX instead of 46,XX). It is the most common female chromosomal abnormality, occurring in approximately 1 in 1,000 female births. As some individuals are only mildly affected or asymptomatic, it is estimated that only 10% of individuals with trisomy X are actually diagnosed. The most common physical features include tall stature, epicanthal folds, hypotonia and clinodactyly. Seizures, renal and genitourinary abnormalities, and premature ovarian failure (POF) can also be associated findings. Children with trisomy X have higher rates of motor and speech delays, with an increased risk of cognitive deficits and learning disabilities in the school-age years. Psychological features including attention deficits, mood disorders (anxiety and depression), and other psychological disorders are also more common than in the general population. Trisomy X most commonly occurs as a result of nondisjunction during meiosis, although postzygotic nondisjunction occurs in approximately 20% of cases. The risk of trisomy X increases with advanced maternal age. The phenotype in trisomy X is hypothesized to result from overexpression of genes that escape X-inactivation, but genotype-phenotype relationships remain to be defined. Diagnosis during the prenatal period by amniocentesis or chorionic villi sampling is common. Indications for postnatal diagnoses most commonly include developmental delays or hypotonia, learning disabilities, emotional or behavioral difficulties, or POF. Differential diagnosis prior to definitive karyotype results includes fragile X, tetrasomy X, pentasomy X, and Turner syndrome mosaicism. Genetic counseling is recommended. Patients diagnosed in the prenatal period should be followed closely for developmental delays so that early intervention therapies can be implemented as needed. School-age children and adolescents benefit from a psychological evaluation with an emphasis on identifying and developing an intervention plan for problems in cognitive/academic skills, language, and/or social-emotional development. Adolescents and adult women presenting with late menarche, menstrual irregularities, or fertility problems should be evaluated for POF. Patients should be referred to support organizations to receive individual and family support. The prognosis is variable, depending on the severity of the manifestations and on the quality and timing of treatment

The mediating effects of first call resolution on call centers’ performance

This article aims to examine and validate the prepositions of the mediating impacts of first call resolution (FCR) on caller satisfaction within the contact center industry.A survey of 168 call center managers was analyzed through structural equation modeling, constituting an overall 43.3 per cent response rate for this study.The results show that FCR positively mediates the relationship between knowledge management, technology-based CRM and caller satisfaction within the inbound customer contact centers.We have empirically assessed call centers/contact centers’ success through caller satisfaction (an observed variable through their 2009 customer survey in Malaysia).Consequently, this study cannot generalize its findings in all other countries.Our strong argument is that within the operational variables, FCR is statistically significant and positively mediates knowledge management applications. But very important to note is that the customer contact centers are first touch points to a company's goods or services, and that many other factors such as product quality, company policy, target markets, decision-making processes and so on are also determinants of caller satisfaction, but fall outside the operational control of contact center activities.This research has empirically established that a company's capability in effectively acquiring a valid understanding of its current and potential customers’ information through CRM technologies will positively impact its acquisitions, customization, management and retention of customers.It also avails both the academic and contact center management the benefits that are inherent in measuring the impact of knowledge management and technology-based CRM on inbound FCR and caller satisfaction.This study finally recommends alternative areas for future research

Functional Assessment of Disease-Associated Regulatory Variants <i>In Vivo</i> Using a Versatile Dual Colour Transgenesis Strategy in Zebrafish

Disruption of gene regulation by sequence variation in non-coding regions of the genome is now recognised as a significant cause of human disease and disease susceptibility. Sequence variants in cis-regulatory elements (CREs), the primary determinants of spatio-temporal gene regulation, can alter transcription factor binding sites. While technological advances have led to easy identification of disease-associated CRE variants, robust methods for discerning functional CRE variants from background variation are lacking. Here we describe an efficient dual-colour reporter transgenesis approach in zebrafish, simultaneously allowing detailed in vivo comparison of spatio-temporal differences in regulatory activity between putative CRE variants and assessment of altered transcription factor binding potential of the variant. We validate the method on known disease-associated elements regulating SHH, PAX6 and IRF6 and subsequently characterise novel, ultra-long-range SOX9 enhancers implicated in the craniofacial abnormality Pierre Robin Sequence. The method provides a highly cost-effective, fast and robust approach for simultaneously unravelling in a single assay whether, where and when in embryonic development a disease-associated CRE-variant is affecting its regulatory function