HIV positive patient with GBS-like syndrome

Introduction. Guillain–Barré Syndrome (GBS) is an acute demyelinating polyneuropathy which can occur post-infection. Criteria of diagnosis of GBS include areflexia with progressive bilateral weakness in arms and legs. GBS can lead to severe respiratory and cardiac complications. The fatality rate can be up to 5 % in patients, depending on the severity of the symptoms. HIV can cause a range of neurological disorders including, on rare occasions, GBS. GBS can occur at any stage of HIV infection, highlighting the complexity of diagnosis of GBS within HIV patients. Case presentation. A 57 year old female with lumbar back pain radiating to the legs, poor mobility and tiredness, with reports of a viral-like illness four days previously, was initially diagnosed with a lower respiratory tract infection and discharged. Seventeen days later the patient was readmitted to hospital with progressive lower and upper limb weakness, areflexia and sensory loss. She was diagnosed with GBS and was unexpectedly discovered to be HIV-positive. HIV avidity was low indicating a recently acquired HIV infection. The patient was treated with intravenous immunoglobulin for five days for the GBS and commenced antriretrovirals for HIV. The patient was discharge from hospital 53 days after admission with walking aids and regular physiotherapy follow-up. Conclusion. This case highlighted the need for all clinicians to be aware that patients with symptoms of GBS, regardless of clinical history should be offered an HIV test. GBS can be the first sign a patient is HIV-positive

Deep learning networks find unique mammographic differences in previous negative mammograms between interval and screen-detected cancers: a case-case study.

BackgroundTo determine if mammographic features from deep learning networks can be applied in breast cancer to identify groups at interval invasive cancer risk due to masking beyond using traditional breast density measures.MethodsFull-field digital screening mammograms acquired in our clinics between 2006 and 2015 were reviewed. Transfer learning of a deep learning network with weights initialized from ImageNet was performed to classify mammograms that were followed by an invasive interval or screen-detected cancer within 12 months of the mammogram. Hyperparameter optimization was performed and the network was visualized through saliency maps. Prediction loss and accuracy were calculated using this deep learning network. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were generated with the outcome of interval cancer using the deep learning network and compared to predictions from conditional logistic regression with errors quantified through contingency tables.ResultsPre-cancer mammograms of 182 interval and 173 screen-detected cancers were split into training/test cases at an 80/20 ratio. Using Breast Imaging-Reporting and Data System (BI-RADS) density alone, the ability to correctly classify interval cancers was moderate (AUC = 0.65). The optimized deep learning model achieved an AUC of 0.82. Contingency table analysis showed the network was correctly classifying 75.2% of the mammograms and that incorrect classifications were slightly more common for the interval cancer mammograms. Saliency maps of each cancer case found that local information could highly drive classification of cases more than global image information.ConclusionsPre-cancerous mammograms contain imaging information beyond breast density that can be identified with deep learning networks to predict the probability of breast cancer detection

Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient–Clinician Communication Model® intervention in a primary health-care setting

Funded by Informed Medical Decisions Foundation. Grant Number: #0175-1 National Health and Medical Research Council Public Health Training Fellowship. Grant Number: 568962Peer reviewedPublisher PD

Plants in constructed wetlands help to treat agricultural processing wastewater

Over the past three decades, wineries in the western United States and sugarcane processing for ethanol in Central and South America have experienced problems related to the treatment and disposal of process wastewater. Both winery and sugarcane (molasses) wastewaters are characterized by large organic loadings that change seasonally and are detrimental to aquatic life. We examined the role of plants for treating these wastewaters in constructed wetlands. In the greenhouse, subsurface-flow flumes with volcanic rock substrates and plants steadily removed approximately 80% of organic-loading oxygen demand from sugarcane process wastewater after about 3 weeks of plant growth; unplanted flumes removed about 30% less. In field studies at two operational wineries, we evaluated the performance of similar-sized, paired, subsurface constructed wetlands with and without plants; while both removed most of the oxygen demand, removal rates in the planted system were slightly greater and significantly different from those of the unplanted system under field conditions

Juegos serios para el tratamiento o la prevención de la depresión: una revisión sistemática

Serious games (computerised interventions which utilise gaming for serious purposes) have been shown to support improved outcomes in several health conditions. We aimed to review evidence regarding serious games for depression. We undertook electronic searches of PsycInfo, EMBASE and Medline, using terms relevant to computer games and depression. We included fulltext articles published in English in peer-reviewed literature since 2000, where the intervention was designed to treat or prevent depression and which included pre-and post-intervention measurement of depression. Nine studies relating to a total of six interventions met inclusion criteria. Most studies were small and were carried out by the developers of the programs. All were tested with young people (ages between 9 and 25 years). Most reported promising results with some positive impact on depression although one universal program had mixed results. Serious gaming interventions show promise for depression, however evidence is currently very limited.Se ha demostrado que los juegos serios (intervenciones computarizadas que utilizan juegos) mejoran los resultados en diferentes problemas de salud. Pretendemos examinar las evidencias de estos juegos para la depresión. Se realizaron búsquedas electrónicas en PsycINFO, EMBASE y Medline usando términos relacionados con juegos de ordenador y depresión. Se incluyeron artículos publicados desde el año 2000, donde se diseñó la intervención para tratar o prevenir la depresión incluyendo medidas pre- y post-intervención. Nueve estudios sobre un total de seis intervenciones cumplieron los criterios de inclusión. La mayoría de estos fueron pequeños y los llevaron a cabo los desarrolladores de los programas. Todos incluían población joven (9 - 25 años). La mayoría presentan resultados prometedores con un impacto positivo sobre la depresión aunque un programa universal tuvo resultados mixtos. Se concluye que las intervenciones basadas en juegos serios son prometedoras para la depresión, aunque la evidencia es todavía muy limitada

Effects of dietary nitrate supplementation on the response to extremity cooling and endothelial function in individuals with cold sensitivity. A double blind, placebo controlled, crossover, randomised control trial

Individuals with cold sensitivity have low peripheral skin blood flow and skin temperature possibly due to reduced nitric oxide (NO•) bioavailability. Beetroot has a high concentration of inorganic nitrate and may increase NO-mediated vasodilation. Using a placebo-controlled, double blind, randomised, crossover design, this study tested the hypotheses that acute beetroot supplementation would increase the rate of cutaneous rewarming following a local cold challenge and augment endothelium-dependent vasodilation in cold sensitive individuals. Thirteen cold sensitive participants completed foot and hand cooling (separately, in 15 °C water for 2 minutes) with spontaneous rewarming in 30°C air whilst skin temperature and cutaneous vascular conductance (CVC) were measured (Baseline). On two further separate visits, participants consumed 140 ml of either concentrated beetroot juice (nitrate supplementation) or nitrate-depleted beetroot juice (Placebo) 90 minutes before resting seated blood pressure was measured. Endothelial function was assessed by measuring CVC at the forearm, finger and foot during iontophoresis of 1% w/v acetylcholine followed by foot and hand cooling as for Baseline. Plasma nitrite concentrations significantly increased in nitrate supplementation compared to Placebo and Baseline (502 ± 246 nmol.L-1; 73 ± 45 nmol.L-1; 74 ± 49 nmol.L-1 respectively; n=11; P 0.05). Nitrate supplementation did not alter endothelial function in the forearm, finger or foot (all P > 0.05) compared to Placebo. Despite a physiologically meaningful rise in plasma nitrite concentrations, acute nitrate supplementation does not alter extremity rewarming, endothelial function or blood pressure in individuals with cold sensitivity