Meeting the challenge of diabetes in ageing and diverse populations: a review of the literature from the UK

The impact of type 2 diabetes on ageing societies is great and populations across the globe are becoming more diverse. Complications of diabetes unequally affect particular groups in the UK older people, and people with a South Asian background are two population groups with increased risk whose numbers will grow in the future. We explored the evidence about diabetes care for older people with South Asian ethnicity to understand the contexts and mechanisms behind interventions to reduce inequalities. We used a realist approach to review the literature, mapped the main areas where relevant evidence exists, and explored the concepts and mechanisms which underpinned interventions. From this we constructed a theoretical framework for a programme of research and put forward suggestions for what our analysis might mean to providers, researchers, and policy makers. Broad themes of cultural competency; comorbidities and stratification; and access emerged as mid-level mechanisms which have individualised, culturally intelligent, and ethical care at their heart and through which inequalities can be addressed. These provide a theoretical framework for future research to advance knowledge about concordance; culturally meaningful measures of depression and cognitive impairment; and care planning in different contexts which support effective diabetes care for aging and diverse populations

Molecular characterisation of the pneumonia virus of mice glycoprotein genes

The molecular characterisation of the major glycoproteins of pneumonia virus of mice (PVM) was undertaken to identify the molecular basis for different pathogenicities for two strains of PVM. One is highly pathogenic and passaged entirely in mice (strain J3666) whilst the other is non-pathogenic and has been passaged entirely in tissue culture (strain 15). Characterisation of the fusion proteins of these two strains revealed little amino acid changes that may account for their pathogenicities. Of the 537 amino acid long fusion protein, only four amino acid changes were observed between the two strains. None of the changes were located within the region encoding the cleavage site of the F₀ polypeptide and the altered amino acids were distributed throughout the fusion protein. The amino acids changes were considered to be fairly conservative and may represent adaptation of the two strains to their different modes of passaging. However, the importance of these changes with regards to cleavage cannot be ruled out since one or more of these changes may be located within the 3-dimensional structure of the F₀ cleavage site. Nucleotide sequence analysis of the attachment (G) glycoproteins of these two strains of PVM showed only two amino acids changes within the extracellular domain of the protein. However, the G proteins of the two strain differed from each other in that the G protein of strain J3666 possessed a N-terminal extension compared to that of strain 15. This amino acid extension forms the cytoplasmic domain of the G protein in strain J3666 but appears to be lacking in that of strain 15. Furthermore, the G proteins of both strains of PVM were synthesised from the second, but not the same, initiation codon. In PVM strain J3666, the first available initiation codon coded for a short polypeptide of 12 amino acids whereas that of strain 15 coded for a short polypeptide of 33 amino acids. Expression of the G genes in vitro produced polypeptides which were approximately 3K larger than their predicted molecular weights. Synthesis of polypeptides due to internal initiation during translation were observed for the G gene of strain J3666. Expression of the G genes using recombinant vaccinia virus expressing the T7 RNA polymerase showed that the G proteins of both strains of PVM were expressed on the surface of cells transfected in vitro. Thus, the signals required for the correct processing and transport of the G proteins of PVM are not contained within the cytoplasmic domain of the proteins. The first steps of an investigation of possible ribosomal frameshifting event occurring within the G gene of PVM strain 15 was undertaken. The initiation codon of the major and short ORF's of the G gene of PVM strain 15 were mutated in a variety of combinations with a view to fusing these mutated fragments to the 5' end of the E. coli β-galactosidase gene that lacks its own initiation codon

High-frequency oscillatory ventilation in pediatric acute hypoxemic respiratory failure: disease-specific morbidity survival analysis.

BackgroundMultiple ventilatory strategies for acute hypoxemic respiratory failure (AHRF) in children have been advocated, including high-frequency oscillatory ventilation (HFOV). Despite the frequent deployment of HFOV, randomized controlled trials remain elusive and currently there are no pediatric trials looking at its use. Our longitudinal study analyzed the predictive clinical outcome of HFOV in pediatric AHRF given disease-specific morbidity.MethodsA retrospective 8-year review on pediatric intensive care unit admissions with AHRF ventilated by HFOV was performed. Primary outcomes included survival, morbidity, length of stay (LOS), and factors associated with survival or mortality.ResultsA total of 102 patients underwent HFOV with a 66 % overall survival rate. Survivors had a greater LOS than nonsurvivors (p = 0.001). Mortality odds ratio (OR) for patients without bronchiolitis was 8.19 (CI = 1.02, 65.43), and without pneumonia it was 3.07 (CI = 1.12, 8.39). A lower oxygenation index (OI) after HFOV commencement and at subsequent time points analyzed predicted survival. After 24 h, mortality was associated with an OI > 35 [OR = 31.11 (CI = 3.25, 297.98)]. Sepsis-related mortality was associated with a higher baseline FiO(2) (0.88 vs. 0.65), higher OI (42 vs. 22), and augmented metabolic acidosis (pH of 7.25 vs. 7.32) evaluated 4 h on HFOV (p < 0.05).ConclusionHigh-frequency oscillatory ventilation may be safely utilized. It has a 66 % overall survival rate in pediatric AHRF of various etiologies. Patients with morbidity limited to the respiratory system and optimized oxygenation indices are most likely to survive on HFOV

ДВОСТОРОННЯ КРОВОТЕЧА З НАДНИРКОВИХ ЗАЛОЗ У ПЛОДА: (клінічний випадок)

Background. Fetal supra renal mass revealed incidentally by routine antenatal ultrasound is a great challenge for diagnosis and management by a surgeon. This is a matter of parental anxiety and diagnostic dilemma to a physician. Indeed, such masses turn out to be complicated by an intra-tumor hemorrhage in neuroblastoma or antenatally diagnosed adrenal hemorrhage. The first one needs intensive management and the latter needs watchful observation. Objective. A case of bilateral fetal adrenal mass revealed by routine fetal ultrasound examination at 28th week of gestation which turned out to be adrenal hemorrhage is presented. This is aimed to make awareness to ensure that clinicians always keep benign etiologies first and thoroughly investigate in case of incidentally detected fetal adrenal mass. Methods. The study is a single case report of incidentally revealed supra renal mass. This case report encompasses differentiating features between the two and investigations that aid the surgeon to avoid unnecessary intervention in a benign hemorrhage. Results. The baby was kept on follow up with serial ultrasound scans in the postnatal period and by the second scan in a month, the hemorrhage had resolved completely. Conclusion. In cases of benign looking masses like adrenal hemorrhage or spontaneously resolving neuroblastoma, appropriate antenatal assessment and close monitoring with serial ultrasound scans can avoid surgery.Вступ. Утворення в наднирниках плода, випадково виявлені під час звичайного допологового ультразвукового дослідження, створюють для хірургів велику проблему в діагностиці та лікуванні. Вони викликають занепокоєння батьків і створюють діагностичну проблему для лікуючого лікаря. Такі утворення можуть виявитися ускладненим внутрішньопухлинним крововиливом у нейробластому або антенатально діагностованим крововиливом у надниркові залози. Перший потребує інтенсивного лікування, а другий потребує уважного спостереження. Мета. Представлено випадок двостороннього утворення в надниркових залозах плода, виявленого під час планового ультразвукового дослідження плода на 28-му тижні вагітності, які виявилися крововиливом у надниркові залози. Випадок представлено для того, щоб клініцисти завжди звертали увагу на доброякісну етіологію та проводили ретельне обстеження у випадку випадкового виявлення новоутворень надниркових залоз плода. Методи. Представлено випадок випадково виявлених утворень надниркових залоз. Описано відмінності між ними та дослідження, які допомагають хірургу уникнути непотрібного втручання при доброякісному крововиливі. Результати. У післяпологовому періоді дитину спостерігали за допомогою серійних ультразвукових досліджень. До другого УЗД через місяць крововилив повністю розсмоктався. Висновки. У випадках доброякісних новоутворень, таких як крововилив у надниркові залози або нейробластома, що спонтанно розсмоктується, відповідна антенатальна оцінка та ретельний моніторинг за допомогою серійних ультразвукових досліджень можуть допомогти уникнути операції