Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia

IMPORTANCE: Febrile neutropenia (FN) is the most common oncologic emergency and is among the most deadly. Guidelines recommend risk stratification and outpatient management of both pediatric and adult FN patients deemed to be at low risk of complications or mortality, but our prior single-center research demonstrated that the vast majority (95%) are hospitalized. OBJECTIVE: From a nationwide perspective, to determine the proportion of cancer patients of all ages hospitalized after an emergency department (ED) visit for FN, and to analyze variability in hospitalization rates. Our a priori hypothesis was that >90% of US cancer-associated ED FN visits would end in hospitalization. DESIGN: Analysis of data from the Nationwide Emergency Department Sample, 2006-2014. SETTING: Stratified probability sample of all US ED visits. PARTICIPANTS: Inclusion criteria were: (1) Clinical Classification Software code indicating cancer, (2) diagnostic code indicating fever, and (3) diagnostic code indicating neutropenia. We excluded visits ending in transfer. EXPOSURE: The hospital at which the visit took place. MAIN OUTCOMES AND MEASURES: Our main outcome is the proportion of ED FN visits ending in hospitalization, with an a priori hypothesis of >90%. Our secondary outcomes are: (a) hospitalization rates among subsets, and (b) proportion of variability in the hospitalization rate attributable to which hospital the patient visited, as measured by the intra-class correlation coefficient (ICC). RESULTS: Of 348,868 visits selected to be representative of all US ED visits, 94% ended in hospitalization (95% Confidence Interval [CI] 93-94%). Each additional decade of age conferred 1.23x increased odds of hospitalization. Those with private (92%), self-pay (92%), and other (93%) insurance were less likely to be hospitalized than those with public insurance (95%, odds ratios [OR] 0.74-0.76). Hospitalization was least likely at non-metropolitan hospitals (84%, OR 0.15 relative to metropolitan teaching hospitals), and was also less likely at metropolitan non-teaching hospitals (94%, OR 0.64 relative to metropolitan teaching hospitals). The ICC adjusted for hospital random effects and patient and hospital characteristics was 26% (95%CI 23-29%), indicating that 26% of the variability in hospitalization rate was attributable to which hospital the patient visited. CONCLUSIONS AND RELEVANCE: Nearly all cancer-associated ED FN visits in the US end in hospitalization. Inter-hospital variation in hospitalization practices explains 26% of the limited variability in hospitalization decisions. Simple, objective tools are needed to improve risk stratification for ED FN patients

Tau and mTOR: The Hotspots for Multifarious Diseases in Alzheimer's Development

The hyperphosphorylation of tau protein and the overexpression of mTOR are considered to be the driving force behind Aβ plaques and Neurofibrillay Tangles (NFT's), hallmarks of Alzheimer's disease (AD). It is now evident that miscellaneous diseases such as Diabetes, Autoimmune diseases, Cancer, etc. are correlated with AD. Therefore, we reviewed the literature on the causes of AD and investigated the association of tau and mTOR with other diseases. We have discussed the role of insulin deficiency in diabetes, activated microglial cells, and dysfunction of blood-brain barrier (BBB) in Autoimmune diseases, Presenilin 1 in skin cancer, increased reactive species in mitochondrial dysfunction and deregulated Cyclins/CDKs in promoting AD pathogenesis. We have also discussed the possible therapeutics for AD such as GSK3 inactivation therapy, Rechaperoning therapy, Immunotherapy, Hormonal therapy, Metal chelators, Cell cycle therapy, γ-secretase modulators, and Cholinesterase and BACE 1-inhibitors which are thought to serve a major role in combating pathological changes coupled with AD. Recent research about the relationship between mTOR and aging and hepatic Aβ degradation offers possible targets to effectively target AD. Future prospects of AD aims at developing novel drugs and modulators that can potentially improve cell to cell signaling, prevent Aβ plaques formation, promote better release of neurotransmitters and prevent hyperphosphorylation of tau

Analisis Hubungan Panjang Berat Pada Ikan Hermaphrodit : Kerapu Sunu (Plectropomus Leopardus) Dan Kerapu Macan (Epinephelus Fuscoguttatus)

Penelitian ini bertujuan untuk mengeksplorasi hubungan panjang berat dua spesies ikan kerapu hermafrodit, yaitu kerapu sunu (Plectropomus leopardus) dan kerapu macan (Ephinephelus fuscoguttatus). Sebanyak 1.263 individu ikan yang terdiri dari 609 dan 654 spesies pertama dan kedua, masing-masing dikumpulkan dari perairan Wangi-Wangi dan Karang Kaledupa Taman Nasional Wakatobi selama September 2018 hingga Februari 2019. Ikan dikumpulkan secara acak yang merupakan hasil tangkapan pancing dan tombak. Hasil kedua spesies menunjukkan pola pertumbuhan alometrik (p 70%), sedangkan E. fuscoguttatus untuk kategori yang sama berada pada persentase yang lebih rendah (<50%). Langkah-langkah pengelolaan pada spesies hermafrodit dapat difokuskan pada proporsionalitas antara betina dan jantan terhadap keberhasilan reproduksi

Phytoremediation: Halophytes as Promising Heavy Metal Hyperaccumulators

The continued accumulation of trace and heavy metals in the environment presents a significant danger to biota health, including humans, which is undoubtedly undermining global environmental sustainability initiatives. Consequently, the need for efficient remediation technologies becomes imperative. Phytoremediation is one of the most viable options in this regard. Hundreds of plants in laboratory experiments demonstrate the potential to remediate varying concentrations of heavy metals; however, the remediation capacity of most of these plants proved unsatisfactory under field conditions. The identification and selection of plants with higher metal uptake capacity or hyperaccumulators are one of the limitations of this technology. Additionally, the mechanism of heavy metal uptake by plants remains to be sufficiently documented. The halophyte plants are famous for their adaptation to harsh environmental conditions, and hence could be the most suitable candidates for heavy metal hyperaccumulation. The state of Qatar in the Gulf region encompasses rich resources of halophytes that have the potential for future investment toward human and environmental health. This chapter, therefore, gives an overview of phytoremediation, with emphasis on halophytes as suitable heavy metal hyperaccumulators for improved remediation of heavy metal–contaminated areas

Medications package inserts’ usefulness to doctors and patients: Sudanese doctors perspective

Background: Written medication information is important for both doctors and patients. In the developing countries, the medication package inserts (PIs) represent the most available and easily accessible source of written medication information. The main objective of the present study was to assess the knowledge, attitude, and practice of Sudanese doctors toward written medication information in the PIs, and its usefulness for both doctors and patients.Methods: Four hundred (n=400) doctors were randomly selected and addressed with an open to answer the questionnaire composed of fifteen questions (n=15).Results: A big majority (95.7%) of the respondents considered the medications’ PIs, which they regularly read (93.2%), as a reliable and useful source of medication information in their prescribing. Only a minority of the respondent doctors (43.6%) used to advise their patients to read the PIs, whereas a majority (62.4%) of respondents believed that patients might find difficulty in understanding written medication information in the PI. The majority (61.3%) of respondent used to rely on pharmacists to provide patients with the needed medication information. The majority of the respondents (82.2%) used to inform their patients about the possible medication side effects. Respondents ranked medications’ dose (79.5%), how to use it (77.3%) and information about side effects (73%) on top of patients’ medication information most needed particulars.Conclusion: Doctors should give more attention to their patients’ medication information specific needs, advice and motivate them to read the PIs before using their medications