Pharmacokinetics and efficacy of oral versus intravenous mixed-micellar phylloquinone (vitamin K-1) in severe acute liver disease

Background/Aims: In patients with severe acute liver dysfunction, i.v. phylloquinone (vitamin K-1) may be given to exclude vitamin K deficiency, rather than impaired hepatic synthesis of coagulation factors alone, as the cause of the coagulopathy. However, there have been no studies of the pharmacokinetics or efficacy of i.v. or oral K-1 in such patients.Methods: 49 adults with severe acute liver disease were randomised double-blind to a single 10 mg dose of i.v. or oral mixed-micellar K-1, or placebo. Serum levels of phylloquinone and undercarboxylated prothrombin (PIVKA-II) were assessed before and after treatment.Results: At admission, 13 patients (27 %) had either low serum K-1 levels or elevated PIVKA-II concentrations, indicative of subclinical vitamin K deficiency. In the 16 patients who received i.v. K-1, there was one (6 %) treatment failure (K-1 rise < 10 ng/ml above baseline), compared with 12 of the 15 (80 %) who received oral K, (P < 0.0001). One patient in the placebo group developed overt vitamin K deficiency.Conclusions: A minority of patients with severe acute liver dysfunction have subclinical vitamin K deficiency at the time of presentation, which is corrected by a single dose of i.v. K-1. The intestinal absorption of mixed-micellar K, is unreliable in adults with severe acute liver dysfunction. (c) 2004 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved

Knowledge, attitudes, and practices of prenatal care practitioners regarding oral health in pregnancy-A systematic review

BackgroundHormonal and behavioral changes during pregnancy may impact the oral health of women, which can influence the pregnancy course. Prenatal care practitioners (PCP) must be aware of this bidirectional relation in order to include an oral assessment in routine prenatal care. ObjectivesTo characterize the knowledge and attitudes of PCP regarding oral health in pregnant women. Search StrategyThe search was carried out in PubMed, Web of Science, Lilacs, Scopus, and Embase on May 2022. Selection CriteriaPeer-reviewed cross-sectional studies published in English within the last 5 years that assessed the knowledge, attitudes, and practices of PCP towards oral health in pregnancy were selected. Data Collection and AnalysisData were standardly extracted by the three reviewers from the selected articles and their bias was assessed. Main ResultsFrom a total of 996 articles, 24 were selected. Overall, most PCP have an adequate level of knowledge regarding the importance of oral health during pregnancy. Although several professionals reported referring their patients to a dentist, the attitudes and practices of the majority of PCP were still inadequate. ConclusionsPCP are aware of the importance of oral health during pregnancy but still lack translating this knowledge into clinical practice.ACKNOWLEDGMENTS The PhD fellowship of MJA was supported by FCT/MCTES scholarship with the reference SFRH/BD/144982/2019

Marine Dermatitis Following Exposure to a Portuguese-Man-of-War

Durante a época do Verão, as lesões cutâneas que surgem na praia são um motivo frequente de recurso aos serviços de urgência e de consulta de dermatologia. Os autores descrevem o caso de uma criança com uma lesão maculopapular dolorosa que resultou de um provável contato com uma caravela-portuguesa. Não apresentava outros sinais ou sintomas pelo que foi medicada em ambulatório com analgesia, anti-histamínico e corticoide tópico. Após uma semana de evolução constatou-se resolução completa das lesões cutâneas. Apesar da gravidade da maioria dos casos de dermatoses marítimas encontradas em Portugal ser ligeira, considera-se ser importante o estudo da fauna e da flora de cada região para adequar os cuidados terapêuticos

Short-term effects of deep ploughing on soil C stocks following renewal of a dairy pasture in New Zealand

In New Zealand’s high producing permanent pastures the topsoil constitutes a large reservoir of soil organic carbon (SOC), which shows a marked stratification with depth. As consequence, sub-surface layers can contain 10 times less carbon than the surface soil. In permanent pastures with high carbon inputs, the formation and decomposition of these surface SOC stocks are often at equilibrium and C storage shows little change over time. Pastoral based dairy systems utilising ryegrass plus clover cultivars require renewal every 7-10 years to avoid reversion to less productive grasses. This may involve spring cultivation (either no-till, shallow till or full cultivation), summer forage cropping and autumn re-grassing. It has been hypothesised that SOC stocks can be increased by inverting the soil profile at pasture renewal through infrequent (once in 25-30 years) deep mouldboard ploughing (up to 30 cm depth). Increased C sequestration occurs when the new grass quickly rebuilds SOC stocks in the new topsoil (exposed low C sub-soil) at a rate faster than the decomposition of SOC in the rich former topsoil transferred to depth (now below 15 cm). However, benefits form accelerated C storage may be offset if crop and pasture production is adversely affected by the ploughing event (e.g., as result of compaction or excessive drainage). Hence, the aim of this work was to assess the short-term effects of infrequent inversion tillage of long-term New Zealand pastoral-based dairy soils under summer crop management and autumn re-grassing. An imperfectly drained Typic Fragiaqualf under dairy grazing was deep ploughed (approx. 25 cm) and re-sown with turnip in October 2016; other treatments included were shallow (< 10 cm) cultivation and no-till. The site was core sampled (0-40 cm) before cultivation and after 5 months of turnip growth to assess changes in SOC. Plant growth, herbage quality, and nutrient leaching were monitored during the 5-month period; root growth was assessed at the end of the crop rotation. Full cultivation transferred SOC below 10 cm depth, as expected. Soil bulk density decreased whereas root mass increased (10-20 cm depth; P < 0.05) under deep cultivation only. Besides, losses of mineral N were attenuated under deep tillage, resulting in a relative increase in crop yield. The potential for infrequent inversion tillage increasing soil C sequestration as a greenhouse gas (GHG) mitigation tool is currently being tested at other sites in New Zealand

Relationship quality perception of spouses and adult child carers of people with dementia.

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Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Positive Serum Antithyroid Antibodies, IgM Antibodies Against Mycoplasma Pneumoniae and Human Herpesvirus 7 PCR in the CSF

We report the case of a boy with an encephalopathy associated with extrapyramidal and psychiatric symptoms and anti-N-methyl-D-aspartate receptor antibodies. He had positive serum antithyroid antibodies, IgM antibodies against Mycoplasma pneumoniae and human herpesvirus 7 polymerase chain reaction in the cerebrospinal fluid. He was successfully treated with rituximab, after steroids, intravenous immunoglobulin and plasma exchange. The pathophysiology of this disorder may be post-infectious and autoimmune

Consent: an event or a memory in lumbar spinal surgery? A multi-centre, multi-specialty prospective study of documentation and patient recall of consent content.

STUDY DESIGN: Prospective, multi-centre, multi-specialty medical notes review and patient interview. PURPOSE: The consenting process is an important communication tool which also carries medico-legal implications. While written consent is a pre-requisite before spinal surgery in the UK, the standard and effectiveness of the process have not been assessed previously. This study assesses standard of written consent for elective lumbar decompressive surgery for degenerative disc disease across different regions and specialties in the UK; level of patient recall of the consent content; and identifies factors which affect patient recall. METHODS: Consent forms of 153 in-patients from 4 centres a, b, c, d were reviewed. Written documentation of intended benefits, alternative treatments and operative risks was assessed. Of them, 108 patients were interviewed within 24 h before or after surgeries to assess recall. RESULTS: The written documentation rates of the operative risks showed significant inter-centre variations in haemorrhage and sphincter disturbance (P = 0.000), but not for others. Analysis of pooled data showed variations in written documentation of risks (P 14 days compared to <2 days before their surgeries had higher recall for paralysis (65.2 vs 43.7%) and recurrence (17.4 vs 2.8%). Patient recall was independent of consenter grade. CONCLUSION: Overall, the standard of written consent for elective lumbar spinal decompressive surgery was sub-optimal, which was partly reflected in the poor patient recall. While consenter seniority did not affect patient recall, younger age and longer consent-to-surgery time improved it