The Family as Recipient and Provider of Home Care: A Primary Care Perspective

Advances in modern medicine, effective medication and high-technology interventions contribute to the growth of chronic comorbidities among older people, and many children with chronic diseases that reach adulthood require long-term care at home, provided by formal and informal caregivers and coordinated by primary healthcare professionals. Home caring, performed under different conditions from those of hospital care, requires the involvement of the family that is recipient and provider of home care. This chapter discusses the contribution of family caregivers to personalized home care of dependent children and elderly recipients, coordinated by primary health professionals. Children and youth with special healthcare needs and children abused and neglected require special involvement of family caregivers. The use of digital healthcare for recipients with medical complexity is a modern way to connect home care patients to specialized care, reducing the costs of the hospital care system. However, the burden in home care should be recognized by the general practitioner. Specific interventions are addressed to the unsupportive families and real hidden patients to help maintain their health and functionality. Future family doctors’ interprofessional communication skills and resourcefulness should meet the societal changes, and the burden of home care in the modern family is approached from the perspective of academic medicine

Characterization of Trametes versicolor: Medicinal Mushroom with Important Health Benefits

Trametes species represents a rich source of nutritive compounds with important pharmacological properties like antioxidant, antiinflammatory and anti-cancer properties. However, factors like genetic background, harvesting period, geographic location, climatic conditions and others are influencing the biosynthesis of bioactive compounds, their fingerprint and their concentration. The aim of this study was to determine the antioxidant capacity, total phenolic compounds and total flavonoids content of two mushroom species, namely Tramestes versicolor (TV) and Trametes gibbosa (TG), mushrooms with potential health benefits, harvested from north-west part of Romania. In order to determine the phenolic compounds profile, water, methanol, and acetone mushroom extracts were analyzed using UV-Vis spectroscopy, FTIR spectroscopy and LC-MS analysis. In total 28 compounds were tentatively identified as phenolic acids (11 compounds), flavonols (6 compounds), flavones (6 compounds), coumarins (2 compounds), flavanols, isoflavonoids and biflavonoids (1 compound). The highest antioxidant activity was determined for the methanolic extract while the highest total polyphenols content and total flavonoids content were determined for the water extract. The results obtained suggested that Trametes species can be considered important sources of bioactive compounds, their phenolics composition and content being influenced by a series of factors like geographic area origin and genetic background

Primary care practitioners’ diagnostic action when the patient may have cancer : an exploratory vignette study in 20 European countries

Availability of data To avoid the risk of identification of individual participants, the datasets generated and analysed during the current study are not publicly available. However, they are available (with any possible identifying information redacted) from the corresponding author on reasonable request. Funding This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. ALN’s time is supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translation Research Centre, with her infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). Acknowledgements We would like to thank all the PCPs who piloted the questionnaire and those who completed the survey. We would also like to thank the European GP Research Network for its support. We are grateful to Prof. Barbara Silverman and Prof. Lital Keinan for the data on cancer survival rates in Israel, and to Dr Yochai Schonmann for his work on those data. Two of the vignettes were used by kind permission of the ICBP; we also thank Dr Peter Murchie and Dr Rhona Auckland, who generously provided the other two vignettes. Prof. Antonius Schneider kindly organised the Technical University of Munich’s data collection.Peer reviewedPublisher PD

Why do European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis? : A qualitative study

Funding The Swedish application for ethical approval was funded by the Jämtland Cancer and Nursing Foundation. The study had no other external fundingPeer reviewedPostprin

Laparoscopic Enucleation of Benign Pancreatic Tumors

Benign pancreatic tumor enucleations have been performed since 1996. Endocrine tumors (ET) are rare yet they represent about 2/3 of the laparoscopic enucleations, a topic still in debate. Preoperative imaging routinely comprises a CT scan but endoscopic ultrasound is mandatory for localizing the tumor and guided biopsy-aspiration. Trocars have to be positioned to avoid “fencing” with the instruments. A Kocher maneuver may be necessary for accessing deep or posterior tumors. Bipolar electrocautery and harmonic scalpel ensure better hemostasis than the monopolar cautery hook. The raw surface can be covered with hemostatics or fibrin glue. The mean operating time is 2 hours. Forced conversions, due mainly to hemorrhage or insufficient exposure, are rare (9%). Pancreatic fistula, the main postoperative complication, affects up to one third of the patients and does not depend on the choice of dissection instruments, management of the remaining cavity or somatostatin use. A risk factor is the location of the tumor at less than 2mm from the main pancreatic duct. Necrotic pancreatitis, pancreatic pseudocyst and duodenal fistula contribute to a surgical morbidity of 60%. Although safe and technically feasible enucleation still has to be considered a low mortality but high morbidity procedure

Redo Antireflux Surgery after Failed Fundoplication

Redo antireflux surgery is an advanced surgical procedure which encompasses the following usual steps: takedown of the previous fundoplication, repair of the hiatal defect followed by the actual antireflux procedure. The aim of our extensive review of current relevant literature is to discuss the indications, techniques, complications and limitations of this surgery. In reoperations, a great percentage of surgeons favor the short floppy Nissen, although partial plications or gastrojejunostomies are also practiced. A shortened esophagus is usually one of several causes for reflux reoccurrence, and requires either an extended periesophageal dissection or a Collis gastroplasty. The surface of the hiatal defect, rather than its diameter, is the most important indication for repair. Many repair variants have been introduced and tested, showing that antireflux surgery is still awaiting ideal prosthetic material, whereas details regarding tailoring, placement and suturing of current meshes are subjects of debate. The most frequent complication is gastric perforation; others include pulmonary or cardiac failure, infections, and acute pancreatitis. Mortality approaches 1% with a procedure success rate of 80%. Thus, due to its complexity and challenges, redo antireflux surgery should be performed by an experienced team in a tertiary center to increase its success rate

Nanotechnology in the Diagnostic and Therapy of Hepatocellular Carcinoma

Hepatocellular carcinoma is the most common liver malignancy and is among the top five most common cancers. Despite the progress of surgery and chemotherapy, the results are often disappointing, in part due to chemoresistance. This type of tumor has special characteristics that allow the improvement of diagnostic and treatment techniques used in clinical practice, by combining nanotechnology. This article presents a brief review of the literature focused on nano-conditioned diagnostic methods, targeted therapy, and therapeutic implications for the pathology of hepatocellular carcinoma. Within each subdomain, several modern technologies with significant impact were highlighted: serological, imaging, or histopathological diagnosis; intraoperative detection; carrier-type nano-conditioned therapy, thermal ablation, and gene therapy. The prospects offered by nanomedicine will strengthen the hope of more efficient diagnoses and therapies in the future

Pot Aloe vera gel – a natural source of antioxidants

Aloe vera (Aloe barbadensis Miller) is widely spread around the world and it is used in the food and cosmetic industry and traditional medicine due to its high content in bioactive compounds. Thus, this article investigated the phenolic compounds of Romanian Aloe vera gel and its antioxidant capacity.  The gel was extracted using 4 different solvents: methanol, ethanol, water, and acetone. Total phenolics were measured by the Folin-Ciocalteu method, total flavonoids by aluminium chloride reaction, and the antioxidant capacity by DPPH radical-scavenging activity. The profile of the phenolic compound was determined using Fourier transform infrared spectroscopy and Liquid Chromatography-Diode Array Detection–Electro-Spray Ionization Mass Spectrometry. The methanolic extract had a significantly higher antioxidant activity, followed by ethanolic, water, and acetone extracts. The methanolic extract had also the highest total polyphenol content, while ethanolic extract had the highest total flavonoid content. The extracts contained 14 compounds identified as 7 chromones (Aloesin, Neoaloesin, Aloinoside A, Aloinoside E, Aloe-emodin-glucoside, Isoaloeresin D, Methoxycoumaroyl-aloresin) 2 flavones (Luteolin-glucoside, Apigenin-glucoside), one hydroxycinnamic acid (Caffeic acid) and 4 to anthrones (Aloin A, Aloin B, Emodin, Aloe-emodin). The LC-MS results showed important quantities of Aloesin, Neoaloesin, Aloeresin E, and Aloe-emodin-glucoside while FTIR analysis showed the presence of polysaccharides, pectins, anthraquinones, and saponins

Molecular diagnostic of Ureaplasma urealyticum presence and tetracycline resistance in urine samples

Sexually transmitted infections (STIs) are among the most common infections in Romania. Infection with Ureaplasma urelyticum is one of the major causes of STIs and can cause serious complications. Although tetracycline is the drug commonly used to treat infections caused by U. urealyticum, several studies indicate the emergence and rapid development of strains resistant to these antibiotics in the United States or Europe. Tetracycline resistance in bacteria is encoded by a number of different genetic determinants but in mycoplasmas the only tetracycline resistance determinant that has been reported is the tetM gene. Tetracycline resistance among Ureaplasma spp. is associated with the presence of the horizontally acquired tetM resistance gene. Our study on bacterial DNA aimed to determine the presence of tetracycline-resistant U. urealyticum strains, by identifying the presence of the tetM gene. We used first void urine samples from 622 STI-suspected subjects. DNA was extracted, purified and amplified via PCR for the simultaneous detection of 6 STIs. 68 patients were diagnosed with U. urealyticum. DNA obtained from these samples was amplified using the tetM gene and U. urealyticum - specific urease gene primers. The urease gene was amplified in all samples, confirming the presence of U. urealyticum. The tetM gene was amplified in 2 samples considered tetracycline-resistant strains. The study confirmed the presence of U. urealyticum strains resistant to tetracycline in Romania. The employed technique can produce quick results both for U. urealyticum detection and determination of its resistance to tetracycline using a single easy-to-collect biological sample

Vaccine Hesitancy among European Parents—Psychological and Social Factors Influencing the Decision to Vaccinate against HPV: A Systematic Review and Meta-Analysis

Background: Due to low adherence to HPV vaccination programs, the European region struggles with vaccination rates lower than 30% among the targeted population. The present report investigated various socio-demographic and psychological factors influencing European parents’ hesitancy towards vaccinating their children. Methods: As of September 2023, four databases were searched. After applying inclusion criteria, all articles comparing psychological and socio-demographic factors in parents who vaccinate or do not vaccinate their children were included. Results: Twenty-five primary publications met the criteria, totaling 385,460 responders, of which 311,803 want to or have already vaccinated their child, and 73,555 do not wish to do so. Immigrant and employment status, religion, age of parents and the child’s gender seemed to influence their decision to vaccinate their child. Previous experience with vaccines, perceived safety and efficacy and the mother’s previous abnormal CCS results also impacted their decision. The caregivers’ education, gender, civil status, number of children, family history of neoplasia or mother’s CCS attendance did not influence their hesitancy to vaccine. Conclusion: Multiple demographic, social, economic and psychological barriers involved in the parents’ hesitancy to vaccinate their children against the HPV virus were highlighted. Specific at-risk categories that need to be targeted with information, education and vaccination campaigns were identified