Foreign body inhalation in the pediatric population: Lessons learned from 106 cases

SummaryObjectivesTo review the cases encountered in a tertiary care center so as to assess the incidence of foreign body aspiration in the pediatric population and to draw on our experience to improve prevention and early diagnosis.Patients and methodsRetrospective study of 106 children under the age of 15years, admitted to the Hôtel-Dieu de France hospital for flexible and/or rigid bronchoscopy between November 1998 and January 2010, for suspected foreign body aspiration (FBA).ResultsAmong the children, 56.6% were aged between one and three years. Peanuts or pistachios were found in 48% of cases. In 73% of cases, the FB was bronchial, and slightly more frequently on the right side (60%); 17.8% of cases presented in emergency immediately after inhalation; 12% presented with life-threatening symptoms; 29% presented within 24hours and 49% were seen later than 72hours. In 81% of subjects, a typical penetration syndrome was found on interviewing the parents. Physical pulmonary examination was normal in 21% of patients and chest X-ray in 21.8%. Rigid bronchoscopy was preceded by flexible bronchoscopy in 12% of cases. Parental underestimation of the gravity of the situation was a significant factor in delayed diagnosis. Among the patients, 64% examined 24hours after inhalation were initially treated for another pathology. Delay in diagnosis and organic vs inorganic FB did not significantly correlate with duration of bronchoscopy. The rate of complications did not significantly increase after a 24-hour diagnostic delay threshold.ConclusionFB aspiration is a serious problem. A high index of suspicion is required in health care providers (ENT, pediatricians and family physicians). Physician and especially parental education are the main guarantors of significantly reduced morbidity and mortality in this pathology

Stem cell therapy for hereditary breast cancer

In this study, we report on recent advances on the functions of embryonic, fetal, and adult stem cell progenitors for hereditary breast cancer therapies. Severalmolecular targeting therapies are described by activation and blocking distinct developmental signaling cascade elements, such as BRCA1, EGFR,hedgehog, Wnt/β catenin, and/or Notch pathways, which are frequently upregulated in cancer progenitor cells during the initiation and development of breast cancer.В огляді наведено дані про недавні досягнення використання попередників зародкових, плідних та дорослих стовбурових клітин в терапії за допомогою молекулярного таргентинга шляхом активації та блокування сигнальних каскадних елементів, таких як BRCA1, EGFR, Wnt/β catenin и Notch pathways, які часто регулюються в попередниках ракових клітин під час ініціації та розвитку рака груді.В настоящем исследовании сообщается о недавних достижениях использования предшественников зародышевых, плодных и взрослых стволовых клеток в терапии наследственного рака груди. Описаны варианты терапии с помощью молекулярного таргетинга путем активации и блокирования сигнальных каскадных элементов, таких как BRCA1, EGFR, hedgehog, Wnt/β catenin и Notch pathways, которые часто регулируются в предшественниках раковых клеток в ходе инициации и развития рака груди

Gender-related factors affecting health seeking for neglected tropical diseases: findings from a qualitative study in Ethiopia

Background Despite known gender-specific differences in terms of prevalence, transmission and exposure to neglected tropical diseases (NTDs), there is limited discussion of the influence of gender in NTD programmes and interventions. There is a paucity of research on how gender interacts with NTD service provision and uptake. This study, part of broader implementation research in Ethiopia, applied a gender lens to health seeking for five NTDs: lymphatic filariasis, podoconiosis, schistosomiasis, soil-transmitted helminth infection and trachoma. Methodology/principal findings The study was conducted in a district of the Southern Nations, Nationalities, and Peoples' Region of Ethiopia where the five NTDs are prevalent. A qualitative methodology was adopted to explore participants’ perspectives and experiences. Data generation methods included 20 interviews and four focus group discussions. Community members, volunteer Health Development Army leaders, Health Extension Workers and a range of health workers at the health post, health centre and hospital level (n = 59) were purposively sampled. Interviews and focus group discussions were audio recorded, transcribed verbatim into English then analysed through open coding, drawing on constant comparative methods. Gender related factors affected care seeking for NTDs and were described as reasons for not seeking care, delayed care seeking and treating NTDs with natural remedies. Women faced additional challenges in seeking health care due to gender inequalities and power dynamics in their domestic partnerships. Participants recommended raising community awareness about NTDs, however this remains problematic due to gender and social norms around appropriate discourse with members of the opposite gender. Conclusions/significance The findings from this study provide crucial insights into how gender interacts with accessing health services, at different levels of the health system. If we are committed to leaving no one behind and achieving universal health coverage, it is essential to address gender disparities to access and utilisation of interventions delivered by national NTD programmes

Species and habitats in danger : estimating the relative risk posed by oil spills in the northern Baltic Sea

Large-scale oil spills can have adverse effects on biodiversity in coastal areas where maritime oil transportation is intense. In this article we conducted a spatial risk assessment to study the risk that potential tanker accidents pose to threatened habitat types and species living in the northern Baltic Sea, which has witnessed a rapid increase in maritime oil transportation within the past two decades. We applied a probabilistic method, which combines three components: a Bayesian network describing tanker accidents and uncertainties related to them, probabilistic maps showing the movement of oil, and a database of threatened species and habitats in the area. The results suggest that spatial risk posed by oil spills varies across the area, and does not correspond, for example, to the frequency of accidents in a given area. The relative risk is highest for seashore meadows, which is important to take into account when managing these habitats. Our analysis underlines the importance of a thorough risk assessment, which is not only based solely on one or two specific factors such as accident probabilities or the trajectories of spilled oil but also contains as broad a view of the consequences as possible. We believe that the probabilistic methodology applied in the study will be of high interest to people who have to cope with uncertainties typical for environmental risk assessment and management.Peer reviewe

Distinct beta frequencies reflect categorical decisions

This is the final version. Available on open access from Nature Research via the DOI in this recordData availability: The data generated in this study have been deposited in the OSF database under the accession code (43) https://osf.io/pza56/. The data are publicly available. Source data are provided in this paper.Code availability: The code used to analyze the data supporting the claims of this study is publicly available here https://osf.io/pza56/.Based on prior findings of content-specific beta synchronization in working memory and decision making, we hypothesized that beta oscillations support the (re-)activation of cortical representations by mediating neural ensemble formation. We found that beta activity in monkey dorsolateral prefrontal cortex (dlPFC) and pre-supplementary motor area (preSMA) reflects the content of a stimulus in relation to the task context, regardless of its objective properties. In duration- and distance-categorization tasks, we changed the boundary between categories from one block of trials to the next. We found that two distinct beta-band frequencies were consistently associated with the two relative categories, with activity in these bands predicting the animals' responses. We characterized beta at these frequencies as transient bursts, and showed that dlPFC and preSMA are connected via these distinct frequency channels. These results support the role of beta in forming neural ensembles, and further show that such ensembles synchronize at different beta frequencies.Austrian Science Fund (FWF)Consejo Nacional de Ciencia y Tecnología (CONACYT)NWO VidiNI

Collective Josephson Vortex Dynamics in Long Josephson Junction Stacks

We investigate the collective phase dynamics in conventional long Josephson junction (LJJ) stacks and in layered superconductors, exhibiting intrinsic LJJ behaviors. Using a theoretical model which accounts for both the magnetic induction effect and the breakdown of local charge neutrality (i.e., charging effect), we show that the collective motion of Josephson vortices, including the dispersion of Josephson plasma mode and the Swihart-type velocity, in an intrinsic LJJ stack such as Bi$_2$Sr$_2$CaCu$_2$O$_{8+y}$ (BSCCO) is significantly modified from those in a conventional LJJ stack. In BSCCO, the strength of the charging effect $\alpha$ is small (i.e., $\alpha \sim 0.1-0.4$), but it leads to notable changes in collective phase dynamics, including changes to the stability condition. Also, we show that splitting of the supercurrent branch in the resistive state is due to collective motion of Josephson vortices. The width of spread of these sub-branches in the linear current-voltage regime depends on $\alpha$, suggesting another way to measure the charging effect in BSCCO.Comment: 27 pages, 6 figures, to appear in Physica C (2002

Community engagement interventions for communicable disease control in low- and lower- middle-income countries : evidence from a review of systematic reviews

BACKGROUND: Community engagement (CE) interventions include a range of approaches to involve communities in the improvement of their health and wellbeing. Working with communities defined by location or some other shared interest, these interventions may be important in assisting equity and reach of communicable disease control (CDC) in low and lower-middle income countries (LLMIC). We conducted an umbrella review to identify approaches to CE in communicable disease control, effectiveness of these approaches, mechanisms and factors influencing success. METHODS: We included systematic reviews that: i) focussed on CE interventions; ii) involved adult community members; iii) included outcomes relevant to communicable diseases in LLMIC; iv) were written in English. Quantitative results were extracted and synthesised narratively. A qualitative synthesis process enabled identification of mechanisms of effect and influencing factors. We followed guidance from the Joanna Briggs Institute, assessed quality with the DARE tool and reported according to standard systematic review methodology. RESULTS: Thirteen systematic reviews of medium-to-high quality were identified between June and July 2017. Reviews covered the following outcomes: HIV and STIs (6); malaria (2); TB (1); child and maternal health (3) and mixed (1). Approaches included: CE through peer education and community health workers, community empowerment interventions and more general community participation or mobilisation. Techniques included sensitisation with the community and involvement in the identification of resources, intervention development and delivery. Evidence of effectiveness of CE on health outcomes was mixed and quality of primary studies variable. We found: i) significantly reduced neonatal mortality following women's participatory learning and action groups; ii) significant reductions in HIV and other STIs with empowerment and mobilisation interventions with marginalised groups; iii) significant reductions in malaria incidence or prevalence in a small number of primary studies; iv) significant reductions in infant diarrhoea following community health worker interventions. Mechanisms of impact commonly occurred through social and behavioural processes, particularly: changing social norms, increasing social cohesion and social capacity. Factors influencing effectiveness of CE interventions included extent of population coverage, shared leadership and community control over outcomes. CONCLUSION: Community engagement interventions may be effective in supporting CDC in LLMIC. Careful design of CE interventions appropriate to context, disease and community is vital

Late percutaneous coronary intervention for an occluded infarct-related artery in patients with preserved infarct zone viability: A pooled analysis of cardiovascular magnetic resonance studies

Background: The results of clinical trials assessing the effect of late opening of infarct-related artery (IRA) on left ventricular ejection fraction (LVEF) and size in stable patients are equivocal, which may be related to the fact that the presence of viability was not a requirement for randomization in these trials. The aim of the study was to assess the influence of late percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) vs. OMT alone on cardiac function and remodeling in patients presenting infarct zone with preserved viability on cardiovascular magnetic resonance (CMR).Methods: The analysis included pooled data of 43 patients from 3 randomized studies. All patients underwent CMR before randomization, but only in 1 previously unpublished study was preserved viability required for randomization to treatment. Follow-up CMR was performed after 6–12 months.Results: Late PCI with OMT led to improved LVEF (+5 ± 7% vs. –1 ± 6%, p = 0.005), decreased left ventricular end-systolic volume (–11 ± 19 mL vs. 12 ± 40 mL, p = 0.02) and a trend towards a decrease in end-diastolic volume (–7 ± 27 mL vs. 15 ± 47 mL, p = 0.07) in comparison to OMT alone. Increased LVEF and decreased left ventricular volumes were observed after the analysis was restricted to patients with left anterior descending artery (LAD) occlusion.Conclusions: In patients with the presence of infarct zone viability, OMT with late PCI for an occluded IRA (particularly LAD) is associated with improvement of left ventricular systolic function and size over OMT alone

Application of multiplex PCR with histopathologic features for detection of familial breast cancer in formalin-fixed, paraffin-embedded histologic specimens

Breast cancer is the most common malignancy among females in the world. Age and familial history are the major risk factors for the development of this disease in Iran. Mutations of BRCA1 and BRCA2 genes are associated with a greatly increased risk for development of familial breast cancer. Frequency of BRCA mutations was identified in familial breast cancers (FBC) and non familial breast cancers (NFBC) by molecular genetics, morphological and Immunohistochemical methods. Thirty forth formalin fixed, paraffin embedded breast tissue tumors were analyzed from 16 patients with FBC and 18 patients with NFBC. Three 5382insC mutations detected by multiplex PCR in 16 familial breast cancers. Immunohistochemical method was used to detect estrogen receptor (ER) and progesterona receptor (PR) and TP53. Comparison of ER, PR and TP53 exhibited high difference (P < 0.0001) in familial breast cancers and nonfamilial breast cancers. Our results demonstrated that 5382insC mutation, ER, PR, TP53, mitotic activity, polymorphism, necrosis and tubules can serve as the major risk factors for the development of FBC.Рак молочної залози (РМЗ) є найбільш частим видом злоякісних пухлин у жінок в світі. В Ірані вік та наявність захворювань РМЗ в найближчих родичів є головними факторами ризику розвитку цього захворювання. Мутації гена BRCA1/2 зумовлюють високий ризик розвитку протягом життя РМЗ. Досліджено частоти мутацій ВRCA в осіб з сімейним раком молочної залози (СРМЗ) та несімейним раком молочної залози (НСРМЗ) з Ірану. Для досягнення поставленої цілі використовували молекулярно-генетичні, морфологічні та імуногістохімічні методи. Проаналізовано 34 тканини пухлин, зафіксованих в парафіні, у 16 хворих СРМЖ і 18 хворих НСРМЖ. При дослідженні генів ВRCA1 та ВRCA2 з мультиплексним ПЦР ідентифіковано три мутації (538insC) в 16 хворих СРМЖ. Імуногістохімічним методом визначали рецептор естрогена (ЕР), рецептор прогестерона (РП) і ТР53. Порівняння ЕР, РП і ТР53 в тканинах СРМЖ та НРМЖ показало високі достовірні відмінності (Р < 0.0001). В результаті досліджень виявлено, що мутація 5382insC, ЭР, РП, TP53, мітотична особливість, поліморфізми, некроз і тубули можуть бути використані як головні фактори ризику розвитку СРМЖ.Отмечено, что рак молочной железы (РМЖ) является наиболее частым видом злокачественных опухолей у женщин в мире. В Иране возраст и наличие заболеваний РМЖ у ближайших родственников являются главными факторами риска развития этого заболевания. Мутации гена BRCA1/2 обусловливают высокий риск развития в течение жизни РМЖ. Исследованы частоты мутаций BRCA у лиц с семейным РМЖ (СРМЖ) и несемейным РМЖ (НСРМЖ) из Ирана. Для достижения поставленной цели использованы молекулярно-генетические, морфологические и иммуногистохимические методы. Проанализированы 34 ткани опухолей, зафиксированных в парафине, у 16 больных СРМЖ и 18 больных НСРМЖ. При исследовании генов BRCA1 и BRCA2 с мультиплексным ПЦР идентифицированы три мутации (5382insC) у 16 больных СРМЖ. Иммуногистохимическим методом определены рецепторы эстрогена (ЭР), прогестерона (РП) и ТР53. Сравнение ЭР, РП и ТР53 в тканях СРМЖ и НРМЖ показало высокие достоверные различия. В результате исследований выявлено, что мутация 5382insC, ЭР, РП, ТР53, митотическая особенность, полиморфизмы, некроз и тубулы можно использовать как главные факторы риска развития СРМЖ

Chagas Cardiomyopathy in the Context of the Chronic Disease Transition

Latin America is undergoing a transition from disease patterns characteristic of developing countries with high rates of infectious disease and premature deaths to a pattern more like industrialized countries, in which chronic conditions such as obesity, hypertension and diabetes are more common. Many rural residents with Chagas disease have now migrated to cities, taken on new habits and may suffer from both types of disease. We studied heart disease among 394 adults seen by cardiologists in a public hospital in the city of Santa Cruz, Bolivia; 64% were infected with T. cruzi, the parasite that causes Chagas disease. Both T. cruzi infected and uninfected patients had a high rate of hypertension (64%) and overweight (67%), with no difference by infection status. Nearly 60% of symptomatic congestive heart failure was due to Chagas disease; mortality was also higher for infected than uninfected patients. Males and older patients had more severe Chagas heart disease. Chagas heart disease remains an important cause of congestive heart failure in this hospital population, but often occurs in patients who also have obesity, hypertension and/or other cardiac risk factors