Transition from pediatric to adult care in emerging adults with type 1 diabetes: a blueprint for effective receivership

Abstract For adolescents and emerging adults, the transition from pediatrics to adult care is fraught with challenges both inside and outside the clinical arena, including assuming independent care for diabetes, working with new adult providers, and overcoming concomitant psychosocial issues, while maintaining work/school-life balance. Not surprisingly, glycemic control in emerging adults with type 1 diabetes is amongst the worst in all age groups. Thus, new and comprehensive strategies are needed by both pediatric and adult diabetes care teams to support young adults during the transition to adult care. In this review, we focus on challenges during the transition period and provide evidence-based recommendations for a receivership model to assist adult diabetes care teams in addressing these concerns. By coordinating efforts with pediatrics providers, identifying strengths and deficiencies in self-care, establishing rapport with young adult patients, directly addressing prevalent psychosocial concerns, and developing a team-based approach to keep patients engaged, adult care teams can prioritize support for the most vulnerable transition patients. Improved strategies to propel emerging adult patients through the transition period towards habits leading to optimal glycemic control could have a major long-term impact on preventing diabetes-related complications.https://deepblue.lib.umich.edu/bitstream/2027.42/148213/1/40842_2019_Article_78.pd

The role of inhalational anesthetic drugs in patients with hepatic dysfunction: A review article

Context: Anesthetic drugs including halogenated anesthetics have been common for many years. Consequent hepatic injury has been reported in the literature. The mechanism of injury is immunoallergic. The first generation drug was halothane; it had the most toxicity when compared to other drugs. The issue becomes more important when the patient has an underlying hepatic dysfunction. Evidence Acquisition: In this paper, reputable internet databases from 1957�2014 were analyzed and 43 original articles, 3 case reports, and 3 books were studied. A search was performed based on the following keywords: inhalational anesthesia, hepatic dysfunction, halogenated anesthetics, general anesthesia in patients with hepatic diseases, and side effects of halogenated anesthetics from reliable databases. Reputable websites like PubMed and Cochrane were used for the searches. Results: In patients with hepatic dysfunction in addition to hepatic system and dramatic hemostatic dysfunction, dysfunction of cardiovascular, renal, respiratory, gastrointestinal, and central nervous systems may occur. On the other hand, exposure to inhalational halogenated anesthetics may have a negative impact (similar to hepatitis) on all aforementioned systems in addition to direct effects on liver function as well as the effects are more pronounced in halothane. Conclusions: Despite the adverse effects of inhalational halogenated anesthetics (especially halothane) on hepatic patients when necessary. The effects on all systems must be considered and the necessary preparations must be provided. These drugs are still used, if necessary, due to the presence of positive effects and advantages mentioned in other studies as well as the adverse effects of other drugs. © 2015, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

Hepatic shock differential diagnosis and risk factors: A review article

Context: Liver as an important organ has a vital role in physiological processes in the body. Different causes can disrupt normal function of liver. Factors such as hypo-perfusion, hypoxemia, infections and some others can cause hepatic injury and hepatic shock. Evidence Acquisition: Published research resources from 2002 to May 2015 in some databases (PubMed, Scopus, Index Copernicus, DOAJ, EBSCO-CINAHL, Science direct, Cochrane library and Google scholar and Iranian search database like SID and Iranmedex) were investigated for the present study. Results: Different causes can lead to hepatic shock. Most of these causes can be prevented by early resuscitation and treatment of underlying factors. Conclusions: Hepatic shock is detected in ill patients, especially those with hemodynamic disorders. It can be prevented by early treatment of underlying disease. There is no definite treatment for hepatic shock and should be managed conservatively. Hepatic shock in patients can increase the mortality rate. © 2015, Kowsar Corp

Intravenous hypnotic regimens in patients with liver disease; a review article

Context: The liver as an important organ in the body has many essential functions in physiological processes. One of the major activities of liver is drug metabolism. Hepatic dysfunction affecting hepatic physiological activities, especially drug metabolism can cause many problems during anesthesia and administration of different drugs to patients. Evidence Acquisition: Studies on hepatic disorders and hypnotic anesthetics prescribed in hepatic disorders were included in this review. For this purpose, reliable databases were used. Results: Anesthesia should be performed with caution in patients with hepatic dysfunction and drugs with long half-life should be avoided in these patients. Conclusions: A review of the literature on the use of hypnotic drugs in patients with liver dysfunction showed that some hypnotic drugs used during anesthesia could be safely used in patients with impaired liver function. In these patients, certain drugs should be used with caution. © 2015, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

Opioid drugs in patients with liver disease: A systematic review

Context: The liver, one of the most important organs of the body, is known to be responsible for several functions. The functional contribution of the liver to the metabolism of carbohydrates, protein, drugs and toxins, fats and cholesterol and many other biological processes are still unknown. Liver disorders are classified into two types: acute and chronic. Different drugs are used in liver diseases to treat and control pain. Most pain relief medications such as opioids are metabolized via the liver; therefore, the adverse reactions of drugs are probably higher for patients with liver disease. The current study aimed to evaluate the effects of opioid drugs on patients with liver disease; therefore, it is necessary to select suitable opioids for such patients.Evidence Acquisition: This reviewwaswritten by referring to research literature including 70 articlesandfour textbooks published from 1958 to 2015 on various reputable sites. Searches were carried out on the key phrases of narcotic pain relievers (opioids), acute and chronic hepatic failure, opioid adverse drug reactions, drug-induced liver injury (DILI) and other similar keywords. References included a variety of research papers (descriptive and analytical), intervention and review articles. Results: In patients with liver disease, administration of opioid analgesics should be observed, accurately. As a general rule, lower doses of drugs should be administered at regular intervals based on the signs of drug accumulation. Secondly, the interactions of opioid drugs with different levels of substrates of the P450 cytochrome enzyme should be considered. Conclusions: Pain management in patients with liver dysfunction is always challenging to physicians because of the adverse reactions of drugs, especially opioids. Opioids should be used cautiously since they can cause sedation, constipation and sudden encephalopathy effects. Since the clearance of these drugs in patients with hepatic insufficiency is decreased, the initial dose must be decreased, the intervals between doses should be increased and some patients need to be continuously assessed. © 2016, Kowsar Corp

Molecular detection of prostate specific antigen in patients with prostate cancer or benign prostate hyperplasia the first investigation from Iran

Prostate cancer is the second common form of cancer in men. Detection of circulating Prostate Specific Antigen (PSA) transcripts has effectively been used for early diagnosis of prostate cancer cells. This investigation employed a reverse transcriptase polymerase chain reaction (RT-PCR) technique to distinguish the patients with either localized or metastatic prostate cancer (CaP) vs. Benign Prostate Hyperplasia (BPH) and control subjects, as compared with clinical and pathological records. With reservation of ethical issues, blood samples were collected from 60 cases. Based on pathological and clinical findings, 25 patients (20 with localized cancer, 5 with metastatic), 22 with BPH, and 13 healthy (including 3 females) subjects as negative controls, were selected from Shariati, Mehrad, Sina,, Khatam and Atie Hospitals in Tehran, Iran. RT-PCR for a 260 bp PSA transcript was then performed. Clinical and pathological records were used for the assessment and comparison of PSA RT-PCR results. None of the control subjects and BPH (with 7 exceptions) were found positive by RT-PCR (Relative specificity= 72.7). In patients with prostate cancer, 21 out of 25 were found PSA positive (Relative sensitivity= 83.4) and the remaining 3 have been shown to be PSA negative (Positive predictive value= 83.4). All of 5 metastatic patients (100) revealed PSA positive results. Our data reflects the clinical relevance and significance of RT-PCR results as assessed with clinical and pathological examinations. PSA RT-PCR might be used as a powerful means for diagnosis, even when either pathological or clinical findings are negative, and could be employed for further molecular epidemiology surveys

Higher harmonic generation of guided waves at delaminations in laminated composite beams

Detection and characterization of delamination damage are of great importance to the assurance of structural safety. This work investigates the potential of a baseline-free structural health monitoring technique based on higher harmonics resulting from the nonlinear interaction of guided wave and a delamination. The nonlinearity considered in this study arises from the clapping of the sub-laminates in the delaminated region, which generates contact acoustic nonlinearity. Both explicit finite element simulations and experimental tests are conducted on composite laminates containing a delamination of different sizes and at different through-thickness locations. The results show that the interaction between the fundamental asymmetric mode (A0) of guided wave and a delamination generates contact acoustic nonlinearity in the form of higher harmonics, which provides a good measure for identifying the existence of delaminations and determining their sizes in laminated composite beams. This new insight into the generation mechanisms of nonlinear higher order harmonics in composite laminates will enhance the detection and monitoring of damage in composite structures.Reza Soleimanpour, Ching-Tai Ng and Chun H.Wan

Effect of central and non-central frequency components on the quality of damage imaging

Accurate image reconstruction of damage through Lamb wave diffraction tomography (LWDT) requires substantial information of scatter field. This can be achieved using transducer network to collect the scatter field data. However, this requires a large number of transducers that creates logistical constraints for the practical applications of the technique. Various methods have been developed to improve the practicability of LWDT. One of the main approaches is to employ data at multiple frequencies within the bandwidth of the excitation signal. The objective of this study is to investigate the performance of using the data at non-central frequencies to reconstruct the damage image using LWDT. This provides an understanding on the influence of data at each individual frequency in the damage image reconstruction.In this paper, a series of numerical case studies with consideration of different damage sizes and shapes are carried out. Different non-central frequencies data is used to reconstruct the damage image. The results show that using the data at different non-central frequencies leads to different qualities of the reconstructed damage images. The quality of these reconstructed damage images are then compared to investigate the information contained of the data at each individual frequency. The study shows that the non-central frequencies data can provide additional information in the damage image reconstruction. Overall, the results of this study provide insights into the influences of the data at different frequencies, which is essential to advance the developments of the LWDT.Gnana Teja Pudipeddi, Ching-Tai Ng, Andrei Kotouso