Recommendations for Diagnosis and Management of Osteoporosis in COPD Men

Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for osteoporosis and fractures because of lifestyle factors, systemic effects of the disease, side effects of treatment, and comorbidities. The initial evaluation of COPD men for osteoporosis must include a detailed medical history and physical examination, assessment of COPD severity, and additional tests, as suggested by results of clinical evaluation. Osteoporosis is diagnosed on the basis of bone mineral density (BMD) measurement with DEXA of the lumbar spine and hip, but fracture risk assessments tools, as FRAX, could be used as useful supplements to BMD assessments for therapeutics interventions. The prevention and treatment of osteoporosis in COPD involves nonpharmacologic and pharmacologic measures, as lifestyle measures and nutritional recommendations, management of COPD treatment (based on the use of limited corticosteroids doses), and drug therapy (bisphosphonates, teriparatide). In this paper, the current recommendations for diagnosis and management of osteoporosis in COPD men, based on recent medical bibliography, are presented and discussed

Brucellosis Presenting as Cholecystitis: A Case Report and Literature Review.

Brucellosis is a zoonotic disease endemic to much of the world. It most often presents with nonspecific symptoms and is a well known cause of undulant fever. Focal forms occur less frequently, with osteoarticular complications being the most common. In this study, we describe a rare case of brucellosis presenting as cholecystitis

Thrombophilia and abdominal vessel thrombosis in a Greek University hospital: A five year experience

Thrombophilia, either congenital or acquired, has foremost consequences in the abdominal vessels. We review here the cases of patients admitted with abdominal vessel thrombosis over a five-year period. Our data focused on gender and age at diagnosis, site of thrombosis, previous thromboembolic events, underlying conditions, and family history. Investigations included measurement of protein C, protein S, activated PC resistance, and antithrombin, and screening for factor V Leiden, prothrombin G20210A, the C677T variant of the methylenetetrahydrofolate reductase gene, and V617F JAK2 mutation, r lupus anticoagulant, antiphospholipid antibodies and paroxysmal nocturnal hemospherinouria, and also serum folate, vitamin 12, and total homocysteine concentrations. Twenty-nine patients were admitted and 18 of their family members also underwent the same thrombophilia investigations. Eighteen patients (62.1%) presented with portal vein thrombosis (PVT), five patients (17.2%) with mesenteric vein thrombosis (MVT), four patients (13.8%) with splenic vein thrombosis (SVT), and two (6.9%) patients with hepatic vein thrombosis (HVT). There was a high incidence of congenital thrombophilia (37.9%), acquired thrombophilic conditions (27.6%), or both (20.7%). Sixteen of 18 patients with PVT, four of five patients with MVT, all four patients with SVT, and one of two patients with HVT had one or more thrombophilic risk factors. In 13.8% of the patients no underlying condition was identified. We concluded that thrombophilia may have major implications in the pathogenesis of abdominal vessel thrombosis in adult life, and a thorough thrombophilia investigation should be performed in all these patients

Salmonella enterica ssp. arizonae infection in a 43-year-old Italian man with hypoglobulinemia: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p><it>Salmonella enterica </it>ssp. <it>arizonae </it>is an uncommon human pathogen with serious infections reported in immunocompromised hosts. In Europe, only a few cases have been described. Patients with this infection usually have a history of contact with reptiles or travel abroad. We present a case report of infection in a patient with hypoglobulinemia and a literature review.</p> <p>Case presentation</p> <p>We describe the case of a 43-year-old Caucasian Italian man with hypoglobulinemia who presented to our hospital with sepsis and diarrhea. A stool culture yielded <it>S. enterica </it>ssp. <it>arizonae</it>. Our patient was treated with oral ciprofloxacin and made a full recovery. We also present a review of the cases of <it>S. enterica </it>ssp. <it>arizonae </it>infections previously reported in Europe.</p> <p>Conclusions</p> <p>The majority of infections from <it>S. enterica </it>ssp. <it>arizonae </it>occur in patients who are immunocompromised. Data from the literature suggests that it may be difficult to eradicate the bacteria and thus, prolonged antibiotic courses are often used. It would be advisable for clinicians to investigate for pre-existing immune dysfunction if <it>S. enterica </it>ssp. <it>arizonae </it>is isolated. In Italy, although there have only been a few cases, the likely route of transmission remains unclear and requires further surveillance.</p

Outcomes of early switching from intravenous to oral antibiotics on medical wards

OBJECTIVES: To evaluate outcomes following implementation of a checklist with criteria for switching from intravenous (iv) to oral antibiotics on unselected patients on two general medical wards. METHODS: During a 12 month intervention study, a printed checklist of criteria for switching on the third day of iv treatment was placed in the medical charts. The decision to switch was left to the discretion of the attending physician. Outcome parameters of a 4 month control phase before intervention were compared with the equivalent 4 month period during the intervention phase to control for seasonal confounding (before-after study; April to July of 2006 and 2007, respectively): 250 episodes (215 patients) during the intervention period were compared with the control group of 176 episodes (162 patients). The main outcome measure was the duration of iv therapy. Additionally, safety, adherence to the checklist, reasons against switching patients and antibiotic cost were analysed during the whole year of the intervention (n = 698 episodes). RESULTS: In 38% (246/646) of episodes of continued iv antibiotic therapy, patients met all criteria for switching to oral antibiotics on the third day, and 151/246 (61.4%) were switched. The number of days of iv antibiotic treatment were reduced by 19% (95% confidence interval 9%-29%, P = 0.001; 6.0-5.0 days in median) with no increase in complications. The main reasons against switching were persisting fever (41%, n = 187) and absence of clinical improvement (41%, n = 185). CONCLUSIONS: On general medical wards, a checklist with bedside criteria for switching to oral antibiotics can shorten the duration of iv therapy without any negative effect on treatment outcome. The criteria were successfully applied to all patients on the wards, independently of the indication (empirical or directed treatment), the type of (presumed) infection, the underlying disease or the group of antibiotics being used

Addressing k-5 students&apos; and pre-service elementary teachers&apos; conceptions of seasonal change

In this paper, primary school students&apos; and pre-service teachers&apos; ideas of seasonal change are investigated. The research was carried out in nine primary schools in Athens and in the Primary Education Department of the University of Athens. Written reports were used for gathering data while students also had the opportunity to support their answers with drawings. The results showed the following. (1) Pre-service teachers address notions which involve the movement of the Sun and/or the Earth, while primary school students address human centred, tautological and phenomenological notions as well. (2) Both primary school students and pre-service teachers mainly adopt two schemes of explanation: alterations in the distance between the Sun and the Earth and alterations in the Earth-Sun relative orientation/illumination. © 2014 IOP Publishing Ltd

New technology and science education: design, implementation and evaluation of a teaching and learning sequence, concerning phenomena which are connected to the solar-terrestrial-lunar system's related movements, in primary education

[…] Στην παρούσα διδακτορική διατριβή επιχειρείται η διδασκαλία βασικών στοιχείων (εννοιών και φαινομένων) του συστήματος Ήλιος–Γη–Σελήνη στην πρωτοβάθμια εκπαίδευση. Συγκεκριμένα, διερευνάται ο βαθμός στον οποίο οι μαθητές των τελευταίων τάξεων του δημοτικού σχολείου, στο πλαίσιο της σχολικής επιστήμης, μπορούν να οικοδομήσουν ένα εννοιολογικό πλαίσιο το οποίο θα ενσωματώνει τις παρακάτω κινήσεις: α) Περιστροφή της Γης γύρω από το νοητό της άξονα με περίοδο 24 ώρες β) Περιφορά της Σελήνης γύρω από τη Γη με περίοδο ένα συνοδικό μήνα (29,3 μέρες) γ) Περιφορά της Γης γύρω από τον Ήλιο με περίοδο ένα ημερολογιακό έτος μέσω της προσπάθειάς τους να ερμηνεύσουν παρατηρησιακά δεδομένα από την καθημερινή τους εμπειρία. Για να διερευνηθεί σε βάθος ο εν λόγω στόχος, δίνεται έμφαση στις δυσκολίες που ανακύπτουν κατά τη διδασκαλία των προαναφερθεισών κινήσεων, αλλά και στην προσπάθεια αντιμετώπισής τους, για να διαπιστωθεί στο τέλος ο βαθμός στον οποίο οι δυσκολίες αυτές είναι δυνατόν να ξεπεραστούν. […