Multiple Infectious Complications in a Severely Injured Patient with Single Nucleotide Polymorphisms in Important Innate Immune Response Genes

Abstract Trauma is a major public health problem worldwide. Infectious complications, sepsis, and multiple organ dysfunction syndrome (MODS) remain important causes for morbidity and mortality in patients who survive the initial trauma. There is increasing evidence for the role of genetic variation in the innate immune system on infectious complications in severe trauma patients. We describe a trauma patient with multiple infectious complications caused by multiple micro-organisms leading to prolonged hospital stay with numerous treatments. This patient had multiple single nucleotide polymorphisms (SNPs) in the MBL2, MASP2, FCN2 and TLR2 genes, most likely contributing to increased susceptibility and severity of infectious diseas

Effects of sequence variations in innate immune response genes on infectious outcome in trauma patients: A comprehensive review

Infectious complications, sepsis, and multiple organ dysfunction syndrome (MODS) remain important causes for morbidity and mortality in patients who survive the initial trauma. Increasing evidence suggests that genetic variants, particularly single nucleotide polymorphisms (SNPs), are critical determinants for interindividual differences in both inflammatory responses and clinical outcome in sepsis patients. Although the effect of SNPs on sepsis and MODS has been studied in many populations and diseases, this review aimed to summarize the current knowledge on the effect of SNPs on infectious complication specifically in trauma patients. A review of available literature was performed in PubMed database. The following genes have been studied in populations of trauma patients: CD14, HMGB1, IFNG, IL1A, IL1B, IL1RN, IL4, IL6, IL8, IL10, IL17F, IL18, MBL2, MASP2, FCN2, TLR1, TLR2, TLR4, TLR9, TNF, LTA, GR, MYLK, NLRP3, PRDX6, RAGE, HSPA1B, HSPA1L, HSP90, SERPINE1, IRAK1, IRAK3, VEGFA, LY96, ANGPT2, LBP, MicroRNA, and mtDNA. In this review, we discuss the genes of the Pattern Recognition Receptors, Signal Transducing Adaptor Proteins, and Inflammatory Cytokines of the innate immune system. A number of genetic variations have so far been studied in cohorts of trauma patients. Studies are often unique and numbers sometimes small. No definitive conclusions can be reached at this time about the influence of specific sequence variations on outcome in trauma patients

Fatal nevirapine-induced Stevens-Johnson syndrome with HIV-associated mania

Mania with psychotic features is one of the common presenting clusters of psychiatric symptoms in HIV-infected patients. Commonly, patients with HIV-associated mania receive antiretroviral treatment, mood stabilisers and antipsychotics. This case of Stevens-Johnson syndrome highlights the dilemmas and complications that may arise when prescribing multiple medications in HIV-associated psychiatric disorders

Tooth loss and oral health-related quality of life: a systematic review and meta-analysis

Contains fulltext : 87677.pdf (publisher's version ) (Open Access)BACKGROUND: It is increasingly recognized that the impact of disease on quality of life should be taken into account when assessing health status. It is likely that tooth loss, in most cases being a consequence of oral diseases, affects Oral Health-Related Quality of Life (OHRQoL). The aim of the present study is to systematically review the literature and to analyse the relationship between the number and location of missing teeth and oral health-related quality of life (OHRQoL). It was hypothesized that tooth loss is associated with an impairment of OHRQoL. Secondly, it was hypothesized that location and distribution of remaining teeth play an important role in this. METHODS: Relevant databases were searched for papers in English, published from 1990 to July 2009 following a broad search strategy. Relevant papers were selected by two independent readers using predefined exclusion criteria, firstly on the basis of abstracts, secondly by assessing full-text papers. Selected studies were grouped on the basis of OHRQoL instruments used and assessed for feasibility for quantitative synthesis. Comparable outcomes were subjected to meta-analysis; remaining outcomes were subjected to a qualitative synthesis only. RESULTS: From a total of 924 references, 35 were eligible for synthesis (inter-reader agreement abstracts kappa = 0.84 +/- 0.03; full-texts: kappa = 0.68 +/- 0.06). Meta-analysis was feasible for 10 studies reporting on 13 different samples, resulting in 6 separate analyses. All studies showed that tooth loss is associated with unfavourable OHRQoL scores, independent of study location and OHRQoL instrument used. Qualitative synthesis showed that all 9 studies investigating a possible relationship between number of occluding pairs of teeth present and OHRQoL reported significant positive correlations. Five studies presented separate data regarding OHRQoL and location of tooth loss (anterior tooth loss vs. posterior tooth loss). Four of these reported highest impact for anterior tooth loss; one study indicated a similar impact for both locations of tooth loss. CONCLUSIONS: This study provides fairly strong evidence that tooth loss is associated with impairment of OHRQoL and location and distribution of tooth loss affect the severity of the impairment. This association seems to be independent from the OHRQoL instrument used and context of the included samples

The need for pharmaceutical care in an intensive care unit at a teaching hospital in South Africa

BACKGROUND. The role of the pharmacist has evolved over the last 2 decades beyond traditional functions such as stock control and dispensing. OBJECTIVES. To describe the functions performed by a clinical pharmacist while based in a surgical and trauma intensive care unit of a teaching hospital. METHODS. An operational research study that included indications of programme success was conducted. Interventions to assess therapy and achieve definite outcomes to satisfy patients’ medicine needs were documented for 51 patients over a study period of 8 weeks. RESULTS. A total of 181 interventions were suggested by the pharmacist, with 127 (70%) accepted and implemented by the medical and nursing staff of the unit. The most frequent interventions were related to: untreated medical conditions (15.5%), appropriate therapy or course (13.8%), investigations indicated or outstanding (12.2%), and inappropriate doses and dosing frequency (11%). Interventions were also made regularly to address system errors or non-compliance and factors hindering therapeutic effect. Of the 250 h the pharmacist spent in the ward, most time was used for pharmaceutical care (28%) and ward rounds (21%) with members of the multidisciplinary team. CONCLUSIONS. The study results demonstrated that a clinical pharmacist’s contribution to patient care at ward level resulted in improved monitoring of pharmacotherapy. Medicine-related problems were identified and addressed.The authors would like to acknowledge Prof. Herman Schoeman for the statistical analysis of the data.Department of Pharmacy, Medunsa campushttp://www.sajcc.org.za/index.php/SAJCCam201

Enhancing offshore service vessel concept design by involving seakeeping: developing a framework to efficiently design high performance offshore service vessel concepts

Algorithms and the Foundations of Software technolog

Translation, Cross-Cultural Adaptation, and Validation of the Pain Sensitivity Questionnaire in Dutch Healthy Volunteers

Contains fulltext : 221714.pdf (publisher's version ) (Open Access

The Artist-Shaman and the \"Gift of Sight\"

Throughout the history of art the role of the artist has been compared to the role of the shaman. This is because the artist’s role has always been one of mediator, transformer and most prominently visionary. The role of both the artist and shaman has always been to stand between two worlds: that of the visible and the invisible. The viewers, or the community in the case of the shaman, entrust the artist to go forth into the realm of the invisible and return with a gift: the invisible transformed into the visible. Traditionally, many artists associated with shamanism such as Joseph Beuys, Max Ernst, Leonora Carrington and later Matthew Barney, have been leaders, idealists, heroes of mythic proportions, artists who return with this gift: a vision or sight to follow. But a different breed of artist associated with shamanism also exists: an ambivalent artist-shaman, a shifty and unreliable character of dubious motivations, who appears to offer the viewer a vision or sight and then throws it back in their face, makes them decide. This is the role that Hany Armanious, John Bock, Carla Cescon, Marcus Coates, Mikala Dwyer, Steinar Haga Kristensen, Jonathan Meese, Paul Thek, Justene Williams and myself have taken. And we take it so as to return to the viewer the very power that is invested in the artist, that of creating a vision: what Rex Butler refers to in relation to Hany Armanious as the “gift of sight.” (Butler 2000). These artists and myself offer the “gift of sight” by reflecting the act of perception and by engaging the viewer in the same process that the artist goes through. The way we do this is by setting up complex, multi-positional, process-based systems that are highly informed and engaging but do not lead to an end position. Because the artist does not presume to idealise this end position, the result is inevitably confusing, slippery, uncertain, and ambivalent, as if the artist has no position or avoids commitment. This thesis sets out to inves! tigate t his ambivalent position taken by the artist-shaman and to show how and why it is taken. It does this in two ways. Firstly it provides a studio component as a practical example of the practice of an artist-shaman who offers the “gift of sight.” Secondly, the written dissertation provides a theory and understanding of the artist-shaman who offers the “gift of sight.” This may then be applied to the practical component, offering a historical and philosophical context with which to frame it