Digestive Diseases and Sciences
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Τετάρτη 13 Ιανουαρίου 2016
Helicobacter pylori infection: Diagnostic strategies in primary diagnosis and after therapy
Effects of pacifier and taste on swallowing, esophageal motility, transit, and respiratory rhythm in human neonates
Neurogastroenterology & Motility
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Patients with large-duct primary sclerosing cholangitis and Crohn's disease have a better outcome than those with ulcerative colitis, or without IBD
Alimentary Pharmacology and Therapeutics
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Obesity does not impact perioperative or postoperative outcomes in patients with inflammatory bowel disease
Journal of Gastrointestinal Surgery
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Assessment of gastric emptying in patients with autoimmune gastritis
Digestive Diseases and Sciences
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The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD)
Metabolism
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Early liver transplantation for severe alcoholic hepatitis in the United States--a single-center experience
American Journal of Transplantation
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Regional gastrointestinal transit times in severe ulcerative colitis
Neurogastroenterology & Motility
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Racial disparities in readmissions for patients with inflammatory bowel disease (IBD) after colorectal surgery
Journal of Gastrointestinal Surgery
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Factors associated with long-term CD4 cell recovery in HIV-infected patients on successful antiretroviral therapy
HIV Medicine
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Predictors of disease complications and treatment outcome among patients with chronic suppurative otitis media attending a tertiary hospital, Mwanza Tanzania
Abstract
Background
Chronic suppurative otitis media (CSOM) is a major health problem in developing countries causing hearing loss and life threatening complications. Early and effective treatment based on the knowledge of causative micro-organisms and predictors of outcome are crucial in preventing these associated complications. This study was conducted to determine the predictors of CSOM complications, treatment outcome and antimicrobial susceptibility of pathogens, thus providing essential evidence to formulate a policy for management of CSOM.
Methods
This was a prospective hospital based cross sectional study involving 301 patients attending Ear Nose and Throat (ENT) clinics at Bugando Medical Centre (BMC) between October 2013 and March 2014. A standardized data collection tool was used to collect demographics and clinical characteristics of patients with CSOM. Ear swabs were collected using sterile cotton swabs and transported to the laboratory for culture and antibiotic susceptibility testing.
Results
Out of 301 patients with CSOM; 187 (62.1 %) had positive aerobic culture within 48 h of incubation. Disease complications and poor treatment outcome were observed in 114 (37.8 %, 95 % CI; 32.2–43.3) and 46 (15.3 %, 95 % CI; 11.2–19.3) respectively. On multivariate logistic regression analysis factors found independently to predict both disease complications and poor treatment outcome were otalgia, being infected by multi drug resistant bacteria and being HIV positive. Prolonged illness duration before seeking medical attention was also found to be associated with disease complications (OR 1.029, 95 % CI 1.007–1.05, p = 0.01). A total of 116 (61 %) of gram negative bacteria were isolated. Of 34 Staphylococcus aureus, 14 (41 %) were found to be methicillin resistant Staphylococcus aureus (MRSA) while of 116 g negative enteric bacteria, 49 (42 %) were extended spectrum beta lactamases producers (ESBL).
Conclusions
Findings of this study suggest that positive HIV status, infection due to multidrug resistant pathogens and otalgia are significantly associated with disease complications and poor treatment outcome. Of great importance this study confirms that prolonged illness duration without seeking medical attention significantly predicts disease complications. Urgent preventive measures and laboratory guided early treatment are necessary to reduce complications associated with CSOM.
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Operational performance of passive multi-family buildings: commissioning with regard to ventilation and indoor climate
The first year commissioning activities in 4 multi-family buildings from a zero-carbon neighbourhood is presented, with focus on the operation of the ventilation systems, the indoor climate and user acceptance. The key parameters to detect the main system failures are identified and the effect of the detected defects and failures on the energy performance of the dwellings is explored using dynamic simulations and monitoring data. It is concluded that commissioning of the building systems during occupancy is a vital part of the operational lifetime of a building project in order to achieve the high building performance targets in reality.
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Development of smart city platform as a tool for supporting more sustainable mobility behaviour
The MOVE smart city platform integrates different data sources, and has been integrated in several projects in order to support mobility research about individual mobility behavior. The platform is applied in specific 'living labs' (e.g. concerning mobility budget, electric company bikes, …), as well as in public mobility campaigns (such as Biking Map Flanders, M-score, Routecoach). We consider the evolution from this technology, from a monitoring instrument towards an instrument for citizens participation and co-creation.
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Improving the dynamic stiffness in a self-sensing BLDC machine drive using estimated load torque feedforward
This paper presents a load torque estimation method for self-sensing brushless DC drives. Torque ripples in brushless DC machines can be reduced using load torque information. This method uses the terminal voltage, the virtual neutral point voltage and the DC-bus current of the machine. The algorithm uses the variation of successive back-EMF samples to estimate the rotor speed. The rotor position is estimated by defining an intermediate function of estimated speed and back-EMF samples. An estimate of acceleration is used to estimate load torque. The load torque information is used for increasing the dynamic stiffness of the drive. The mathematical background is given and discussed and the simulations as well as the experimental results prove the performance of the proposed method.
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Generalized benders decomposition to reoptimize water production and distribution operations in a real water supply network
Water supply networks are designed to effectively and efficiently supply water to some originally targeted agglomerations. However, the dynamics over time of water-demand patterns and electricity cost schemes may render these designs inefficient and expensive to operate. This paper considers the challenging problem of optimizing water production and distribution operations in one of the largest water supply networks operating in Flanders (Belgium) while accounting for the water-demand and electricity cost dynamics. Optimizing operations in a real water supply network is a difficult task as it involves many constraints. In addition to the complex hydraulic nonlinear equality constraints stemming from friction losses and pump curves, specific constraints for accurate modeling of storage buffers must be taken into account. These constraints require additional binary variables to model free inflow or possible reinjection of water to the network. The resulting optimization problem is thus a nonconvex mixed-integer and nonlinear mathematical problem that is computationally expensive to solve. A particularly appealing method for solving such optimization problems is Generalized Benders Decomposition (GBD). This paper extends this method to the water supply network optimization problem mentioned previously. It is experimentally shown that the approach is successful through careful selection of the complicating variables and values for the penalty term. Results of the experiments carried out on two network instances show that the carefully fine-tuned model allows convergence to near-optimal solutions. Compared to state-of-the-art solvers, the proposed approach proved to be competitive on the tested networks in terms of solution quality and computational time.
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A new multi-level switching amplifier architecture with improved power efficiency
This paper describes a new multi-level switching amplifier concept, targeting increased power efficiency for analog signals with a very high crest factor. Interesting application fields include audio power amplifiers or line drivers in central-office ADSL and VDSL equipment. Calculations prove its superior power efficiency compared to conventional class-D switching amplifiers as well as linear class-AB and class-G amplifiers. A silicon implementation of a multi-level switching VDSL line driver chip is currently in progress.
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Het belang van commissioning in energetisch performante woningen: de CO2-neutrale woonwijk Venning
In de context van het Europese CONCERTO ECO-Life project wordt de Kortrijkse Venningwijk getransformeerd tot een CO2-neutrale woonwijk met 196 woningen. Aan de gebouwschil en de technische installaties werden hoge energieprestatie-eisen opgelegd en een hedendaags lage temperatuur warmtenet voorziet de volledige wijk van warmte uit biomassa. Een belangrijke doelstelling van het project is om de hoge niveaus van energieprestatie, comfort en leefkwaliteit ook in realiteit te verwezenlijken. Om de reële werking van de gebouwen en installaties in gebruikstoestand te evalueren, worden commissioning-activiteiten verdergezet tijdens de eerste jaren van ingebruikname, en worden ondermeer de energiestromen permanent gemonitord.
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Fully integrated high-voltage generators with optimized power efficiency
This paper describes how the power efficiency of fully integrated Dickson charge pumps in high-voltage IC technolo-gies can be improved considerably by implementing charge recycling techniques, by replacing the normal PN junction diodes by pulse-driven active diodes, and by choosing an appropriate advanced smart power IC technology. A detailed analysis reveals that the combination of these 3 methods more than doubles the power efficiency compared to traditional Dickson charge pump designs.
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Vulvovaginal candidosis: contemporary challenges and the future of prophylactic and therapeutic approaches
Summary
Vulvovaginal candidosis (VVC) is a common gynaecological disorder that is delineated by the inflammation of vaginal wall and it is caused by the opportunistic fungal pathogen Candida species. In fact, three out of every four women will experience at least one occasion of VVC during some point in their lives. Although uncomplicated VVC is relatively harmless, the complicated VVC such as recurrent attack often creates restlessness and depression in the patients, thus greatly affects their quality of life. Managements of VVC are usually associated with the use of antimycotic suppositories, topical cream or oral agents. These antimycotic agents are either available over-the-counter or prescribed by the clinicians. In recent decades, the rise of clinical challenges such as the increased prevalence of resistant Candida strains, recurrent VVC infection and adverse effects of multidrug interactions have necessitated the development of novel therapeutic or prophylactic options to combat the complicated VVC in the future. In this review, we discuss the current antimycotic treatments available for Candida vaginitis and the problems that exist in these seemingly effective treatments. Besides, we attempt to contemplate some of the future and prospective strategies surrounding the development of alternative therapeutic and prophylactic options in treating and preventing complicated VVC respectively.
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High frequency of Candida fabianii among clinical isolates biochemically identified as Candida pelliculosa and Candida utilis
Summary
Clinical yeast isolates belonging to Candida pelliculosa, Candida utilis and Candida fabianii are difficult to distinguish in a routine mycology laboratory using common biochemical tests. The aims of this study were to determine the prevalence of C. pelliculosa, C. utilis and C. fabianii in clinical samples and to compare their minimum inhibitory concentrations (MICs) to systemic antifungals. Two hundred and forty-eight clinical yeast isolates obtained from eight large hospitals in the Czech Republic were included in this study. Identification was performed biochemically using ID 32C kit and by MALDI-TOF MS. MICs were determined using colorimetric broth dilution Sensititre YeastOne panels. From a total number of 248 isolates, 175 were identified as C. pelliculosa and 73 as C. utilis using the biochemical kit. In contrast, MALDI-TOF MS identified 222 isolates as C. fabianii, 20 as C. pelliculosa and 6 as C. utilis. The highest mean MICs were found in C. fabianii and, regardless of the studied species, in isolates from blood cultures and central venous catheters. MALDI-TOF MS revealed C. fabianii to be most prevalent in clinical samples as compared with the other studied species. Higher MIC values in C. fabianii support the importance of correct identification of this species.
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Blood Genome-Wide Transcriptional Profiles of HER2 Negative Breast Cancers Patients
Tumors act systemically to sustain cancer progression, affecting the physiological processes in the host and triggering responses in the blood circulating cells. In this study, we explored blood transcriptional patterns of patients with two subtypes of HER2 negative breast cancers, with different prognosis and therapeutic outcome. Peripheral blood samples from seven healthy female donors and 29 women with breast cancer including 14 triple-negative breast cancers and 15 hormone-dependent breast cancers were evaluated by microarray. We also evaluated the stroma in primary tumors. Transcriptional analysis revealed distinct molecular signatures in the blood of HER2− breast cancer patients according to ER/PR status. Our data showed the implication of immune signaling in both breast cancer subtypes with an enrichment of these processes in the blood of TNBC patients. We observed a significant alteration of "chemokine signaling," "IL-8 signaling," and "communication between innate and adaptive immune cells" pathways in the blood of TNBC patients correlated with an increased inflammation and necrosis in their primary tumors. Overall, our data indicate that the presence of triple-negative breast cancer is associated with an enrichment of altered systemic immune-related pathways, suggesting that immunotherapy could possibly be synergistic to the chemotherapy, to improve the clinical outcome of these patients.
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One-Year Outcome of Geriatric Hip-Fracture Patients following Prolonged ICU Treatment
Purpose. Incidence of geriatric fractures is increasing. Knowledge of outcome data for hip-fracture patients undergoing intensive-care unit (ICU) treatment, including invasive ventilatory management (IVM) and hemodiafiltration (CVVHDF), is sparse. Methods. Single-center prospective observational study including 402 geriatric hip-fracture patients. Age, gender, the American Society of Anesthesiologists (ASA) classification, and the Barthel index (BI) were documented. Underlying reasons for prolonged ICU stay were registered, as well as assessed procedures like IVM and CVVHDF. Outcome parameters were in-hospital, 6-month, and 1-year mortality and need for nursing care. Results. 15% were treated > 3 days and 68% 3d cohort were significantly increased (). Most frequent indications were cardiocirculatory pathology followed by respiratory failure, renal impairment, and infection. 18% of patients needed CVVHDF and 41% IVM. In these cohorts, 6-month mortality ranged > 80% and 12-month mortality > 90%. 100% needed nursing care after 6 and 12 months. Conclusions. ICU treatment > 3 days showed considerable difference in mortality and nursing care needed after 6 and 12 months. Particularly, patients requiring CVVHDF or IVM had disastrous long-term results. Our study may add one further element in complex decision making serving this vulnerable patient cohort.
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Effectiveness of Thoracoscopic Talc Pleurodesis in the Management of Complicated Spontaneous Pneumothorax
Background: Complicated (recurring or persistent) spontaneous pneumothorax requires intervention either by surgical or nonsurgical pleurodesis or other interventions. As for high-risk patients, aggressive interventions may be associated with morbidity, the safety and effectiveness of less aggressive alternative interventions like thoracoscopic talc pleurodesis (TTP) should be evaluated. Methods: Data were extracted on patients who had undergone TTP for complicated spontaneous pneumothorax at Interventional Clinic, University Hospital, Brussels, Belgium. The complications, length of hospital stay, and success rate over a 24-month period were studied. Results: A total of 41 TTP procedures were performed for 25 (61%) cases of primary spontaneous pneumothorax and for 16 (39%) cases of secondary spontaneous pneumothorax. Twenty-four cases were first episodes, whereas it was a recurrence in 17. Of 4 patients with blebs/bullae, 2 had recurrence after TTP. No patient had acute respiratory distress syndrome or any other serious complication after TTP. Recurrence rates after TTP in primary and secondary spontaneous pneumothorax were 9.5% and 25% at 24 months, respectively. The mean length of hospital stay after TTP was 3±3.2 days. Conclusions: TTP is a safe and effective intervention in complicated spontaneous pneumothorax.from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ShGmw5
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Tracheal Fibroepithelial Polyp
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Cryotechnology in Diagnosing and Treating Lung Diseases
Cryotechnology has been used in treating lung cancer for many years, now it is emerging to have a new indication in diagnosing lung diseases. Cryoprobe transbronchial lung biopsy has been introduced into clinical practice as a new technique, providing a larger biopsy specimen, potentially improving the diagnostic yield of transbronchial biopsies in parenchymal lung diseases. Although recent small pilot studies suggest that cryotransbronchial lung biopsies are comparable to conventional transbronchial biopsies in terms of diagnostic yield and safety profile in lung transplant patients, cryoprobe transbronchial lung biopsy is still being evaluated and its role in clinical practice is not well defined. Cryotherapy has been proven as a safe and effective method to debulk endobronchial lesions, providing palliation for advanced central obstructive tumors. Its use and efficacy is also studied in direct cryosurgery and percutaneous application in lung cancer. Cryoprobes can also be used to extract foreign bodies from the airways by causing cryoadhesion. We aim to summarize the therapeutic and diagnostic application of cryotechnology in pulmonary diseases.from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Ohyoiw
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The Effect of General Anesthesia Versus Intravenous Sedation on Diagnostic Yield and Success in Electromagnetic Navigation Bronchoscopy
Background: Navigational bronchoscopy is utilized to guide biopsies of peripheral lung nodules and place fiducial markers for treatment of limited stage lung cancer with stereotactic body radiotherapy. The type of sedation used for this procedure remains controversial. We performed a retrospective chart review to evaluate the differences of diagnostic yield and overall success of the procedure based on anesthesia type. Methods: Electromagnetic navigational bronchoscopy was performed using the superDimension software system. Once the targeted lesion was within reach, multiple tissue samples were obtained. Statistical analysis was used to correlate the yield with the type of sedation among other factors. A successful procedure was defined if a diagnosis was made or a fiducial marker was adequately placed. Results: Navigational bronchoscopy was performed on a total of 120 targeted lesions. The overall complication rate of the procedure was 4.1%. The diagnostic yield and success of the procedure was 74% and 87%, respectively. Duration of the procedure was the only significant difference between the general anesthesia and IV sedation groups (mean, 58 vs. 43 min, P=0.0005). A larger tumor size was associated with a higher diagnostic yield (P=0.032). All other variables in terms of effect on diagnostic yield and an unsuccessful procedure did not meet statistical significance. Conclusions: Navigational bronchoscopy is a safe and effective pulmonary diagnostic tool with relatively low complication rate. The diagnostic yield and overall success of the procedure does not seem to be affected by the type of sedation used.from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Ohyo2d
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Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: Indian Perspective
No abstract available
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Construct Validity of the Simbionix Bronch Mentor Simulator for Essential Bronchoscopic Skills
Background: Although simulation-based bronchoscopy has been shown to be an effective training modality, formal assessment should still be performed as new technology emerges. We sought to validate a simulator in essential bronchoscopic tasks, and survey perceptions of bronchoscopists on simulation. Methods: A cohort study at 2 medical centers used 3 groups to assess construct validity of the Simbionix Bronchoscopy Simulator: 7 first-year fellows with 1000 bronchoscopies each (expert). Participants were tested in 4 tasks (1: scope manipulation, 2: guided anatomic navigation, 3: airway anatomy, and 4: lymph node anatomy). Participants were scored and surveyed on their impressions of simulation. The means and Kruskal-Wallis test among groups were compared by task item (Pfrom #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1OhynLG
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Lipoid Pneumonia as a Complication of Lorenzo’s Oil Therapy in a Patient With Adrenoleukodystrophy
Lipoid pneumonia (LP) is a rare exogenous condition caused by inhalation or aspiration of lipid material into the lungs. It is often associated with the therapeutic use of different types of oil, and the diagnosis is based on the demonstration of lipid-laden macrophages in bronchoalveolar lavage fluid. We reported the case of a 39-year-old male with X-linked adrenoleukodystrophy who developed LP secondary to the use of Lorenzo's oil. To our knowledge, the association between the use of Lorenzo's oil and LP has never been reported in literature.from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1OhynLv
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A Remedy for Hoarseness in a Patient With Granulomatosis With Polyangiitis
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A Young Woman With Recurrent Lower Respiratory Tract Infection
Tracheobronchomegaly is a rare congenital abnormality with marked widening of the trachea and major bronchi, in most cases associated with chronic recurrent respiratory tract infection. We present this rare syndrome in a young woman who presented with recurrent respiratory tract infection. She was found to have tracheobronchomegaly on flexible bronchoscopy, which was confirmed with high-resolution computed tomography findings.from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ShGmfy
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Extracorporeal Membrane Oxygenation to Support Whole-lung Lavage in Pulmonary Alveolar Proteinosis: Salvage of the Drowned Lungs
Pulmonary alveolar proteinosis is a rare lung disease characterized by accumulation of lipoproteinaceous material within the alveoli. Therapeutic whole-lung lavage (WLL) under general anesthesia is the standard treatment in patients with progressive symptomatic disease. Severe hypoxemic respiratory failure is uncommon, yet when present poses a technical challenge to performing WLL without further compromising respiratory status. Rarely, hyperbaric chamber or extracorporeal membrane oxygenation (ECMO) has been utilized to perform WLL to manage severe hypoxemia, with venovenous ECMO being used more often. We present a case of hypoxemic and hypercarbic respiratory failure from pulmonary alveolar proteinosis successfully managed by placing the patient on venoarterial ECMO to facilitate the performance of bilateral WLL.from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1OhylU2
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Multiple Endobronchial Polyps
Multiple endobronchial polyps are a rare finding. We describe a case of multiple benign endobronchial polyps in a 60-year-old woman who presented with a chronic cough and occasional hemoptysis. Chest computed tomography revealed bilateral basal cylindrical bronchiectasis, with filling defects in both main bronchi. Bronchoscopy revealed the presence of polyps in the distal trachea, both main bronchi, and in the lobar and segmental bronchi of all lobes of both lungs, with lesions from 2 to 10 mm in diameter. Larger lesions were treated with argon plasma coagulation. Histopathology was consistent with benign fibroepithelial polyps. Culture from bronchial washings isolated Pseudomonas aeruginosa, and the patient was treated with ciprofloxacin followed by a prolonged course of azithromycin. Symptoms improved, and repeat bronchoscopy at 3 and 6 months revealed complete resolution of all polyps.from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ShGk7m
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James E. Peck, Pseudohypacusis: False and Exaggerated Hearing Loss. ISBN-13 Number: 978-1-59756-397-0, ISBN-10 Number: 1-59756-397-8.
Publication date: February 2016
Source:International Journal of Pediatric Otorhinolaryngology, Volume 81
Author(s): Ross J. Roeser
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