Training medical students to improve the management of people with epilepsy

Purpose: To evaluate the knowledge, attitude and perception of medical students prior to and after a training course about epilepsy. Methods: We used a KAP questionnaire with sixty-one questions which assesses knowledge, attitude and practice of epilepsy. Questionnaires were completed by 185 medical students, before and after epilepsy training. We compared the answers to see whether the lecture had changed the knowledge, attitude and practice in epilepsy. Results: One hundred and six students completed the questionnaire before an eight hour course on epilepsy and 79 students completed the questionnaire one year after the course. Comparison of the knowledge scores prior to (mean=53.9, standard deviation=11.4) and after the course (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the course (t-test=5.6, p < 0.001). Discussion: Training course on epilepsy for medical students can promote improvement in the knowledge, attitudes and perception regarding epilepsy, which is maintained one year later. These results highlight the importance of continuous educational programs within the Medical Curriculum

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk.

Blood pressure is a heritable trait influenced by several biological pathways and responsive to environmental stimuli. Over one billion people worldwide have hypertension (≥140 mm Hg systolic blood pressure or  ≥90 mm Hg diastolic blood pressure). Even small increments in blood pressure are associated with an increased risk of cardiovascular events. This genome-wide association study of systolic and diastolic blood pressure, which used a multi-stage design in 200,000 individuals of European descent, identified sixteen novel loci: six of these loci contain genes previously known or suspected to regulate blood pressure (GUCY1A3-GUCY1B3, NPR3-C5orf23, ADM, FURIN-FES, GOSR2, GNAS-EDN3); the other ten provide new clues to blood pressure physiology. A genetic risk score based on 29 genome-wide significant variants was associated with hypertension, left ventricular wall thickness, stroke and coronary artery disease, but not kidney disease or kidney function. We also observed associations with blood pressure in East Asian, South Asian and African ancestry individuals. Our findings provide new insights into the genetics and biology of blood pressure, and suggest potential novel therapeutic pathways for cardiovascular disease prevention

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Cirurgia robótica em pacientes com tumor testicular

Introdução: o tumor testicular é a neoplasia mais comum entre homens jovens de 15 a 35 anos de idade. Nos últimos anos, a incidência dessa patologia tem aumentado, o que torna necessária a adoção de tratamentos mais eficazes e menos invasivos. Nesse sentido, a cirurgia robótica é uma realidade, mais ágil e mais segura do que os métodos tradicionais, para um bom prognóstico dessa doença. Objetivo: o trabalho teve como objetivo avaliar a eficácia da cirurgia robotizada em casos de tumor testicular. Material e método: o presente estudo trata de uma revisão de literatura a partir de vinte artigos redigidos em língua inglesa, obtidos das bases de dados do PubMed, selecionados utilizando-se os Descritores em Ciência da Saúde (DeCS): “surgery”, “robotic”, “cancer” e “testicular”, com critério de data de publicação entre 2014 e 2019. Foram selecionados artigos que relataram a cirurgia robótica para o tratamento do câncer de testículo. Resultados: os resultados se basearam na comparação da cirurgia robótica com a laparoscopia tradicional, ambas realizadas com o objetivo de dissecção de linfonodo retroperitoneal pós-quimioterapia, para tratamento de câncer testicular. O primeiro procedimento citado, apesar de ainda ser considerado o padrão, é tecnicamente difícil, e acarreta maior perda de sangue (uma média de 500Ml), tempo de operação (200 a 350 minutos) e complicações. Em contrapartida, a cirurgia robotizada tem perda de sangue mínima (50mL a 200mL) e demanda menos horas de centro cirúrgico (uma variação de 150 a 200 minutos). Quase todos os pacientes submetidos à robotização receberam alta no 1º dia de pós-operatório, pouco se queixando de dor ou desconforto. Além disso, após uma média de sete meses de acompanhamento, os indivíduos operados apresentaram-se assintomáticos. A taxa de complicação também foi mínima, bem como os valores de morbimortalidadedade, o que demonstra a efetividade da cirurgia robotizada.. Conclusão: diante do exposto, constatou-se que a cirurgia robotizada para tratamento de câncer testicular é um procedimento viável e oncologicamente seguro, com morbidade e riscos mínimos. Nesse sentido, é uma estratégia bastante eficaz, e vem sendo introduzida cada vez mais nos centros hospitalares. Contudo, é imprescindível ter uma tecnologia avançada e profissionais mais especializados e capacitados para a realização dessa técnica, visando a segurança máxima do paciente

ORAL CAVITY MESENCHYMAL STEM CELLS: ORIGIN, SURFACE MARKERS, AND REGENERATIVE POTENTIAL

  Objective: This review investigated the origin, surface markers, and the regenerative potential of mesenchymal stem cells from the oral cavity. Background:  This review addresses the regenerative potential of mesenchymal stem cells (MSCs) from the oral cavity,  including the formation of dental tissues, pulp tissue, and periodontal tissues, and a whole bio-hybrid tooth composed of dentin, cementum, periodontal ligament, and alveolar bone. Teeth sequelae can be caused by cavities, trauma, or infection, leading to endodontic problems, periodontal disease, and tooth loss. Method:  This work selected 67 articles revising the literature using PubMed and Google Scholar, these stem cells were separated according to their origin, surface markers, and regenerative potential. Conclusion: Although a lot of research and clinical trials have to be done to validate clinical use of this knowledge in humans,  this field is vast and promising, bringing light to new therapies that can solve clinical problems and reformulate dental treatments shortly.RESUMENObjetivo:Esta revisión investigó el origen, los marcadores de superficie y el potencial regenerativo de las células madre mesenquimales de la cavidad oral.Antecedentes:Esta revisión aborda el potencial regenerativo de las células madre mesenquimales (MSC) de la cavidad oral, incluyendo la formación de tejido dental, tejido pulpar y tejido periodontal, así como de un diente biohíbrido completo compuesto por dentina, cemento, ligamento periodontal y hueso alveolar. Las secuelas dentales pueden ser causadas por caries, traumatismos o infecciones, lo que puede provocar problemas endodóncicos, enfermedad periodontal y pérdida de piezas dentales.Método:Este trabajo seleccionó 67 artículos mediante una revisión bibliográfica en PubMed y Google Académico. Estas células madre se clasificaron según su origen, marcadores de superficie y potencial regenerativo. Conclusión:Si bien se requiere mucha investigación y ensayos clínicos para validar el uso clínico de este conocimiento en humanos, este campo es amplio y prometedor, y arroja luz sobre nuevas terapias que pueden resolver problemas clínicos y reformular los tratamientos dentales en el futuro cercano.Objective: This review investigated the origin, surface markers, and the regenerative potential of mesenchymal stem cells from the oral cavity. Background:  This review addresses the regenerative potential of mesenchymal stem cells (MSCs) from the oral cavity,  including the formation of dental tissues, pulp tissue, and periodontal tissues, and a whole bio-hybrid tooth composed of dentin, cementum, periodontal ligament, and alveolar bone. Teeth sequelae can be caused by cavities, trauma, or infection, leading to endodontic problems, periodontal disease, and tooth loss. Method:  This work selected 67 articles revising the literature using PubMed and Google Scholar, these stem cells were separated according to their origin, surface markers, and regenerative potential. Conclusion: Although a lot of research and clinical trials have to be done to validate clinical use of this knowledge in humans,  this field is vast and promising, bringing light to new therapies that can solve clinical problems and reformulate dental treatments shortly

Pharmaceutical services for endemic situations in the Brazilian Amazon: organization of services and prescribing practices for Plasmodium vivax and Plasmodium falciparum non-complicated malaria in high-risk municipalities

<p>Abstract</p> <p>Background</p> <p>In spite of the fact that pharmaceutical services are an essential component of all malaria programmes, quality of these services has been little explored in the literature. This study presents the first results of the application of an evaluation model of pharmaceutical services in high-risk municipalities of the Amazon region, focusing on indicators regarding organization of services and prescribing according to national guidelines.</p> <p>Methods</p> <p>A theoretical framework of pharmaceutical services for non-complicated malaria was built based on the Rapid Evaluation Method (WHO). The framework included organization of services and prescribing, among other activities. The study was carried out in 15 primary health facilities in six high-risk municipalities of the Brazilian Amazon. Malaria individuals ≥ 15 years old were approached and data was collected using specific instruments. Data was checked by independent reviewers and fed to a data bank through double-entry. Descriptive variables were analyzed.</p> <p>Results</p> <p>A copy of the official treatment guideline was found in 80% of the facilities; 67% presented an environment for receiving and prescribing patients. Re-supply of stocks followed a different timeline; no facilities adhered to forecasting methods for stock management. No shortages or expired anti-malarials were observed, but overstock was a common finding. On 86.7% of facilities, the average of good storage practices was 48%. Time between diagnosis and treatment was zero days. Of 601 patients interviewed, 453 were diagnosed for <it>Plasmodium vivax</it>; of these, 99.3% received indications for the first-line scheme. Different therapeutic schemes were given to <it>Plasmodium falciparum </it>patients. Twenty-eight (4.6%) out of 601 were prescribed regimens not listed in the national guideline. Only 5.7% individuals received a prescription or a written instruction of any kind.</p> <p>Conclusions</p> <p>The results show that while diagnostic procedure is well established and functioning in the Brazilian malaria programme, prescribing is still an activity that is actually not performed. The absence of physicians and poor integration between malaria services and primary health services make for the lack of a prescription or written instruction for malaria patients throughout the Brazilian Amazon. This fact may lead to a great number of problems in rational use and in adherence to medication.</p

The effect of improvisational music therapy on the treatment of depression: protocol for a randomised controlled trial

Background. Music therapy is frequently offered to individuals suffering from depression. Despite the lack of research into the effects of music therapy on this population, anecdotal evidence suggests that the results are rather promising. The aim of this study is to examine whether improvisational, psychodynamically orientated music therapy in an individual setting helps reduce symptoms of depression and improve other health-related outcomes. In particular, attention will be given to mediator agents, such as musical expression and interaction in the sessions, as well as to the explanatory potential of EEG recordings in investigating emotion related music perception of individuals with depression. Methods. 85 adults (18&#8211;50 years of age) with depression (ICD-10: F 32 or F33) will be randomly assigned to an experimental or a control condition. All participants will receive standard care, but the experimental group will be offered biweekly sessions of improvisational music therapy over a period of 3 months. A blind assessor will measure outcomes before testing, after 3 months, and after 6 months. Discussion. This study aims to fill a gap in knowledge as to whether active (improvisational) music therapy applied to people with depression improves their condition. For the first time in this context, the mediating processes, such as changes in musical expression and interaction during the course of therapy, will be objectively investigated, and it is expected that the results will provide new insights into these processes. Furthermore, the findings are expected to reveal whether music related emotional experiences, as measured by EEG, can be utilized in assessing a depressive client's improvement in the therapy. The size and the comprehensiveness of the study are sufficient for generalizing its findings to clinical practice as well as to further music therapy research. Trial registration. ISRCTN84185937peerReviewe

Meal-induced inflammation: postprandial insights from the Personalised REsponses to DIetary Composition Trial (PREDICT) study in 1000 participants

Background: Meal-induced metabolic changes trigger an acute inflammatory response, contributing to chronic inflammation and associated diseases. Objectives: We aimed to characterize variability in postprandial inflammatory responses using traditional (IL-6) and novel [glycoprotein acetylation (GlycA)] biomarkers of inflammation and dissect their biological determinants with a focus on postprandial glycemia and lipemia. Methods: Postprandial (0–6 h) glucose, triglyceride (TG), IL-6, and GlycA responses were measured at multiple intervals after sequential mixed-nutrient meals (0 h and 4 h) in 1002 healthy adults aged 18–65 y from the PREDICT (Personalised REsponses to DIetary Composition Trial) 1 study, a single-arm dietary intervention study. Measures of habitual diet, blood biochemistry, gut microbiome composition, and visceral fat mass (VFM) were also collected. Results: The postprandial changes in GlycA and IL-6 concentrations were highly variable between individuals. Participants eliciting an increase in GlycA and IL-6 (60% and 94% of the total participants, respectively) had mean 6-h increases of 11% and 190%, respectively. Peak postprandial TG and glucose concentrations were significantly associated with 6-h GlycA (r = 0.83 and r = 0.24, respectively; both P &lt; 0.001) but not with 6-h IL-6 (both P &gt; 0.26). A random forest model revealed the maximum TG concentration was the strongest postprandial TG predictor of postprandial GlycA and structural equation modeling revealed that VFM and fasting TG were most strongly associated with fasting and postprandial GlycA. Network Mendelian randomization demonstrated a causal link between VFM and fasting GlycA, mediated (28%) by fasting TG. Individuals eliciting enhanced GlycA responses had higher predicted cardiovascular disease risk (using the atherosclerotic disease risk score) than the rest of the cohort. Conclusions: The variable postprandial increases in GlycA and their associations with TG metabolism highlight the importance of modulating TG in concert with obesity to reduce GlycA and associated low-grade inflammation–related diseases. This trial was registered at clinicaltrials.gov as NCT03479866