Hasil untuk "Internal medicine"

S. Ettinger

Bradford P. Smith

M. Stabin, R. Sparks, E. Crowe

A. Karnad, A. Verghese

M. Jane Morwitzer, Ying Yi Zheng, Heather Friberg et al.

Dengue is caused by the four serotypes of dengue virus (DENV-1-4) and poses a significant global public health challenge, with an estimated 100–400 million infections annually. Severe dengue manifestations, such as Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), are influenced by immune responses, particularly during secondary infections with different serotypes. Antibody-dependent enhancement (ADE) of DENV infection is a critical mechanism in dengue immunopathogenesis, underscoring the need for comprehensive evaluation of antibody responses. Traditional cell lines used for DENV propagation exhibit variability and present logistical challenges for assessing non-neutralizing antibody functions. Here, we report the establishment of a stable CEM-NKR cell line expressing DC-SIGN, designated CEM2001, capable of supporting continuous infection with all four DENV serotypes. These cell lines allow for continuous DENV infection, enabling detailed immunoassays to evaluate serotype-specific and cross-reactive non-neutralizing antibody responses. Our approach offers a significant advancement in dengue research, providing a consistent and reliable system to study DENV immune responses and supporting future efforts to develop and evaluate dengue therapeutics and vaccines.

Sophia Daum, Lilith Decristoforo, Mira Mousa et al.

Abstract The dynamic interactions between tumor endothelial cells (TECs) and the immune microenvironment play a critical role in the progression of non-small cell lung cancer (NSCLC). In general, endothelial cells exhibit diverse immunomodulatory properties, influencing immune cell recruitment, antigen presentation, and regulation of immune checkpoint expression. Understanding the multifaceted roles of TECs as well as assigning specific functional hallmarks to various TEC phenotypes offer new avenues for targeted development of therapeutic interventions, particularly in the context of advanced immunotherapy and anti-angiogenic treatments. This review provides insights into the complex interplay between TECs and the immune system in NSCLC including discussion of potential optimized therapeutic opportunities.

Elizabeth Santiago Dager, Cecilia Venzant Fontaine, Bárbara Olaydis Hechavarría Martínez et al.

El tratamiento de dientes permanentes inmaduros necróticos constituye un desafío en la odontopediatría, y son múltiples las opciones terapéuticas propuestas para solucionar esta problemática. A tales efectos se realizó el presente estudio con el objetivo de exponer la evolución histórica de dicho tratamiento, para lo cual se efectuó una exhaustiva búsqueda bibliográfica. Se tomó como método general de la investigación el dialéctico-materialista y, de manera particular, los métodos de revisión documental histórico-lógico, de análisis-síntesis e inductivo-deductivo. A partir de determinados hitos históricos se establecieron 3 etapas, cada una de ellas con sus aportes y limitaciones; asimismo, se identificaron las regularidades y tendencias, así como los fundamentos que sustentan la necesidad de continuar investigando sobre nuevos enfoques terapéuticos.

Danelia Gómez-Torres, Karla Sofía Gómez-Alcántara, Aida Maris-Peres et al.

Objetivo: determinar las habilidades de la enfermera de enlace para la continuidad de los cuidados en el alta hospitalaria. Materiales y métodos: estudio cualitativo, descriptivo, método de estudio de casos múltiples, fundamentado por la teoría de las competencias. Las participantes fueron ocho enfermeras de enlace. Los datos se recolectaron de manera presencial mediante una guía de entrevista semiestructurada y otra de observación, se analizaron los datos mediante explanaciones concurrentes. Resultados: todas las participantes contaban con más de 3 años de experiencia como enfermeras de enlace, con un rango de edad entre los 32 y los 56 años. Las enfermeras de enlace tienen habilidades enfocadas a la gestión, comunicación, negociación y coordinación de los elementos de salud. Conclusión: las habilidades de las enfermeras de enlace favorecen el cuidado continuado a pacientes tras el alta hospitalaria, el conocer las habilidades permite crear un perfil profesional para que esta figura de enfermería sea implementada en los sistemas de salud.

In-Young Yoon

Shuhei Yoshida, Haruki Matsumoto, Jumpei Temmoku et al.

Temporal arteritis (TA) is a large-vessel vasculitis mostly seen in older patients. Amyloid A (AA) amyloidosis secondary to a chronic inflammation induces multiple organ dysfunctions, including a dysfunction of the gastrointestinal tract. Herein, we present a case of TA complicated by AA amyloidosis that was resistant to oral and intravenous steroids. An 80-year-old man with a history of new-onset headache, jaw claudication, and distended temporal arteries was referred to our department. On admission, the patient presented with tenderness and a subcutaneous temporal nodule in both temple arteries. Ultrasonography of the nodule revealed an anechoic perivascular halo surrounding the right temporal artery. Following the diagnosis of TA, high-dose prednisolone therapy was initiated. However, the patient presented with recurrent abdominal pain and refractory diarrhea. Due to the unclear origin of refractory diarrhea, an extensive workup, including biopsy of the duodenal mucosa, was performed. Endoscopy revealed chronic inflammation in the duodenum. Immunohistochemical analysis of duodenal mucosal biopsy samples revealed AA amyloid deposition resulting in the diagnosis of AA amyloidosis. After tocilizumab (TCZ) administration, refractory diarrhea reduced; however, the patient died of intestinal perforation 1 month after the start of TCZ administration. Gastrointestinal involvement was the main clinical manifestation of AA amyloidosis in the present case. This case highlights the importance of bowel biopsy screening for amyloid deposition in patients with unexplained gastrointestinal tract symptoms, even in a recent onset of large-vessel vasculitis. In the present case, the carriage of the SAA1.3 allele likely contributed to the rare association of AA amyloidosis with TA.

Akram Amani

Testicular cancer (TC) is among the specific clinical problems of our time. Current therapy is highly effective, confirming 5-year disease-free survival in approximately 95% of ill people. TC is a prevalent type of cancer diagnosed in males between 14 and 44 ages, with an incidence of less than 1 in 9.9 cases per 100,000 men nationwide, but the total number of TC. Increase worldwide. In addition, the danger of expanding cancer in people with cancer during 15 years after diagnosis is 2%. These complicated and different conditions must be found in the clinical evidence base. Genetic, environmental, and hormonal elements are related to developing diseases and disorders in response to treatment and danger of relapse. This research discusses current topics that explain the relative contribution of the problems mentioned above to TC development. Additionally, we pay attention to environmental chemicals and heat exposure, their function in cancer development, and recent advances at the molecular level have been studied.

Vinicius C. Iamonti, Gerson F. Souza, Antonio A. M. Castro et al.

Limited information is available regarding the role of anaerobic metabolism capacity on GOLD 1 and 2 COPD patients during upper limb exercise. We aimed to compare the upper limb anaerobic power capacity, blood lactate concentration, cardiovascular and respiratory responses, in male COPD patients versus healthy subjects during the 30-s Wingate anaerobic test (WAnT). The rate of fatigue and time constant of the power output decay (τ, tau) were also calculated and a regression analysis model was built to assess the predictors of τ in these patients. Twenty-four male COPD patients (post-bronchodilator FEV1 73.2 ± 15.3% of predicted) and 17 healthy subjects (FEV1 103.5 ± 10.1% of predicted) underwent the WAnT. Measurements were performed at rest, at the end of the WAnT, and during 3′ and 5′ of recovery time. Peak power (p = 0.04), low power (p = 0.002), and mean power output (p = 0.008) were significantly lower in COPD patients than in healthy subjects. Power output decreased exponentially in both groups, but at a significantly faster rate (p = 0.007) in COPD patients. The time constant of power decay was associated with resistance (in ohms) and fat-free mass (r2 = 0.604, adjusted r2 = 0.555, and p = 0.002). Blood lactate concentration was significantly higher in healthy subjects at the end of the test, as well as during 3′ and 5′ of recovery time (p < 0.01). Compared with healthy subjects, COPD patients with GOLD 1 and 2 presented lower upper limb anaerobic capacity and a faster rate of power output decrease during a maximal intensity exercise. Also, the WAnT proved to be a valid tool to measure the upper limb anaerobic capacity in these patients.

Kasande M, Natwijuka A, Katushabe E Snr et al.

Meble Kasande, Andrew Natwijuka, Eve Katushabe Snr, Anne Tweheyo Otwine Snr Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, UgandaCorrespondence: Meble Kasande, Bishop Stuart University, Faculty of Nursing and Health Sciences, P.O Box 09, Mbarara, Uganda, Tel +256 7812551, Email meblekasande@gmail.com; aotweheyo@nhs.bsu.ac.ugPurpose: This study aims at exploring experiences of people caring for adolescents living with HIV, also known as caregivers. By 2021, 150,000 adolescents were living with HIV and 32,000 adolescents were dying of AIDS related causes. HIV/AIDS remains one of the most serious public health problems, especially among the adolescents. This has placed a heavy burden on many caregivers, yet they are essential in caring for ALHIV. However, focus of all interventions has excluded caregivers of ALHIV. Thus, this is the reason why this study is being conducted to find out caregivers’ experience in caring for ALHIV.Participants and Methods: A phenomenological study was carried out. Purposive sampling was used to select a total of 15 caregivers to participate in the study. These participants were subjected to in-depth semi-structured interviews. Their responses were recorded, transcribed and translated for thematic analysis.Results: While analyzing the results, six themes emerged. They include: diagnosis and reaction to diagnosis, experiences on adolescent’s HIV serostatus disclosure, stigma and discrimination, care disengagement, and lastly, challenges during care and coping strategies. Caregivers experienced feelings of fear, Guilt, suicidal thoughts after diagnosis. Stigma and discrimination of adolescents living with HIV which was common at school and from the neighbors and the adolescent stage were some of the challenges experienced by the caregivers and it makes it hard to retain ALHIV in care.Conclusion: Families are the main source of caregiving to the adolescents living with HIV (ALHIV). The study’s findings indicate that caregivers in the families experience challenges related to family needs, and psychological challenges resulting from the adolescence stage. So, families should not be left to shoulder the burden of caring for ALHIV. As a way forward, social network and financial support should also be strengthened for most caregivers as a coping strategy.Keywords: ALHIV, adolescents living with HIV, caregivers and experiences

Paige C. Barker, Neal P. Holland, Oliver Shore et al.

Objective Completion of an advance directive (AD) document is one component of advanced care planning. We evaluated a brief intervention to enhance AD completion and assess whether the intervention effect varied according to health literacy. Methods A randomized controlled study was conducted in 2 internal medicine clinics. Participants were over 50, without documented AD, no diagnosis of dementia, and spoke English. Participants were screened for health literacy utilizing REALM-SF. Participants were randomized in a 1:1 ratio to the intervention, a 15-minute scripted introduction (grade 7 reading level) to our institution’s AD forms (grade 11 reading level) or to the control, in which subjects were handed blank AD forms without explanation. Both groups received reminder calls at 1, 3, and 5 months. The primary outcome was AD completion at 6 months. Results Five hundred twenty-nine subjects were enrolled; half were of limited and half were of adequate health literacy. The AD completion rate was 21.7% and was similar in the intervention vs. the control group (22.4% vs 22.2%, P  = .94).More participants with adequate health literacy completed an AD than those with limited health literacy (28.4% vs 16.2%, P  = .0008), although the effect of the intervention was no different within adequate or limited literacy groups. Conclusion A brief intervention had no impact on AD completion for subjects of adequate or limited health literacy. Practice Implications Our intervention was designed for easy implementation and to be accessible to patients of adequate or limited health literacy. This intervention was not more likely than the control (handing patients an AD form) to improve AD completion for patients of either limited or adequate health literacy. Future efforts and research to improve AD completion rates should focus on interventions that include: multiple inperson contacts with patients, contact with a trusted physician, documents at 5th grade reading level, and graphic/video decision aids. Trial Registration Number NCT02702284, Protocol ID IRB201500776

J. Callum, J. Waters, B. Shaz et al.

Jian-bo CHANG, Ren-zhi WANG, Ming FENG

Both manifestations and treatments of intracranial hemorrhage (ICH) are varied and the effect meets bottlenecks. Recently, the artificial intelligence (AI) technology has developed rapidly. This review aims to help clinicians understand AI technology regarding its application in ICH by systematically reviewing the historical and current examples. Hope to stimulate the AI progress and enhance the level of treatment in ICH in the future. Ultimately, the treatment of ICH would be precision and individualization. DOI:10.3969/j.issn.1672-6731.2019.09.004

K. Hinchcliff, L. Couëtil, Peter Knight et al.

Background Published studies of exercise‐induced pulmonary hemorrhage (EIPH), when assessed individually, often provide equivocal or conflicting results. Systematic reviews aggregate evidence from individual studies to provide a global assessment of the quality of evidence and to inform recommendations. Objectives Evaluate evidence to determine: if EIPH adversely affects the health, welfare or both of horses; if EIPH affects the athletic capacity of horses; the efficacy of prophylactic interventions for EIPH; and if furosemide affects the athletic capacity of horses. Animals None. Materials and Methods Systematic review. A panel of 7 experts was formed to assess evidence in the peer reviewed literature addressing each of the 4 objectives. Methodology followed that of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Publications were assessed for quality of evidence by working groups of the panel, and a summary of findings was presented in tables. Recommendations were based on quality of evidence and were determined by a vote of the panel. Results Much of the evidence was of low to very low quality. Experimental studies frequently lacked adequate statistical power. There was moderate to high quality evidence that EIPH is progressive, is associated with lung lesions, that it adversely affects racing performance, that severe EIPH (Grade 4) is associated with a shorter career duration, that furosemide is efficacious in decreasing the incidence and severity of EIPH, and that administration of furosemide is associated with superior race performance. Conclusions and clinical significance Strong recommendation that EIPH be considered a disease and a weak recommendation for use of furosemide in management of racehorses with EIPH.

J. M. Lankelma, M. Nieuwdorp, W. Vos et al.

Rachel D. Havyer, Majken T. Wingo, N. Comfere et al.

D. L. Roberts, T. Shanafelt, L. Dyrbye et al.