Thursday, 27 April 2017

'Brain Age' May Help Predict When You'll Die


At the point when the cerebrum ages quicker than ordinary, individuals are at uplifted hazard for mind infection and debilitation, and in addition early demise, another British review proposes. The review creators said the finding may acquaint a route with utilize imaging of the cerebrum as a biomarker - an approach to gauge a natural condition or process. "Such biomarkers could conceivably distinguish those at danger of age-related medical issues years before indications show up, and be utilized as result measures in trials of therapeutics gone for postponing the onset of age-related sickness," said ponder lead creator James Cole, from Imperial College London. 

The analysts led cerebrum outputs of right around 700 grown-ups in Scotland who were altogether conceived in 1936. Those whose brains seemed more seasoned on imaging filters than their ordered age had a tendency to have weaker grasps, poorer lung work, slower strolling velocity and more wear and tear on their bodies, the review found. The general population with "more established" brains were additionally more awful at tackling new issues and had poorer exhibitions while applying rationale and distinguishing designs, contrasted with those whose cerebrum age coordinated their real age. 

The scientists likewise said it was conceivable to utilize cerebrum sweeps to set up a 73-year-old's mind anticipated age and to decide if that individual would bite the dust by the age of 80. The review creators reasoned that joining cerebrum anticipated age with certain DNA elements of maturing further enhances forecasts about a man's danger of death.

Wednesday, 26 April 2017

Investigation on Conventional and Cross-linked UHMWPE Artificial Joint Biomaterials Using a BiotriboPOD Method


Wear has been recognized as the key factor affecting the long-term performance of artificial joints such as hip, knee and spine prostheses. In this paper, the wear of ultra-high molecular weight polyethylene (UHMWPE) and cross-linked UHMWPE counter with cobalt chromium alloy was investigated using a new BiotriboPOD-Multi wear testing apparatus for orthopedic implant materials. Via this apparatus, an effective testing method for the wear evaluation of orthopedic implants can be achieved.Osteolysis induced by ultra-high molecular weight polyethylene (UHMWPE) wear particles is regarded as an important factor in the long-term durability of total joint arthroplasty. Up to 100,000 micron sized UHMWPE wear particles are released per footstep. 

Such wear particles can activate the immune system as well as be deposited into the surrounding tissue, which results in the lifetime of the most artificial joints limited to about 10-15 years. Therefore, the investigation on the wear performance of UHMWPE material is one of the important research areas in artificial joints. Since material selection and component design are two essential factors in the wear performance and durability of orthopedic implants, both biomaterial and product wear test are needed. Because the tribological property of orthopedic biomaterials has significant influence on the wear performance of implants, the bench wear evaluation of orthopedic biomaterials is regarded as another important testing methodology. A proper bench wear test can be used to develop an understanding of wear mechanisms and the influence of environmental, design, and material parameters on wear behavior. Moreover, due to the low productivity, complex structure and high cost of joint simulator wear testing, a reliable and effective wear testing methodology for orthopedic biomaterials is expected and required. In the tribological evaluation of orthopedic implants, POD testing methods have also been applied. 

However, unfortunately, the conventioncal POD test devices with unidirectional relative motions between a pin and a disk could not reproduce the wear factors obtained in clinic. For example, the wear factors obtained for the most common combination, ultra high molecular weight polyethylene (UHMWPE) against polished CoCrMo alloy in bovine serum are of the order of 10-8 mm3 / Nm whereas the true clinical wear factors measured from retrieved acetabular cups of artificial hip joints are of the order of 10-6 mm3 /Nm. According to the study on the joint movements in human activities, researchers have observed a directional dependence on the wear rate of orthopedic biomaterials. Thus, the multi-directional motion has been regarded as fundamental importance in laboratory wear tests for orthopedic biomaterials. Following this rule, studies on the development of new POD devices for orthopedic biomaterials are being carried out. Saikko developed a high-capacity hip wear simulator of the circular translation pin-on-disk type, call super-CTPOD, which could provide 100 separated test stations and reproduced the wear of artificial hip joints in vitro. The present authors designed a single-station POD apparatus, and validation test results show the wear factor agreed with those obtained in clinic. In this study, the wear performance of conventional ultra high molecular polyethylene (UHMWPE) and cross-linked UHMWPE were investigated by a new BiotriboPOD-Multi method in a long-term testing duration. Wear factors were calculated and compared with clinical results.  

Tuesday, 25 April 2017

FDA Warns 14 Companies on Bogus Cancer 'Cures'


The U.S. Nourishment and Drug Administration on Tuesday presented cautioning letters on 14 organizations that are offering more than 65 fake tumor treatments.The sham items incorporate pills, containers, powders, creams, teas, oils and treatment and demonstrative units. They're most normally promoted and sold without FDA endorsement on sites and online networking stages, the FDA declaration of its activity said. The medicines are much of the time promoted as "characteristic" and frequently erroneously marked as dietary supplements, the office included. 

"Purchasers ought not utilize these or comparable problematic items since they might be hazardous and could keep a man from looking for a proper and possibly lifesaving growth finding or treatment," said Douglas Stearn. He is chief of the Office of Enforcement and Import Operations in the FDA's Office of Regulatory Affairs. "We urge individuals to stay careful whether on the web or in a store, and abstain from acquiring items showcased to treat malignancy with no evidence they will work," he said in a FDA news discharge. 

Nicole Kornspan is a customer security officer at the FDA. "Any individual who experiences malignancy, or knows somebody who does, comprehends the dread and edginess that can set in. There can be an incredible enticement to seize anything that seems to offer a shot for a cure," she said in a moment organization news discharge Tuesday. Buyers ought to be careful about specific expressions frequently utilized as a part of the promoting of these medicines: "treats all types of growth," "inexplicably murders disease cells and tumors," "shrivels harmful tumors," "specifically executes malignancy cells," "more powerful than chemotherapy," "assaults growth cells, leaving solid cells in place," and "cures tumor." 

The FDA encourages patients to dependably talk about growth treatment choices, including exploratory medications, with an authorized human services supplier.

Monday, 24 April 2017

Assessing Patient Safety Culture in an Emergency Department


Safety of care is a public health priority. There are in France 2.6 serious adverse events (AEs) preventable 1,000 patientdays, between 120 and 190,000 preventable AEs during hospitalization each year [1]. In addition to the solutions adopted as new regulatory texts, development of standards and the assessment and training of professionals, safety culture of care allows a collective awareness to make the safety of care a priority. In other words, it allows each professional to always have in mind the question of the impact of its decisions and actions on the safety of care. Because emergency medicine is a risky activity, the culture of safety was estimated from the different actors of the Emergency Department (ED). There are several tools to measure safety culture of care. The French translation of the Hospital Survey On Patient Safety Culture (HSOPSC) [3] recommended by the french Haute Autorité de Santé [4] was used. This questionnaire has been validated in several other countries [5-10]. It allows to estimate the safety culture of care across ten dimensions. This has given us paths for action to improve the safety of care.

The direct assessment showed a Gaussian distribution quotes (Figure 1) with a mean value equal to 5.3 ± 2.1 on 10. HSOPSC explores the culture of safety in ten dimensions, each evaluated by 3-6 different issues. They are the overall perception of safety (50% positive response, confidence interval 95% (CI95: 40-60), frequency of reporting adverse events (60%, CI95: 50-69), relationships with supervisors (82%, CI95: 73- 88), learning organization and continuous improvement of service (feedback) (59%, CI95: 49-68), teamwork (86%, CI95: 78-91), freedom of expression (67%, CI95: 57-75), not repression of error (49%, CI95: 39-59), human resources (39%, CI95: 30-49), safety management (32%, CI95: 24-42) and teamwork between departments.

The response rate is very high, superior to those found in the literature. Safety culture of care is generally unsatisfactory with only half of positive responses on the general criterion. A recent international study, with response rates between 52% and 87% showed between 49% and 64% of positive responses on this criterion [6]. 63% [CI: 52-72%] of agents believe that the security level of care is “acceptable” and 20% [CI: 13-30%] “very good” (Figure 1). We found in the literature a rate of 62% acceptable in Dutch hospitals, 43% in Japan, 46% in Taiwan and 22% in hospitals Americans (45% of the respondents felt very good) [6, 8]. Dimensions “reporting errors or adverse events” and “feedback” are related with a positive response rate of respectively 60% and 59%. The dimension “freedom of expression” is penalized by the fact that agents do not feel free to question the decisions of their superiors. Other negative points are the dimensions beyond the perimeter of the ED (non-punitive response, human resources, safety management and teamwork between departments) with the lowest rate of positive responses, less than 50%. These low scores highlight a strategic deficit institution of safety culture of care, with a low level of bureaucratic maturity.

Friday, 21 April 2017

Humeral Intra-Osseous Lipoma with Hemorrhage-A Case Report

Intraosseous lipoma has a 1% incidence among the primary tumors of the bone, and it frequently occurs in the calcaneous. As it is rare, it may be mistaken for nonossifying fibroma, aneurysmal bone cyst, simple bone cyst, bone infarct and chondroid tumors. Intraosseous lipomas are usually followed up conservatively due to their spontaneous involution. However, surgery is required in the presence of fracture risk, malignant transformation potential and/or extensive pain. Herein we report a case with intraosseous lipoma involving the proximal left humerus, causing cortical expansion. This presentation is unusual for this type of tumor both in terms of localization and radiology. Conventional radiography was not successful in the initial diagnosis of the condition. Advanced modalities including CT and MRI proved to have a pivotal role in diagnosis of the patient.

The intraosseous lipoma is the most common lipogenous lesion of bone. Intraosseous lipoma is found most frequently in the calcaneus and intertrochanteric region of the proximal femur. The symptoms may result from remodeling of bone due to expansion, or due to intralesional ischemia, noted to be a common consequence of a longstanding calcaneal intraosseous lipoma. Intraosseous lipoma is an uncommon benign bone tumor which, as it slowly expands and remodels adjacent osseous structures, acquires a typical appearance that should be readily diagnostic on plain radiographs and MRI. Intraosseous lipomas may present with bone pain up to 66% of the time from chronic expansion, or with acute symptoms related to pathologic (insufficiency) fracture. Although there exists a differential diagnosis, including bone infarct, unicameral bone cyst, aneursymal bone cyst, chondromyxoid fibroma, osteoblastoma and giant cell tumor, the presence of patently obvious fat signal intensity on T1-weighted MR images should allow a near 100% sensitivity and specificity in the diagnosis of calcaneal intraosseous lipoma .

A 21-year-old man presented with a 3-months history of gradually increasing left shoulder and arm pain with vague history of old trauma. The pain increased with movements, lifting any objects and reduced with rest. On clinical examination revealed tenderness at the upper left arm; still no definite swelling identified.

Thursday, 20 April 2017

The Keratoconus Year

Several events have marked the ophthalmological practice in this year 2016, in terms of innovation, equipment and consumables as well as diagnosis and treatment. One of the most striking facts is the obtaining, in April, of the FDA authorization for corneal collagen cross-linking (CXL) in the treatment of keratoconus, when this process is widely used outside the United States since its Developed in Germany by Dr Theo Seiler in 1998. This technique allows the stabilization of the evolution of the keratoconus by stiffening the cornea. Under the effect of UVA, the riboflavin instilled on the cornea generates free radicals at the origin of covalent bonds from the corneal collagen. Several studies have demonstrated the effectiveness of this technique; variants of the procedure have been proposed to bypass certain difficulties encountered during the CXL. The accelerated CXL (by increasing the intensity and reducing the exposure time) makes it possible to reduce the total time of the procedure; the use of a contact lens makes it possible to propose this treatment even in the case of thin pachymetry. 

CXL alone or in combination with other processes (PRK, intracorneal rings) becomes essential in the management of keratoconus; it is the first step from the age of 12 years, before the introduction of an optical treatment. Today, several companies offer more and more efficient devices; it is even possible to use a removable CXL device mounted on the slit lamp for easier handling and better performance. The use of CXL has demonstrated its destructive effect on living organisms and keratocytes. Therefore, PACK-CXL (photo activated chromophore for infectious keratitis) has been proposed for the treatment of corneal infections, in the case of severe ulcers and then alone as a first-line treatment for bacterial infections. It may help reduce the global burden of microbial resistance to antibiotics and other therapeutic agents. 

The celebration of the World Keratoconus Day, for the first time this year on November 10th, testifies to the interest of the medical ophthalmological community in keratoconus and the need to support patients, who are often helpless in the face of the multiplicity of solutions and the lack of a single consensus of care. The keratoconus, far from being a fashionable phenomenon, remains a potentially blinding capricious disease requiring precise and early clinical and therapeutic diagnosis and whose treatment will firstly involve corneal cross-linking to stabilize the disease and then discuss on a case by case basis the different solutions (Glasses, lenses, PRK, rings or implants) to obtain optimal refraction. A long way over but much remains to be done.

Tuesday, 18 April 2017

Just 1 in 5 Mentally Ill Women Gets Cervical Cancer Screenings


Cervical malignancy screening rates are much lower among ladies with serious emotional instability than among other ladies, another review finds. 

"The aftereffects of this vast review show that we have to better organize cervical malignancy screening for these high-chance ladies with serious emotional instabilities," said concentrate senior creator Dr. Christina Mangurian. She's a partner teacher of clinical psychiatry at the University of California, San Francisco. 

Analysts evaluated 2010-11 California Medicaid information for the review. Of the ladies with serious emotional sickness, 42 percent had some type of schizophrenia.Almost 33% of the ladies had significant melancholy Nearly one in five had bipolar disorder,and the rest had tension or another turmoil. 

The review demonstrated that 20 percent of ladies with extreme emotional sickness were screened for cervical malignancy. Be that as it may, 42 percent of ladies in the overall public got screening. 

"The ladies were accepting administrations in a general wellbeing setting, however were not getting preventive administrations as frequently as ladies in the overall public," Mangurian noted. 

What adds to the worry is that ladies with serious psychological wellness issues have a more serious hazard for cervical disease.

Monday, 17 April 2017

Vaccine Targeting Brain Tumors Seems Safe in Study


An exploratory antibody treatment demonstrates guarantee in treating individuals with savage glioblastoma mind tumor, scientists behind a little, preparatory review report. With current standard care, half of glioblastoma patients bite the dust inside 15 months of analysis. Four of the 11 patients in this review made due for over five years after antibody/chemotherapy treatment, the Duke Cancer Institute inquire about group said. 

"This is a little review, however it's one in a succession of clinical trials we have led to investigate the utilization of an immunotherapy that particularly focuses on a protein on glioblastoma tumors," said lead creator Dr. Kristen Batich. "While not a controlled adequacy ponder, the survival results were astonishing, and they propose the likelihood that consolidating the antibody with a more exceptional regimen of this chemotherapy advances a solid helpful advantage," she included a Duke University news discharge. 

The trial - the first of three required for U.S. endorsement - was set up to test the security of the chemotherapy/antibody mix in 11 patients. Patients got an increased measurement of the chemotherapy tranquilize temozolomide, trailed by no less than six antibody infusions. The immunization medicines were all around endured, the specialists said. The immunization treatment targets cytomegalovirus (CMV) proteins, which are copious in glioblastoma tumors, as indicated by the review creators. 

"Our methodology was to benefit from the safe inadequacy brought on by the temozolomide regimen," Batich said. "It appears to be nonsensical, yet when the patient's lymphocytes are exhausted, it's really an ideal time to present the immunization treatment. It fundamentally gives the resistant framework walking requests to mount assets to assault the tumor." Lymphocytes are white platelets that shape some portion of the invulnerable framework.

Friday, 14 April 2017

Severe Side Effects of Vaccines in the Veterinary Setting

Since in the last 5 years, our research activity has involved veterinary Universities, Hospitals and Institutions and private animal clinics, together with human clinicians in comparative studies between human mankind and domestic or wild animals; the aim is to clarify some common physiopathology pathways, and to share diagnostics and therapeutic steps with animal cohorts having a shorter overall survival perspective compared with the human beings; in this way it is possible to accelerate the recognition of investigational drugs outcome. In the paper, we perform a retrospective study about vaccination toxicity in some animal species, mainly cats and dogs. Although there is no government obligation for veterinarians to report vaccine reactions, cumulative incidence of vaccination adverse events data between dogs and cats are reported to the vaccine manufacturer and/or to the Canadian Centre for Veterinary Biologics (CCVB) by the veterinarian or pet owner in Canada between 2010 and 2014 (Table 1). Table 1: Suspected adverse reactions for small animals (dogs, cats) vaccines reported to the Canadian Centre for Veterinary Biologics between 2010 and 2014.

The most common registered adverse reactions are allergic: 2663 cases per 10.000 vaccinated domestic animals. Indeed, Type III allergic reactions, including cutaneous vasculopathy and Arthus reactions (36 cases) occurred mainly at the rabies vaccination, could be correlated to a genetic predisposition. Transient symptoms, such as fever (570 cases), lethargy (3.396 cases), injection site swelling/tenderness (1833 cases), pain (200 cases), or anorexia (24 cases), prolonged up to 48 h, were observed in several cats and dogs [6-8]. Feline injection site sarcomas are rare (1 to 10 per 10.000 cats), but serious, since involve prolonged or repeated inflammatory processes in genetically predisposed individuals and can occur also in response to injected therapeutics including steroids, non-steroidal anti-inflammatory drugs (NSAIDS), non-absorbable sutures, and a microchip device. Neurological symptoms (e.g. head tremor/bobbing, encephalitis, head pressing, convulsion/seizure, rigidity, weakness, altered reflexes) have been reported in animals (1186 cases per 10.000 doses) that are showed an allergic reaction or pronounced inflammatory reaction (Cooper C and Naczynski Z, CFIA CCVB, 2015, personal communication). 

Type II immunemediated disorders such as immune-mediated thrombocytopenia and immune-mediated hemolytic anemia are very rare in small animals (62 cases per 10000 doses), but case control studies did not demonstrate a causal relationship between vaccine administration and autoimmune disorders. Protective and susceptible gene haplotypes have been identified in dogs, demonstrating genetic predisposition to type II hypersensitivities. As vaccines are designed to stimulate an immune response, it is not surprising that a predisposed individual may react to vaccination due to the production of inflammatory mediators. A retrospective study in nine veterinary hospitals in Sydney recorded, in 705 rabbits, 17 (1.8%) adverse reactions: 13 (76.5%) were local injection site reactions involving alopecia, abrasions and scabbing. Other reactions, including systemic signs of gastrointestinal tract stasis, lethargy and forelimb lameness, were also documented. A significant association between increasing age and decreased incidence of adverse events was demonstrated (p value: 0.038).

Thursday, 13 April 2017

Sildenafil Citrate Administration Resulting in Death


Sildenafil citrate is a phosphodiesterase (PDE) 5 inhibitor. Many case reports have described associated with acute coronary syndrome of Sildenafil citrate ingestion. However, mortality due to ventricular arrhythmias has not been reported for Sildenafil yet. We described a case of a patient with no cardiac history, resulting in death due to ventricular tachycardia (VT) occurring after ingestion sildanafil citrate.

A -56- year old man was brought to the emergency department (ED) with palpitation. After he had taken orally 100 milligram sildenafil citrate tablet (Viagra, Pfizer, New York) because of his erectile dysfunction, the patient experienced palpitation in approximately 6 hours. There were no any cardiopulmonary symptom and disease in the patient’s past medical history. A physical examination revealed a body temperature of 36.7°C (axillary), arterial blood pressure of 110/50 mm/Hg, and a pulse rate of 185 beats/min. Sustained monomorphic ventricular tachycardia was determined in 12-lead electrocardiogram (ECG) recorded when the patient was admitted to the ED (Figure 1).

Three hundred milligrams of Amiodarone was administered for treatment of VT intravenously. But, VT cannot be returned to sinus rhythm. He was transferred to coronary care unit (CCU) and simultaneously, the patient went into hemodynamic instability there. Electrical cardioversion was performed. Asystole appeared after electrical cardioversion and cardiopulmonary resuscitation was performed. However, asystole did not respond to performed cardiopulmonary resuscitation and he patient was dead.

PDE 5 inhibitors were developed as cardiovascular drugs and were incidentally found to enhance erections. Sildenafil citrate, is widely used to treat male erectile dysfunction, is a PDE 5 inhibitor. Since the introduction of the first sildenafil citrate, in 1998, there has been concern about the effects of these agents on the heart and its safety in patients with cardiovascular disease. These concerns can be collected to three subjects: effects on blood pressure and heart rate, effects on cardiac electrophysiology, and the number of cardiovascular adverse events.  

Wednesday, 12 April 2017

Using Experts’ Perceptual Skill for Dermatological Image Segmentation


There is a growing reliance on imaging equipment in medical domain, hence medical experts’ specialized visual perceptual capability becomes the key of their superior performance. In this paper, we propose a principled generative model to detect and segment out dermatological lesions by exploiting the experts’ perceptual expertise represented by their patterned eye movement behaviors during examining and diagnosing dermatological images. The image superpixels’ diagnostic significance levels are inferred based on the correlations between their appearances and the spatial structures of the experts’ signature eye movement patterns. In this process, the global relationships between the superpixels are also manifested by the spans of the signature eye movement patterns. Our model takes into account these dependencies between experts’ perceptual skill and image properties to generate a holistic understanding of cluttered dermatological images. A Gibbs sampler is derived to use the generative model’s structure to estimate the diagnostic significance and lesion spatial distributions from superpixel-based representation of dermatological images and experts’ signature eye movement patterns. We demonstrate the effectiveness of our approach on a set of dermatological images on which dermatologists’ eye movements are recorded. It suggests that the integration of experts’ perceptual skill and dermatological images is able to greatly improve medical image understanding and retrieval.

Image understanding in knowledge-rich domains is particularly challenging, because experts’ domain knowledge and perceptual expertise are demanded to transform image pixels into meaningful contents. This motivates using active learning methods to incorporate experts’ specialized capability into this process in order to improve the segmentation performance. However, traditional knowledge acquisition used by active learning methods, such as manual markings, annotations and verbal reports, poses series of significant problems. Because tacit (implicit) knowledge as an integral part of expertise is not consciously accessible to experts, it is difficult for them to identify exactly the diagnostic reasoning processes involved in decision-making, On the other hand, empirical studies suggest that eye movements, as both direct input and measurable output of real time signal processing in the brain, provide us an effective and reliable measure of both human cognitive processing and perceptual skill. Recently, studies try to incorporate perceptual skill into image understanding approaches. Experts’ eye movement data are projected into image feature space to evaluate feature saliency by weighting local features close to each fixation. Salient image features are then mapped back to spatial space in order to highlight regions of interest and at-tention selection. Furthermore, a conceptual framework is developed to measure image feature relevance based on corresponding patterned eye movement deployments defined by pair-wise comparison between multiple experts’ eye movement data. 

In an image retrieval study images are segmented generically based on image features first. In the later step of image matching, the similarity measures between query image segments and candidate images are weighted by subjects’ fixation data. There are significant limits associated with these approaches. Some of them treat eye movements as a static process by solely using fixation locations without taking the dynamic nature into account. Other studies apply dynamic models to capture sequential information of eye movements, but the cardinality is heuristic and the eye movement descriptions are limited. Since these studies directly use the observed eye movement data, which are noisy and inconsistent, to evaluate image features, their methods’ reliability and robustness are undermined.

Tuesday, 11 April 2017

Strategies for Caries Prevention


Prevention of the carious diseases constitutes the preliminary step of caries therapies. It takes place prior any clinical intervention on dental tissues. Preventive options are divided into primary (pit and fissure sealants, and topically applied fluorides including toothpastes and varnishes), secondary and tertiary prevention, involving the patient and professionally. Prevention implies a clear understanding of the characteristics of enamel disorders. It includes the identification of acidproducing bacteria, diet-counseling comprising a long list of fermentable carbohydrates, and host factors, involving teeth and saliva as well. During the last 30 years, 70 per cent of children aged 5 to 11 years were caries-free, whereas 70 per cent of the 12-17 yearold still had caries. Prevention suggests also an effective role for enamel remineralization. In this context, fluorides play role as key factors for caries treatments. Initial carious lesions of dental enamel may be identified even they may be undetectable. Dental caries processes consists in a bacterial film that produces acids as a byproduct of its metabolism. 

The acidsdiffuse through the whole thickness of the dental plaque. Modern methods allow identifying the initial carious decay. For years, following Black’s classification, mechanical rules were applied to teeth preparations. Small area of subsurface demineralization occurs beneath the dental plaque. Drilling creates large cavities prepared according to geometrical requirements. This is required imperatively for the stabilization of the cavity, prophylactic extension, and preparation of horizontal or vertical walls. Mutans streptococci, S. sobrinus and lactobacilli produce lactic acid and appear in plaque before any caries could be clinically observed. Recent spectacular evolutions of dental materials, namely the adhesive properties of resins and glass ionomers, have modified the general concept. As a consequence, this is leading to Minimal Intervention Dentistry. However, different available concepts are determining the rules of Minimal Adhesive Restorations or what is sustaining the preventive concepts implicated in carious diseases.

 Bacteria are responsible for acid production of dental caries. Dietary fermentable carbohydrates contribute to the dissolution of enamel hydroxyapatite. Due to fluoride intake or to crystal remineralization, the prevention or development of dental caries constitutes a major step for dental caries prevention. Since the pioneer work of GV Black on operative dentistry, carious lesions are anatomically classified in five classes. The shape and preparation of cavities are related to the anatomical localization of the lesion. Class I concerns exclusively occlusal fissures. Class II develops in the proximal aspects of molars and involves also the occlusal surfaces. Class III affects the proximal surfaces of incisors and canine. Class IV is a mixture of the two previous classes in single-rooted teeth. Cervical lesions, identified as Class V are developing in the collar of teeth, at the junction between enamel, cementum and dentin. 

Monday, 10 April 2017

The Ghost Aim in Medical Research – A Subjective Limit in Intake to Prevent Fattening/Insulin Resistance/Overall Inflammation


The division had a start when I read the Handbook of Physiology of the American Society for Physiology, in 1967. I was charged with the treatment of malnutrition and diarrhoea in the University of Florence. I read the handbook to become aware about mucosal digestion and absorption. At that time, these points had to be diagnosed to treat malnourished children. Before beginning any research, I intended to adapt intake to intestinal physiology. I read that 50% - 60% or more immune cells of the human body reside in the mucosa of small intestine (Mowat, 1987, 44; Brandtzaeg et al., 1989; Abrams, 1977). Bacteria grow in small and large intestine by slow energy production without oxygen use. All fibers and small amounts of sugars, carbohydrates, proteins, fats escape intestinal digestion and provide energy for one bacterial replication per day (Hungate, 1967). Food avoided absorption due either to excessive intake or to incapability to be digested. Fibers like cellulose and pectin escape digestion and promote slow growth of poorly immunogenic bacteria species and prevent harmful microbiome developments. 

Bacterial growthbecomes immunogenic and harmful when energy dense food is largely available. In the mammal intestine, bacterial indiscriminate, harmful growth is proportionate to a positive energy balance in blood and in body. Thus I studied bacteria number on intestinal mucosa in time after last meal. A longer interval from the meal produced a decrease in bacteria number. An increase in mucosal and overall immune stimulation is associated with bacteria growth on intestinal mucosa, with preprandial blood glucose (BG) and with a slowdown of meal absorption (Ciampolini et al., 1996; 2000). Energy balance directly affects these correlated variables either increasing or lowering the conflict between bacteria activity and mucosal immune response. The initial hunger meal pattern (IHMP) was devised to reduce bacterial growth and reduce the mucosal immune response at nutrient absorption. This conflictual state between bacteria and mucosa has been confirmed (Cooper, Siadaty, 2014; Mccoy, Köller, 2015). The many successful cures of gastrointestinal pathologies suggest that the conflictual theory that was used for recovery was objective, i.e. reproduced the events in small and large intestine. In this view, the question:” what food provokes cancer?” is absurd. Malignancy needs to be surveilled and prevented through an increase in efficiency of immune system (Kristensen, 2017). Lower intestinal stimulation may be the way to achieve higher immune efficiency also in the body (Abrams, 1977; Brandtzaeg et al, 1989; Ciampolini et al, 1996; Kubes, Meahl, 2012; Lynch, Pedersen, 2016). 

Thus health(general immune efficiency) follows the relation between energy intake and expenditure. Hundreds or thousands of bacterial species live and multiply in the intestine, 5% - 15% of the species elicit IgG production, the intestinal mucosa responds with an immune reaction and, lastly, the immune stimulation by bacterial antigens spreads of to all body tissues (Overall Subclinical Inflammation). Thus, many observations sustain the conflictual view for the absorption of every energy dense food. Unfortunately, a different, confounding opinion may be repeated by a high number of researchers and become the dominant view. Now, hundreds of scientific Journals ask me for submitting articles. I am alone and cannot produce hundred articles that are new and different each other to repeat the statements about the conflictual absorption and the IHMP solution for health maintenance and recovery. Yet, the upsurge of malignant and vascular risks, not to mention malnutrition that affects one billion of malnourished people, impose to spread the awareness on this “ghost aim”. 

Friday, 7 April 2017

Antimicrobial Efficacy of Callus and in Vitro Leaf Extracts of Sapindus Mukorossi Gaertn. Against Pathogenic Microbes

Sapindus mukorossi is well known medicinal and economical plant. Antibacterial and antifungal activities were evaluated from various extracts (ethanolic, methanolic and aqueous) of callus and in vitro leaf against several Gram positive and Gram negative bacteria and clinically isolated fungus. Antimicrobial activities were more in in vitro leaf extracts. Callus extract have showed antibacterial activity against S. aureus and E. coli. Maximum inhibition zone (8.06±0.17 mm) was observed against C. tropicalis from methanolic extracts of in vitro leaf. In vitro leaf extracts have shown efficient antifungal activity. Callus and in vitro leaf extract can be used for production of different phytochemicals and plant based antibiotics.

Plants are rich source of secondary metabolites and have great therapeutic potential to treat various diseases. A large population of world uses plant based principles for their primary health care. Medicinal plants may be proved as best source of a variety of drugs. About 20% of plants present in the world have been examined for pharmaceuticals and biological tests. The commonly present antibiotics are either derived from natural or synthetic resources. Several researchers have reported the various biological activities such as antimicrobial, anti-inflammatory, anti-HIV, anti-cancer, antidiabetic etc. from different group of plants. Current research shows that researchers and medical professionals are more interested in the use of indigenous drugs for the cure of human health ailments. Due to expensiveness and more side effects of synthetic drugs clinical microbiologists are paying their attention for screening of medicinal plants for phytochemicals and antimicrobial activity as potent therapeutics. Antimicrobial activities of medicinal plants are due to presence of different groups of phytochemicals such as alkaloids, polyphenolic compounds, terpenoids, lignans etc. Human pathogens are developing drug resistance against commonly used antibiotics have compelled researchers for searching new antimicrobial substances from other natural sources including plants. So, there is an essential need to develop a new generation of antibiotics from natural source. S. mukorossi Gaertn. is a popular medicinal and economical tree and well-known for their therapeutic values. S. mukorossi plant is rich in antioxidants and polyphenolic compounds and exhibiting antioxidants properties. Earlier, Aneja et al. have assessed the antibacterial activity of fruit extract against dental caries causing pathogen. Antimicrobial activities of leaf and fruit extracts of this plant were also evaluated on some bacteria and fungus. For the validation of antimicrobial potential of this plant this research study was undertaken. This is the first report of antimicrobial activity by using callus and in vitro leaf (IVL) extracts.

Leaves of S. mukorossi were collected from the campus of Banaras Hindu University, Varanasi, in the month of April. Callus and IVL were regenerated by following the protocol of Singh et al. Callus was shade dried at room temperature for 4-5 days and at 40-45°C for 2 h and grinded in mechanical grinder to make coarse powder. Five gram of callus powder was extracted in 150 ml of solvents for 10 h using Soxhlet apparatus. Ethanol, methanol and double distilled water were used as solvents for the extraction. Extracts were then dried at 40°C in rotary evaporator and stored at -20°C for further use. Test samples were prepared in different concentrations for further experiments in their respective extraction solvents. In vitro leaf (200 mg) was collected and grinded in mortar and pestle by adding the solvents. Finally, volume of extract was maintained about 20 ml.

Wednesday, 5 April 2017

Many Disabled Adults Aren't Screened for Colon Cancer: Study


American grown-ups with inabilities have bring down colon growth screening rates than different grown-ups, another review finds.Researchers looked into South Carolina Medicaid and Medicare claims, state wellbeing arrangement cases and doctor's facility release information from 2000 to 2009. 

Around 48 percent of the overall public revealed having routine screenings, contrasted with 34 percent of those with scholarly incapacities; 44 percent of those with spinal rope wounds, and 46 percent of individuals with visual impairment or constrained sight. 

"These people may not be routinely screened for colon malignancy because of an absence of instruction and mindfulness, transportation challenges or different hindrances," think about creator Chelsea Deroche said in a University of Missouri-Columbia news discharge. She is an aide teacher in the Department of Health Management and Informatics. 

"These discoveries bolster the requirement for expanded mindfulness and focused on support outreach endeavors to both doctors and parental figures to guarantee all people are screened suitably," she included. 

Colon tumor is fourth most basic sort of disease in the United States and the second driving reason for malignancy passings. Deroche noticed that just about 60 percent of these passings could be avoided if individuals would get standard screenings beginning at age 50.

Tuesday, 4 April 2017

Is Fecal Transplant a Solution to our Civilized State of Health?

“I am not what happen to me, I am what I choose to become” (Carl Gustav Jung) 1875. With the start of the 21st century people all over the world became integrated with each other, in food, habits and communication, so changes reached the core of the human body. New diseases had erupted and diseases not known in certain societies became known and widely spread. The 20th century was known as the century of antibiotics. The hygiene hypothesis was introduced and other hypotheses were also suggested to explain the increase surge of certain diseases and abolishment of others. The hygiene hypothesis stated that early exposure to germs will cause the immune system to steer towards infection-fighting mode, and away from over-reacting to normally benign substances. The Microbiota hypothesis stated that the assumption that a modern/industrialized lifestyle leads to altered microbial diversity which affects the etiology of some disease. The Biodiversity hypothesis, which is extension of both the hygiene and microbiota hypothesis, provides a link between the two. The Pathobiont theory stated that some potentially pathogenic bacteria that coexist in very low abundance with the commensal bacteria in a healthy individual, exhibit pathogenic properties, whenever there is dysbiosis, causing immune activation and inflammation. All the above theories stress on the fact that composition of microbial flora has an effect on human body and development of diseases and health state. With all these explanations we could not reach to a satisfactory and convincing complete explanation why our health, immunity, and quality of life are deteriorating. So if we manipulate the microbial flora, can we make a difference in human health and diseases?

Here came the idea of fecal microbial transplant (FMT). Fecal microbial transplant came to the surface of therapy. History of FMT is long, but the first true fecal transport occurs while the fetus is normally vaginally delivered [6]. FMT, also known as a stool transplant, is the process of inoculation or transferring fecal bacteria from a healthy individual into a recipient. FMT entails restoration of the gut microflora by introducing healthy bacterial flora via stool infusion

The gut microbiota consists of different functional microorganisms such as candidate probiotics and viable beneficial microorganisms. Probiotics have several effects including improving intestinal epithelial cell function, modulating cytokine secretion profiles, protecting against physiologic stress, affecting T-lymphocyte populations, and increasing antibody secretion. Probiotics have provided significant therapeutic options for various diseases through different mechanisms. Probiotics communicate with the host by modulating the main signaling pathways, such as nuclear factor kappa B (NFκB) and mitogen-activated protein kinase (MAPK) to enhance or suppress activation and affect downstream pathways. Hence, beneficial microbes can greatly change the physiology of the gastrointestinal tract. Understanding their mechanisms of action could lead to new diagnostic and therapeutic methods.

Monday, 3 April 2017

Beliefs about Anti-Seizure Medications-A Possible Reason for Low Adherence


Adherence to anti-seizure medications (ASMs) is one of the several important epilepsy-related challenges. Adherence is an extremely intricate and poorly understood subject but clearly a health-promoting behavior, both in general and for epilepsy. Besides several operational and culture-related reasons, one of the infrequently explored culture-oriented possible reasons for non-adherence among epilepsy subjects is the beliefs epilepsy patients have about ASMs. In general, it is reported that patient’s (or probably family’s as well) beliefs affect adherence and outcome of treatment. Also, it is reported that beliefs of those who intentionally adhere are different from those of intentional non-adherers. With regards to epilepsy, only three studies have been reportedly performed, all in Westernized populations, that have provided mixed results regarding patient’s beliefs and their relation to non-adherence. 

Another survey amongepilepsy patients in an American population found patient’s beliefs robust enough to determine treatment outcome. How this may work in societies that are hierarchical, cultureoriented, and take decisions collectively in a family? In a recent survey in Tehran (Iran), it was found that patients do have inherent concerns regarding ASMs, particularly regarding dependence and long-term use of ASMs, however ‘necessity’ of ASMs prevailed for them over ‘concerns’ of ASMs since most patients (78.2%) were found to have good adherence, as tested with a locally-validated medication adherence rating scale. This was despite the fact that 54.5% consider epilepsy as supernatural, 91.2% had convulsive seizures and 52.2% were on polytherapy. Thus, it is likely that despite their inherent concerns about ASMs, patients may still remain adherent to ASMs. Having concerns (real or myth) about use of medications is not limited to ASMs but widely present for other medications as well, such as insulin which are widely considered as addictive. From our work in Iran, it was also observed that such beliefs may only have a partial impact on adherence. For instance, 14.0% estimated possible variance in adherence due to ‘worry about becoming too dependent on ASMs in the longterm’. 

Moreover, the impact of such patient’s undue beliefs about ASMs can be mitigated through good patient-doctor interaction as well as being in a hierarchical society with unequal power dynamics between patients and doctors. Support for these can be taken from results as well, for instance ASMs was not considered a ‘mystery’ by most patients (73.9%) which may support a good communication and ‘concordance’ between patient and doctor; a method of positive health outcome. Also, when patients adhere despite concerns about medications may suggest a traditional medical model wherein relationship between doctor and patient is of unequal power dynamics and patient may not necessarily be the one who ultimately decides whether or not they adhere to the recommended regimen. Overall, use of medications would almost always have some concerns in patient’s mind. Such concerns are not limited to ASMs. Undue patient beliefs may be present but may not always be practically influential towards medication adherence in every society. Moreover, patient beliefs may explain practical influence on non-adherence to a partial extent alone. Undue patient beliefs can be mitigated through good doctor-patient interaction and being in a traditional medical model with unequal power dynamics. A concordance (such as between patient and doctor) is therefore essential to keep patients adherent to medications.