Introduction
New insights into the pathophysiology of mental disorders and innovations in psychiatric care depend on the availability of representative, longitudinal and multidimensional datasets ...across diverse, transdiagnostic populations. Biobanks usually attempt to collect such data in parallel to clinical routine, which is resource-intensive, puts additional burden on health-care providers, and may reduce the generalizability of the results. Despite containing rich phenotypic and biological information, data generated in routine clinical care is seldomly used for research purposes, because it is usually unstructured and locked in data silos. To truly link clinical practice and research, solutions that optimize the generation and scientific utilization of real-world clinical data are needed.
Objectives
Evaluation of a new digital infrastructure which warrants the efficient, automatized, and structured collection of real-world data in psychiatric care, and integrates the generated data into existing biobanking efforts.
Methods
We have developed a new documentation system which augments the existing IT-structures, enables the collection of routine clinical data in a structured format and involves patients in the data generation process. In an implementation science approach, to replicate and extend the findings of Blitz et al. (JMIR Ment Health 2021), we are investigating the acceptance, efficacy, and safety of the system in our outpatient clinic for affective disorders.
Results
First results describing the technical safety, usage metrics, and acceptance of the system, and the quality of the collected data will be presented.
Conclusions
Challenges of collecting real-world data for biobanking and research purposes and perspectives on future digital solutions will be discussed.
Disclosure
No significant relationships.
Neutropenia and agranulocytosis (N&A) are relatively rare, but potentially fatal adverse drug reactions (ADR). This study presents cases of N&A related to one or more antipsychotic drugs (APDs) in ...psychiatric inpatients. Data on APD utilization and reports of N&A caused by APDs were analyzed by using data from an observational pharmacovigilance program in German-speaking countries—Arzneimittelsicherheit in der Psychiatrie (AMSP)—from 1993 to 2016. 333,175 psychiatric inpatients were treated with APDs for schizophrenia and other indications during the observation period. A total of 124 cases of APD-induced N&A were documented, 48 of which fulfilled the criteria for agranulocytosis, corresponding to a rate of 0.37, respectively, 0.14 in 1000 inpatients treated with APDs. Neutropenia was more often detected in women, whereas there was no difference regarding sex in cases of agranulocytosis. Clozapine had the highest relative risk for inducing N&A and was imputed alone as a probable cause of N&A in 60 cases (1.57‰ of all patients exposed). Perazine showed the second highest relative risk with 8 cases and an incidence 0.52‰, followed by quetiapine (15 cases resp. 0.23‰ of all patients exposed) and olanzapine (7 cases; 0.13‰ of all patients exposed). N&A most often occurred during the first 3 months of treatment. Overall N&A are severe and potentially fatal complications that can occur during treatment with APDs. The results from this study largely agree with the currently available literature, highlighting the positive effects of alertness and established appropriate monitoring.
Objective
To assess the effectiveness of introducing condom‐catheter uterine balloon tamponade (UBT) for postpartum haemorrhage (PPH) management in low‐ and middle‐income settings.
Design
Stepped ...wedge, cluster‐randomised trial.
Setting
Eighteen secondary‐level hospitals in Uganda, Egypt and Senegal.
Population
Women with vaginal delivery from October 2016 to March 2018.
Methods
Use of condom‐catheter UBT for PPH management was introduced using a half‐day training and provision of pre‐packaged UBT kits. Hospitals were randomised to when UBT was introduced. The incident rate (IR) of study outcomes was compared in the control (i.e. before UBT) and intervention (i.e. after UBT) periods. Mixed effects regression models accounted for clustering (random effect) and time period (fixed effect).
Main outcome measures
Combined IR of PPH‐related invasive surgery and/or maternal death.
Results
There were 28 183 and 31 928 deliveries in the control and intervention periods, respectively. UBT was used for 9/1357 and 55/1037 women diagnosed with PPH in control and intervention periods, respectively. PPH‐related surgery or maternal death occurred in 19 women in the control period (IR = 6.7/10 000 deliveries) and 37 in the intervention period (IR = 11.6/10 000 deliveries). The adjusted IR ratio was 4.08 (95% confidence interval 1.07–15.58). Secondary outcomes, including rates of transfer and blood transfusion, were similar in the trial periods.
Conclusions
Introduction of condom‐catheter UBT in these settings did not improve maternal outcomes and was associated with an increase in the combined incidence of PPH‐related surgery and maternal death. The lack of demonstrated benefit of UBT introduction with respect to severe outcomes warrants reflection on its role.
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Stepped wedge trial shows UBT introduction does not reduce the combined incidence of PPH‐related surgery or death.
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Stepped wedge trial shows UBT introduction does not reduce the combined incidence of PPH‐related surgery or death.
A method for the determination of total dietary fiber (TDF), as defined by the CODEX Alimentarius, was validated in foods. Based upon the principles of AOAC Official MethodsSM 985.29, 991.43, ...2001.03, and 2002.02, the method quantitates high- and low-molecular-weight dietary fiber (HMWDF and LMWDF, respectively). In 2007, McCleary described a method of extended enzymatic digestion at 37°C to simulate human intestinal digestion followed by gravimetric isolation and quantitation of HMWDF and the use of LC to quantitate low-molecular-weight soluble dietary fiber (LMWSDF). The method thus quantitates the complete range of dietary fiber components from resistant starch (by utilizing the digestion conditions of AOAC Method 2002.02) to digestion resistant oligosaccharides (by incorporating the deionization and LC procedures of AOAC Method 2001.03). The method was evaluated through an AOAC collaborative study. Eighteen laboratories participated with 16 laboratories returning valid assay data for 16 test portions (eight blind duplicates) consisting of samples with a range of traditional dietary fiber, resistant starch, and nondigestible oligosaccharides. The dietary fiber content of the eight test pairs ranged from 11.57 to 47.83%. Digestion of samples under the conditions of AOAC Method 2002.02 followed by the isolation and gravimetric procedures of AOAC Methods 985.29 and 991.43 results in quantitation of HMWDF. The filtrate from the quantitation of HMWDF is concentrated, deionized, concentrated again, and analyzed by LC to determine the LMWSDF, i.e., all nondigestible oligosaccharides of degree of polymerization >or=3. TDF is calculated as the sum of HMWDF and LMWSDF. Repeatability standard deviations (s(r)) ranged from 0.41 to 1.43, and reproducibility standard deviations (s(R)) ranged from 1.18 to 5.44. These results are comparable to other official dietary fiber methods, and the method is recommended for adoption as Official First Action.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The dilemma of allergy to food additives Bahna, Sami L; Burkhardt, Joshua G
Allergy and asthma proceedings,
2018-Jan-01, Letnik:
39, Številka:
1
Journal Article
Recenzirano
To provide a brief summary on food additives and to outline a practical approach for evaluating subjects suspected of having reactions to food additives.
Information was derived from selected reviews ...and original articles published in peer-reviewed journals, supplemented by the clinical experience of the authors.
Priority was given to studies that used blinded, placebo controlled, oral challenges to confirm adverse reactions to food additives. In addition, selected, appropriately evaluated case reports were included.
A large number of food additives are widely used in the food industry. Allergic reactions to additives seem to be rare but are very likely underdiagnosed, primarily due to a low index of suspicion. A wide variety of symptoms to food additives have been reported, but a cause-and-effect relationship has not been well documented in the majority of cases.
Reactions to food additives should be suspected in patients who report symptoms related to multiple foods or to a certain food when commercially prepared but not when home made. It is also prudent to investigate food additives in subjects considered to have "idiopathic" reactions. Except for a limited number of natural additives, there is a small role for skin tests or in vitro testing. Oral challenge, in stages, with commonly used additives is the definitive procedure for detecting the offending agent. Once the specific additive is identified, management is strict avoidance, which can be difficult.
“Gluten sensitivity” has become commonplace among the public. Wheat allergy (WA) and celiac disease (CD) are well‐defined entities, but are becoming a fraction of individuals following a gluten‐free ...diet (GFD). Wheat allergy has a prevalence of <0.5%. Wheat, specifically its omega‐5 gliadin fraction, is the most common allergen implicated in food‐dependent, exercise‐induced anaphylaxis. CD is a non‐IgE hypersensitivity to certain cereal proteins: gluten in wheat, secalin in rye, hordein in barley, and to a lesser extent avenin in oat. It is a rare disease, with an estimated prevalence that varied widely geographically, being higher in Northern Europe and the African Saharawi region than in South‐East Asia. In addition to suggestive symptoms, serologic testing has high diagnostic reliability and biopsy is a confirmatory procedure. Patients with CD have extra‐intestinal autoimmune comorbid conditions more frequently than expected. A third entity is nonceliac gluten sensitivity, which has been created because of the increasing number of subjects who claim a better quality of life or improvement of their variety of symptoms on switching to a GFD. The phenomenon is being fueled by the media and exploited by the industry. The lack of a specific objective test has been raising substantial controversy about this entity. Allergists and gastroenterologists need to pay attention to the multitudes of individuals who elect to follow a GFD. Many such subjects might have WA, CD, or another illness. Providing them with appropriate evaluation and specific management would be of great advantages, medically and economically.
(BJOG. 2019;126:1612–1621)The World Health Organization has recommended uterine balloon tamponade (UBT) as one intervention for postpartum hemorrhage (PPH), a leading cause of maternal mortality ...worldwide. This is important for low- and middle-income countries (LMICs), where uterotonics, blood products, and skilled surgical teams may not be readily available. A few studies have reviewed the use of condom-catheter UBT in LMICs, but they have demonstrated conflicting findings or lacked robust evidence on its effectiveness. The aim of this study was to examine if condom-catheter UBT reduced maternal morbidity and mortality associated with PPH in LMICs.
Cisplatin preferentially accumulates in cells of the S3 segment of the renal proximal tubule and is toxified intracellularly by hydration. The earliest manifestation of toxicity is inhibition of ...protein synthesis. GSH depletion is another important mechanism causing CP toxicity. Intracellular binding to SH groups leads to GSH depletion, resulting in lipid peroxidation and eventually mitochondrial damage. New measures to prevent GSH depletion and scavenge intracellular free oxygen radicals have been tried in clinical studies. Promising results indicate that cisplatin nephrotoxicity can be further reduced in the future.
The relative lability, elemental stoichiometry, and remineralization rates of various particulate organic matter (POM) substrates by natural heterotrophic marine microorganisms were investigated. POM ...was harvested from laboratory cultures of a marine diazotroph (Trichodesmium IMS101), a cosmopolitan diatom (Thalassiosira weissflogii), a common marine cyanobacteria (Prochlorococcus MED4), and from surface waters off the Oregon coast. These POM resources were used as inoculants in a field experiment conducted at the Hawaii Ocean Time-series Station ALOHA in the North Pacific Subtropical Gyre. POM from these various sources was added to seawater collected from below the surface mixed layer, incubated in the dark, and remineralization rates were quantified via high-frequency measurement of soluble phosphorus (P) and nitrogen (N) concentrations over a 6-d period. Rapid solubilization and near complete remineralization of particulate P (PP) occurred in all treatments where cultured POM was used, with lesser relative mobilization of P from a 'natural' POM sample isolated from surface seawater off the Oregon coast. Soluble P pools, likely consisting of surface-adsorbed inorganic P and inorganic P liberated from cells during harvesting of biomass accounted for 28% of natural PP pools and 80 plus or minus 32% of cultured PP. 31P nuclear magnetic resonance (NMR) confirmed that PP was predominately present as orthophosphate in all POM types. By the end of the incubation period, all added P from cultured material had been converted to dissolved inorganic P. This finding may be a caveat of our utilization of laboratory cultures and natural POM which has been exposed to high inorganic P concentrations (0.8-5.0 mu molL-1), albeit it is consistent with previous reports of significant contributions of surface-adsorbed P to total particulate P. In contrast, over the course of these experiments, only 37-40% of added N had been remineralized to ammonium (NH4+). In general, N remineralization rates of cultured material increased with the amount of N added (per gram of dry material). The net yield of bacterial cells was also positively correlated to the initial amount of C and N added. Most notably, when corrected for non-biological turnover (i.e. removal of soluble pools), the N:P remineralization ratio of cultured material (8.5 plus or minus 1.3) was independent of the N:P of added organic material (5-23).
Purpose: To analyze quantitatively the influence of different renal uptakes of
99
m
Tc
‐DMSA on the absolute index of renal function (IRF), using Monte Carlo simulated images of voxel phantoms ...family. Method and Materials: Four anthropomorphic phantoms of GSF family (Baby, Helga, Donna and Children) were simulated with SimSET code. The phantoms have different dimensions in the region of interest (e.g. renal depth, distance between kidneys, renal volume, body volume). Planar acquisitions were modeled using a parallel LEHR collimator. The phantoms were positioned 10 cm from the collimator. A 20% energy window was used to acquire
99
m
Tc
projection onto 128 × 128 matrices. The energy resolution was modeled with a 10% Gaussian function. For each phantom, five normal and abnormal uptakes were assigned, from 50%–50% (normal) to 10%–90% (severe). The IRF was calculated using the software DMSAQuant, based on the Raynaud method. The results were compared with true activity in each kidney, known by Monte Carlo simulations. Results: The results of the IRF have shown differences between the calculated indexes and the true index. The higher deviations (75%) are associated with lower relative uptakes (10%). For relative uptakes higher than 40%, the difference between the calculated indexes and the true index remains constant between 5% and 10%. Conclusion: Our results showed that Raynaud method do not provide accurate values of the absolute IRF when lower relative uptakes are present due to renal diseases. The results have shown that the values of the absolute index of the diseased kidney are influenced by the contralateral kidney. This could be justified because the method only corrects renal depth and age. We suggest that more studies will need to be done to clarify the factors influencing the renal quantification and to model a new correction factor.
This work was supported by CNPq, Radiopharmacus and FAPERGS.
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