Optimal involvement of palliative care (PC) services in the management of patients with decompensated cirrhosis and end‐stage liver disease (ESLD) is limited. This may result from both ignorance and ...the failure to recognize the spectrum and unpredictability of the underlying liver condition. Palliative care is a branch of medicine that focuses on quality of life (QoL) by optimizing symptom management and providing psychosocial, spiritual, and practical support for both patients and their caregivers. Historically, palliative care has been underutilized for patients with decompensated liver disease. This review provides an evidence‐based analysis of the benefits of the integration of palliative care into the management of patients with ESLD. Liver Transplantation 24 961–968 2018 AASLD.
It is uncertain to what extent oral supplementation with zinc can reduce episodes of malaria in endemic areas. Protection may depend on other nutrients. We measured the effect of supplementation with ...zinc and other nutrients on malaria rates.
In a 2×2 factorial trial, 612 rural Tanzanian children aged 6-60 months in an area with intense malaria transmission and with height-for-age z-score≤-1.5 SD were randomized to receive daily oral supplementation with either zinc alone (10 mg), multi-nutrients without zinc, multi-nutrients with zinc, or placebo. Intervention group was indicated by colour code, but neither participants, researchers, nor field staff knew who received what intervention. Those with Plasmodium infection at baseline were treated with artemether-lumefantrine. The primary outcome, an episode of malaria, was assessed among children reported sick at a primary care clinic, and pre-defined as current Plasmodium infection with an inflammatory response, shown by axillary temperature ≥37.5°C or whole blood C-reactive protein concentration ≥ 8 mg/L. Nutritional indicators were assessed at baseline and at 251 days (median; 95% reference range: 191-296 days). In the primary intention-to-treat analysis, we adjusted for pre-specified baseline factors, using Cox regression models that accounted for multiple episodes per child. 592 children completed the study. The primary analysis included 1,572 malaria episodes during 526 child-years of observation (median follow-up: 331 days). Malaria incidence in groups receiving zinc, multi-nutrients without zinc, multi-nutrients with zinc and placebo was 2.89/child-year, 2.95/child-year, 3.26/child-year, and 2.87/child-year, respectively. There was no evidence that multi-nutrients influenced the effect of zinc (or vice versa). Neither zinc nor multi-nutrients influenced malaria rates (marginal analysis; adjusted HR, 95% CI: 1.04, 0.93-1.18 and 1.10, 0.97-1.24 respectively). The prevalence of zinc deficiency (plasma zinc concentration <9.9 µmol/L) was high at baseline (67% overall; 60% in those without inflammation) and strongly reduced by zinc supplementation.
We found no evidence from this trial that zinc supplementation protected against malaria.
ClinicalTrials.gov NCT00623857
The aim of this study was to use both quantitative and qualitative data to assess pain in idiopathic Parkinson's disease (IPD) and classify it according to cause. In this descriptive cross-sectional ...study, 123 patients were interviewed and pain was assessed using patient descriptions, the Brief Pain Inventory, and Visual Analogue Scales. Patients reported 285 pains (median 2 per patient), and 22.8% had 4 or more pains. Pain was reported as a problem in 85% and was IPD-related in 62.6% of patients, unrelated to IPD in 64.2%, indirectly related to IPD in 8.1%, related to multiple causes in 4.1%, and treatment related in 0.8%. Pain unrelated to IPD was more common, more constant, and more severe than IPD-related pain. Overall, analgesic use was low. This study demonstrates the benefits of adopting a systematic and logical approach to the assessment of pain in IPD and the merits of a simple new classification system.
Objective: To determine whether topical benzydamine hydrochloride 3% cream is more effective than placebo in reducing pain related to pressure areas in palliative care patients. Design: Randomized ...double-blind, placebo-controlled trial. Setting: Three specialist palliative care units in the north of England, with local ethical committee approval for all sites. Subjects: Hospice in-patients with pain related to pressure areas. Interventions: A single application of either benzydamine hydrochloride 3% cream or placebo cream to the painful pressure area. Main outcome measures: Pain assessed using 100 mm VAS, an 11 point numerical pain score and a five-point pain relief score. Results: There was no statistically significant difference between topical benzydamine hydrochloride 3% cream and placebo cream in reducing pain related to pressure areas in palliative care patients. Conclusions: This study does not demonstrate a statistically significant difference between the two treatments. However the study does provide reliable information with respect to the use of different pain measurement tools in late-stage palliative patients. It also provides information regarding the baseline characteristics of this group of patients which may be useful in the planning of any future similar studies.
Size at birth, postnatal weight gain, and adult risk for type 2 diabetes may reflect environmental exposures during developmental plasticity and may be mediated by epigenetics. Both low birth weight ...(BW), as a marker of fetal growth restraint, and high birth weight (BW), especially after gestational diabetes mellitus (GDM), have been linked to increased risk of adult type 2 diabetes. We assessed DNA methylation patterns using a bead chip in cord blood samples from infants of mothers with GDM (group 1) and infants with prenatal growth restraint indicated by rapid postnatal catch‐up growth (group 2), compared with infants with normal postnatal growth (group 3). Seventy‐five CpG loci were differentially methylated in groups 1 and 2 compared with the controls (group 3), representing 72 genes, many relevant to growth and diabetes. In replication studies using similar methodology, many of these differentially methylated regions were associated with levels of maternal glucose exposure below that defined by GDM the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study or were identified as changes observed after randomized periconceptional nutritional supplementation in a Gambian cohort characterized by maternal deprivation. These studies provide support for the concept that similar epigenetic modifications may underpin different prenatal exposures and potentially increase long‐term risk for diseases such as type 2 diabetes.—Quilter, C. R., Cooper, W. N., Cliffe, K. M., Skinner, B. M., Prentice, P. M., Nelson, L., Bauer, J., Ong, K. K., Constância, M., Lowe, W. L., Affara, N. A., Dunger, D. B., Impact on offspring methylation patterns of maternal gestational diabetes mellitus and intrauterine growth restraint suggest common genes and pathways linked to subsequent type 2 diabetes risk. FASEB J. 28, 4868–4879 (2014). www.fasebj.org
We examine issues to consider when reframing conservation science and practice in the context of global change. New framings of the links between ecosystems and society are emerging that are changing ...peoples' values and expectations of nature, resulting in plural perspectives on conservation. Reframing conservation for global change can thus be regarded as a stage in the evolving relationship between people and nature rather than some recent trend. New models of how conservation links with transformative adaptation include how decision contexts for conservation can be reframed and integrated with an adaptation pathways approach to create new options for global-change-ready conservation. New relationships for conservation science and governance include coproduction of knowledge that supports social learning. New processes for implementing adaptation for conservation outcomes include deliberate practices used to develop new strategies, shift world views, work with conflict, address power and intergenerational equity in decisions, and build consciousness and creativity that empower agents to act. We argue that reframing conservation for global change requires scientists and practitioners to implement approaches unconstrained by discipline and sectoral boundaries, geopolitical polarities, or technical problematization. We consider a stronger focus on inclusive creation of knowledge and the interaction of this knowledge with societal values and rules is likely to result in conservation science and practice that meets the challenges of a postnormal world. Examinamos cuestiones para considerar cuándo se deben modificar los marcos de trabajo de la ciencia y la práctica de la conservación en el contexto del cambio global. Nuevos marcos de trabajo sobre las conexiones entre los ecosistemas y la sociedad están emergiendo y están cambiando los valores de las personas y las expectativas de la naturaleza, lo que resulta en perspectivas plurales sobre la conservación. La modificación de los marcos de trabajo de la conservación para el cambio global puede por lo tanto ser considerado como una fase de la relación en evolución entre la gente y la naturaleza, en lugar de una tendencia reciente. Los nuevos modelos sobre sobre la relación de la conservación con la adaptación transformativa incluyen la forma en que los contextos de las decisiones pueden ser re-enmarcados e integrados dentro de una estrategia de vías de adaptación para crear nuevas opciones para la conservación lista para el cambio global. Las nuevas relaciones para la ciencia de la conservación y la gobemanza incluyen la co-producción de conocimiento que apoye el aprendizaje social. Los nuevos procesos para la implementación de la adaptación para resultados de conservación incluyen prácticas deliberadas usadas para desarrollar estrategias nuevas, cambiar las visiones globales, trabajar con el conflicto, dirigirse al poder y a la equidad intergeneracional en las decisiones, y construir conciencia y creatividad que empodere a los agentes para actuar. Argumentamos que la modificación de los marcos de trabajo de la conservación para el cambio global requiere que los científicos y los practicantes implementen estrategias que no estén restringidas por disciplina ni fronteras sectoriales, polaridades geopolíticas, o problemas técnicos. Consideramos que un mayor enfoque en la creación inclusiva del conocimiento y la interacción de este conocimiento con los valores y las reglas sociales probablemente resulten en una ciencia y práctica de la conservación que cumpla con los retos de un mundo pos-normal.
HIV-1 infection substantially increases the risk of developing tuberculosis (TB). Mechanisms such as defects in the Th1 response to
in HIV-infected persons have been widely reported. However, ...Th1-independent mechanisms also contribute to protection against TB. To identify a broader spectrum of defects in TB immunity during HIV infection, we examined IL-17A and IL-22 production in response to mycobacterial Ags in peripheral blood of persons with latent TB infection and HIV coinfection. Upon stimulating with mycobacterial Ags, we observed a distinct CD4
Th lineage producing IL-22 in the absence of IL-17A and IFN-γ. Mycobacteria-specific Th22 cells were present at high frequencies in blood and contributed up to 50% to the CD4
T cell response to mycobacteria, comparable in magnitude to the IFN-γ Th1 response (median 0.91% and 0.55%, respectively). Phenotypic characterization of Th22 cells revealed that their memory differentiation was similar to
-specific Th1 cells (i.e., predominantly early differentiated CD45RO
CD27
phenotype). Moreover, CCR6 and CXCR3 expression profiles of Th22 cells were similar to Th17 cells, whereas their CCR4 and CCR10 expression patterns displayed an intermediate phenotype between Th1 and Th17 cells. Strikingly, mycobacterial IL-22 responses were 3-fold lower in HIV-infected persons compared with uninfected persons, and the magnitude of responses correlated inversely with HIV viral load. These data provide important insights into mycobacteria-specific Th subsets in humans and suggest a potential role for IL-22 in protection against TB during HIV infection. Further studies are needed to fully elucidate the role of IL-22 in protective TB immunity.
PDF
