Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, ...Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, with lesser incidences of retinopathy of prematurity, intraventricular haemorrhage, and necrotising enterocolitis. Many studies have shown correlations between the receipt of blood transfusions and the development of these conditions, but little is known of the underlying pathophysiology of this relationship. Recent studies are beginning to provide some answers. This review examines recent findings with regard to the influence of preparation and storage of paediatric packed red blood cell units on heme, iron, and oxidative status of the units and relates these to the ability of the premature baby to deal with these changes following the receipt of blood transfusions. Paediatric packed red blood cell units are a potential source of heme, redox active iron and free radicals, and this increases with storage age. Haemolysis of transfused red blood cells may add further iron and cell free haemoglobin to the recipient baby. Premature babies, particularly those with low birth weight and gestational age appear to have littlereserve to cope with any additional iron, heme and/or oxidative load. The consequences of these events are discussed with regard to their contribution to the major complications of prematurity and a novel hypothesis regarding transfusion-related morbidity in premature babies is presented. The review concludes with a discussion of potential means of limiting transfusion related iron/heme and oxidative load through the preparation and storage of packed red blood cell units and through modifications in clinical practice.展开更多
Introduction: Artemisinin-based combination therapies are the first-line antimalarial drugs used to treat uncomplicated Plasmodium falciparum malaria in many endemic countries worldwide. In Chad, since the adoption of...Introduction: Artemisinin-based combination therapies are the first-line antimalarial drugs used to treat uncomplicated Plasmodium falciparum malaria in many endemic countries worldwide. In Chad, since the adoption of artemisinin-based combination therapy (ACTs) in its first-line treatment policy for uncomplicated malaria in 2005, Artemether-Lumefantrine and Artesunate-Amodiaquine have been used in many hospitals and health centers. The main objective of this study was to provide the baseline data of Artemether-Lumefantrine and Artesunate-Amodiaquine efficacy in three regions where many people suffered from malaria disease. Material and Methods: The baseline efficacy of two combination therapies was evaluated between January and April 2020 in Mosoro, Mondou and Dourbali Provinces in Chad. A two-arm single cohort study was conducted to assess the clinical efficacy of artesunate-amodiaquine and artemether-lumefantrine for the treatment of 1113 children aged from 6 to 59 months with uncomplicated Falciparum malariae diagnosed by thick blood smear examination, using the World Health Organization validated protocol. Results: On day 3, all patients in both groups had cleared parasitemia, after treatment, the patients presented a higher hemoglobin level in both groups artemether-lumefantrine (10.97 ± 1.39) and artesunate-amodiaquine (11.87 ± 1.81), respectively. On day 28, all patients had adequate clinical and parasitological responses with 99.82% of artesunate-amodiaquine and 99.10% of artemether-lumefantrine. Overall, both drugs were well tolerated at the clinical and biological level, no late parasitological failures have been recorded in artemether-lumefantrine and artesunate-amodiaquine groups, also both forms of Artemisinin-based combination therapy were still effective and safe in the treatment of uncomplicated P. falciparum malaria in Chad.展开更多
OBJECTIVE： To compare the use of complementary and alternative medicine （CAM）, including dietary supplements, by individuals with and without features of metabolic syndrome （FeMS）. METHODS： Using a cross section...OBJECTIVE： To compare the use of complementary and alternative medicine （CAM）, including dietary supplements, by individuals with and without features of metabolic syndrome （FeMS）. METHODS： Using a cross sectional study design, information was obtained by self-administered questionnaires from 300 university individuals. FeMS was defined as any individuals self-reporting at least one of the clinical diagnoses of diabetes, hypertension, hyperlipidemia, or obesity. Finally, two categories were created for cross tabulation, and individuals with and without FeMS were compared. RESULTS： Of the 192 individuals completing the study, 39% （n=76） were currently using or had used CAM therapies in the past 12 months. Individuals with FeMS （n=54, 28%） were more likely （P〈0.05） to use different types of CAM therapies, in particular dietary and herbal supplements, aromatherapy and massage therapy compared to individuals without FeMS （n=138, 72%）. CONCLUSION： Individuals with FeMS were more likely to use CAM, particularly supplements. Doctors need to properly inquire about and understand their patients＇ supplement use, especially if CAM therapies are used in coniunction with conventional medications.展开更多
Background: The care of patients with leg ulceration has developed over the p ast 15 years, although there is little information available to determine how th ese changes have affected clinical and patient defined out...Background: The care of patients with leg ulceration has developed over the p ast 15 years, although there is little information available to determine how th ese changes have affected clinical and patient defined outcomes. Objectives: To describe and evaluate the implementation of a leg ulcer strategy. Patients/metho ds: This study used a pre-and postimplementation evaluation within population -based services within the boundaries of community services providing leg ulce r care. Evidence-based leg ulcer services were developed, including standardiz ed assessment using Doppler ultrasound, rationalization of treatment using multi layer elastic high compression, development of referral criteria and acute servi ce support. Complete ulcer healing rates, health-related quality of life and u se of health resources were evaluated after 12 weeks in both pre-and postimple mentation cycles. Results: A total of 955 patients were evaluated (518 preimplem entation, 437 postimplementation). The levels of assessment and treatment were p oor prior to the change in practice with just one patient having evidence of cor rect assessment and 49 (11% ) receiving high compression therapy. Postimplement ation, this improved to 412 of 437 (94% ) having evidence of measurement of the ankle brachial pressure index, and 85% receiving compression. Twelve-week h ealing rates preimplementation ranged between 9% and 24% , and postimplementa tion rose from 19% to 39% . Combined overall healing rates improved from 71 o f 518 (14% ) to 160 of 437 (37% ), odds ratio = 3- 53, P < 0.00l. Frequency o f treatment visits reduced from a mean (SD) of 24.0 (16.1) over 12 weeks to 13.5 (8.6), P < 0.00l. Intervention led to major improvements in health-related qu ality of life (measured using the Nottingham Health Profile), with significant i mprovements for energy, pain, sleep and mobility (P < 0.0l). Conclusions: Rationalization of leg ulcer services through a total service change results in improvements in pr ofessional practice, better patient outcomes, and efficient use of current resou rces. This study highlights the importance of a multifaceted approach to improve practice focused on the needs of individual organizational settings.展开更多
The paper explores the concept of integrative medicine（IM） in relation to complementary and alternative medicine（CAM）.It contrasts IM available in China to its availability in the West.The second part of the paper...The paper explores the concept of integrative medicine（IM） in relation to complementary and alternative medicine（CAM）.It contrasts IM available in China to its availability in the West.The second part of the paper highlights tools which could facilitate opportunities for IM.The paper concludes with a plea to ensure and maintain the integrity of traditional Chinese medical practice,and to continue to increase developing the evidence base through a funded European Coordination Action between EU member states and China.展开更多
基金Supported by The Northcott Devon Medical FoundationThe NHS SW Researchand Development Fund
文摘Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, with lesser incidences of retinopathy of prematurity, intraventricular haemorrhage, and necrotising enterocolitis. Many studies have shown correlations between the receipt of blood transfusions and the development of these conditions, but little is known of the underlying pathophysiology of this relationship. Recent studies are beginning to provide some answers. This review examines recent findings with regard to the influence of preparation and storage of paediatric packed red blood cell units on heme, iron, and oxidative status of the units and relates these to the ability of the premature baby to deal with these changes following the receipt of blood transfusions. Paediatric packed red blood cell units are a potential source of heme, redox active iron and free radicals, and this increases with storage age. Haemolysis of transfused red blood cells may add further iron and cell free haemoglobin to the recipient baby. Premature babies, particularly those with low birth weight and gestational age appear to have littlereserve to cope with any additional iron, heme and/or oxidative load. The consequences of these events are discussed with regard to their contribution to the major complications of prematurity and a novel hypothesis regarding transfusion-related morbidity in premature babies is presented. The review concludes with a discussion of potential means of limiting transfusion related iron/heme and oxidative load through the preparation and storage of packed red blood cell units and through modifications in clinical practice.
文摘Introduction: Artemisinin-based combination therapies are the first-line antimalarial drugs used to treat uncomplicated Plasmodium falciparum malaria in many endemic countries worldwide. In Chad, since the adoption of artemisinin-based combination therapy (ACTs) in its first-line treatment policy for uncomplicated malaria in 2005, Artemether-Lumefantrine and Artesunate-Amodiaquine have been used in many hospitals and health centers. The main objective of this study was to provide the baseline data of Artemether-Lumefantrine and Artesunate-Amodiaquine efficacy in three regions where many people suffered from malaria disease. Material and Methods: The baseline efficacy of two combination therapies was evaluated between January and April 2020 in Mosoro, Mondou and Dourbali Provinces in Chad. A two-arm single cohort study was conducted to assess the clinical efficacy of artesunate-amodiaquine and artemether-lumefantrine for the treatment of 1113 children aged from 6 to 59 months with uncomplicated Falciparum malariae diagnosed by thick blood smear examination, using the World Health Organization validated protocol. Results: On day 3, all patients in both groups had cleared parasitemia, after treatment, the patients presented a higher hemoglobin level in both groups artemether-lumefantrine (10.97 ± 1.39) and artesunate-amodiaquine (11.87 ± 1.81), respectively. On day 28, all patients had adequate clinical and parasitological responses with 99.82% of artesunate-amodiaquine and 99.10% of artemether-lumefantrine. Overall, both drugs were well tolerated at the clinical and biological level, no late parasitological failures have been recorded in artemether-lumefantrine and artesunate-amodiaquine groups, also both forms of Artemisinin-based combination therapy were still effective and safe in the treatment of uncomplicated P. falciparum malaria in Chad.
基金supported by grants from the University of West London
文摘OBJECTIVE： To compare the use of complementary and alternative medicine （CAM）, including dietary supplements, by individuals with and without features of metabolic syndrome （FeMS）. METHODS： Using a cross sectional study design, information was obtained by self-administered questionnaires from 300 university individuals. FeMS was defined as any individuals self-reporting at least one of the clinical diagnoses of diabetes, hypertension, hyperlipidemia, or obesity. Finally, two categories were created for cross tabulation, and individuals with and without FeMS were compared. RESULTS： Of the 192 individuals completing the study, 39% （n=76） were currently using or had used CAM therapies in the past 12 months. Individuals with FeMS （n=54, 28%） were more likely （P〈0.05） to use different types of CAM therapies, in particular dietary and herbal supplements, aromatherapy and massage therapy compared to individuals without FeMS （n=138, 72%）. CONCLUSION： Individuals with FeMS were more likely to use CAM, particularly supplements. Doctors need to properly inquire about and understand their patients＇ supplement use, especially if CAM therapies are used in coniunction with conventional medications.
文摘Background: The care of patients with leg ulceration has developed over the p ast 15 years, although there is little information available to determine how th ese changes have affected clinical and patient defined outcomes. Objectives: To describe and evaluate the implementation of a leg ulcer strategy. Patients/metho ds: This study used a pre-and postimplementation evaluation within population -based services within the boundaries of community services providing leg ulce r care. Evidence-based leg ulcer services were developed, including standardiz ed assessment using Doppler ultrasound, rationalization of treatment using multi layer elastic high compression, development of referral criteria and acute servi ce support. Complete ulcer healing rates, health-related quality of life and u se of health resources were evaluated after 12 weeks in both pre-and postimple mentation cycles. Results: A total of 955 patients were evaluated (518 preimplem entation, 437 postimplementation). The levels of assessment and treatment were p oor prior to the change in practice with just one patient having evidence of cor rect assessment and 49 (11% ) receiving high compression therapy. Postimplement ation, this improved to 412 of 437 (94% ) having evidence of measurement of the ankle brachial pressure index, and 85% receiving compression. Twelve-week h ealing rates preimplementation ranged between 9% and 24% , and postimplementa tion rose from 19% to 39% . Combined overall healing rates improved from 71 o f 518 (14% ) to 160 of 437 (37% ), odds ratio = 3- 53, P < 0.00l. Frequency o f treatment visits reduced from a mean (SD) of 24.0 (16.1) over 12 weeks to 13.5 (8.6), P < 0.00l. Intervention led to major improvements in health-related qu ality of life (measured using the Nottingham Health Profile), with significant i mprovements for energy, pain, sleep and mobility (P < 0.0l). Conclusions: Rationalization of leg ulcer services through a total service change results in improvements in pr ofessional practice, better patient outcomes, and efficient use of current resou rces. This study highlights the importance of a multifaceted approach to improve practice focused on the needs of individual organizational settings.
文摘The paper explores the concept of integrative medicine（IM） in relation to complementary and alternative medicine（CAM）.It contrasts IM available in China to its availability in the West.The second part of the paper highlights tools which could facilitate opportunities for IM.The paper concludes with a plea to ensure and maintain the integrity of traditional Chinese medical practice,and to continue to increase developing the evidence base through a funded European Coordination Action between EU member states and China.
