Medical management of diabetes after bariatric surgery

Several studies indicate that bariatric surgery frequently leads to resolution or improvement of type 2 diabetes in overweight patients. However, the medical postoperative management requires lifelong counselling, monitoring and nutrient supplements in patients in remission as well as in patients who continue to be diabetic. The aim of such management is to avoid nutritional deficiencies, and to delay diabetes relapse by optimizing the control of risk factors. To this end, diet and pharmacological prescriptions, including vitamin and mineral supplements, are indispensable, despite the fact that specific recommendations, until now, have been lacking for these particular patients.

CD40/CD154 system and pro-inflammatory cytokines in young healthy male smokers without additional risk factors for atherosclerosis

OBJECTIVE AND DESIGN

Atherosclerosis, as an inflammatory disease, is characterized by pathologically altered levels of cytokines. We investigated whether smoking affects the CD40/CD154 system and pro-inflammatory cytokines in young males without other risk factors for atherosclerosis.

SUBJECTS

Young male smokers (n=13) and 14 non-smoking controls were investigated.

METHODS

The differences in CD40/CD154 system and serum cytokines between the groups were measured using flow cytometry and ELISA.

RESULTS

In smokers, there was a strong trend (P<0.06) for increased CD40 expression on platelets as compared with non-smokers. However, there were no significant differences in CD40 expression on monocytes or in CD154 expression on platelets and T-cells between smokers and non-smokers. There was a strong trend for increased platelet-monocyte aggregates in smokers (P<0.06). Also, smokers had slightly but not significantly elevated hsCRP and IL-6 levels, and slightly decreased TNF-alpha and MCP-1. Interestingly, IL-18, a cytokine which has the ability to promote both Th1 and Th2 responses, was significantly decreased in smokers group (P=0.03 vs controls).

CONCLUSIONS

In young healthy males, smoking is not associated with dramatic changes in CD40/CD154 system. However, cigarette smoke alters the secreted cytokine profile, leading to significant decrease in systemic IL-18 levels.

Prevalence of musculoskeletal injuries among adolescent squash players in the Western Cape

Objective. To determine the prevalence of musculoskeletal injuries among adolescent squash players in the Western Cape. Design. A retrospective descriptive survey was conducted during the first week of May 2006. Three schools were randomly selected from a list of the top 10 schools in the Western Cape high school squash league of 2005, with 106 squash players aged 13 - 18 years participating in the study. Setting. Injury data were collected for 106 players at three schools randomly selected from a list of the top 10 schools in the Western Cape high school squash league of 2005. Interventions. An adapted structured self-administered questionnaire based on a previously validated musculoskeletal injury questionnaire was used to collect the data. Main outcome measures. The main variables investigated were prevalence, mechanism and injury site of musculoskeletal squash injuries. Results. Twenty-nine per cent of the players (N = 31) reported that they had sustained a squash injury in the 4 weeks prior to data collection. A total of 48 injuries were reported by the injured players. The most common injuries included those of the thigh (19%), shoulder (13%) and lower back (13%). Forty-two per cent of players reported no specific mechanism of injury, but experienced pain not associated with a traumatic injury only while playing squash. Conclusion. A relatively high prevalence of squash injuries was found. This preliminary study serves as a baseline for future research. Areas for further investigation were identified and this could lead to the implementation of preventive programmes and education to prevent injuries among adolescent squash players. South African Journal of Sports Medicine Vol. 19 (1) 2007: pp. 3-8

[Active drainage combined with air-fluid exchange for silicone oil removal: advantages and long-term follow-up]

INTRODUCTION

A number of silicone oil removal procedures are in use today. The purpose of this study was to evaluate the advantages of active drainage with air-fluid exchange for silicone oil removal.

PATIENTS AND METHODS

We conducted a prospective study on patients operated on for retinal detachment with vitrectomy with silicone oil intraocular tamponade between January 2005 and January 2006. The surgical procedures were three-port vitrectomy with silicone tamponade. Silicone oil was removed with active drainage and air-fluid exchanges. Visual acuity, floaters, intraocular pressure, emulsion, and silicone oil complications were evaluated at 3, 6, 12, and 18 months.

RESULTS

Fifty patients (50 eyes) underwent vitrectomy with silicone oil intraocular tamponade for RD with proliferative vitreoretinopathy. The mean duration of intraocular silicone oil tamponade was 4.5 months (1-15 months). Seventeen patients had complementary procedures such as phacoemulsification, epimacular membrane peeling, complementary retinopexy or intravitreal triamcinolone. At 1 year, the mean visual acuity was 3.2/10. One patient reported floaters. One patient had recurrent retinal detachment, one patient had intraocular hypertony, and significant emulsion was found in one patient. Microscopic emulsion was found in 20 patients.

DISCUSSION

This surgical technique is longer and more invasive than simple passive ablation. However, complementary procedures could decrease the risk of recurrent retinal detachment and provide better visual rehabilitation. Better silicone oil removal seems to limit residual emulsion.

CONCLUSION

Active drainage with air-fluid exchange for silicone oil removal is an interesting procedure. It could reduce short- and medium-term silicone oil complications in vitreoretinal surgery and increase the final visual outcome. However, a prospective comparative and randomized study is necessary to confirm our results.

The UCSC Genome Browser Database: update 2009

The UCSC Genome Browser Database (GBD, http://genome.ucsc.edu) is a publicly available collection of genome assembly sequence data and integrated annotations for a large number of organisms, including extensive comparative-genomic resources. In the past year, 13 new genome assemblies have been added, including two important primate species, orangutan and marmoset, bringing the total to 46 assemblies for 24 different vertebrates and 39 assemblies for 22 different invertebrate animals. The GBD datasets may be viewed graphically with the UCSC Genome Browser, which uses a coordinate-based display system allowing users to juxtapose a wide variety of data. These data include all mRNAs from GenBank mapped to all organisms, RefSeq alignments, gene predictions, regulatory elements, gene expression data, repeats, SNPs and other variation data, as well as pairwise and multiple-genome alignments. A variety of other bioinformatics tools are also provided, including BLAT, the Table Browser, the Gene Sorter, the Proteome Browser, VisiGene and Genome Graphs.

Principles and uses of HIV incidence estimation from recent infection testing - a review

Since the 1990s, the development of laboratory-based methods has allowed to estimate incidence of human immunodeficiency virus (HIV) infections on single samples. The tests aim to differentiate recent from established HIV infection. Incidence estimates are obtained by using the relationship between prevalence, incidence and duration of recent infection. We describe the principle of the methods and typical uses of these tests to characterise recent infection and derive incidence. We discuss the challenges in interpreting estimates and we consider the implications for surveillance systems. Overall, these methods can add remarkable value to surveillance systems based on prevalence surveys as well as HIV case reporting. The assumptions that must be fulfilled to correctly interpret the estimates are mostly similar to those required in prevalence measurement. However, further research on the specific aspect of window period estimation is needed in order to generalise these methods in various population settings.

Principles and uses of HIV incidence estimation from recent infection testing--a review

Since the 1990s, the development of laboratory-based methods has allowed to estimate incidence of human immunodeficiency virus (HIV) infections on single samples. The tests aim to differentiate recent from established HIV infection. Incidence estimates are obtained by using the relationship between prevalence, incidence and duration of recent infection. We describe the principle of the methods and typical uses of these tests to characterise recent infection and derive incidence. We discuss the challenges in interpreting estimates and we consider the implications for surveillance systems. Overall, these methods can add remarkable value to surveillance systems based on prevalence surveys as well as HIV case reporting.The assumptions that must be fulfilled to correctly interpret the estimates are mostly similar to those required in prevalence measurement. However, further research on the specific aspect of window period estimation is needed in order to generalise these methods in various population settings.

Endogenous steroid production in the spinal cord and potential involvement in neuropathic pain modulation

It has recently been demonstrated that the spinal cord (SC) is an active production center of neuroactive steroids including pregnenolone, dehydroepiandrosterone, progesterone and allopregnanolone. Indeed, anatomical, cellular and biochemical investigations have shown that the SC dorsal horn (DH), a pivotal structure in nociception, contains various active steroidogenic enzymes such as cytochrome P450side-chain-cleavage, cytochrome P450c17, 3beta-hydroxysteroid dehydrogenase, 5alpha-reductase and 3alpha-hydroxysteroid oxido-reductase. Reviewed here are several data obtained with in vitro and vivo experiments showing that endogenous steroids synthesized in the SC are involved in the modulation of nociceptive mechanisms. Various approaches were used as the real-time polymerase chain reaction after reverse transcription to determine the effects of neuropathic pain on the expression of genes encoding steroidogenic enzymes in the DH. Combination of the pulse-chase technique with high performance liquid chromatography and continuous flow scintillation detection allowed investigations of the impact of noxious signals on the activity of steroid-producing enzymes in the SC in vitro. Radioimmunological analyses of spinal tissue extracts contributed to determine the link between the painful state and endogenous steroid secretion in the SC in vivo. Finally, the physiological relevance of the modification of endogenous steroid formation in the SC during painful situation was discussed.

Evaluation of quality indicators (QIs) for colorectal cancer care in a community setting

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Background: We compared two existing sets of QIs for colorectal cancer care to evaluate our performance as compared to published data. We also explored reasons for non-adherence to these QIs to determine how we could increase our compliance. Methods: Chart review of all patients who were newly diagnosed with colorectal cancer at our institution in 2004 and 2005 for compliance with QIs for colorectal cancer care as presented by National Initiative for Cancer Care Quality (NICCQ) and Moffitt Network Initiative on Practice Quality (MNIPQ). When 85% compliance was not observed, charts were reviewed as to why care differed from QI. Results: Adherence rate was less than 85% in 5 of 25 NICCQ colon cancer measures and patients overall received 83% of recommended care. Reasons for <85% adherence on NICCQ were most often due to patient decision (patient decision after informed discussion, refusal of treatment, patient initiated delay) or co-morbidity (poor wound healing, infection, medical co-morbidity). In one item regarding counseling of family members about colorectal screening we were truly noncompliant without documentation of reason. Review of MNIPQ items observed less than 85% adherence rate in 2 of 9. Reason for non-adherence in MNIPQ review was due most often to co- morbidity, and true noncompliance (no reason documented for lack of pretreatment CEA). Conclusions: Our adherence rates for NICCQ and MNIPQ measures compare favorably with published values. Lower compliance rates on NICCQ and MNIPQ measures were most often due to patient choice or co-morbidities. In setting benchmarks for these individual QIs it should be noted that for some indicators (such as those regarding adjuvant therapy) higher percent adherence does not always reflect better care. Higher compliance may actually mean that thoughtful consideration of patient co-morbidity and complications, or including patients in decision making is not occurring or that the population being served is younger or has fewer co-morbidities. Other indicators such as those regarding staging documentation, documentation of chemotherapy, and patient education factors the higher the compliance the better. We conclude that some sampling of reason for non- adherence is necessary when assessing quality of care.

No significant financial relationships to disclose.