Medicine by Alexandros G. Sfakianakis

Πέμπτη 9 Αυγούστου 2018

Clinical Characteristics of Asymmetric Bilateral Gynecomastia: Suggestion of Desirable Surgical Method Based on a Single-Institution Experience

Methadon gegen Krebs

Zusammenfassung

Die Wirksamkeit von Methadon als Krebstherapeutikum wird von einigen Ärzten und Wissenschaftlern propagiert. Grundlage dafür sind mehrere In-vitro-Studien und individuelle Heilversuche. Die große mediale Aufmerksamkeit hat in der Öffentlichkeit zu dem Eindruck geführt, Methadon sei ein vielversprechendes Heilmittel gegen Krebs. In unserem Beitrag analysieren wir die ethischen Aspekte dieser Debatte. Ethische Fragen ergeben sich hinsichtlich der guten wissenschaftlichen Praxis, der Selbstbestimmung von Patienten und der Darstellung von Methadon in den Medien. Wir kommen zu dem Schluss, dass nach derzeitigem Stand der Forschung die Propagierung von Methadon als Heilmittel gegen Krebs ethisch unzulässig ist. Einerseits gerät ein solches Vorgehen aufgrund der mangelnden empirischen Evidenz mit der guten wissenschaftlichen Praxis in Konflikt. Andererseits sind dadurch die Selbstbestimmung von Patienten und das Patientenwohl gefährdet. Des Weiteren führt besonders die mediale Darstellung der Thematik zu Konflikten in der Beziehung von Patient und Arzt.

Selenium and drinking water quality indicators in Mongolia

Abstract

Mongolia is characterized by restricted sources of drinking water and intensive water pollution due to high rates of urbanization, mining industry development, enormous amount of livestock, and ever-growing attempts in domestic production of cereals and vegetables. Among others, Se is the least studied element in Mongolian water resources. Based on fluorimetric method of analysis, the first results on Se levels in drinking water of five aimags, Ulaanbaatar, and Erdenet were obtained. Uneven distribution of Se in Mongolia was manifested, the highest Se concentrations being typical for the southern resources (up to 18,600 μg/L) and the lowest, for the Northern ones (up to 0.022 μg/L). ICP-MS data of Al, As, B, Ca, Cd, Co, Cr, Cu, Fe, Hg, I, K, Li, Mg, Mn, Na, Ni, P, Pb, Si, Sn, Sr, V, and Zn contents indicate poly-microelementosis existence in the South of Mongolia (Dorno-Gobi aimag) where ground water is characterized by elevated levels of As and extremely high levels of Se, Li, Na, F, Cl, B, and nitrates ions, exceeding maximum permissible levels by 1.86; 4.3; 3.1; 3.1; 2.7; 3.4; and 1.8 times respectively. Toxic concentrations of Se in groundwater of Dorno-Gobi aimag contradict with the published low human serum Se and low content of the element in horseflesh that suggests the possible effect of the above pollutants on Se bioavailability. Revealed phenomenon and mosaic distribution of heavy metals in areas with high and low Se content in water resources indicate the need of direct search for Se and other pollutant transfer in food chain in various ecological loading conditions, creation of a map of Se distribution in water resources of other Mongolian regions, and large-scale evaluation of the human poly-elemental status.

Behavior and histopathology as biomarkers for evaluation of the effects of paracetamol and propranolol in the neotropical fish species Phalloceros harpagos

Abstract

Pharmaceutical drugs in the aquatic environment can induce adverse effects on nontarget organisms. This study aimed to assess the short-term effects of sublethal concentrations of both paracetamol and propranolol on the fish Phalloceros harpagos, specifically light/dark preference, swimming patterns, skin pigmentation, histopathology, and liver glycogen levels. Fish were acutely exposed to sublethal concentrations of both paracetamol (0.008, 0.08, 0.8, 8, 80 mg L⁻¹) and propranolol (0.0001, 0.001, 0.01, 0.1, 1 mg L⁻¹) under controlled conditions. For scototaxis, a significant preference for the dark compartment was observed for the group exposed to the highest concentration of paracetamol (80 mg L⁻¹). Propranolol exposure significantly altered the swimming pattern, especially in fish exposed to the 0.001 mg L⁻¹ concentration. Pigmentation was reduced in propranolol-exposed fish (0.1, 1 mg L⁻¹). The lowest concentration of propranolol (0.0001 mg L⁻¹) induced a decrease of histochemical reaction for hepatic glycogen. These data demonstrate that pharmaceuticals can induce sublethal effects in nontarget organisms, even at low concentrations, compromising specific functions of the individual with ecological relevance, such as energy balance and behavior.

Hepatozelluläres Karzinom

Answers to the comments on “Air pollution, biological marker and lung function in children”

Deep surgical site infection after ankle fractures treated by open reduction and internal fixation in adults: A retrospective case‐control study

International Wound Journal, EarlyView.

Readiness for Responding to a Severe Pandemic 100 Years After 1918

Abstract

The 1918 H1N1 pandemic caused unprecedented mortality worldwide. The tools to deal with the global emergency were limited with insufficient surveillance systems and a dearth of diagnostic, treatment, and prevention options. With continuing focus on pandemic planning, technologic advances in surveillance, vaccine capabilities, and 21st century medical care and countermeasures, we are more prepared for a severe pandemic than 100 years ago; however, notable gaps remain.

Time-Series Analysis of Air Pollution and Health Accounting for Covariate-Dependent Overdispersion

Abstract

Time-series studies are routinely used to estimate associations between adverse health outcomes and short-term exposures to ambient air pollutants. Poisson log-linear model with the assumption of constant overdispersion is the most common approach, particularly when estimating association between daily air pollution concentrations and aggregated counts of adverse health events over a geographical region. We examined how the assumption of constant overdispersion plays a role in air pollution effect estimation by comparing estimates derived from standard approach to those estimated from covariate-dependent Bayesian generalized Poisson and negative binomial models that accounted for potential time-varying overdispersion. Through simulation studies, we found that while there was negligible bias in effect estimates, the standard quasi-Poisson approach can result in larger standard error when the constant overdispersion assumption is violated. This was also observed in a time-series study of daily emergency department visits for respiratory diseases and ozone concentration in Atlanta, Georgia, 1999-2009. Allowing for covariate-dependent overdispersion resulted in a reduction in ozone effect standard error, while the ozone-associated relative risk remained robust to different model specifications. Our findings suggest that improved characterization of overdispersion in time-series modeling can result in more precise health effect estimates in studies of short-term environmental exposures.

An innovative study design to assess the community effect of interventions to mitigate HIV epidemics using transmission-chain phylodynamics

Abstract

Given globalization and other social phenomena, controlling the spread of infectious diseases has become an imperative public health priority. A plethora of interventions which in theory can mitigate the spread of pathogens have been proposed and applied. Evaluating the effectiveness of such interventions is costly and in many circumstances unrealistic. Most importantly, the community effect (i.e. the ability of the intervention to minimize the spread of the pathogen from people who received the intervention to other community members) can rarely be evaluated. Here we propose a study design that can build and evaluate evidence in support of the community effect of an intervention. The approach exploits molecular evolutionary dynamics of pathogens in order to track new infections as having arisen from either a control or an intervention group. It enables us to evaluate whether an intervention reduces the number and length of new transmission chains in comparison to a control condition, and thus let us estimate the relative decrease in new infections in the community due to the intervention. We provide as an example one working scenario of how the approach can be applied with a simulation study and associated power calculations.

The 1918-19 Influenza Pandemic in Portugal: A Regional Analysis of Mortality Impact

Abstract

Although many archeo-epidemiological studies have assessed the mortality impact of the 1918-19 influenza pandemic, detailed estimates are not available for Portugal. We applied negative binomial models to monthly mortality data from respiratory and all-causes at the national and district-level from Portugal, 1916-1922. Influenza-related excess mortality was computed as the difference between observed and expected deaths. Poisson regression was used to estimate the association between geographic, socio-demographic factors and excess mortality. Two waves of pandemic influenza were identified between July 1918-January 1919 and April- May 1919, representing an excess all-cause death rate of 195.7 per 10,000. All districts of Portugal were affected. The pandemic hit earlier in southeastern districts and the main cities, while excess mortality was highest in the Northeast, in line with the high mortality burden experienced by northern Spanish provinces. During the period of intense excess mortality (fall winter 1918-19), population density was negatively associated with pandemic impact. This pattern changed in the March 1919-June 1920 wave, where excess mortality increased with population density, and north and west directions. Portuguese islands were less and later affected. Given the geographic heterogeneity evidenced in our study, subnational socio-demographic characteristics and connectivity should be integrated in pandemic preparedness plans.

Live Birth Bias and Observed Associations between Air Pollution and Autism

Abstract

A recent analysis found that exposure to air pollution in specific pregnancy weeks is negatively associated with risk of autism spectrum disorder (ASD) when mutually adjusted for postnatal air pollution exposure. In this commentary, we describe two possible selection bias processes that may lead to such results, both related to live birth bias, i.e. the inevitable restriction of the analyzed sample to live births. The first mechanism is described using a directed acyclic graph and relates to the chance of live birth being a common consequence of both exposure to air pollution and another risk factor of ASD. The second mechanism involves preferential depletion of fetuses susceptible to ASD in the higher air pollution exposure group. We further discuss the assumptions underlying these processes and their causal structures, their plausibility, and other studies where similar phenomenon may have occurred.