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Clioquinol (5-chloro-7-indo-8-quinolinol), a chelator and ionophore of copper/zinc, was extensively used as an amebicide to treat indigestion and diarrhea in the mid-1900s. However, it was withdrawn from the market in Japan because its use was epidemiologically linked to an increase in the incidence of subacute myelo-optic neuropathy (SMON). SMON is characterized by the subacute onset of sensory and motor disturbances in the lower extremities with occasional visual impairments, which are preceded by abdominal symptoms. Although pathological studies demonstrated axonopathy of the spinal cord and optic nerves, the underlying mechanisms of clioquinol toxicity have not been elucidated in detail. In the present study, a reporter assay revealed that clioquinol (20-50 µM) activated metal response element-dependent transcription in human neuroblastoma SH-SY5Y cells. Clioquinol significantly increased the cellular level of zinc within 1 h, suggesting zinc influx due to its ionophore effects. On the other hand, clioquinol (20-50 µM) significantly increased the cellular level of copper within 24 h. Clioquinol (50 µM) induced the oxidation of the copper chaperone antioxidant 1 (ATOX1), suggesting its inactivation and inhibition of copper transport. The secretion of dopamine-β-hydroxylase (DBH) and lysyl oxidase, both of which are copper-dependent enzymes, was altered by clioquinol (20-50 µM). 3TYP Noradrenaline levels were reduced by clioquinol (20-50 µM). Disruption of the ATOX1 gene suppressed the secretion of DBH. This study suggested that the disturbance of cellular copper transport by the inactivation of ATOX1 is one of the mechanisms involved in clioquinol-induced neurotoxicity in SMON.
Acute elbow dislocations are complex injuries that predispose to chronic instability and pain. The ideal treatment strategy is part of controversial discussion and evidence-based recommendations for the treatment could not be concluded from the literature. The purpose of the present study was to assess current epidemiological data, injury pattern, and the changing trend for treatment.
This study presents a retrospective review of 72 patients ≥ 18years of age who were treated in our level I trauma centre with acute elbow dislocations from 2014 to 2018. The data were acquired by analysis of the institution's database, and radiological examinations.
The average age of the patients was 48.5years (range 18-86). The ratio of male to female patients was 1.91. A fall onto the outstretched arm (42%) was the most common injury mechanism. By classification, 42% of the elbow dislocations were simple, and 58% complex. A total of 85% of patients underwent surgery including 73% of the simple elbow dislocations due to remaining instability or non-congruency of the reduced elbow. The indication for surgical treatment correlated merely with the grade of instability and displacement, but not with age.
Acute elbow dislocations need identification of the precise injury pattern and instability after reduction of the elbow joint. To achieve a congruent and stable joint, we recommend primary surgical repair as first-line treatment for patients with unstable simple and complex elbow dislocation independent of age.
Acute elbow dislocations need identification of the precise injury pattern and instability after reduction of the elbow joint. To achieve a congruent and stable joint, we recommend primary surgical repair as first-line treatment for patients with unstable simple and complex elbow dislocation independent of age.
Health literacy is an area of growing research and clinical interest, necessitating short, accurate measures of this complex construct. Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measures prose, document, and quantitative literacy by self-administration on a touchscreen computer.
The objective of this study was to assess the validity of a short form of Health LiTT and to identify a meaningful cutoff score for adequate health literacy.
A subsample of 137 participants from the Literacy and Cognitive Function among Older Adults study completed a 10-item Health LiTT short form and three interviewer-administered health literacy measures Test of Functional Health Literacy in Adults (TOFHLA), Rapid Estimate of Adult Literacy in Medicine (REALM), and Newest Vital Sign (NVS). Convergent validity was assessed by correlating scores for all measures, and known-groups validity was assessed by comparing mean Health LITT scores across TOFHLA levels (inadequate, marginal, adequate). Irties of a valid and reliable short form of the flexible, technologically advanced Health Literacy Assessment Using Talking Touchscreen Technology measure, as well as a cutoff score to note adequate versus marginal/inadequate health literacy.
The Health Literacy Questionnaire (HLQ) is a multidimensional generic questionnaire developed to capture a wide range of health literacy needs. There is a need for validation evidence for the Norwegian version of the HLQ (N-HLQ).
The present study tested an initial version of the Norwegian HLQ by exploring its utility and construct validity among a group of nursing students.
A pre-test survey was performed in participants (N = 18) who were asked to consider every item in the N-HLQ (44 items across nine scales). The N-HLQ was then administered to 368 respondents. Scale consistency was identified and extracted in a series of factor analyses (principal component analysis [PCA] with oblimin rotation) demanding a nine-dimension solution performed on randomly drawn 50% of the samples obtained by bootstrapping. Correlations between the nine factors obtained in the 13-factor PCA and the scale scores computed by the scale scoring syntaxes provided by the authors of the original HLQ were estimated.
The pre-testian population.The Safe to Sleep campaign started in 1994, reducing the risk of sudden infant death syndrome (SIDS) by 40% to 60%. However, an undesirable consequence has been a 400% to 600% increase in positional head deformities. We review the risks for positional plagiocephaly or brachycephaly, treatment modalities, and when to refer. Differential diagnoses for non-positional deformities are discussed. Risks for positional head deformities include prenatal, perinatal and postnatal factors. These include torticollis, inadequate tummy time, abnormal intrauterine positioning, premature or postmature birth, prolonged labor, complex medical conditions, prolonged hospitalizations, developmental delay, and use of supportive or convenience devices. Recommended treatment involves repositioning techniques or physical therapy with or without helmet use. Early referral to physical therapy or a head shape program insures better outcomes for full correction of the deformity. The severity of residual deformities is directly related to the age at which the child is referred. [Pediatr Ann. 2020;49(10)e440-e447.].Attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders, which are the most common pediatric mental health problems, frequently co-occur. The overlap of symptoms and the varied presentations of both disorders can make diagnosis and treatment planning challenging. Picking an initial treatment target with reassessment of the diagnoses based on response may help clinicians successfully treat children with comorbid ADHD/anxiety. Treating ADHD with stimulants can lead to improvement in ADHD-related anxiety symptoms. Treating anxiety can reduce anxiety-related attentional problems and executive functioning. Atomoxetine and alpha agonists treat ADHD and may have some benefit for anxiety symptoms. Behavioral treatment should be part of the plan for ADHD co-occurring with anxiety disorders. [Pediatr Ann. 2020;49(10)e436-e439.].Psychotropic medications are an essential component of treating pediatric mental health disorders, and pediatricians are increasingly likely to prescribe them. Commonly used psychotropic medications include stimulants and nonstimulants used in the treatment of attention-deficit/hyperactivity disorder (ADHD); antidepressants used in the treatment of anxiety and depression; and antipsychotics indicated for use in autism, schizophrenia, mood disorders, severe impulsivity, and aggression. Stimulants are commonly associated with appetite suppression and initial insomnia and nonstimulants for ADHD are associated with sedation. Antidepressants are generally well tolerated; adverse effects include behavioral activation early in treatment and, rarely, treatment-emergent mania and suicidal ideation. Potential adverse effects of atypical antipsychotics include weight gain and metabolic syndrome. Monitoring strategies are reviewed. [Pediatr Ann. 2020;49(10)e431-e435.].Mental health disorders emerge in predictable patterns across pediatric development. Understanding these patterns can help clinicians anticipate emerging mental health problems. In this article, we review child development, merging concepts from developmental psychology with motor, language, cognitive, and social development. We point out developmental red flags for mental health disorders in each developmental period. [Pediatr Ann. 2020;49(10)e426-e430.].Systematic mental health screening is a recommended but controversial process in the pediatricians' behavioral health tool kit. Although the American Academy of Pediatrics and other organizations promote routine behavioral health screening, implementing an effective and sustainable screening program can be challenging. We discuss the rationale for and barriers to screening in pediatric settings, identify accessible validated tools that can be easily incorporated into practice, and suggest a practical strategy for implementing a more accurate screening system for common mental health concerns in pediatric primary care. [Pediatr Ann. 2020;49(10)e421-e425.].Pediatricians are increasingly asked to address the mental health care needs of their patients, despite lack of formal mental health training. Pediatricians who wish to expand their scope of practice to include mental health care may benefit from didactic training as well as ongoing consultative or collaborative relationships with mental health specialists. Consultative and collaborative relationships between mental health and primary care have evolved in various models across the country. We outline models of mental health consultation and collaboration, address some considerations for pediatricians prior to adopting a model, and list key collaborative care resources. [Pediatr Ann. 2020;49(10)e416-e420.].Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in December 2019 in Wuhan, Hubei province, China. Soon after, it was discovered to be a novel human virus and it subsequently spread throughout the world, leading to a global pandemic. From the experience we have so far with this virus, it appears that compared to most other respiratory viral illnesses to which they are typically highly susceptible, children are affected less by SARS-CoV-2 than adults. It will continue to be important to collect data and study different populations to learn more about how children are affected by the disease, particularly as we head back to school in different forms this fall. We also must pay close attention to whether or not children are significant transmitters of the disease, as this is largely unknown and will have an affect on those who are providing care for children at school, daycare, and at home. [Pediatr Ann. 2020;49(10)e407-e412.].
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