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Detecting dengue acne outbreaks in Malaysia employing geospatial strategies.
This suggests that insoluble aggregates of tau incorporate into the membrane and modify ionic currents, changing plasma membrane potential and activating VGCCs, which induces a calcium influx that triggers ROS production in NADPH oxidase. The combination of all these effects likely leads to toxicity, as only the same insoluble tau aggregates which demonstrated membrane-active properties produced neuronal cell death. This article is protected by copyright. All rights reserved.BACKGROUND Gallstone pancreatitis (GSP) has evidence-based guidelines regarding management. Both the International Association of Pancreatology/American Pancreatology Association and American College of Gastroenterology recommend index admission cholecystectomy (IAC) in patients presenting with mild GSP. The aim of this study was to examine guideline adherence and GSP recurrence rate when IAC was not performed. A comparison between admitting specialty was also performed to examine the difference in compliance rates. METHODS A retrospective chart review was conducted on all patients who presented to the Sunshine Coast Hospital and Health Service with GSP from December 2013 to December 2016. Patient demographics, timing of surgery, admitting specialty, laboratory and imaging results were recorded. RESULTS A total of 95 patients were identified with a first presentation of mild GSP during the study period. Of whom, 66 (69.5%) underwent IAC and 29 (30.5%) were discharged prior to cholecystectomy with 10 of those patients receiving index admission endoscopic sphincterotomy. Five patients (17%) who did not receive IAC were readmitted with gallstone-related complications with the mean time to re-presentation of 12.8 days (range 7-21 days). Patients were more likely to receive IAC when admitted under surgery compared with gastroenterology (76% versus 20%, P less then  0.001). CONCLUSION Two out of three patients presenting with mild GSP underwent IAC in accordance with evidence-based management guidelines. Patients should be admitted under a surgical service to prevent delay in definitive management. © 2020 Royal Australasian College of Surgeons.Hartmann's reversal can be complex, with complications reaching 40% [1]. Patients who undergo Hartmann's procedure are often unstable so that an open procedure is. This reduces the chances of subsequent laparoscopic reversal even though the latter leads to a more rapid postoperative recovery [2,3]. This article is protected by copyright. All rights reserved.BACKGROUND In recent years, there has been a concerted drive for an increase in public reporting of hospital-level outcomes as a means of identifying strategies to improve patient safety. Surgical care, as a high-risk area of medical practice, has come under sharp scrutiny. This study uses data from the Victorian Audit of Surgical Mortality (VASM) in conjunction with data from the Victorian Admitted Episode Dataset to compare hospital rates of clinically identified serious clinical management issues that were definitely or probably preventable and caused or contributed to the death of the patient who would otherwise be expected to survive. METHODS Cases where the date of death was between 1 July 2015 and 30 June 2017 that completed the full VASM audit process were extracted from the VASM database and combined with data extracted from the Victorian Admitted Episode Dataset, where a surgical admission occurred in the same time period. A logistic regression model was used as a method of indirect standardization to derive the probability of preventable clinical management issues, which was then used to calculate the standardized incident rate for all Victorian surgical hospitals. Hospitals were compared by plotting the standardized incident rates on three funnel plots. RESULTS There were five hospitals (8.3%) of the 60 that deviated significantly from the state-wide rate of 0.00012. CONCLUSION The risk adjustment model identified several hospitals that may have a systematic issue which warrant further clinical quality assurance investigation. © 2020 Royal Australasian College of Surgeons.The interaction of platelet agonists with their respective membrane receptors triggers intracellular signaling, among which cytosolic ion fluxes play an important role in activation processes. While the key contribution of intercellular free calcium is accepted, sodium and potassium roles in platelet activation have been less investigated in recent studies. Here, we implemented a novel flow-cytometric method to monitor over time cytosolic free calcium, sodium, and potassium ion fluxes upon platelet activation and we demonstrate the feasibility of real-time visualization of ion kinetics, in particular with a focus on sodium and potassium. Platelets were loaded with selective ion indicators, Fluo-3 (Ca2+ ), ION NaTRIUM Green-2 (Na+ ), and ION Potassium Green-2 (K+ ). Fluorescence was monitored by flow cytometry. After measurement of a stable baseline, platelets were activated and ion indicator fluorescence was acquired over time, up to 10 min. Platelets were activated with either thromboxane analogue U46619, ADP, thrombin, TRAP6 (PAR-1 agonist), AYPGKF (PAR-4 agonist), convulxin (collagen receptor GPVI agonist), or combinations thereof. We evaluated preanalytical parameters (in particular dye loading time and concentration) to implement an accurate method. Subsequently, we characterized cytosolic calcium, sodium, and potassium kinetics in response to platelet agonists. We observed different patterns of agonist synergism. In conclusion, the present work highlights the use of cytosolic ion monitoring by flow cytometry to investigate characteristic calcium, sodium, and potassium mobilization patterns following platelet activation. This easy technique opens a new way to analyze signaling in different platelet subpopulations and it should prove useful for investigating platelet pathophysiology. © 2020 International Society for Advancement of Cytometry.BACKGROUND Pleomorphic dermal sarcoma (PDS) is a rare, poorly defined skin neoplasm with features similar to atypical fibroxanthoma, but with adverse histopathological characteristics indicating metastatic potential such as tumour necrosis, invasion beyond superficial subcutis or vascular and/or perineural infiltration. Optimal treatment for PDS is uncertain and reported outcomes vary due to the rarity of this diagnosis and uncertainty over histopathological categorization. The aim of this study was to review the clinical and histopathological features of PDS in a single Australian centre. METHODS A retrospective review of all patients managed at the Peter MacCallum Cancer Centre with PDS between 2003 and 2017 was performed by a search of electronic records and histories reviewed. RESULTS A total of 27 patients were identified, mostly elderly males (85.2%, mean age 79.8 years). Lesions were seen most commonly on the head and neck region (96.3%), predominantly on the scalp (63%). Mean tumour radial surgical excision margin was 12.8 mm. Eighteen patients (66.7%) underwent radiotherapy; 13 adjuvant, three neoadjuvant and two with palliative intent. After median follow-up of 46.4 months, two patients had recurrence (7.4%); both had inadequate deep margins at first excision. There were three all-cause deaths in the cohort. learn more There was one disease-specific mortality with metastatic PDS disease at the time of initial presentation. CONCLUSION PDS is a rare cutaneous malignancy most commonly found in the head and neck region in elderly men, which is best managed with adequate surgical excision. The role of radiotherapy is undefined and an area for future investigation. © 2020 Royal Australasian College of Surgeons.AIM Although there are established guidelines for first surveillance colonoscopy (FSC) after polypectomy, there is no consensus on second surveillance colonoscopy (SSC), especially in Asian countries. The study aimed to investigate the association of SSC findings with index total colonoscopy (TCS) and FSC results. METHODS This was a single-center retrospective cohort study involving 1,928 consecutive Japanese patients who received three or more colonoscopies. High-risk findings were defined as advanced adenoma (size ≥10 mm, with villous histology or with high-grade dysplasia) or more than three adenomas, whereas the low-risk findings were defined as one to two non-advanced adenomas. On the basis of index TCS results, the patients were divided into the no adenoma (NA) (n = 888), low-risk (LR) (n = 476), and high-risk (HR) (n = 564) groups, respectively. RESULTS In the NA group, the rate of high-risk findings on SSC was significantly higher in the patients with high-risk or low-risk findings than in those with no adenoma on FSC (7.7%, 7.9%, and 2.2%, respectively, P less then  0.05). In the LR and HR groups, significantly higher rates of high-risk SSC findings were found for patients with high-risk FSC findings than for those with low-risk or no adenoma FSC findings (LR group 28.6%, 9.4%, and 5.9 %, respectively, P less then  0.01; HR group 34.5%, 18.8%, and 7.9%, respectively, P less then  0.01). CONCLUSIONS Index TCS and especially FSC findings were predictive of SSC results. The study results may be useful for determining appropriate surveillance intervals in Asian countries. This article is protected by copyright. All rights reserved.BACKGROUND To address the opioid crisis, much work has focused on minimizing opioid supply to surgical patients upon hospital discharge. Research is limited regarding handover to primary care providers. The aim of this study was to evaluate the communication of post-operative opioid prescribing information provided by hospitals to general practitioners (GPs). METHODS This study comprised two components. First, a retrospective audit of discharge summaries for opioid-naïve surgical patients supplied with an opioid on discharge was conducted to evaluate accuracy of opioid documentation and presence of an opioid management plan. Second, a survey was distributed to GPs to seek their opinions regarding adequacy of communication about hospital-initiated opioids in discharge summaries, challenges experienced in opioid management and suggestions for improvement. RESULTS Discharge summaries for 285 patients were audited. Twenty-seven (9.5%) patients had no discharge summary completed. Of the remaining 258, 63 (24.4%) summaries had at least one discrepancy between the opioid(s) listed and the opioid(s) dispensed. Only 33 (12.8%) summaries contained an opioid management plan. From 57 GP-completed surveys, 41 (71.9%) GPs rarely or never received an opioid management plan from hospital surgical units and 34 (59.7%) were dissatisfied/very dissatisfied with information provided about opioid supply and management. Qualitative responses highlighted difficulties GPs experience managing opioid treatment for post-surgical patients after discharge, differing patient expectations and the need to improve communication at times of transition. CONCLUSION When opioid-naive patients are discharged from hospital on opioids, communication from hospitals to GPs is poor. Future interventions should focus on strategies to improve this. © 2020 Royal Australasian College of Surgeons.
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