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Credentials along with Key Clerkships: Who is Coaching The Medical professional Associate Individuals (along with Can it Matter)?
Objectives To describe the characteristics of fibromyalgia among Nigerian patients and assess the sensitivities of the American College of Rheumatology (ACR) criteria of 1990, 2010, 2011, and 2016 for making the diagnosis of fibromyalgia. Methods Consecutive patients diagnosed clinically with fibromyalgia by a rheumatologist were assessed. ACR criteria for fibromyalgia of 1990, 2010, 2011, and 2016 were applied to each patient. Polysymptomatic distress scores (PSD) were calculated from the Widespread Pain Index and Symptom Severity Scores. Sleep was assessed using the Pittsburgh Sleep Quality Index; fatigue by the Fatigue Severity Scale and the severity of fibromyalgia was determined using the Revised Fibromyalgia Impact Questionnaire (FIQR). Results A total of 660 new patients were seen out of which a diagnosis of fibromyalgia was made in 114 (17.3%). The mean age of the patients was 44.6 ± 15.6 years and females accounted for 84.2%. Twenty-one (18.4%) patients had changed or quit their jobs due to fibromyalgia. Problematic fatigue was present in 80 (70.2%), and sleep disturbance was reported in 83 (72.8%) patients. The severity of fibromyalgia, poor sleep, severe or very severe PSD, and male gender were associated with problematic fatigue, but only moderate/severe fibromyalgia independently predicted problematic fatigue (P = .004). The number of tender points (P = .001) and FIQR score (P = .038) were associated with changing or quitting jobs. The sensitivities of the ACR1990, ACR2010, ACR2011 and ACR2016 were 38.5%, 68.2%, 76.7% and 76.7%, respectively. Conclusion The ACR1990 had low sensitivity when used to diagnose fibromyalgia in this population and the ACR2010 encounters problems while applying the somatic symptom list.Background Throughout the last years, carbon-fibre-reinforced PEEK (CFP) pedicle screw systems were introduced to replace standard titanium alloy (Ti) implants for spinal instrumentation, promising improved radiotherapy (RT) treatment planning accuracy. We compared the dosimetric impact of both implants for intensity modulated proton (IMPT) and volumetric arc photon therapy (VMAT), with the focus on uncertainties in Hounsfield unit assignment of titanium alloy. Methods Retrospective planning was performed on CT data of five patients with Ti and five with CFP implants. Carbon-fibre-reinforced PEEK systems comprised radiolucent pedicle screws with thin titanium-coated regions and titanium tulips. For each patient, one IMPT and one VMAT plan were generated with a nominal relative stopping power (SP) (IMPT) and electron density (ρ) (VMAT) and recalculated onto the identical CT with increased and decreased SP or ρ by ±6% for the titanium components. Results Recalculated VMAT dose distributions hardly deviated from the nominal plans for both screw types. IMPT plans resulted in more heterogeneous target coverage, measured by the standard deviation σ inside the target, which increased on average by 7.6 ± 2.3% (Ti) vs 3.4 ± 1.2% (CFP). Larger SPs lead to lower target minimum doses, lower SPs to higher dose maxima, with a more pronounced effect for Ti screws. Conclusions While VMAT plans showed no relevant difference in dosimetric quality between both screw types, IMPT plans demonstrated the benefit of CFP screws through a smaller dosimetric impact of CT-value uncertainties compared to Ti. Reducing metal components in implants will therefore improve dose calculation accuracy and lower the risk for tumor underdosage.Objective To assess lens capsule opacity (LCO) following phacoemulsification in dogs receiving long-term topical ophthalmic flurbiprofen sodium 0.03%. Animal studied Twenty-five client owned dogs undergoing phacoemulsification surgery for either diabetic or nondiabetic cataracts. Methods Prospective, randomized, masked clinical study assessing two groups of dogs for twelve months following phacoemulsification. All dogs underwent a complete eye examination and were photographed at each visit, beginning three weeks post-surgery, and repeated at 2, 3, 6, and 12 months post-surgery. Post-operative treatment protocols were similar for both groups, except that Group F received topical flurbiprofen once daily for 12 months and Group A received artificial tears once daily for 12 months. Digital photographs were analyzed for LCO using a subjective grading scale (0-4). The change in capsular opacities from 3 weeks to 12 months post-surgery was evaluated for each dog, and the groups were compared. Results There were 25 dogs evaluated post-phacoemulsification at each designated time point of the study. There were 12 dogs in Group A and 13 dogs in Group F. There was no significant statistical difference in LCO score between Groups A and F at baseline (3 weeks post-surgery), 6 months post-surgery, or 12 months post-surgery. Scores did not change significantly from baseline to 12 months within or between groups. Conclusions Topical ophthalmic flurbiprofen sodium 0.03% solution applied once daily for 12 months following phacoemulsification does not appear to lead to a decrease in LCO formation as compared to artificial tears control.Despite the fact that the estrogenic effects of bisphenols were first described 80 years ago, recent data about its potential negative impact on birth outcome parameters raises a strong rationale to investigate further. The adverse health effects of plastics recommend to measure the impacts of endocrine-disrupting compounds (EDCs) such as bisphenols (BPA, BPS, BPF), bis(2-ethylhexyl) phthalate, and dibutyl phthalate (DBP) in human health. Exposure to these compounds in utero may program the diseases of the testis, prostate, kidney and abnormalities in the immune system, and cause tumors, uterine hemorrhage during pregnancy and polycystic ovary. These compounds also control the processes of epigenetic transgenerational inheritance of adult-onset diseases by modulating DNA methylation and epimutations in reproductive cells. The early developmental stage is the most susceptible window for developmental and genomic programming. The critical stages of the events for a normal human birth lie between the many transitions occurring between spermatogenesis, egg fertilization and the fully formed fetus. As the cells begin to grow and differentiate, there are critical balances of hormones, and protein synthesis. Data are emerging on how these plastic-derived compounds affect embryogenesis, placentation and feto-placental development since pregnant women and unborn fetuses are often exposed to these factors during preconception and throughout gestation. Impaired early development that ultimately influences fetal outcomes is at the center of many developmental disorders and contributes an independent risk factor for adult chronic diseases. This review will summarize the current status on the impact of exposure to plastic derived EDCs on the growth, gene expression, epigenetic and angiogenic activities of the early fetal development process and their possible effects on birth outcomes.The large number of pharmacological agents available to treat type 2 diabetes (T2D) makes choosing the optimal drug for any given patient a complex task. SU1498 cell line Since newer agents offer several advantages, whether and when sulfonylureas (SUs) should still be used to treat T2D is controversial. Published treatment guidelines and recommendations should govern the general approach to diabetes management. However, expert opinions can aid in better understanding local practices and in formulating individual choices. The present consensus paper aims to provide additional guidance on the use of sulfonylureas in T2D. We summarize current local treatment guidelines in European countries, showing that SUs are still widely proposed as second line treatment after metformin and often ranked at the same level as newer glucose-lowering medications. Strong evidence now shows that SGLT2-i and GLP-1RAs are associated with low hypoglycemia risk, promote weight loss, and exert a positive impact on vascular, cardiac, and renal endpoints. Thus, using SUs in place of SGLT2-i and GLP-1RAs may deprive patients of key advantages and potentially important cardiorenal benefits. In subjects with ascertained cardiovascular disease or at very high cardiovascular risk, SGLT2-i and/or GLP-1RAs should be used as part of diabetes management, in the absence of contraindications. Routine utilization of SUs as second line agents continues to be acceptable in resource-constrained settings. This article is protected by copyright. All rights reserved.With the introduction of clotting factor concentrates in the early 1970s, significant improvements in quality of life and life expectancy of persons with haemophilia (PWH) were realized. Unfortunately, as a result of transmission of HIV and hepatitis C virus (HCV) by contaminated concentrates in the 1980s, many of these gains were lost. Now with four decades of PWH unexposed to contaminated factor products and current treatments capable of suppressing and eliminating HIV and HCV, respectively, the survival rate is once again increasing. In addition to the usual comorbidities associated with advanced age in the general population, several specific issues occur in patients with bleeding disorders. This manuscript explores the incidence and management of the comorbidities of the ageing PWH with a focus on cardiovascular disease and osteoporosis.Among the increasing number of new psychoactive substances (NPS), 3',4'-methylenedioxy-α-pyrrolidinohexanophenone (MDPHP) belongs to the group of synthetic cathinones, that are derivatives of the naturally occurring compound cathinone, the main psychoactive ingredient in the khat plant. Currently, only limited data exist for MDPHP and no information on human metabolism is available so far. We describe the toxicological investigation of nine cases associated with the use of MDPHP during the period between February to June 2019. Serum MDPHP concentrations showed a high variability ranging from 3.3 to 140 ng/mL (mean 30.3 ng/mL, median 16 ng/mL). Intoxication symptoms of the described cases could not be explained by the abuse of MDPHP alone, since in all cases co-consumption of other psychotropic drugs with frequent occurrence of opiates and benzodiazepines could be verified. Hence, the patients presented with different clinical symptoms including aggressive behaviour, delayed physical response, loss of consciousness and coma. Furthermore, liquid chromatography high-resolution mass spectrometry (LC-HR-MS) was successfully applied to investigate the human in vivo metabolism of MDPHP using authentic human urine samples. The metabolism data for MDPHP was further substantiated by analysis of human urine by gas chromatography-mass spectrometry (GC-MS). The analysis of urine samples disclosed the presence of seven phase I metabolites and three phase II metabolites as glucuronides. GC-MS spectral data for MDPHP and metabolites is provided, since the widely used systematic toxicological analysis by GC-MS is appropriate for the toxicological detection of MDPHP intake. The identified metabolite pattern corroborates the principal metabolic pathways of α-pyrrolidinophenones in humans.Acquired bleeding disorders can accompany hematological, neoplastic, autoimmune, cardiovascular or liver diseases, but can sometimes also arise spontaneously. They can manifest as single factor deficiencies or as complex hemostatic abnormalities. This review addresses (a) acquired hemophilia A, an autoimmune disorder characterized by inhibitory autoantibodies against coagulation factor VIII; (b) acquired von Willebrand syndrome in patients with cardiovascular disorders, where shear stress abnormalities result in destruction of von Willebrand factor; and (c) liver function disorders that comprise complex changes in pro- and anti-hemostatic factors, whose clinical implications are often difficult to predict. The article provides an overview on the pathophysiology, diagnostic tests and state-of-the-art treatment strategies.
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