scholarly journals Management of pharmaceutical and recreational drug poisoning

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Bruno Mégarbane ◽  
Mathieu Oberlin ◽  
Jean-Claude Alvarez ◽  
Frederic Balen ◽  
Sébastien Beaune ◽  
...  
Keyword(s):  
Recreational Drug ◽  
Médecine D’Urgence ◽  
Level Of Evidence ◽  
Drug Poisoning ◽  
Epidemiological Changes ◽  
Evidence Grade ◽  
Strong Consensus ◽  
High Level ◽  
Made In

Abstract Background Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. Methods A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d’Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. Results The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. Conclusions The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.

Unstimulated high-sensitive thyroglobulin is a powerful prognostic predictor in patients with thyroid cancer

2019 ◽  
Vol 58 (1) ◽  
pp. 130-137 ◽  
Author(s):  
Luca Giovanella ◽  
Marco Castellana ◽  
Pierpaolo Trimboli
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Differentiated Thyroid Carcinoma ◽  
Level Of Evidence ◽  
Prognostic Performance ◽  
Clinical Scenarios ◽  
High Level ◽  
Operating Points

Abstract Background Differentiated thyroid carcinoma (DTC) has an excellent prognosis and the role of high-sensitive thyroglobulin measured during levothyroxine (ON-T4 hs-Tg) testing to discriminate patients with structural from not-evidence of disease (SED and NED, respectively) has been investigated. We conducted a systematic review and meta-analysis evaluating the performance of ON-T4 hs-Tg in two clinical scenarios considering its negative predictive value (NPV) as primary outcome: (1) diagnostic performance of Tg when undetectable value and NED status are simultaneously demonstrated; (2) prognostic performance of undetectable Tg in predicting NED in the subsequent follow-up. Methods This systematic review and meta-analysis were registered on PROSPERO (CRD42019125092). PubMed, Scopus, CENTRAL and Web of Science were searched until February 12, 2019. Original articles reporting data on SED/NED in patients with detectable/undetectable ON-T4 hs-Tg were selected. Summary operating points were estimated using a random-effects model. Results Out of 1413 retrieved papers, 10 studies evaluating 1796 patients were included. Participants were outpatients diagnosed with DTC, treated with near-total (NTx) or total thyroidectomy (TTx) with or without radioactive iodine (RAI). The NPV of ON-T4 hs-Tg for diagnostic and prognostic performance was 99.4% (95% CI 98.9–99.9; I2 = 13%) and 99.4% (95% CI 98.8–100; I2 = 0%), respectively. Conclusions Our findings show that ON-T4 hs-Tg is an excellent diagnostic tool and prognostic factor to rule-out SED. A high level of evidence is provided to decrease the intensity and frequency of follow-up in those DTC patients having undetectable high-sensitive Tg.

scholarly journals Epidemiological aspects of bovine trypanosomosis in an endemic focus of eastern Zambia: The role of trypanosome strain variability in disease pattern

2012 ◽  
Vol 79 (2) ◽  
Author(s):  
Justin Masumu ◽  
G. Tshilenge ◽  
V. Mbao
Keyword(s):  
Severe Infection ◽  
Tsetse Flies ◽  
Bovine Trypanosomosis ◽  
High Prevalence ◽  
Disease Pattern ◽  
Epidemiological Changes ◽  
Different Strains ◽  
High Level ◽  
Strain Variability

Bovine trypanosomosis displays various epidemiological aspects in various areas. In some instances the disease has a high prevalence in animals with high impact on production whereas in other cases the disease has a low impact on production despite a high level of infection in animals. In addition epidemiological changes are frequently observed in various areas and are related to many factors including the vectors, the host, the parasites, the environment as well as the livestock management. However the implication of these factors in these changes is not fully elucidated. In eastern Zambia, factors predicting the establishment of severe infection in cattle are all present. However trypanosomosis occurring in cattle in this area has a low impact on livestock production. Several studies on the characterisation of trypanosome strains circulating in domestic and wild animals have been conducted in order to clarify the epidemiology of this disease in this area. These studies aimed at evaluating genetic and biological characteristics of these strains including their virulence profiles, their transmissibility by tsetse flies, their resistance to drugs and interference between different strains. In this review these findings are analysed in order to elucidate the implication of trypanosome strain variability in the distribution and the expression of this disease in the study area. The evolutionary trends of the situation occurring in this study area are also explained. Use of these findings is the context of disease control in the study area is further discussed.

scholarly journals Mediterranean Diet and Cardiodiabesity: A Systematic Review through Evidence-Based Answers to Key Clinical Questions

Nutrients ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 655 ◽  
Author(s):  
Marcella Franquesa ◽  
Georgina Pujol-Busquets ◽  
Elena García-Fernández ◽  
Laura Rico ◽  
Laia Shamirian-Pulido ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mediterranean Diet ◽  
Obese Patients ◽  
Healthy Individuals ◽  
Primary And Secondary Prevention ◽  
Level Of Evidence ◽  
Clinical Questions ◽  
High Level

The Mediterranean Diet (MedDiet) has been promoted as a means of preventing and treating cardiodiabesity. The aim of this study was to answer a number of key clinical questions (CQs) about the role of the MedDiet in cardiodiabesity in order to provide a framework for the development of clinical practice guidelines. A systematic review was conducted to answer five CQs formulated using the Patient, Intervention, Comparison, and Outcome (PICO) criteria. Twenty articles published between September 2013 and July 2016 were included, adding to the 37 articles from the previous review. There is a high level of evidence showing that MedDiet adherence plays a role in the primary and secondary prevention of cardiovascular disease (CVD) and improves health in overweight and obese patients. There is moderate-to-high evidence that the MedDiet prevents increases in weight and waist circumference in non-obese individuals, and improves metabolic syndrome (MetS) and reduces its incidence. Finally, there is moderate evidence that the MedDiet plays primary and secondary roles in the prevention of type 2 diabetes mellitus (T2DM). The MedDiet is effective in preventing obesity and MetS in healthy and at-risk individuals, in reducing mortality risk in overweight or obese individuals, in decreasing the incidence of T2DM and CVD in healthy individuals, and in reducing symptom severity in individuals with T2DM or CVD.

scholarly journals Measuring Primitive Reflexes in Children with Learning Disorders

2017 ◽  
Vol 5 (1) ◽  
pp. 285 ◽  
Author(s):  
Dr. Sulltane Bilbilaj ◽  
Dr. Aranit G ◽  
Dr. Fatlinda S
Keyword(s):  
Learning Disabilities ◽  
Qualitative Study ◽  
Learning Disorders ◽  
Biological Time ◽  
Primitive Reflexes ◽  
Home Test ◽  
High Level ◽  
The City ◽  
Made In

The paper aims to show that the children with learning diabilities have a high level of unconstrained primitive reflexes and that their undeserved suffering also comes from the increased presence of instinctive reflexive movements. This qualitative study is conducted with 20% of the children with learning disabilities 6-10 years old,in the city of Vlora,Albania. Also their cognitive development is held “as hostage” by stumbling power of the reflexive movements for the creation of new nerve pathways and schemes. The study is represented by a rich references with contemporary information on the role of primitive neurological reflexes in utero, in the first years of life and the non-integration consequences within their biological time. The study primarily measured the primitive retained reflexes in children in the study. As an instrument for measuring primitive reflexes, the study used "home test" developed by Sally Goddard Blythe. Measurements were made in just eight primitive reflexes based on the work of Petter and Sally Goddard Blythe; Moro, Rooting, Sucking, ATNR, TLR, Handheld, Galant, and STNR. Data were collected from the measurements on the type and percentage of the retained primitive reflexes. It was proven that children with learning disorders have a high level of retained primitive reflexes compared to other children. The findings of this study lead to the need for scientific research to inhibit the primitive reflexes at a young age, but also when they are present beyond their biological age.

scholarly journals Indebtedness and the road to monetary sovereignty following the international recognition of Montenegro in 1878

2021 ◽  
Vol 21 ◽  
pp. 287-303
Author(s):  
Radoslav Raspopovic
Keyword(s):  
Research Work ◽  
Independent State ◽  
The Road ◽  
Historical Significance ◽  
Scientific Research Work ◽  
Accepted Standard ◽  
Banking Institutions ◽  
High Level ◽  
Made In

The paper is dedicated to furthering the research into different aspects of Montenegrin sovereign status gained the Congress of Berlin, with a focus on the country’s financial sovereignty. Becoming an independent state had great historical significance for Montenegro, marking the realisation of the centuries-old aspirations for liberation. Still, exercising sovereign power proved challenging for Montenegro as the country was still an underdeveloped, agrarian country with a high percentage of illiterate population, scarce human resources and modest economic opportunities. Aside from this, there were still many congressional restrictions to exercising the rights acquired by gaining access to the sea. The author seeks to determine the reasons for the high level of indebtedness, as well as the decisions made in trying to resolve the challenges in maintaining the country’s financial sovereignty. The author also touches upon the broader subject of the role of gold standard in international trade and argues to which extent Montenegro was able to adhere to this internationally accepted standard, having established its banking institutions and having introduced its own currency. Considering that this paper is a part of the scientific research work on the project ‘Montenegro on the political and cultural map of Europe’ (CLIO MAP), exhibiting the reasons for minting the first Montenegrin coin is but a way to examine a segment in exibiting the country’s sovereign status acquired at the Congress of Berlin.

scholarly journals International postgraduate students' experiences of plagiarism education in the UK: Student, tutor and expert perspectives

2012 ◽  
Vol 8 (2) ◽  
Author(s):  
Mary Davis
Keyword(s):  
International Students ◽  
North African ◽  
Education Students ◽  
Master's Degrees ◽  
Postgraduate Students ◽  
Student Tutor ◽  
The Uk ◽  
High Level ◽  
Made In

The role of plagiarism education is being increasingly highlighted as a key area of learning good academic practice, but to date, few case studies have focused on international1 postgraduate students' experiences of plagiarism education. Therefore, this study examines the experiences of eight Asian and North African international students at the end of Master's degrees at a UK university. In addition, interviews with their postgraduate tutors were made in order to gather further insights. The students and tutors reported different understandings of the university's plagiarism definition and problems with the availability of plagiarism education. Students reported that support was limited and they had many concerns about plagiarism; tutors reported that they lacked time or thought instruction should be provided elsewhere. At the same time, the tutors recognised that they required students to use sources at a high level. Interviews were also made with a number of global plagiarism education experts, who called for a greater focus on learning rather than just following regulations, less outsourcing of the problem, and more awareness about the tendency to connect international students with plagiarism. The study emphasises the need for more attention to plagiarism definitions and to international students' experiences of plagiarism education through continuous pedagogical support during their study.

The expression of hybrid vigour in Drosophila subobscura

1955 ◽  
Vol 144 (915) ◽  
pp. 159-171 ◽  
Keyword(s):  
Natural Selection ◽  
Hybrid Vigour ◽  
Wild Populations ◽  
Balanced Polymorphism ◽  
Wide Range ◽  
In The Wild ◽  
High Level ◽  
Species Hybrids ◽  
Made In

By hybrid vigour we mean the possession by outbred organisms of a number of characters which would confer fitness in a wide range of environments. This definition deliberately includes both cases where heterozygous individuals are fitter in a Darwinian sense in the wild, and cases of species or other distant hybrids showing vigour in, for example, efficient utilization of food, long life, or high resistance to disease, although of low fitness because of infertility or for some other reason. Both types of phenomenon are well known, but whether it is convenient to consider them under the same heading will depend on the aspect of the problem being studied. For example, Dobzhansky (1950) preferred to divide hybrid vigour into ‘euheterosis’ as found in wild populations, and ‘luxuriance’ as exemplified in species hybrids. Such a distinction is a helpful one when the aspect studied is the role of natural selection in maintaining a balanced polymorphism in the wild. However, the high level of heterozygosity maintained by natural selection in many wild populations suggests that for many pairs of alleles the heterozygote is fitter than either homozygote. Where we have some knowledge of the mode of action of the different alleles present in a wild population at a given locus, as we have, for example, for the blood groups in man, it appears that different alleles produc qualitatively different substances. This has led to the suggestion that outbred organisms may be biochemically more versatile (Haldane 1948, 1954; Robertson & Reeve 1952). It is such versatility that all ‘hybrids’ may have in common, whether they result from outbreeding in the wild or from distant crosses made in the laboratory.

A Comparison of General Anesthesia and Regional Anesthesia as a Risk Factor for Deep Vein Thrombosis Following Hip Surgery: A Critical Review

1990 ◽  
Vol 64 (04) ◽  
pp. 497-500 ◽  
Author(s):  
Martin H Prins ◽  
Jack Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Lower Incidence ◽  
Hip Surgery ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Postoperative Thrombosis ◽  
High Level ◽  
Deep Vein

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

Searching for ‘success’: generation, gender and onward migration in the Iranian diaspora

2017 ◽  
Vol 14 (1) ◽  
pp. 101-112 ◽  
Author(s):  
Melissa Kelly
Keyword(s):  
Life History ◽  
Young Age ◽  
Onward Migration ◽  
Social Fields ◽  
Transnational Social Fields ◽  
High Level ◽  
Iranian Diaspora

This article uses the concepts of ‘transnational social fields’ and ‘habitus’ to explore the multifaceted role families play in shaping the aspirations of onward migrating youth. The article draws on biographical life history interviews conducted with the children of Iranian migrants who were raised in Sweden but moved to London, UK as adults. The findings of the study suggest that from a young age, all the participants were pressured by their parents to perform well academically, and to achieve high level careers. These goals were easier to achieve in London than in Sweden for several reasons. Interestingly, however, participants’ understandings of what constituted success and their motivations for onward migration were nuanced and varied considerably by gender. The study contributes to an understanding of the role of multi-sited transnational social fields in shaping the aspirations of migrant youths, as well as the strategies taken up by these migrants to achieve their goals.

Bridging the Knowledge Gaps in Arrhythmogenic Cardiovascular Conditions: The Critical Role of Registries

2016 ◽  
Vol 10 (2) ◽  
pp. 1 ◽  
Author(s):  
Melody Hermel ◽  
Rebecca Duffy ◽  
Alexander Orfanos ◽  
Isabelle Hack ◽  
Shayna McEnteggart ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Natural History ◽  
Risk Stratification ◽  
Critical Role ◽  
Knowledge Gaps ◽  
Level Of Evidence ◽  
The Future

Cardiac registries have filled many gaps in knowledge related to arrhythmogenic cardiovascular conditions. Despite the less robust level of evidence available in registries when compared with clinical trials, registries have contributed a range of clinically useful information. In this review, the authors discuss the role that registries have played – related to diagnosis, natural history, risk stratification, treatment, and genetics of arrhythmogenic cardiovascular conditions – in closing knowledge gaps, and their role in the future.

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