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Archivos Argentinos de Pediatria Dec 2021Short frenulum, or ankyloglossia, may lead to breastfeeding problems, with an impact on infant development, nipple damage, and early abandonment of breastfeeding. There... (Review)
Review
Short frenulum, or ankyloglossia, may lead to breastfeeding problems, with an impact on infant development, nipple damage, and early abandonment of breastfeeding. There are currently no homogeneous diagnostic criteria, thus leading to both overdiagnosis and underdiagnosis and associated clinical consequences. The challenge to approach this condition lies in establishing whether it is a normal anatomical variation or a lingual frenulum without a functional impact and when breastfeeding difficulties which are typically attributed to it are actually caused by the frenulum. Approximately 50% of ankyloglossia cases do not result in breastfeeding problems or these can be resolved with support and advice. Surgery may be proposed for the rest of the cases. This article offers an update on the classification and treatment of ankyloglossia, which will help health care providers to provide an adequate management to these patients.
Topics: Ankyloglossia; Breast Feeding; Child; Female; Health Personnel; Humans; Infant; Lingual Frenum; Nipples
PubMed: 34813240
DOI: 10.5546/aap.2021.eng.e600 -
Indian Journal of Plastic Surgery :... Oct 2021Medical professionals that treat patients with alopecia usually lack knowledge about hair cosmetics. Trichologists focus on hair cycling and growth problems and not on... (Review)
Review
Medical professionals that treat patients with alopecia usually lack knowledge about hair cosmetics. Trichologists focus on hair cycling and growth problems and not on the hair shaft integrity. This may lead to abandon of the use of the prescribed treatment, such as topical minoxidil or to inadequate traumatic grooming habits that may jeopardize hair follicle health. Shampoos, hair dyes, and hair-straightening products may alter hair fiber structure, remove lipids, and elude protein. Hair procedures such as hair dying and straightening have side effects and health concerns, especially for pregnant women or sensitive hair and scalp patients. Hair breakage, follicle traction, frizz, contact dermatitis, and mutagenicity are possible side effects of hair cosmetics misuse. The proper use of hair care products may help to increase patients' adherence to alopecia treatments and avoid health problems related to inadequate application of hair cosmetics and procedures.
PubMed: 34984093
DOI: 10.1055/s-0041-1739241 -
Neuropsychopharmacologia Hungarica : a... Sep 2020The incidence of borderline personality disorder (BPD) in psychiatric care has shown growing tendencies. Despite its frequency, it is an underdiagnosed disease. Profound... (Review)
Review
The incidence of borderline personality disorder (BPD) in psychiatric care has shown growing tendencies. Despite its frequency, it is an underdiagnosed disease. Profound knowledge of etiological factors of BPD is essential for the proper diagnosis and treatment. The present study aims to provide a developmental psychopathological analysis of borderline personality disorder, which includes a thorough review of genetic and environmental etiological factors, an introduction to the functionalist approach of evolutionary perspective, and an overview of age specific characteristics of borderline symptoms. Recent research suggests that in addition to neurobiological and psychosocial factors, genetic vulnerability may be responsible for the development of BPD. Psychosocial background includes childhood trauma, maternal mental illness, maladaptive parenting styles and dysfunctional parent-child relationship, all of which are recognized as contributing factors to the development of insecure or disorganized attachment styles in the infant. Regarding the neurobiological background, changes in the hypothalamic-pituitary-adrenal axis, neurotransmission, endogenous opioid system, and neuroplasticity play a prominent role, the development of which is also affected by childhood traumatic events. Brain imaging studies reveal differences in the limbic system (hippocampus, amygdala) and frontal cortex, which are also involved in stress response, cognition, memory function, and emotion regulation. Early developmental processes may also play an important role in the development of the disorder, as depression during pregnancy or increased stress affects the quality of maternal care and may also affect gene expression through epigenetic mechanisms. With respect to the gene-environment interaction, the interaction of the child's impulsive traits and the invalidating family environment can be highlighted, which can lead to disruption of emotion regulation. The persistence of BPD symptoms is supported by the evolutionary approach concerning several aspects. Fear of abandonment can be explained by the anticipation of exclusion and maladaptive attempts to avoid it. Developmental psychopathological analysis contributes to the development of effective prevention and intervention tools through a better understanding of the background of borderline personality disorder. In terms of prognosis, as a result of effective treatments, symptoms can be reduced, so improvement can be achieved in a large proportion of patients.
Topics: Borderline Personality Disorder; Female; Humans; Hypothalamo-Hypophyseal System; Impulsive Behavior; Pituitary-Adrenal System; Pregnancy; Psychopathology
PubMed: 33055291
DOI: No ID Found -
European Heart Journal Jan 2022Patients with ischaemic left ventricular dysfunction frequently undergo myocardial viability testing. The historical model presumes that those who have extensive areas...
Patients with ischaemic left ventricular dysfunction frequently undergo myocardial viability testing. The historical model presumes that those who have extensive areas of dysfunctional-yet-viable myocardium derive particular benefit from revascularization, whilst those without extensive viability do not. These suppositions rely on the theory of hibernation and are based on data of low quality: taking a dogmatic approach may therefore lead to patients being refused appropriate, prognostically important treatment. Recent data from a sub-study of the randomized STICH trial challenges these historical concepts, as the volume of viable myocardium failed to predict the effectiveness of coronary artery bypass grafting. Should the Heart Team now abandon viability testing, or are new paradigms needed in the way we interpret viability? This state-of-the-art review critically examines the evidence base for viability testing, focusing in particular on the presumed interactions between viability, functional recovery, revascularization and prognosis which underly the traditional model. We consider whether viability should relate solely to dysfunctional myocardium or be considered more broadly and explore wider uses of viability testingoutside of revascularization decision-making. Finally, we look forward to ongoing and future randomized trials, which will shape evidence-based clinical practice in the future.
Topics: Coronary Artery Bypass; Humans; Myocardial Ischemia; Myocardial Revascularization; Myocardium; Prognosis; Ventricular Dysfunction, Left
PubMed: 34791132
DOI: 10.1093/eurheartj/ehab729 -
Vaccines Aug 2022is the leading cause of global diarrheal deaths that currently lacks a licensed vaccine. Shigellosis drives antimicrobial resistance and leads to economic impact... (Review)
Review
is the leading cause of global diarrheal deaths that currently lacks a licensed vaccine. Shigellosis drives antimicrobial resistance and leads to economic impact through linear growth faltering. Today, there is a robust pipeline of vaccines in clinical development which are broadly divided into parenteral glycoconjugate vaccines, consisting of O-antigen conjugated to carrier proteins, and oral live attenuated vaccines, which incorporate targeted genetic mutations seeking to optimize the balance between reactogenicity, immunogenicity and ultimately protection. Proof of efficacy has previously been shown with both approaches but for various reasons no vaccine has been licensed to date. In this report, we outline the requirements for a vaccine and describe the current pipeline in the context of the many candidates that have previously failed or been abandoned. The report refers to papers from individual vaccine developers in this special supplement of which is focused on vaccines. Once readouts of safety and immunogenicity from current trials of lead candidate vaccines among the target population of young children in low- and middle-income countries are available, the likely time to licensure of a first vaccine will become clearer.
PubMed: 36146457
DOI: 10.3390/vaccines10091376 -
Ambio Sep 2019Poisoning of wild birds following ingestion of lead from ammunition has long been recognised and considerable recent research has focused on terrestrial birds, including... (Review)
Review
Poisoning of wild birds following ingestion of lead from ammunition has long been recognised and considerable recent research has focused on terrestrial birds, including raptors and scavengers. This paper builds upon previous reviews and finds that both the number of taxa affected and geographical spread of cases has increased. Some lead may also be absorbed from embedded ammunition fragments in injured birds which risk sub-lethal and welfare effects. Some papers suggest inter-specific differences in sensitivity to lead, although it is difficult to disentangle these from other factors that influence effect severity. Sub-lethal effects have been found at lower blood lead concentrations than previously reported, suggesting that previous effect-level 'thresholds' should be abandoned or revised. Lead poisoning is estimated to kill a million wildfowl a year in Europe and cause sub-lethal poisoning in another ≥ 3 million. Modelling and correlative studies have supported the potential for population-level effects of lead poisoning in wildfowl, terrestrial birds, raptors and scavengers.
Topics: Animals; Animals, Wild; Birds; Europe; Lead; Lead Poisoning
PubMed: 30879267
DOI: 10.1007/s13280-019-01159-0 -
AJPM Focus Mar 2023In recent years, cities across the world have seen widespread growth in unsheltered homelessness, in which a person sleeps in a place not meant for human habitation such... (Review)
Review
CONTEXT
In recent years, cities across the world have seen widespread growth in unsheltered homelessness, in which a person sleeps in a place not meant for human habitation such as cars, parks, sidewalks, and abandoned buildings. It is widely understood that people experiencing homelessness have poorer health outcomes than the general population. Less is known about the health of people who are unsheltered, yet they may be exposed to greater health risks than their sheltered counterparts. The purpose of this literature review is to evaluate and summarize the evidence on unsheltered homelessness and health.
EVIDENCE ACQUISITION
A literature search was conducted using PubMed to identify publications on unsheltered homelessness and health. A total of 42 studies were included for review.
EVIDENCE SYNTHESIS
Unsheltered populations experience higher rates of chronic disease, serious mental illness, and substance abuse than sheltered populations. Unsheltered homelessness is strongly associated with chronic homelessness that exacerbates serious mental illness and substance use, which is often co-occurring. Despite having large unmet health needs, unsheltered populations have lower healthcare utilization and often lack health insurance.
CONCLUSIONS
Evaluating the impact of shelter status on health outcomes has important implications for the allocation of housing and health services. Longitudinal studies are needed to examine the relationship between the duration of sheltered and unsheltered homelessness and health outcomes and explore the mediating mechanisms that lead to poor health among unsheltered populations. Despite these limitations, our results also suggest an urgent need to address the unique and severe challenges facing unsheltered populations and the need for intervention approaches that are sensitive to these unique disease burdens.
PubMed: 37789936
DOI: 10.1016/j.focus.2022.100043 -
Europace : European Pacing,... Dec 2023Single-connector (DF4) defibrillator leads have become the predominantly implanted transvenous implantable cardioverter-defibrillator lead. However, data on their... (Review)
Review
AIMS
Single-connector (DF4) defibrillator leads have become the predominantly implanted transvenous implantable cardioverter-defibrillator lead. However, data on their long-term performance are derived predominantly from manufacturer product performance reports.
METHODS AND RESULTS
We reviewed medical records in 5289 patients with DF4 leads between 2011 and 2023 to determine the frequency of lead-related abnormalities. We defined malfunction as any single or combination of electrical abnormalities requiring revision including a sudden increase (≥2×) in stimulation threshold, a discrete jump in high-voltage impedance, or sensing of non-physiologic intervals or noise. We documented time to failure, predictors of failure, and management strategies. Mean follow-up after implant was 4.15 ± 3.6 years (median = 3.63), with 37% of leads followed for >5 years. A total of 80 (1.5%) leads demonstrated electrical abnormalities requiring revision with an average time to failure of 4 ± 2.8 years (median = 3.5). Of the leads that malfunctioned, 62/80 (78%) were extracted and replaced with a new lead and in the other 18 cases, malfunctioned DF4 leads were abandoned, and a new lead implanted. In multivariable models, younger age at implant (OR 1.03 per year; P < 0.001) and the presence of Abbott/St. Jude leads increased the risk of malfunction.
CONCLUSION
DF4 defibrillator leads demonstrate excellent longevity with >98.3% of leads followed for at least 5 years still functioning normally. Younger age at implant and lead manufacturer are associated with an increased risk of DF4 lead malfunction. The differences in lead survival between manufacturers require further investigation.
Topics: Humans; Defibrillators, Implantable; Equipment Failure; Retrospective Studies
PubMed: 38000900
DOI: 10.1093/europace/euad347