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Limitations of epidemiologic exposure studies on the health effects of asbestos
Published in Dorsett D. Smith, The Health Effects of Asbestos, 2015
Epidemiologic studies are usually divided into four types: Cohort studies, or a prospective observational study, of a group that is exposed to asbestos as compared with a group not exposed to asbestos, and then following their outcomes over a defined period. The results in cohort studies are commonly expressed as the (RR; risk ratio), meaning the incidence of disease in the exposed group divided by the corresponding incidence in the unexposed group.Case–control studies are retrospective studies evaluating groups, in which a certain outcome such as mesothelioma is compared to a control group without a mesothelioma and then determining risk factors for the disease. The data are commonly expressed as the odds ratio (OR) or the odds of exposure in the group with disease as compared to the control group.Cross-sectional studies are observational studies that evaluate the absence or presence of an exposure and disease at a specific time.Case reports, or case series, are descriptive reports on a single case or series of cases with a specific disease and a specific exposure reported to raise a hypothesis, but they cannot test a hypothesis because they do not include an appropriate comparison group.
Carbon nanomaterials: a new way against tuberculosis
Published in Expert Review of Medical Devices, 2019
Flavio De Maio, Valentina Palmieri, Marco De Spirito, Giovanni Delogu, Massimiliano Papi
Lipid-based systems, classically named liposomes and solid lipid nanoparticles (SLNs), have been largely studied for TB treatment. Liposomes are vesicles with a hydrophilic core enclosed in a lipid bilayer mainly used for drug delivery. Liposomal RIF or INH [59,61–64], PZA [65], rifabutin [66], amikacin [67,68] and clofazimine [69] have been produced. A case report of a patient with severe multidrug-resistant tuberculosis described a well toleration of liposomal amikacin with clinical improvements [68]. Liposomes can be prepared by a variety of lipid compositions, with different size and then stabilized by molecules such as cholesterol to alter their in vivo biodistribution. In the work of Deol and colleagues [70], a double strategy was proposed to increase the liposome accumulation in the lungs: (a) the inclusion of molecules in liposomes such as O-stearylamylopectin, dicetylphosphate, monosialoganglioside, distearylphosphatidylethanolamine-polyethylene glycol or (b) pre-administration of phosphatidyl-choline and cholesterol liposomes before the injection of lung specific stealth liposomes. Similar to liposomes, the niosomes have been also analyzed for TB treatment. Niosomes are liposomes with the addition of nonionic surfactant which stabilizes them in circulation [71]. Niosomes loaded with ethambutol [72] and rifampicin [73] have been tested in vivo.
Comprehensive, technology-based, team approach for a patient with locked-in syndrome: A case report of improved function & quality of life
Published in Assistive Technology, 2019
Keara McNair, Madeline Lutjen, Kara Langhamer, Jeremiah Nieves, Kimberly Hreha
The admission information regarding the patient in this case report classified him as having classic LIS, in which the patient has no active movement beyond vertical eye gaze. Besides having a successful thrombectomy and being in rehabilitation, A.R. was provided the opportunity to access both motor and communication sources, particularly through the use of various multi-modal technologies. This case report indicates that the combination of early use of these technologies, optimistic goal setting, and treatments that were multi-modal, sensory, and frequent could have been the key to what essentially helped A.R.’s recovery. This approach may be challenging to implement in its entirety in other settings due to the resources available. However, a clinician could utilize portions of the same model suggested in this case report with a focus on motor recovery. For example, FES cycling utilizes principles of neuromuscular reeducation paired with repetitive task practice. A clinician who does not have access to FES cycling equipment can promote the same principles by using a two-channel NMES unit while having the individual participate in massed practice of a functional task. This case report suggests treatment should be focused on motor recovery for the LIS population by utilizing whatever resources are available.
Renal risk stratification in left ventricular assist device therapy
Published in Expert Review of Medical Devices, 2018
Raymond C. Givens, Veli K. Topkara
Rates of chronic RRT after LVAD range widely from 3% to 38% [22,41,57]. Among 137 patients receiving LVADs at a single center, 10 (7%) underwent 281 intermittent hemodialysis (HD) sessions via temporary or tunneled dialysis catheters. Session terminations, occurring mostly during the first 2 months after HD initiation, involved hypotension in nine instances (3%) and ventricular tachycardia in one. Two LVAD low-flow alarms were registered. There were no deaths or adverse events attributable to HD among these patients [63]. A case report of a patient managed with long-term HD catheter access showed no adverse events directly related to HD, but the patient did have repeated episodes of bacteremia [64]. There are only case reports of long-term peritoneal dialysis after LVAD placement, but some authors have argued in favor of its use for chronic RRT because of theoretically gentler hemodynamic shifts and lower likelihood of infection than with intravascular access [65,66]. There is a theoretical concern for poor arteriovenous fistula (AVF) maturation in the setting of nonpulsatile flow [67], but there are no available data that compare AVF to arteriovenous graft. Successful AVF creation and assisted AVF maturation with resultant long-term patency have been reported [68,69]. In a series of three patients, a cubito-basilic AVF was first used at 39, 42, and 45 days after creation; 2 of the patients later required intervention for the development of short stenotic segments, but each had long-term patency [70]. Multicenter efforts are needed to establish the optimal access and method for chronic RRT after LVAD placement.