FITT

Fibrinolytic therapy with tPA failed because it was based on a flawed concept

Published on: 16th June, 2020

OCLC Number/Unique Identifier: 8628672035

Fibrinolytic therapy has become synonymous with tissue plasminogen activator (tPA) based on the belief that tPA alone was responsible for natural fibrinolysis. Although this assumption was belied from the outset by disappointing clinical results, it persisted, eventually causing fibrinolysis to be discredited and replaced by an endovascular procedure. Since time to reperfusion is the critical determinant of outcome, which in acute myocardial infarction (AMI) means within two hours, a time-consuming hospital procedure is ill-suited as first line treatment. For this purpose, fibrinolysis is more fitting. The assumption that tPA is responsible for fibrinolysis is contradicted by published findings. Instead, tPA ‘s function is limited to the initiation of fibrinolysis, which is continued by urokinase plasminogen activator (uPA) and that has the dominant effect. tPA and uPA gene deletion and clot lysis studies showed the activators have complementary functions, requiring both for a full effect at fibrin-specific doses. They are also synergistic in combination thereby requiring lower doses for efficacy. A clinical proof of concept study in 101 AMI patients who were treated with a 5 mg bolus of tPA followed by a 90 minute infusion of prouPA, the native form of uPA. A near doubling of the 24 h TIMI-3 infarct artery patency rate was obtained compared to that in the best of the tPA trials (GUSTO). In further contrast to tPA, there were no reocclusions and the mortality was only 1% [1]. A sequential combination of both activators, mimicking natural fibrinolysis, holds promise to significantly improve the efficacy and safety of therapeutic fibrinolysis.
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Histological clonal change - A feature for dysplasia diagnosis

Published on: 28th August, 2018

OCLC Number/Unique Identifier: 7856144153

Aims: Histological diagnostic criteria are used for the assessment of the degree of dysplasia and hence the risk of cancer progression for premalignant lesions. Clonal changes in the form of hyperorthokeratosis and hyperchromasia that are sharply demarcated from adjacent areas are not currently part of the criterion for dysplasia diagnosis. The objective of this study was to determine whether such clonal change should be regarded as a diagnostic feature for dysplasia. The following histological conditions were used to define such change: (1) hyperorthokeratosis; (2) hyperchromatism but no other features of dysplasia; (3) sharp margin demarcation from adjacent area by both the hyperorthokeratosis and hyperchromasia (clonal change), and (4) no prominent rete ridges, marked acanthosis or heavy inflammation. Lesions fitting these criteria were termed orthokeratotic lesions with no dysplasia. Methods: Patients from a population-based longitudinal study with more than 10 years of follow up were analyzed. Of the 214 patients with primary oral premalignant lesions, 194 had mild or moderate dysplasia (dysplasia group) and 20 fit the criteria for orthokeratotic lesions without dysplasia (orthokeratotic with no dysplasia group). The two groups were compared for their cancer risks using clinical (site and toluidine blue), histological (nuclear phenotype score), and molecular criteria (loss of heterozygosity) and by outcome (progression). Results and conclusions: The lesions from orthokeratotic with no dysplasia group showed a similar cancer risk (clinical, histological and molecular risk) and time to progression as the dysplastic lesions. We recommend that the clonal change should be included as a criterion for dysplasia diagnosis
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Prevalence of premarital sexual practice and associated factors among Goba town high school students, South East-Ethiopia

Published on: 12th March, 2020

OCLC Number/Unique Identifier: 8553234584

Background: Premarital sexual practice significantly attributes for increase adolescent’s risk of unintended pregnancy, early marriage, abortion and STIs. In Ethiopia adolescents were intended to engage at early initiation to sexual intercourse without having proper protection has been one of the concerns. Study aimed to assess the prevalence of premarital sexual practice and associated factors among high school students. Method: A facilities based study design was employed. Data were collected from 291 randomly selected Negade and Finca Bamo high school students using structured questionnaire from June 1-30, 2018. Bi-variate logistic regression used to identify variables that crudely associated and variables with p - value < = 0.05 fitted to multiple logistic regression. Odds ratio with 95% confidence interval was estimated using multivariable logistic regression to identify independent predictors of premarital sex. Result: Among high school students, 31.2% reported had experienced premarital sexual practices. This shows that premarital sexual practices among high school adolescent’s students were high. Drinking alcohol [AOR = 4.06, 95%CI, (2.06 - 7.99)]. Watching pornographic video [AOR: 2.78, 95%CI, (1.45 - 5.3)] and educational status of mothers [AOR: 0.33; 95% CI (0.13, -0.84)] were significantly associated factors. Conclusion: Drinking alcohol, watching pornography and mother education were predominantly significantly associated. Therefore, an integrated effort needs to be highlighted to deter the health behavioral problems of school adolescents at the early stages. 
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Is advanced Coupling Methods best fitted in Biosensing of Microparticles?

Published on: 17th July, 2017

OCLC Number/Unique Identifier: 7317651486

Microparticles (MPs) are considered important diagnostic biological markers in many diseases with promising predictive value. There are several methods that currently used for the detection of number and characterization of structure and features of MPs. Therefore, the MP detection methods have been remained pretty costly and time consuming. The review is depicted the perspectives to use coupling methods for MP measurement and structure assay. Indeed, there is large body evidence regarding that the combination of atomic force microscopy or coupling nanoparticle tracking analysis (NTA) with microbeads, plasmon resonance method and fluorescence quantum dots could exhibit much more accurate ability to detect both number and structure of MPs when compared with traditional flow cytometry and fluorescent microscopy. Whether several combined methods would be useful for advanced MP detection is not fully clear, while it is extremely promising.
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Induction therapy with Erlotinib (E) and Gemcitabine/Platinum (GP) in stage III NSCLC

Published on: 28th January, 2021

OCLC Number/Unique Identifier: 8913463613

Background: In 2004 we started a phase II trial in non-small lung cancer (NSCLC), stage III, with erlotinib followed by a combination with a platinum-based doublet in unselected patients to identify molecular subgroups benefitting from an EGFR targeting approach. Patients and methods: Induction with erlotinib (E, 150 mg, d1-42) was followed by three cycles of gemcitabine (G, 1250 mg/m², d1+d8, q3w) and cisplatin (P, 80 mg/m², d1, q3w). Patients with at least stable disease after E were treated with a GP + E combination. Induction was followed by surgery and radiation. The trial was conducted as a prospective, multi-center, open label, exploratory phase II study to determine pathological response rate (pRR), as well as secondary endpoints disease free survival (DFS) and overall survival (OS). Results: Of 38 prescreened patients 16 were included in the main study. Due to slow recruitment the study had to be terminated early. Combination of E and GP was well tolerated, surgery was feasible after induction therapy in 12 of 16 patients, 7/12 (58%) patients had a major pathological response (MPR). Median overall survival for patients with MPR was 57.7 months (confidence interval (CI), 37.4 to 78.0; n = 7) and for patients without MPR 11.9 months (CI, 6.4 to 17.4; n = 5). 2/16 patients had an epidermal growth factor receptor (EGFR) mutation. Conclusion: Before discovery of distinct molecular mechanisms in NSCLC our study was an attempt to identify clinical and pathological subgroups that would benefit from E induction. Two patients with an EGFR mutation were identified. MPR was a predictor of long term disease free and overall survival.
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Practical implementation of the SWEEP-session of Stimulation-Registration in CI fitting

Published on: 11th October, 2017

OCLC Number/Unique Identifier: 7325438281

Levels of electrically evoked stapedial reflex thresholds (eESRTs) are frequently used as most comfortable levels (MCL) in cochlear implant fitting. The problem of routine one-channel-technique of reflexometry is long duration of this procedure. In order to “compress the time” we suggest method of consecutive stimulation of all electrodes of implant with simultaneous registration of stapedial reflexes-SWEEP-session. Practical implementation of the SWEEP-session is described here. This method has been successfully used in several hundred CI patients. Registration of evoked electrical stapedial reflex thresholds (eESRTs) during CI fitting is long procedure. In order to “compress the time” we suggest our SWEEP-session method. Practical implementation of this SWEEP-session is described here in accordance with the patent of Russian Federation.
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A model of the 2014 Ebola virus: Evidence of West Africa

Published on: 2nd May, 2019

OCLC Number/Unique Identifier: 8164049985

Outbreaks of Ebola virus can cause substantial mortality in affected countries. The largest outbreak of Ebola to date is currently underway in West Africa, with 3944 cases reported as of September 5, 2014. For the sake of deriving a better understanding of the Ebola transmission dynamics, we have undertaken to revisit data from the initial spark of origin of the Ebola virus, which occurred in 1976 in Zaire (now Democratic Republic of Congo). By fitting a mathematical process to time series stratified by disease onset, outcome and source of infection, we have managed to estimate several epidemiological quantities, previously admitted to be too challenging to measure, including hospital and infected community contribution infection to the widespread transmission.
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Dealing with Depression in Family Caregivers

Published on: 27th March, 2017

OCLC Number/Unique Identifier: 7317595274

Aims and objectives: By reporting the use of therapeutic nursing interventions to facilitate the process of change in a depressive elderly caregiver, this paper seeks to underline the importance of fitting interventions to individual clients. Background: In assisting families of chronic illness sufferers, it must be remembered that the perceptions and functions of both clients and families are determined by family members, and that changes, if any, are made by those clients and families, rather than by nurses. However, nurses do play an important role in facilitating the process of change. Design: This is a case report. Methods: A case study of a depressive elderly caregiver is used to examine the use of therapeutic nursing interventions to facilitate the process of change with problem analysis, case conceptualisation and specific skills employed documented. Results: The change from one therapeutic approach (Cognitive-behavioural therapy) to another (Narrative Therapy) facilitates enlisting the caregiver’s unique strengths, resources and competence to overcome the difficulties and challenges identified during the process of change. In dealing with depression in family caregivers, nurses should not only be flexible but also remain sceptical in using different approaches, with heightened awareness of the client’s circumstances.
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Ground-state bands of doubly even 166Hf Nucleus

Published on: 15th July, 2020

OCLC Number/Unique Identifier: 8656796393

This study was carried out to investigate the rotational structure of even-even 166Hf isotopes using the phenomenological fitting, Sood’s semi-empirical formula. The rotational energies from the calculated values were compared to the experimental spectrum. The result shows that in 166Hf, calculated energies fit the experimental values to a remarkable degree of accuracy.
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FITT-CORRECT: Updated dynamic and evidence-based principle of exercise prescription

Published on: 15th February, 2021

OCLC Number/Unique Identifier: 9038777023

Objective: The FITT (Frequency, Intensity, Time, and Type) principle is an effective foundation in EP. However, the CORRECT components; C–Combination of interventions, O–Order of the Interventions, R–Repetitions, R–Rest period between sets and between sessions, E–Exercise at home, C–Cognitive domain, T–Total dose and re-evaluation plans, should be considered. The purpose of this paper was to describe the updated dynamic and evidence based FITT-CORRECT principle of EP and demonstrates its application using a case study. Results: Literatures, related to EP, clinical reasoning and clinical decision-making, were critically reviewed. Established evidence is summarized to describe an updated dynamic and evidence-based principle of EP. The gaps within the FITT and other related principles of EP are addressed. The FITT-CORRECT principle was introduced and an effective outcome of the updated principle was demonstrated using a case study. The FITT-CORRECT principle integrates many components that are missing in the FITT and other related EP principles. Based on the reported case study, the FITT-CORRECT principle of EP should optimize patients’ intervention outcomes. Physiotherapists can potentially improve their EP by utilizing the FITT-CORRECT in clinical practice.
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Assessment of knowledge, practice and associated factors towards prevention of novel corona virus among clients attending at Debre Tabor General Hospital, Debre Tabor Town, North West Ethiopia, 2020: Institutional based cross-sectional study

Published on: 7th December, 2020

OCLC Number/Unique Identifier: 8872655439

Background: Corona virus disease is a highly infectious disease caused by the newly innovated corona virus. An emerging respiratory disease was abbreviated as COVID-19, after it has been first reported in December 2019 in Wuhan city of China. Ethiopia Ministry of health initiated multidisciplinary approach to tackle COVID-19 of which awareness creation is the main. The aim of this study is to assess knowledge, practice and associated factors towards prevention of novel corona virus among clients in Debre Tabor general hospital, Northwest Ethiopia, 2020. Methods: Institution based cross sectional study design was conducted in Debre Tabor General hospital from May 15 to May 30, 2020. A structured questionnaire was used for data collection. The data were entered into epi data version 4.4 and exported to SPSS window version 25 for analysis. Binary and multivariable logistic regression was fitted. Odds Ratios with 95% Confidence interval and p - value ≤ 0.05 were considered to assert significance. Result: A total of 345 clients were analyzed and the response rate was 96.4%. The mean age was 32.95 with S.D ± 13.18 years. Majority of the respondents were male (75.7%). Among the study participants 54.2% with (95% CI: [49.0, 59.2%]) and 49.0% with (95% CI: [43.5, 53.4%]) have good knowledge and god practice on COVID-19 preventions respectively. Sex AOR: 4.33 (2.06, 9.09), family size AOR: 2.49 (1.01, 6.15 and heard from social media AOR: 2.78 (1.21, 6.39) were significantly associated with knowledge of respondents. Knowledge AOR: 3.11 (1.59, 6.10) was significantly associated with practice of clients. Residency and those heard from TV were significant variables for both. Conclusion and recommendation: In this study the overall knowledge and preventive practices of the respondents were found to be low. Sex, family size, residency and sources of information were associated factors for knowledge. In addition to this knowledge was significant factor for practice. Health education programs aimed at mobilizing and improving COVID-19 related knowledge and practice intend to be strengthened.
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Nonlinear relationship between blood glucose and 30-day mortality in critical patients with acute kidney injury: A retrospective cohort study

Published on: 27th April, 2021

OCLC Number/Unique Identifier: 9026723753

Background: Acute kidney injury (AKI) is a major health problem affecting millions of people worldwide. Effective preventative and therapeutic treatments remain to be produced. We aim to determine the association between blood glucose and mortality in critical patients with AKI. Method: This cohort study included 18,703 patients with AKI. The exposure of interest was baseline blood glucose. The outcome was 30-day mortality. Multivariable Cox regression analyses and smooth curve fitting were adopted to assess the independent association between blood glucose and 30-day mortality. Results: We identified 18,703 consecutive individuals with AKI. The average age of the participants was 66.8 ± 16.0 years, and about 42.7% of them were female. The overall 30-day mortality was 16.9%. Through the multivariate COX regression model and smooth curve fitting, we observed that the correlation between blood glucose and 30-day mortality is nonlinear. An inflection point was found at about 5.93 mmol/L. On the left side of inflection point, the effect size was 0.81 (HR: 0.81, 95% CI 0.74-0.89, p < 0.001). On the right side of inflection point, the effect size was 1.02 (HR: 1.02,95% CI 1.01-1.03, p < 0.001). Conclusion: Our study suggested that, among patients with AKI, there was a nonlinearity relationship between blood glucose and mortality in patients with AKI. The optimal of blood glucose associated with the lowest risk of 30-day mortality was around 5.93 mmol/L. 
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