The efficacy of valproate in acute mania, bipolar depression and maintenance therapy for bipolar disorder: an overview of systematic reviews with meta-analyses.

Objective: This study aims to conduct an overview on the comparative efficacy of valproate in acute mania, bipolar depression and maintenance treatment of bipolar disorder (BD).

Method: We performed an overview of systematic reviews with meta-analyses of randomised controlled trials (RCTs), registered in PROSPERO (CRD42024497749). We searched Medline and Cochrane Database of Systematic Reviews.

Correlation between levels of perceived stress and depressive symptoms in the functional disability of patients with fibromyalgia.

Objective: The aim of this study was to evaluate the factors that are most correlated with the levels of functional disability in patients with fibromyalgia.

Methods: This is a cross-sectional descriptive study in which 42 patients diagnosed with fibromyalgia according to the criteria of the American College of Rheumatology reported their status using the following questionnaires: the Beck Depression Inventory, the Perceived Stress Scale 14, the Revised Fibromyalgia Impact Questionnaire, the Visual Analog Pain Scale, and the Health Assessment Questionnaire.

Results: Moderate to severe levels of depression (Beck Depression Inventory: 22.

Management of common mental disorders should take place in primary health or specialized care? Clinical decisions of psychiatrists from Latin American countries.

Objective: The objective of our study was to explore clinical decisions of psychiatrists regarding the management of common mental disorders in primary care (PC) in four Latin Americans countries, through the application of clinical vignettes.

Methods: Using a cross-sectional design, we conducted a self-administered online questionnaire survey of psychiatrists from Bolivia, Brazil, Cuba, and Chile. The questionnaire covered sociodemographic and professional information.

Neutrophil-to-Lymphocyte Ratio Predicts Cancer Outcome in Locally Advanced Clear Renal Cell Carcinoma.

Background: To evaluate the association of neutrophil-to-lymphocyte ratio (NLR) with recurrence-free survival (RFS) and overall survival (OS) in patients with locally advanced nonmetastatic clear cell renal cell carcinoma (ccRCC) undergoing radical nephrectomy.

Material And Methods: We retrospectively identified 880 nephrectomies performed between January 2009 and December 2016 in a single center, reviewed data from 478 radical nephrectomies for kidney tumors and identified 187 patients with locally advanced nonmetastatic ccRCC (pT3-T4 N0M0). NLR was obtained preoperatively and calculated by dividing absolute neutrophil count by absolute lymphocyte count.

Adaptation to Brazilian Portuguese and Latin-American Spanish and psychometric properties of the Mental Illness Clinicians' Attitudes Scale (MICA v4).

Objective: To describe translation to Spanish and Portuguese and adaptation of the Mental Illness Clinicians' Attitudes Scale version 4 (MICA v4).

Methods: The questionnaire was administered to primary care physicians (PCPs) from four Latin-American countries, Brazil, Bolivia, Chile, and Cuba. The validation process included four phases: 1) translation of the questionnaire to Spanish and Portuguese; 2) assessment of face validity; 3) assessment of reliability; and 4) evaluation of construct validity with confirmatory factor analysis (CFA).

Real estate data to analyse the relationship between property prices, sustainability levels and socio-economic indicators.

Recent studies have sought to explore the relationship between environmental and financial performance, in particular the relationship between the energy efficiency level of a building and its financial value. The present real estate dataset contains 43 variables of repeat sales transactions, energy performance certificate (EPC) rating, index of multiple deprivation (IMD), and geographical location of properties in England and Wales involved in a total of 4,201 transactions from 1995 to 2012. This dataset enables researchers and practitioners to further explore important questions regarding the nexus between the real estate industry, sustainability levels, and socio-economic aspects.

Sphere-sphere intersection for investment portfolio diversification - A new data-driven cluster analysis.

Aiming at supporting the process of investment portfolio diversification by using a data-driven approach, the present methodological paper proposes a new cluster analysis, which compares publicly traded companies, mainly in times of high volatility (e.g. crisis times).

Skin manifestations of tick bites in humans.

Ticks are blood-sucking arthropods that attach to human skin through oral devices causing diverse initial cutaneous manifestations, and may also transmit serious infectious diseases. In certain situations, the Health Teams (and especially dermatologists) may face difficulties in identifying the lesions and associating them to the parasites. To assist them in clinical diagnosis, we suggest a classification of the skin manifestations in primary lesions, which occur by the attachment the tick to the host (for toxicity and the anticoagulant substances in the saliva and/or marked inflammation by the penetration and permanence of the mouthparts) and secondary lesions that are manifestations of infections caused by rickettsia, bacteria, protozoa and fungi inoculated by the ticks.

Building Connections With Patients and Families in the Intensive Care Unit: A Canadian Top-Performer Success Story.

Consumers are increasingly becoming the voice and impetus for hospital organizational change in the United States. This is in part due to their increased stake in cost sharing with hospitals, health systems, and the ambulatory setting and revisions to health plans with higher deductibles and copays. With customers wanting services better, faster, and more economical than in the past, organizations need to break the ceiling on improvement levels for exceeding expectations of patient experience.

Inhibition of Epithelial-mesenchymal Transition in Response to Treatment with Metformin and Y27632 in Breast Cancer Cell Lines.

Background: ROCK-1 expression is associated with the malignant character of tumors, while inhibiting this molecule results in a significant suppression of tumor metastasis. Likewise, transforming growth factor beta (TGF-β) is associated with this malignancy by having the ability to induce epithelial-mesenchymal transition (EMT). Metformin, a drug used in the treatment of diabetes, has previously been shown to inhibit EMT in breast cancer cells.

Patient with a Starr-Edwards prosthesis in the aortic position for 40 years.

Herein is reported the case of a patient who presented initially with aortic insufficiency and a fistula between the sinus of Valsalva and right atrium when aged 31 years. Closure of the fistula and replacement of the aortic valve with a Starr-Edwards A-9 caged-ball prosthesis was performed in 1972, since when the valve has survived for 40 years without dysfunction. This is one of the longest follow ups of the Starr-Edwards prosthesis reported, and highlights the possibility of acceptable valve performance over long periods of time.

Compliance with surgical care improvement project blood glucose--a marker for euglycemia, but does it put our patients at risk?

To improve outcomes in open heart surgery (OHS) patients, the Surgical Care Improvement Project (SCIP) requires 6 am postoperative day (POD) 1 and 2 blood glucose (BG) to be ≤200mg/dL. This study examined risk factors for SCIP noncompliance when using an insulin infusion protocol (IIP) and evaluated this SCIP metric as a surrogate for glycemic control. The authors divided 99 consecutive OHS patients, all subjected to 1 uniform IIP, into 2 groups: Group 1-SCIP compliant (n=79) and Group 2-SCIP noncompliant (n=20).

[Rheumatoid arthritis and cardiovascular disease: what is known about this relationship and what can currently be done for affected patients?].

There is increasing interest in autoimmune diseases, especially their relationship with cardiovascular disease. Rheumatoid arthritis in particular has been considered an independent risk factor for coronary artery disease in recent years. Various studies have aimed to clarify important aspects of risk stratification and treatment options in patients with rheumatoid arthritis, and specific therapies are being studied that promise to reduce their long-term cardiovascular risk.

Cardiothoracic surgeon management of postoperative cardiac critical care.

Objective: To determine whether postoperative cardiac care by cardiothoracic surgeons in a semiclosed intensive care unit model could be distinguished from that given by intensivists who are not board certified in cardiothoracic surgery.

Design: From January 2007 to February 2009, we retrospectively examined data on patients after cardiac operations from 2 consecutive periods during which full-time management of intensive care was changed from noncardiothoracic intensivists (period 1, 168 patients) to cardiothoracic surgeons (period 2, 272 patients).

Main Outcome Measures: Variables measured included Society of Thoracic Surgeons observed and expected mortality, central venous line infections, ventilator-acquired pneumonia, red blood cell exposure, adherence to blood glucose level target at 6 am on the first and second postoperative days, length of stay, and intensive care unit pharmacy costs.

Intense implementation of a strict insulin infusion protocol does not guarantee postoperative glycemic control.

Background: The Surgical Care Improvement Project (SCIP) has benchmarked 6:00 AM blood sugars on postoperative days (PODs) 1 and 2 at <200 mg/dL as an indicator of overall glycemic control (GC) in postoperative cardiac surgery patients. However, even in demonstration hospitals that publicly report for incentive payments, only 10% are compliant with this benchmark. The objectives of this study were to validate that the SCIP indicator correlates with overall GC, and relate the intensity of implementation of an insulin infusion protocol (IIP) (goal, blood sugar 100 to 140 mg/dL) to effective GC.

Atrial fibrillation correction surgery: lessons from the Society of Thoracic Surgeons National Cardiac Database.

Background: We used The Society of Thoracic Surgeons National Cardiac Database to document the utilization of surgical atrial fibrillation (AF) correction procedures in North America. We also examined the subset of patients having mitral valve surgery to determine whether concurrent surgical AF correction procedures were associated with an increased risk of morbidity or mortality.

Methods: Retrospective review of outcomes for 67,389 patients with AF having cardiac surgery between January 2004 and December 2006 was conducted.

Induction immunosuppression after heart transplantation: monoclonal vs. polyclonal antithymoglobulins. Is there a difference?

Induction immunosuppression after heart transplantation is believed to reduce the risk of acute graft rejection. While monoclonal and polyclonal antithymoglobulins are considered the optimal induction agents, controversy remains regarding their relative superiority. This article presents a systematic review of the literature and a meta-analysis in order to assess the relative benefits and side-effects of monoclonal vs.

Clinical outcomes are similar in pulsatile and nonpulsatile left ventricular assist device recipients.

Background: Despite concerns about the adequacy of support provided by continuous-flow left ventricular assist devices (LVADs), direct comparisons of patient characteristics and outcomes between first-generation pulsatile and second-generation nonpulsatile LVADs are absent. We hypothesized that a nonpulsatile Jarvik 2000 LVAD (Jarvik Heart, Inc, New York, NY) would result in comparable outcomes to those of similarly ill patients implanted with a pulsatile LVAD (Novacor, WorldHeart Inc, Oakland, CA; and HeartMate XVE, Thoratec, Pleasanton, CA).

Methods: We retrospectively compared common pre-LVAD clinical characteristics and indicators of heart failure severity between 13 pulsatile and 14 nonpulsatile LVAD recipients.

Angiographic, pathologic, and clinical relationships in coronary artery disease in cardiac allografts.

Background: To date, the etiologic factors involved in the development of allograft coronary disease remain speculative and the treatment uncertain. The purpose of this study was to review the relationship of clinical, angiographic, and pathologic features of cardiac allograft vascular disease in a large population of heart transplant recipients followed for up to 15 years.

Methods: From 1981 to 1996, 789 angiograms from 255 cardiac allografts were reviewed to determine the prevalence and severity of coronary artery disease.

Left Ventricular Assist Devices for the Treatment of Congestive Heart Failure.

The mainstay of heart failure therapy is aggressive medical management with consideration of resynchronization therapy and automatic implantable cardioverter-defibrillator. This is best done with the support of a multidisciplinary team. Transplantation, when possible, remains the therapy of choice for patients who are refractory to medical therapy.

Intercontinental LVAS patient transport.

Mechanical circulatory support is currently indicated for patients with cardiac insufficiency as a bridge to transplantation or as a bridge to recovery. These systems continue to evolve and improve, and many patients (after they are stabilized) are now able to be discharged from the hospital. This article reports our experience with the intercontinental transportation of a patient while being supported with a Novacor left ventricular assist system (WorldHeart Corp, Ottawa, Canada).

Clinical outcomes with the Hancock II bioprosthetic valve.

Background: The Hancock II bioprosthetic valve, which was first introduced to clinical use in 1978, differs from its predecessor in several ways. This study was designed to evaluate the durability and outcomes with this valve in patients who had isolated aortic or mitral valve replacements.

Methods: From 1991 to 1999, 459 patients underwent aortic valve replacement and 138 patients underwent mitral valve replacement with the Hancock II bioprosthesis (Medtronic Inc, Minneapolis, MN).

Virtual anatomical three-dimensional fit trial for intra-thoracically implanted medical devices.

Our purpose is to develop a system that converts computed tomography (CT) scans into an interactive three-dimensional (3-D) model of the thoracic cavity. This study will allow for the preoperative determination of optimal anatomical fit of intra-thoracically implanted medical equipment such as circulatory support devices. From the radiology data bank, we consecutively selected 34 cardiac and 42 noncardiac patients who had CT scans of the chest.