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Search Results: 1 - 10 of 469024 matches for " Mary-Ann A. Mastrangelo "
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IL-6-Mediated Activation of Stat3α Prevents Trauma/Hemorrhagic Shock-Induced Liver Inflammation
Ana Moran, Stephen A. Thacker, Ayse Akcan Arikan, Mary-Ann A. Mastrangelo, Yong Wu, Bi Yu, David J. Tweardy
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0021449
Abstract: Trauma complicated by hemorrhagic shock (T/HS) is the leading cause of morbidity and mortality in the United States for individuals under the age of 44 years. Initial survivors are susceptible to developing multiple organ failure (MOF), which is thought to be caused, at least in part, by excessive or maladaptive activation of inflammatory pathways. We previously demonstrated in rodents that T/HS results in liver injury that can be prevented by IL-6 administration at the start of resuscitation; however, the contribution of the severity of HS to the extent of liver injury, whether or not resuscitation is required, and the mechanism(s) for the IL-6 protective effect have not been reported. In the experiments described here, we demonstrated that the extent of liver inflammation induced by T/HS depends on the duration of hypotension and requires resuscitation. We established that IL-6 administration at the start of resuscitation is capable of completely reversing liver inflammation and is associated with increased Stat3 activation. Global assessment of the livers showed that the main effect of IL-6 was to normalize the T/HS-induced inflammation transcriptome. Pharmacological inhibition of Stat3 activity within the liver blocked the ability of IL-6 to prevent liver inflammation and to normalize the T/HS-induced liver inflammation transcriptome. Genetic deletion of a Stat3β, a naturally occurring, dominant-negative isoform of the Stat3, attenuated T/HS-induced liver inflammation, confirming a role for Stat3, especially Stat3α, in preventing T/HS-mediated liver inflammation. Thus, T/HS-induced liver inflammation depends on the duration of hypotension and requires resuscitation; IL-6 administration at the start of resuscitation reverses T/HS-induced liver inflammation, through activation of Stat3α, which normalized the T/HS-induced liver inflammation transcriptome.
Malaria among Children in Suriname, South America  [PDF]
Mary-Ann Wagijo, Edward van Eer, Remy A. Hirasing
Advances in Infectious Diseases (AID) , 2016, DOI: 10.4236/aid.2016.62006
Abstract: Malaria in children is a serious infectious disease. In Suriname, many children died due to malaria in the past. To prevent malaria in children, anti-malaria campaigns were executed. The last campaign was implemented from 2005 to 2010. To develop a strategy for the future, the current prevalence and mortality rates are needed. Since 1955, all confirmed malaria cases were registered by the Medical Mission and this database was used to determine the prevalence rate. For the mortality rates we used the cause of death which was registered on death certificates. Since 2005 no children died due to malaria. Also the prevalence rate dropped dramatically from 7255 in 2001 to 10 in 2014. However, despite these great results, 10 children were still diagnosed with malaria and there is a need for continuous attention to bring this number down to zero. The mobile goldmine workers can impose a threat for a new malaria epidemic, if they spread the malaria infection in Suriname. Therefore, effective prevention measures and treatment are still needed.
Prevention of Hypovolemic Circulatory Collapse by IL-6 Activated Stat3
Jeffrey A. Alten, Ana Moran, Anna I. Tsimelzon, Mary-Ann A. Mastrangelo, Susan G. Hilsenbeck, Valeria Poli, David J. Tweardy
PLOS ONE , 2008, DOI: 10.1371/journal.pone.0001605
Abstract: Half of trauma deaths are attributable to hypovolemic circulatory collapse (HCC). We established a model of HCC in rats involving minor trauma plus severe hemorrhagic shock (HS). HCC in this model was accompanied by a 50% reduction in peak acceleration of aortic blood flow and cardiomyocyte apoptosis. HCC and apoptosis increased with increasing duration of hypotension. Apoptosis required resuscitation, which provided an opportunity to intervene therapeutically. Administration of IL-6 completely reversed HCC, prevented cardiac dysfunction and cardiomyocyte apoptosis, reduced mortality 5-fold and activated intracardiac signal transducer and activator of transcription (STAT) 3. Pre-treatment of rats with a selective inhibitor of Stat3, T40214, reduced the IL-6-mediated increase in cardiac Stat3 activity, blocked successful resuscitation by IL-6 and reversed IL-6-mediated protection from cardiac apoptosis. The hearts of mice deficient in the naturally occurring dominant negative isoform of Stat3, Stat3β, were completely resistant to HS-induced apoptosis. Microarray analysis of hearts focusing on apoptosis related genes revealed that expression of 29% of apoptosis related genes was altered in HS vs. sham rats. IL-6 treatment normalized the expression of these genes, while T40214 pretreatment prevented IL-6-mediated normalization. Thus, cardiac dysfunction, cardiomyocyte apoptosis and induction of apoptosis pathway genes are important components of HCC; IL-6 administration prevented HCC by blocking cardiomyocyte apoptosis and induction of apoptosis pathway genes via Stat3 and warrants further study as a resuscitation adjuvant for prevention of HCC and death in trauma patients.
Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia
Della A Forster, Helen L McLachlan, Jane Yelland, Jo Rayner, Judith Lumley, Mary-Ann Davey
BMC Health Services Research , 2006, DOI: 10.1186/1472-6963-6-83
Abstract: A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73), exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning). Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives) and a medical practitioner from eachselected hospital.Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives) providing postnatal care. Staffing issues impact on hospitals' ability to provide continuity of care. Recruitment and retention of midwives are significant issues, particularly in rural areas.Staffing in postnatal wards is a challenging issue, and varies with hospital locality and model of care. Staff/patient ratios and recruitment of midwives in rural areas are the two areas that appear to have the greatest negative impact on staffing adequacy and provision of quality care. Future research on postnatal care provision should include consideration of any impact on staff and staffing.Having a baby is the most common reason for hospitalisation in Australia, and each year around 63,000 women give birth in Victoria. A decade of Victorian research has found low levels of satisfaction with the hospital stay following birth. Women are less likely to be satisfied with postnatal care than antenatal and intrapart
Opioid Use in Fibromyalgia Is Associated with Negative Health Related Measures in a Prospective Cohort Study
Mary-Ann Fitzcharles,Neda Faregh,Peter A. Ste-Marie,Yoram Shir
Pain Research and Treatment , 2013, DOI: 10.1155/2013/898493
Abstract:
The 2010 American college of rheumatology fibromyalgia survey diagnostic criteria and symptom severity scale is a valid and reliable tool in a French speaking fibromyalgia cohort
Fitzcharles Mary-Ann,Ste-Marie Peter A,Panopalis Pantelis,Ménard Henri
BMC Musculoskeletal Disorders , 2012, DOI: 10.1186/1471-2474-13-179
Abstract: Background Fibromyalgia (FM) is a pain condition with associated symptoms contributing to distress. The Fibromyalgia Survey Diagnostic Criteria and Severity Scale (FSDC) is a patient-administered questionnaire assessing diagnosis and symptom severity. Locations of body pain measured by the Widespread Pain Index (WPI), and the Symptom Severity scale (SS) measuring fatigue, unrefreshing sleep, cognitive and somatic complaints provide a score (0–31), measuring a composite of polysymptomatic distress. The reliability and validity of the translated French version of the FSDC was evaluated. Methods The French FSDC was administered twice to 73 FM patients, and was correlated with measures of symptom status including: Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), McGill Pain Questionnaire (MPQ), and a visual analogue scale (VAS) for global severity and pain. Test-retest reliability, internal consistency, and construct validity were evaluated. Results Test-retest reliability was between .600 and .888 for the 25 single items of the FSDC, and .912 for the total FSDC, with all correlations significant (p < 0.0001). There was good internal consistency measured by Cronbach’s alpha (.846 for FSDC assessment 1, and .867 for FSDC assessment 2). Construct validity showed significant correlations between the FSDC and FIQ 0.670, HAQ 0.413, MPQ 0.562, global VAS 0.591, and pain VAS 0.663 (all p<0.001). Conclusions The French FSDC is a valid instrument in French FM patients with reliability and construct validity. It is easily completed, simple to score, and has the potential to become the standard for measurement of polysymptomatic distress in FM.
Opioid Use in Fibromyalgia Is Associated with Negative Health Related Measures in a Prospective Cohort Study
Mary-Ann Fitzcharles,Neda Faregh,Peter A. Ste-Marie,Yoram Shir
Pain Research and Treatment , 2013, DOI: 10.1155/2013/898493
Abstract: As pain is the cardinal symptom of fibromyalgia (FM), strategies directed towards pain relief are an integral component of treatment. Opioid medications comprise a category of pharmacologic treatments which have impact on pain in various conditions with best evidence for acute pain relief. Although opioid therapy other than tramadol has never been formally tested for treatment of pain in FM, these agents are commonly used by patients. We have examined the effect of opioid treatments in patients diagnosed with FM and followed longitudinally in a multidisciplinary pain center over a period of 2 years. In this first study reporting on health related measures and opioid use in FM, opioid users had poorer symptoms and functional and occupational status compared to nonusers. Although opioid users may originally have had more severe symptoms at the onset of disease, we have no evidence that these agents improved status beyond standard care and may even have contributed to a less favourable outcome. Only a formal study of opioid use in FM will clarify this issue, but until then physicians must be vigilant regarding the multiple adverse consequences of opioid therapy. 1. Introduction Chronic widespread pain is the pivotal symptom of fibromyalgia (FM). In the composite score that has been proposed for the new 2010 diagnostic criteria for FM, pain has been weighted to signify two thirds of the symptom component, with other symptoms including fatigue, sleep disturbance, cognitive changes, and somatic symptoms combined to represent the remaining one third of the symptom complex [1]. It is therefore logical that treatments directed towards pain relief will be an integral part of FM care. Traditional pharmacological treatments for managing pain are centered on simple analgesics, nonsteroidal anti-inflammatory drugs, and the opioid group of medications. Other than tramadol, opioids have never been formally studied as a therapeutic modality in FM and reports of efficacy are based solely on anecdotal and patient report [2]. Opioids are therefore not recommended by any current guidelines for the treatment of FM symptoms. Even in the absence of evidence for effect in FM, about 30% of Canadian and American FM patients reportedly using opioids [3, 4]. Opioids are also perceived by patients to offer the best symptom relief according to an internet survey of persons with self-reported FM [2]. There is however increasing concern regarding the negative effects associated with chronic opioid use, including an increased death rate especially in association with other agents such
COSMOS: COmparing Standard Maternity care with One-to-one midwifery Support: a randomised controlled trial
Helen L McLachlan, Della A Forster, Mary-Ann Davey, Judith Lumley, Tanya Farrell, Jeremy Oats, Lisa Gold, Ulla Waldenstr?m, Leah Albers, Mary Biro
BMC Pregnancy and Childbirth , 2008, DOI: 10.1186/1471-2393-8-35
Abstract: A two-arm RCT design will be used. Women who are identified at low medical risk will be recruited from the antenatal booking clinics of a tertiary women's hospital in Melbourne, Australia. Baseline data will be collected, then women randomised to caseload midwifery or standard low risk care. Women allocated to the caseload intervention will receive antenatal, intrapartum and postpartum care from a designated primary midwife with one or two antenatal visits conducted by a 'back-up' midwife. The midwives will collaborate with obstetricians and other health professionals as necessary. If the woman has an extended labour, or if the primary midwife is unavailable, care will be provided by the back-up midwife. For women allocated to standard care, options include midwifery-led care with varying levels of continuity, junior obstetric care and community based general medical practitioner care. Data will be collected at recruitment (self administered survey) and at 2 and 6 months postpartum by postal survey. Medical/obstetric outcomes will be abstracted from the medical record. The sample size of 2008 was calculated to identify a decrease in caesarean birth from 19 to 14% and detect a range of other significant clinical differences. Comprehensive process and economic evaluations will be conducted.Australian New Zealand Clinical Trials Registry ACTRN012607000073404.Continuity of carer in the provision of maternity care has been strongly recommended and encouraged in Victoria and throughout Australia. The Victorian Department of Human Services (DHS) released a policy document "Future directions for Victoria's maternity services" [1] in June 2004 which endorsed and promoted the expansion of public models of maternity care that offer continuity of carer. Many hospitals have responded by introducing caseload midwifery, a one to one midwifery model of care in which women are cared for by a primary midwife throughout pregnancy, birth and the early postnatal period; a model of care
The Clinical Concept of Fibromyalgia as a Changing Paradigm in the Past 20 Years
Mary-Ann Fitzcharles,Muhammad B. Yunus
Pain Research and Treatment , 2012, DOI: 10.1155/2012/184835
Abstract: Fibromyalgia (FMS) is a valid clinical condition that affects 2%–4% of the population with a pivot symptom of widespread body pain. The cause and cure of FMS are as yet unknown. The concept of FMS has evolved over the past two decades to incorporate symptoms beyond pain as contributing to the global spectrum of suffering. FMS is now recognized to be grounded in the neurological domain with evidence of dysregulation of pain processing. Appreciation of the neurophysiologic mechanisms operative in FMS has contributed to rational treatment recommendations, although a “gold standard treatment” does not currently exist. Ideal treatments for FMS patients should be individualized with emphasis on active patient participation, good health practices, and multimodal intervention, incorporating nonpharmacologic and pharmacologic treatments. Predictors of outcome, which is favourable in over 50% of patients, are unknown, but those with better outcome do more physical activity and use fewer medications. 1. Introduction 1.1. The Coming of Age after 20 Years Fibromyalgia (FMS) is a condition characterized by the pivot symptom of pain throughout the body, and with abnormality centered in the nervous system [1]. Over the past 20 years, knowledge regarding both the clinical as well as the neurophysiological basis for this condition has accumulated. FMS affects 2%–4% of populations worldwide and is a cause of considerable suffering and functional impairment [2]. The clinical concept of FMS was initially described by Yunus and colleagues and crystallized by the publication of the 1990 American College of Rheumatology (ACR) criteria for the classification of FMS [3, 4]. An evolution of the clinical understanding of FMS over the last two decades has emphasised the importance of symptoms beyond pain which form an integral part of this condition and contribute to global suffering. In this context, it became necessary for the criteria for a diagnosis of FMS to be reevaluated. The coming of age of FMS was heralded by the publication of updated criteria for the diagnosis of FMS, taking into consideration additional symptoms that are present to a variable degree in individual patients [5]. In addition, the new concept of FMS recognizes that symptoms are not an all-or-none phenonemon, but can be expressed with varying severity with periods of waxing and waning [6]. Neurophysiological studies have contributed to the acceptance of FMS as a valid condition. Demonstration of objective changes in the research setting has given clinicians the confidence to acknowledge a condition that
Provider-Initiated HIV Testing and Counselling for Children
Mary-Ann Davies ,Emma Kalk
PLOS Medicine , 2014, DOI: 10.1371/journal.pmed.1001650
Abstract:
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