Multiple rare variants in high-risk pancreatic cancer-related genes may increase risk for pancreatic cancer in a subset of patients with and without germline CDKN2A mutations

Abstract

The risk of pancreatic cancer (PC) is increased in melanoma-prone families but the causal relationship between germline CDKN2A mutations and PC risk is uncertain, suggesting the existence of non-CDKN2A factors. One genetic possibility involves patients having mutations in multiple high-risk PC-related genes; however, no systematic examination has yet been conducted. We used next-generation sequencing data to examine 24 putative PC-related genes in 43 PC patients with and 23 PC patients without germline CDKN2A mutations and 1001 controls. For each gene and the four pathways in which they occurred, we tested whether PC patients (overall or CDKN2A+ and CDKN2A− cases separately) had an increased number of rare nonsynonymous variants. Overall, we identified 35 missense variants in PC patients, 14 in CDKN2A+ and 21 in CDKN2A− PC cases. We found nominally significant associations for mismatch repair genes (MLH1, MSH2, MSH6, PMS2) in all PC patients and for ATM, CPA1, and PMS2 in CDKN2A− PC patients. Further, nine CDKN2A+ and four CDKN2A− PC patients had rare potentially deleterious variants in multiple PC-related genes. Loss-of-function variants were only observed in CDKN2A− PC patients, with ATM having the most pathogenic variants. Also, ATM variants (n = 5) were only observed in CDKN2A− PC patients with a family history that included digestive system tumors. Our results suggest that a subset of PC patients may have increased risk because of germline mutations in multiple PC-related genes.

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How Variable Is Our Delivery of Information? Approaches to Patient Education About Oral Chemotherapy in the Pediatric Oncology Clinic

In pediatric patients with acute lymphoblastic leukemia, adherence to oral chemotherapy relies largely on a parent's comprehension of the drug's indication and administration guidelines. We assessed how pediatric oncology providers educate families about oral chemotherapy. We conducted a cross-sectional survey of 68 physicians and nurses from 9 institutions in the Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium. The inter-individual approach to patient education is variable and may consist of handouts, treatment calendars, and discussions.

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Epidemiological Analysis of Ocular Melanoma in University Clinic Center in Tuzla, Bosnia and Herzegovina

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Amra Nadarevic Vodencarevic, Vahid Jusufovic, Svjetlana Terzic, Musfaha Burgic, Meliha Halibasic, Mersiha Sinanovic.
Aim: Melanoma represents a malignant tumour arising from melanocytes. Uveal melanoma is the most common primary ocular malignancy among the adult population. The aim of the study was to examine epidemiological characteristics of ocular melanoma in University Clinic Centre in Tuzla, Bosnia and Herzegovina from January 2001 till November 2015. Methods and Materials: In this retrospective study we used all available medical documentation to investigate the clinical findings which included age, gender, tumour size, histopathological features and the precise anatomic origin of the ocular melanoma. Results: Over the 14 year period of this study, there were 32 patients with microscopically confirmed ocular melanoma at the Department of Pathology. All malignant melanoma were uveal origin. Discussion and conclusion: For early detection of the disease, regular checkups are necessary, especially in older population. As there is a limited number of reports on the epidemiology of malignant tumors of eye and ocular adnex in our region, this is very important study. We conclude that this is a first study in Bosnia and Herzegovina that document the number of uveal melanomas.


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Are Macro and Micro Environment Affecting Management of Fresh Water Resources? A Case from Iran with PESTLE Analysis

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Golrokh Atighechian, Mohammad Reza Maleki, Aidin Aryankhesal, Katayoun Jahangari.
Introduction: Oil spill in fresh water can affect ecological processes and accordingly it can influence human health. Iran, due to having 58.8 % of the world oil reserves, is highly vulnerable to water contamination by oil products. Aim: The aim of this study was to determine environmental factors affecting the management of the oil spill into one of the river in Iran using the PESTLE analysis. Material and methods: This was a qualitative case study conducted in 2015 on an oil spill incident in Iran and its roots from a disaster management approach. Semi-structured interviews were conducted for data collection. Seventy managers and staffs with those responsible or involved in oil spill incident management were recruited to the study. Qualitative content analysis approach was employed for the data analysis. Document analysis was used to collect additional information. Results: Findings of the present study indicated that different factors affected the management of the event of oil spill onto one of the central river and consequently the management of drink water resources. Using this analysis, managers can plan for such events and develop scenarios for them to have better performance for the future events.


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Hyperhomocysteinemia and Its Treatment in Patients with Parkinsons Disease

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Omer C. Ibrahimagic, Dzevdet Smajlovic, Zikrija Dostovic, Zejneba Pasic, Suljo Kunic, Amra Iljazovic, Denisa Salihovic Hajdarevic.
Introduction: Homocysteine is process-product of methionine demethylation. It has proatherogenic, prothrombotic, prooxidative, proapoptotic, osteoporotic, neurotoxic, neuroinflamatory, and neurodegenerative effects. Hyperhomocysteinemia correlates with C667T MTHFR mutation, decrease of folic acid and vitamin B, as well as prolonged use of certain medications. Materials and Methods: We measured levels of homocysteine in thirty patients (15::15) with de novo Parkinsons disease, with average age 64.17 ± 13.19 (28-82) years (Department of Neurology, University Clinical Center Tuzla). Normal level of homocysteine for women was 3.36-20.44 micromole/l and 5.9-16 micromole/l for men. We followed the effects of medicament approach (folic acid) every six months for next five years. Results: 20% of patients with de novo Parkinsons disease exhibited hyperhomocysteinemia. An average level of homocysteine was 13.85 ± 5.82 micromole/l. Differences due to age and homocysteine levels, regardless of sex, were not concluded. For the next five years intake of folic acid (periodically, 1-2 months, 5 mg per day, orally) was effective to normalized levels of homocysteine in all. Conclusion: Hyperhomocysteinemia is present in every fifth patient with de novo Parkinsons disease. Folic acid is medication of choice in treatment of hyperhomocysteinemia coexisting with Parkinsons disease.


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Beliefs About Medicines in Patients with Hypertension: the Instrument Validity and Reliability in Iran

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Firoozeh Mostafavi, Arash Najimi, Gholamreza Sharifirad, Parastoo Golshiri.
Purpose: Despite the importance of patients believes as one of the most important predictors of treatment adherence behavior, it is rarely considered in numerous studies. Then the current survey was aimed to develop and study the beliefs about medicines questionnaire (BMQ) in patients with hypertension. Materials and Methods: The BMQ developed by Horn and et al. was used in the current study. This questionnaire included 18 questions in both public and private beliefs regarding drug. Face and content validity of the tool was investigated using experts panel. In final, aforementioned tool was tested in 612 participants. To explore structure validity and internal consistency, exploratory and confirmatory factor analysis and alpha coefficient was conducted. To evaluate the final validity of instrument, the mean score of the beliefs about medicines of patients with appropriate medication adherence were compared to patients without medication adherence. Results: The mean age of patients was 44.08 ± 10.38 years. Women were 314 of participants. Calculated face validity by the impact score for each item indicated that all the items of the questionnaire had the impact score of more than 1.5. In total, all items had scored higher than 0.79 by considering 18 items for content validity. The average of content validity index for the questionnaire was 0.93. Load of factors were in the range of 0.51 to 0.79. Four items explained % 57 of the total variance. Comparison of all instrument items in the two groups showed that patients with good adherence had higher score in 15 items (% 83 of all items). Conclusion: The findings suggested that the BMQ in patients with hypertension as a valid and reliable instrument can be used to evaluate the patients medication adherence.


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Mothers Satisfaction with Treatment Opportunities for their Children with Autism Spectrum Disorder in Bosnia and Herzegovina

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Elvira Mujkanovic, Haris Memisevic, Edin Mujkanovic, Sadata Zecic, Inga Biscevic.
Aim: The goal of this study was to examine the general satisfaction of mothers of children with autism spectrum disorder (ASD) with treatment opportunities for their children in Bosnia and Herzegovina. An additional goal was to assess the level of mothers satisfaction with their own involvement in the creation and implementation of Individual Education Plans. Methods: The sample consisted of 98 mothers of children with ASD. Mothers answered to questions related to their perceived satisfaction with treatment options. Results: The results of this study indicated that mothers are generally satisfied with educational opportunities for their children (61.2%). However, their satisfaction with involvement in the creation and implementation of Individual Education Programs was much lower (35.7%). Most comments of the mothers were that the treatment options should be more widely available and that the educational programs could be improved. Conclusions: Parents of children with ASD should have more information on the treatment options available for their children. More educational opportunities need to be offered to children with ASD in Bosnia and Herzegovina.


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The Effect of Educational Intervention on Knowledge and Self-efficacy for Pain Control in Patients with Multiple Sclerosis

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Seyde Shahrbanoo Daniali, Hossein Shahnaz, Samira Kazemi, Elnaz Marzbani.
Introduction: Multiple Sclerosis (MS) is one of the most common autoimmune diseases affecting the central nervous system. The prevalence of it is increasing in our country too. The pain from disorders can affect quality of life. Several studies have pointed to the improvement of patients through educational intervention. This study attempted to evaluate the effectiveness of an educational intervention based on raising the awareness and self-efficacy for pain control among patients with multiple sclerosis during 2015 under the coverage of Isfahan MS Society (IMSS). Materials and methods: This was a quasi-experimental study involving pre-test, post-test and randomized control group conducted on 100 patients with MS referred to the Isfahan MS Society (IMSS). The educational intervention group learned the pain management self-care lesson during 4 weekly sessions. The data were collected through a self-structured questionnaire with adequate validity and reliability, containing demographic data, awareness and self-efficacy of pain control. The data were assessed through descriptive and analytical tests assisted by SPSS 17. The significant level was considered as P


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Parents Attitudes on the Introduction of Health Education in the Education System

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Branko Kristo, Ljubica Cuk, Ivanka Krzelj.
Introduction: We explored parents views on the introduction of HE into the educational system, as well as differences in the degree of agreement, depending on the gender of the respondents, the school which the children attend and childrens age. Patients and methods: Examinees in this study were parents (N = 531) of children attending primary and secondary schools in the area of Municipality Livno. The study was conducted by using cross-sectional study and a special questionnaire was created assessing attitudes on the introduction of HE in the education system which contains 26 items. Results: Parents have positively disposed towards the introduction of HE in schools (M = 2.85) if it would be carried out according to previously anticipated and clearly defined literature (M = 3.89), which they should be pre-acquainted with (M = 3.78). They also consider that the lecturers should be exclusively health workers (M = 3.50) and certainly should cover the topics of the quality of human life (M = 4.07), the prevention of addiction (M = 4.03), prevention of bullying (M = 4.14) and the culture of social communication (M = 4.15). Surely the content of the lectures should be adapted to the age of the child and should be adjusted with the principles and values imposed by the religion (M = 3.61). Parents most varied in their views when it comes to the introduction of sex education in schools (M = 2.9, SD = 1.53), however, if the contents would correspond with the age of the child (M = 3.7). There are no gender differences on the issue of the introduction of HE in schools (t = 0.018, DF = 499, p> 0.05), as well as differences between the schools (F = 1.937, DF = 5,520, p> 0.05), nor between children of various age groups (F = 1.667, DF = 2,523, p> 0.05).


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The Management of Transfusion Services, Analysis and Assessment

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Dzenana Begic, Ermina Mujicic, Lejla Zunic.
Introduction: The hospital blood bank (HBB) need to timely provide adequate amounts of blood and blood products for surgeries. For various surgical programs are performed assessments of the average number of blood doses needed for surgery. By using two types of requisitions BT/AB (blood type/antibody) and BT/AB/MT (blood type/antibody/match test) for pretransfusion immunohaematological testing in General Hospital Prim. Dr. Abdulah Nakas is achieved more rational consumption of blood and blood derivatives and financial savings through reduced number of matching tests (MT). Goal: To determine the total amount of pre-operative requisitions (BT/AB and BT/AB/MT) for blood and blood products at surgical departments of the General Hospital Prim. Dr. Abdulah Nakas in the period from June 1, 2014 December 31, 2014 and analyze the consumption/return of blood in reserve in relation to the surgical disciplines, the total number of savings in MT. Conduct assessments MSBOS (Maximum Surgical Blood Ordering Schedule). Results: The total amount of preoperative requisitions for blood and blood products in surgical wards was 927 requests from which 623 demands or 67.2% is tested by BT/MT, while 304 or 32.8% was tested by BT/AB/MT. Transfused in total was 617 units of blood and blood products, 275 units were not transfused. Probability of transfusions for surgery was 51.3, the highest in the case of surgical intensive care 70.4 and the lowest for the department of general surgery 37.2%. Assessment of indicators of efficient resource management indicates they are the best at the delivery ward 0.89, while a total for surgical wards is 0.69. In total for surgery on the average were required 2.1 units of blood. By using two types of requisitions for pretransfusion immunohaematological testing (BT/AB and CG/AB/MT) is achieved more rational use of MT. In 623 requests for BT/AB only 61 MT were performed. Average of blood units issued in accordance with these requirements is 0.08 and the savings in the number of MT amounts to 562.


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Comparison Between Sublingual and Vaginal Route of Misoprostol in Management of First Trimester Miscarriage Missing

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Zahra Dehbashi, Mahmood Moosazadeh, Mahdi Afshari.
Background: Each year, more than forty million abortions are occurred whole of the world. Misoprostol is a prostaglandin analogue with a strong uterotonic effect. The present study aimed to compare the efficacy of Misoprostol in first trimester abortion through two sublingual and vaginal routes of administration. Methods: This randomized clinical trial was conducted on 52 consecutive women in first trimester candidate for pregnancy termination because of fetal IUFD or missed abortion in sonography reports. The patients were hospitalized and then randomly assigned to receive sublingual Misoprostol (400 μg, n 27) or vaginal Misoprostol (400 μg placed in posterior fornix, n = 25). Findings: None of the pregnant in the sublingual group developed complete abortion at the end of follow-up time, while 36% of women inducted with vaginal misoprostol experienced complete abortion indicating a intergroup significant difference (p = 0.001). Compared with vaginal group, those women in sublingual group experienced more complications including diarrhea (22.2% versus 20.0%), nausea and vomiting (22.2% versus 0.0%), and abdominal pain (3.7% versus 0.0%). Conclusion: The use of Misoprostol in vaginal route results in more abortion completeness as well as lower complication rate as compared to sublingual prescription of the drug.


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Platelet Count in Women with Pregnancy Induced Hypertension in University Hospital Center of Mother and Child Healthcare Koço Gliozheni, Tirana, Albania

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Zamir Damani.
Introduction: One of the most common and potential life threatening complications of pregnancy is pregnancy induced hypertension. This cross-sectional study aimed to investigate the relationship between platelet count and pregnancy induced hypertension. Material and methods: Twenty (20) patients (subjects) and twenty (20) healthy pregnant women (control) visiting the Obstetrics and Gynecology Hospital University of Koço Gliozheni Tirana Albania were registered in the study and followed during their pregnancy. Both, subjects and control participants were subject to platelet count manually performed using standard methods on. Results: The mean platelet count of the control group (38448±235500) was significantly higher than that of the subject group (217050±50780.7) (p


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Relationship of Assess Self-esteem and Locus of Control with Quality of Life during Treatment Stages in Patients Referring to Drug Addiction Rehabilitation Centers

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Mohammad Heidari, Mansureh Ghodusi.
Objective: Thus, the present research was carried out aimed at determining the relationship between self-esteem and locus of control and quality of life during treatment stages in the patients referring to drug addiction rehabilitation centers of Borujen city, Iran. Methods: The current study was a sectional research of descriptive correlation type. The research sample was 150 individuals of patients referring to addiction rehabilitation centers of Borujen city. For data gathering, Rosenberg Self-esteem Scale, Rotters Locus of Control Scale, and SF36 Quality of Life Questionnaire were used. Following collection of questionnaires, the data were analyzed using SPSS/16 software. Results: According to the results, in the 12th day of treatment, 96 patients exhibited moderate self-esteem, 102 patients had internal locus of control, and the score of their overall quality of life was 40.43±12.71. Furthermore, Pearsons correlation coefficient indicated that a significant and positive relationship was observed between locus of control and quality of life during different treatment stages. Conclusion: It seems that quality of life improves during addiction treatment stages due to improvement of personality traits including locus of control and self-esteem. Therefore, consultation methods as a very crucial priority in addiction rehabilitation centers shall be taken into account by the health sector authorities and managers and can play an essential role in enhancing quality of life.


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Adherence and Quality of Life in Patients With Type II Diabetes Mellitus in Northern Greece

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Efrosini Zioga, Kyriakos Kazakos, Evagelos Dimopoulos, Christos Koutras, Kalliopi Marmara, Eleni-Efrosini Marmara, Athanasios Marmaras, Maria Lavdaniti.
Introduction: Adherence as a concept includes various types of health-related behavior. Better medical adherence leads to improved disease control and fewer diabetesrelated complications. Quality of life and medication adherence are interrelated. Patients with diabetes who adhere to their treatment can experience an improvement in quality of life and vice versa. Aim: To assess treatment adherence in patients with type II diabetes, as well as the connection between adherence and quality of life. Methodology: A descriptive non-experimental study was conducted in a provincial hospital in Northern Greece. The sample examined was a convenience sample consisting of 108 patients with type II diabetes mellitus. They completed the Diabetes Self-Care Activities Questionnaire and SF-36 Quality of Life Questionnaire. Results: Participants demonstrated good adherence to diet and blood test / blood glucose test routines, but did not experience high levels of quality of life. The type of treatment affected the adherence to blood tests with a statistically significant difference (p=0,000). Also, marital status affected mental health with a statistically significant difference (p=0,032). The adherence sub scales are correlated with the all domains of quality of life. Conclusions: According to our findings, it is important to plan interventions to enhance adherence to other types of treatment and to help patients to further improve their quality of life.


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Investigation of the Effectiveness of Acupuncture in the Treatment of Frozen Shoulder

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Mahsa Asheghan, Amidoddin Khatibi Aghda, Ebrahim Hashemi, Moammadadtaghi Hollisaz.
Background: Adhesive capsulitis is a common disease that causes pain and reduced range of motion, but vague on the shoulder. Woman are affected fewer than men, but there is no known racial or genetic tendency. Most patients with adhesive capsulitis will improve with nonsurgical treatment. Acetaminophen and nonsteroidal anti-inflammatory drugs for pain relief in patients without contraindication are first-line options. Acupuncture considered being safe and effective in reducing pain. The aim of this study was to Investigation of the effectiveness of acupuncture in the treatment of frozen shoulder. Materials and Methods: In a controlled clinical trial, patients referred to the Baqiatallah clinic in 91 years with shoulder pain, frozen shoulder diagnosed based on history and physical exam, they have been enrolled. Indicators measured in the study was included the involved joint pain, range of motion and quality of life. Patients, first at baseline, one and a half months later (end of session) and then 3 months after the examination information about each individual entered in the from of questionnaires were pre-determined and data were analyzed by SPSS 17 software. Results: In this clinical trial study total 40 patients with frozen shoulder (20 interference with the acupuncture and 20 people control) study that patients average age 55/54. Age maximum 71 years and minimum 44 years. Acupuncture in the treatment of frozen shoulder with the results achieved in the general case acupuncture may improve shoulder motion in patients. VAS index at three months after treatment compared with the control group had a greater improvement. Conclusion: In the case of acupuncture and ultimately improve the overall look of all the movement of flexion and adduction of the shoulder, but the movement has been further improved, VAS index at three months after treatment compared with the control group had a greater improvement and finally, we perform acupuncture as a way to improve shoulder motion in patients with frozen shoulder offered.


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Study of the Status of Tuberculosis Control Program Based on the Implementation of the Directly Observed Treatment Short-course Strategy (DOTS)

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Fereshteh Farzianpour, Mahdokht Afarin Kooshad.
Introduction: Ascendant trend of tuberculosis in the world introduces this disease to be one of the most important infectious diseases in the world. So that every year, 9 million people are afflicted to active TB and about 5.1 million people die of the disease. As the HIV contaminated cases are increased, emergence and spread field of Multidrug-resistant tuberculosis (MDR-TB) bacilli has been provided. Objective: This study aimed to assess the Tuberculosis Control Program from 2005 to 2012 to determine the overall situation of disease epidemiology and prioritized strategies in disease control program within the south of Tehran. Materials and Methods: This cross-sectional study was extracted and analyzed retrospectively on the basis of records of all TB patients in TB health center and TB software in south Tehran in 2005-2012 years. Results: From the total population under protection of health center of south Tehran, 99% are urban and 1% are rural. During 2005-2012, 1242 TB cases have been registered and they were treated by DOTS method. There were 553 cases of new smear-positive pulmonary TB (44%), 222 cases of smear-negative pulmonary TB (18%) and 336 cases of extra-pulmonary tuberculosis (27%), 26 cases of recurrence (2%) and 11 cases of MDR (0.9%). Smear-positive pulmonary tuberculosis has included 67.4% of all tuberculosis patients. Conclusions: The results showed that, in accordance with TB worldwide statistics, at the health center of south Tehran, pulmonary TB is the most common form of the disease (67.4%). The incidence of smear-positive tuberculosis and all forms of TB cases has been an ascending trend over the period between 2005 and 2012.


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The Comparing of Antimicrobial Activity of CSN1S2 Protein of Fresh Milk and Yoghurt Goat Breed Ethawah Inhibited the Pathogenic Bacteria

2016-07-23T16-58-17Z
Source: Materia Socio Medica
Lidwina Faraline Triprisila, Suharjono Suharjono, Antonius Christianto, Fatchiyah Fatchiyah.
Background: Goat milk is reported to have antimicrobial activity of several pathogen bacteria that contained on food materials. The research related with antimicrobial activity of Alpha-S2 casein from goat milk is relatively less than other casein components. Herein, we reported the antimicrobial activity of caprine Alpha-S2 Casein (CSN1S2) protein from Ethawah breed goat milk and yoghurt in Gram positive (Listeria monocytogenes, Staphylococcus aureus and Bacillus cereus) and negative pathogen bacteria (Escherichia coli, Salmonella typhi and Shigella flexneri). Those bacteria were known as pathogens that caused gastrointestinal infection. Methods: Serial dilution and agar diffusion analysis with three different concentrations of caprine CSN1S2, 1.25 mg/ml, 2.5 mg/ml, and 5 mg/ml were used to test the inhibition effect of protein on the viability of bacteria cells. The inhibitory activity of caprine CSN1S2 was based on dose dependent manner. Agar diffusion analysis was showed the larger diameter of clear zone at B. cereus and S. flexneri. Results: The serial dilution analysis was shown the inhibition of almost in all groups of bacteria with concentration 5 mg/ml higher by CSN1S2 protein of goat fresh milk than yogurt. The inhibitory activity caprine CSN1S2 protein of fresh milk was shown a vary inhibition clear zone with optimal concentration 5 mg/ml, however CSN1S2 protein of goat yogurt intermediate effectively was only in gram negative bacteria. The weakness bacteria against inhibition activity caprine CSN1S2 protein was B. cereus (Gram positive) and S. flexneri (Gram negative). Meanwhile the strongest bacteria against inhibition activity caprine CSN1S2 protein was S. typhi (Gram negative), may cause in this bacteria has lipopolysaccharide prevent to interact with that protein as proper. Conclusion: This study result concluded that the caprine CSN1S2 protein has inhibition activity in opposition to pathogenic bacteria by optimal concentration 5 mg/ml in all bacteria and indicated caprine CSN1S2 protein as anti-microbial agent.


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Quadriceps and hamstring muscle activity during cycling as measured with intramuscular electromyography

Abstract

Purpose

The aim of this study was to describe thigh muscle activation during cycling using intramuscular electromyographic recordings of eight thigh muscles, including the biceps femoris short head (BFS) and the vastus intermedius (Vint).

Methods

Nine experienced cyclists performed an incremental test (start at 170 W and increased by 20 W every 2 min) on a bicycle ergometer either for a maximum of 20 min or to fatigue. Intramuscular electromyography (EMG) of eight muscles and kinematic data of the right lower limb were recorded during the last 20 s in the second workload (190 W). EMG data were normalized to the peak activity occurring during this workload. Statistical significance was assumed at p ≤ 0.05.

Results

The vastii showed a greater activation during the 1st quadrant compared to other quadrants. The rectus femoris (RF) showed a similar activation, but with two bursts in the 1st and 4th quadrants in three subjects. This behavior may be explained by the bi-articular function during the cycling movement. Both the BFS and Vint were activated longer than, but in synergy with their respective agonistic superficial muscles.

Conclusion

Intramuscular EMG was used to verify muscle activation during cycling. The activation pattern of deep muscles (Vint and BFS) could, therefore, be described and compared to that of the more superficial muscles. The complex coordination of quadriceps and hamstring muscles during cycling was described in detail.

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Haematological Changes and Nitric Oxide Levels Accompanying Artemether-Lumefantrine Administration in Male Guinea Pigs: Effect of Unsweetened Natural Cocoa Powder.

2016-07-23T16-18-42Z
Source: Journal of Intercultural Ethnopharmacology
Isaac Julius Asiedu-Gyekye, Charles Antwi-Boasiako, Seth Oppong, Stella Arthur, Joseph Edusei Sarkodie.
Background: Unsweetened natural cocoa powder (UNCP), prepared after removal of the cocoa butter, is a common beverage in Ghana. It possesses antimalarial prophylactic property and has beneficial effect on blood components. Aim: To determine whether regular dietary supplement of UNCP mitigates high dose (HD) artemether-lumefantrine (A-L)-induced haematological disorders and the effect on nitric oxide (NO) levels. Methods: Adult male guinea-pigs (300 g - 350 g) were randomly divided into 5 groups of 6 guinea-pigs each. 3 groups were treated with UNCP (300, 900 and 1500 mg/kg body weight) for 14 days. A-L (75 mg/kg) was administered from the 12th to 14th day. One of the remaining 2 groups received distilled water only ie vehicle control group (VCG) whilst the other received 75 mg/kg A-L only ie negative control group (NCG). Blood samples from all groups were obtained by cardiac puncture (day 15) followed by haematological and NO analysis. Results: A-L reduced white blood cells (WBC) by 31.87%, lymphocyte count (45.99 %), haemoglobin (11.72%), haematocrit (18.56%) and platelet count (33.08%) in the NCG. Administration of various doses of UNCP increased WBC and lymphocyte count (P˃0.05) compared to the NCG. UNCP and A-L combination caused an increase in NO levels when compared to the VCG. Conclusion: Regular consumption of UNCP by guinea-pigs increases plasma NO and restores some haematological disorders induced by a 3-day HD A-L administration.


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Off-duty Fla. nurse saves lives at beach

By Jill Whalen
The Standard-Speaker

CLEARWATER, Fla. — Cassandra "Cassie" Yakubik Thomas was on the beach near Sand Key in Clearwater, Florida, earlier this week when she spotted stormy skies in the distance.

Fearing a thunderstorm, she and her husband, Jay, gathered their two children and retreated to their 16th floor vacation condo.

"The storm was bad. The thunder came rolling in and it sounded like it was right above us," said Thomas, of Pardeesville, a pediatric nurse at Janet Weis Children's Hospital/Geisinger in Danville. "I heard a huge bang, looked up and saw a pink lightning bolt strike the beach. I said to my husband, 'Jay, that just struck the beach. Something's not right.'"

Her intuition was correct. Through the drenching rain, Thomas saw two people lying on the beach.

"I said, 'Jay, those people are laying there! I think they got struck!'" she said. "I just started screaming, 'Are you OK? Are you OK?'"

One of those who was on the ground — later identified as Jansen Tabor, 18, of North Carolina — yelled for her help. He and his friend, Cameron Poimboeuf, 15, also of North Carolina, had been struck by lightning.

"I turned to my husband and said, 'Jay, call 911! I'm going down!'" she said.

When Thomas couldn't summon an elevator, she ran down 16 flights of stairs to the beach. Lightning continued and thunder boomed.

"As I was running, I was thinking how unsafe it was to be going out there. (I was) just praying to God in the back of my mind to keep me safe so I could get to them," she said.

She went to Poimboeuf first.

"He was face down in the sand," she said. "I rolled him over and immediately started compressions."

The teen didn't have a pulse and wasn't breathing. His skin had turned a bluish-gray.

Thomas continued cardiopulmonary resuscitation. Soon thereafter, off-duty police officer Kirk Pattison, and his wife, Jenny, from Illinois, arrived and helped with CPR.

"We just kept working and working until a firefighter came down and said, 'We got to get him off the beach. Let's go,'" Thomas said. "We picked Cameron up and ran him up the beach. We got him under an area at the pool so we had cover."

As responders from the Clearwater Fire & Rescue Department ran for equipment, Thomas continued CPR.

"Other medics came and we just kept working," she said. "We got him hooked to the AED, shocked him and he got a pulse."

Both boys were rushed to local hospitals. Tabor was released Thursday, and Poimboeuf continues his recovery, learwater police spokesman Rob Shaw said.

"He's walking and talking again," Shaw said of Poimboeuf.

On Friday, Clearwater police awarded Thomas and the Illinois couple with Good Samaritan medals, an award given to those who go above and beyond in helping others. Tabor, who was released from hospital care Thursday, attended the ceremony with his family.

"She was in the right place at the right time and was able to use all her medical background and talents to save these teenagers," Shaw said of Thomas. "What she did on Tuesday was a selfless and heroic act."

Clearwater news station WFLA reported that doctors called both boys' survival "a miracle."

"No one survives that kind of hit the boys took," said Tabor's mother, Claudette Tabor.

The parents also told the news station that they aren't sure what could have happened had Thomas and the couple not stepped in.

"We're blessed by the grace of God that Cameron is still here," said Poimbouef's father, Kevin Poimbouef.

Copyright 2016 the Standard-Speaker 

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A case of autoimmune pancreatitis effectively treated with an immunosuppressant (azathioprine)

Abstract

The patient was a 42-year-old man who presented at our hospital with obstructive jaundice. Although antinuclear antibody test results were negative, and immunoglobulin G4 (IgG4) was not elevated, endoscopic ultrasound revealed a mixed internal hyperechoic and diffuse hypoechoic pattern, a finding consistent with autoimmune pancreatitis. Endoscopic retrograde cholangiopancreatography further revealed irregular narrowing of the main pancreatic duct and sclerosing cholangitis with distal biliary stricture. In addition, endoscopic ultrasound with fine needle aspiration cytology resulted in a diagnosis of type 1 autoimmune pancreatitis. Oral prednisolone treatment was initiated at 30 mg/day, and the dosage was gradually decreased. However, in accordance with the patient's wishes, maintenance treatment was discontinued once dosage reached 5 mg/day. Despite this, relapse of obstructive jaundice occurred 1 month post discontinuation, and was treated with methyl-prednisolone pulse therapy (500 mg/day) followed by oral prednisolone. However, computed tomography, magnetic resonance imaging, and endoscopic ultrasound did not reveal sufficient improvement after 6 months of treatment. Therefore, an immunosuppressant (azathioprine) was introduced. Subsequent imaging analyses and endoscopic ultrasound fine needle aspiration revealed clear improvements in pathology.

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$3000.00 Sign on Bonus Paramedic - First Response Ambulance

Purpose: To provide Advance Life Support patient care and ambulance transportation. Providing emergent and non-emergent patient care and transfers. Also performs other duties as assigned as needed. Essential Job Functions 1) Provides emergency and non-emergency ambulance operations in conjunction with a partner, demonstrating excellent driving judgment and due regard for public safety during operation ...

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A comparative study of endotracheal intubation as per intubation difficulty score, using Airtraq and McCoy laryngoscopes with manual-in-line axial stabilization of cervical spine in adult patients

2016-07-23T08-20-42Z
Source: International Journal of Research in Medical Sciences
Nilesh Sarvaiya, Deepali Pankaj Thakur, Bharati Anil Tendolkar.
Background: The different types of laryngoscopes have been invented to improve the laryngoscopic view of the glottis in normal and difficult airway which helps anaesthesiologists to safeguard the airway during anaesthesia. Patients with cervical spine injury have deleterious compression forces on the spinal cord and that should be avoided by taking protective measures which include application of rigid collar, a forehead tape and manual-in-line axial stabilisation (MILAS). The objective of the study was to evaluate the ease of intubation with Airtraq and McCoy laryngoscope as per intubation difficulty score (IDS) with manual-in-line axial stabilization of cervical spine. Methods: In this prospective observational study, 100 adults of ASA I-II, aged 18 to 60 years, with Mallampati classification I and II, undergoing elective surgery under general anaesthesia with oral endotracheal intubation were included. Fifty patients were intubated using Airtraq (Group A). Another fifty patients were intubated using McCoy laryngoscope (Group B). During intubation with both devices, neck was immobilized using MILAS. Ease of intubation as per IDS, insertion of device as per Likert scale, duration of laryngoscopy and intubation, number of attempts, haemodynamic changes and complications were compared for both devices. Results: Demographic characteristics were comparable in both groups. There is no significant difference observed in the heart rate, systolic and diastolic blood pressure during device insertion, intubation and up to 10 minutes after intubation in Airtraq and McCoy group. There is statistically significant difference in number of intubation attempts, duration of laryngoscopy and intubation in both groups. As per Likert scale, ease of insertion of device was statistically insignificant between two groups. McCoy group had statistically significant higher intubation difficulty scores (2.9±0.68) compared to Airtraq group (0.56±0.54) (p=0.000). All patients in Airtraq group showed Cormack and Lehane grade 1, while 30% patients in McCoy group had Cormack and Lehane grade more than 1. Conclusions: The Airtraq facilitates the ease of intubation by providing a better view of the larynx as compared to McCoy laryngoscope in patients with manual-in-line axial stabilization of cervical spine.


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Image assessment of Barrett’s esophagus using the simplified narrow band imaging classification

Abstract

Background

A simplified narrow band imaging (NBI) classification has been proposed with the objective of integrating multiple classifications of NBI surface patterns in Barrett's esophagus (BE). Little is known about the impact of the simplified NBI classification on the diagnosis of BE when using high-definition magnification endoscopy with NBI (HM-NBI). This study aimed to evaluate (a) the reproducibility of NBI surface patterns and predicted histology and (b) the diagnostic accuracy of interpreting HM-NBI images by using the simplified NBI classification.

Methods

Two hundred and forty-eight HM-NBI images from macroscopically normal areas in patients with BE were retrieved from endoscopy databases and randomized for review by four endoscopists (two experts, two non-experts). We evaluated inter- and intra-observer agreement of the interpretation of NBI surface patterns and the predicted histology (dysplasia vs. non-dysplasia), as calculated by using κ statistics, and diagnostic values of the prediction.

Results

The overall inter-observer agreements were substantial for mucosal pattern (κ = 0.73) and vascular pattern (κ = 0.71), and almost perfect for predicting dysplastic histology (κ = 0.80). The overall intra-observer agreements were almost perfect for mucosal (κ = 0.84) and vascular patterns (κ = 0.86), and predicting dysplastic histology (κ = 0.89). The mean accuracy in predicting dysplastic histology for all reviewers was 95 % (experts: 96.8 %, non-experts: 93.1 %).

Conclusions

The simplified NBI classification has the potential to provide high diagnostic reproducibility and accuracy when using HM-NBI.

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Smart Anesthesia—Another Way of Communication During Emergence from Anesthesia Using a Smartphone

No abstract available

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Clinical Pattern in Hypotensive Transfusion Reactions

BACKGROUND: Hypotensive transfusion reactions (HyTRs) may be underreported and have been associated with patients taking angiotensin-converting enzyme inhibitors (ACEIs) receiving poststorage leukoreduced blood products through negatively charged filters. Although bedside leukoreduction is no longer commonplace, HyTRs still occur and are insufficiently characterized in the prestorage leukoreduction era. We describe recently reported cases at our institution. METHODS: We reviewed transfusion reaction records at Stanford Healthcare from January 2014 to April 2015. HyTRs were defined by National Health Safety Network Hemovigilance Module classification. RESULTS: Eleven HyTRs occurred in 10 patients. All were adults (mean age 71.7 years; range 45–92 years), 7 were male, and all underwent major surgery 0 to 2 days before the reaction. Nine patients underwent cardiac or vascular surgery, and all 10 were taking ACEIs with the last dose taken within 48 hours of the transfusion reaction in 9 patients. Nine patients were on extracorporeal circuits within 24 hours before the reaction (median duration 180 minutes; range 87–474 minutes). In 5 reactions, the implicated unit was restarted with resultant recurrent hypotension. Implicated units included 9 packed red blood cells, 1 apheresis platelet, and 1 plasma frozen within 24 hours. CONCLUSIONS: Contrary to what has been previously reported in the era of prestorage leukoreduction, HyTRs at our institution showed consistent patterns in patients at risk. Patients scheduled to undergo major surgery with cardiopulmonary bypass may benefit from earlier preoperative cessation of ACEIs or temporarily switching to an alternative drug class.

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Factors Influencing the Choice of Anesthesia as a Career by Undergraduates of the University of Rwanda

BACKGROUND: Rwanda currently faces a severe shortage of trained medical personnel, including physician anesthesiologists. The recruitment of residents into the anesthesia program has been consistently low. This study aimed at determining the factors that influence undergraduates' decision to pursue anesthesia as a career choice. METHODS: A questionnaire was created and administered to final year undergraduate medical students at the University of Rwanda. The questionnaire was created based on factors identified from literature review and key informant interviews. The questionnaire was translated, field-tested, and refined. The final survey questionnaire contains 27 4-point Likert scale items and 4 free-text questions. RESULTS: Seventy-nine final year undergraduate medical students responded to the survey. Only 2 students (2.5%) chose anesthesia as their top choice for postgraduate training. The most frequently named factors for not choosing anesthesiology were long work hours and high stress level, insufficient mentorship, and low job opportunity. CONCLUSIONS: The issues identified by our survey must be considered when making efforts toward increasing anesthesia recruitment in Rwanda. Factors such as lack of material resources and high workload will not be easily addressed. Others can be addressed through changes in medical student anesthesiology rotations and better mentorship by anesthesiologists during formative years. Focusing on factors that can be changed now may increase enrollment into anesthesiology. Future studies will include broadening the survey population and further investigating the influencing factors elucidated by this study.

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The Impact of Surgery and Stored Red Blood Cell Transfusions on Nitric Oxide Homeostasis

BACKGROUND: Cell-free hemoglobin (Hb) forms in stored red blood cells (RBCs) as a result of hemolysis. Studies suggest that this cell-free Hb may decrease nitric oxide (NO) bioavailability, potentially leading to endothelial dysfunction, vascular injury, and multiorgan dysfunction after transfusion. We tested the hypothesis that moderate doses of stored RBC transfusions increase cell-free Hb and decrease NO availability in postoperative surgical patients. METHODS: Twenty-six patients undergoing multilevel spine fusion surgery were studied. We compared those who received no stored RBCs (n = 9) with those who received moderate amounts (6.1 ± 3.0 units) of stored RBCs over 3 perioperative days (n = 17). Percent hemolysis (cell-free Hb), RBC-NO (heme-NO), and plasma nitrite and nitrate were measured in samples from the stored RBC bags and from patients' blood, before and after surgery. RESULTS: Posttransfusion hemolysis was increased approximately 3.5-fold over preoperative levels (P = 0.0002) in blood samples collected immediately after surgery but not on postoperative days 1 to 3. Decreases in both heme-NO (by approximately 50%) and plasma nitrite (by approximately 40%) occurred postoperatively, both in nontransfused patients (P = 0.036 and P = 0.026, respectively) and transfused patients (P = 0.0068 and P = 0.003, respectively) and returned to preoperative baseline levels by postoperative day 2 or 3. Postoperative plasma nitrite and nitrate were decreased significantly in both groups, and this change was slower to return to baseline in the transfused patients, suggesting that blood loss and hemodilution from crystalloid administration contribute to this finding. CONCLUSIONS: The decrease in NO metabolites occurred irrespective of stored RBC transfusions, suggesting this decrease may be related to blood loss during surgery and hemodilution rather than to scavenging of NO or inhibition of NO synthesis by stored RBC transfusions.

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Postoperative Cognitive Dysfunction and the Change of Regional Cerebral Oxygen Saturation in Elderly Patients Undergoing Spinal Surgery

BACKGROUND: In this study, we examined the relationship between postoperative cognitive dysfunction (POCD) and intraoperative regional cerebral oxygen saturation (rSO2) in elderly patients undergoing spinal surgery. METHODS: We enrolled 87 patients older than 65 years. All patients were tested using a battery of cognitive function tests (Korean Mini-Mental State Examination and visuomotor test of Dynamic Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version) the day before their surgical operation and on the seventh postoperative day. Our threshold for defining POCD for a given patient was a Reliable Change Index score of

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A Clinical Prediction Model for Postcardiac Surgery Atrial Fibrillation in an Asian Population

BACKGROUND: Postoperative atrial fibrillation (AF) is associated with increased morbidity, mortality, and resource utilization. Current prediction models for postoperative AF are based primarily on Western populations. In this study, we sought to develop a clinical prediction rule for postcardiac surgery AF for a multiethnic Asian population. METHODS: Two thousand one hundred sixty-eight patients undergoing coronary artery bypass graft or valve surgery with cardiopulmonary bypass were prospectively enrolled in this observational study between August 2008 and July 2012 at Singapore's 2 national heart centers. Postoperative AF was defined as an irregularly irregular electrocardiogram rhythm without identifiable P wave after surgery and before hospital discharge that lasted more than an hour, or affected hemodynamics (ie, systolic blood pressure 120 minutes (OR, 1.92; 95% CI, 1.47–2.52, P

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Amitriptyline, but Not Pregabalin, Reverses the Attenuation of Noxious Stimulus–Induced Analgesia After Nerve Injury in Rats

BACKGROUND: Noxious stimulus–induced analgesia (NSIA) is a type of conditioned pain modulation in rats that has been used to assess endogenous pain control systems. The descending noradrenergic system is involved in NSIA, and nerve injury induces plastic changes of descending noradrenergic neurons. Thus, we hypothesized that nerve injury would affect NSIA strength and that amitriptyline and pregabalin, which often are used for treating neuropathic pain, might further modulate NSIA through effects on the descending noradrenergic system. METHODS: We examined the change in NSIA over time after right L5 spinal nerve ligation (SNL) in rats by measuring the contralateral hind paw withdrawal threshold after left forepaw capsaicin injection. In addition, we examined NSIA after 5 daily intraperitoneal injection of amitriptyline or pregabalin. Microdialysis studies were performed to measure noradrenaline levels after left forepaw capsaicin injection in the left spinal dorsal horn in noninjured rats, SNL rats, and SNL rats that had received 5 daily intraperitoneal injections of amitriptyline or pregabalin. RESULTS: NSIA was dramatically attenuated 5 and 6 weeks after SNL (P

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Heterogeneity in the Structure of the Left Ventricular Outflow Tract: A 3-Dimensional Transesophageal Echocardiographic Study

BACKGROUND: The left ventricular outflow tract (LVOT) is a composite of adjoining structures; therefore, a circular or elliptical shape at one point may not represent its entire structure. The purpose of this study was to evaluate the presence of heterogeneity in the LVOT. METHODS: Patients with normal valvular and ventricular function undergoing elective coronary revascularization surgery were included in the study. Intraoperative R-wave gated 3-dimensional (3D) transesophageal echocardiographic imaging of the LVOT was performed at end-systole, with the midesophageal long axis as the reference view. Acquired data were analyzed with the Philips Q-Lab software with multiplanar reformatting in the sagittal (minor axis), transverse (major axis), and coronal (cross-sectional area by planimetry) views of the LVOT. These measurements were made on the left ventricular side or proximal LVOT, aortic side, or distal LVOT and mid-LVOT. RESULTS: Fifty patients were included in the study. The LVOT minor (sagittal) axis dimension did not differ across the mid-LVOT, proximal LVOT, and distal LVOT (P = .11). The major axis diameter of LVOT differed among the 3 regions of the LVOT (P

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Anesthetizing Patients and Their Immune Systems: Volatile Anesthetics at Work

No abstract available

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Predicting the Best Fit: A Comparison of Response Surface Models for Midazolam and Alfentanil Sedation in Procedures With Varying Stimulation

BACKGROUND: Selecting an effective dose of sedative drugs in combined upper and lower gastrointestinal endoscopy is complicated by varying degrees of pain stimulation. We tested the ability of 5 response surface models to predict depth of sedation after administration of midazolam and alfentanil in this complex model. The procedure was divided into 3 phases: esophagogastroduodenoscopy (EGD), colonoscopy, and the time interval between the 2 (intersession). METHODS: The depth of sedation in 33 adult patients was monitored by Observer Assessment of Alertness/Scores. A total of 218 combinations of midazolam and alfentanil effect-site concentrations derived from pharmacokinetic models were used to test 5 response surface models in each of the 3 phases of endoscopy. Model fit was evaluated with objective function value, corrected Akaike Information Criterion (AICc), and Spearman ranked correlation. A model was arbitrarily defined as accurate if the predicted probability is

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The Effects of Fentanyl on Hepatic Mitochondrial Function

BACKGROUND: Remifentanil interferes with hepatic mitochondrial function. The aim of the present study was to evaluate whether hepatic mitochondrial function is affected by fentanyl, a more widely used opioid than remifentanil. METHODS: Human hepatoma HepG2 cells were exposed to fentanyl or pretreated with naloxone (an opioid receptor antagonist) or 5-hydroxydecanoate (5-HD, an inhibitor of mitochondrial adenosine triphosphate (ATP)-sensitive potassium [mitoKATP] channels), followed by incubation with fentanyl. Mitochondrial function and metabolism were then analyzed. RESULTS: Fentanyl marginally reduced maximal mitochondrial complex–specific respiration rates using exogenous substrates (decrease in medians: 11%–18%; P = 0.003–0.001) but did not affect basal cellular respiration rates (P = 0.834). The effect on stimulated respiration was prevented by preincubation with naloxone or 5-HD. Fentanyl reduced cellular ATP content in a dose-dependent manner (P

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The Effect of Local Anesthetic Volume Within the Adductor Canal on Quadriceps Femoris Function Evaluated by Electromyography: A Randomized, Observer- and Subject-Blinded, Placebo-Controlled Study in Volunteers

BACKGROUND: Single-injection adductor canal block (ACB) provides analgesia after knee surgery. Which nerves that are blocked by an ACB and what influence—if any—local anesthetic volume has on the effects remain undetermined. We hypothesized that effects on the nerve to the vastus medialis muscle (which besides being a motor nerve innervates portions of the knee) are volume-dependent. METHODS: In this assessor- and subject-blinded randomized trial, 20 volunteers were included. On 3 separate days, subjects received an ACB with different volumes (10, 20, and 30 mL) of lidocaine 1%. In addition, they received a femoral nerve block and a placebo ACB. The effect on the vastus medialis (primary endpoint) and the vastus lateralis was evaluated using noninvasive electromyography (EMG). Quadriceps femoris muscle strength was evaluated using a dynamometer. RESULTS: There was a statistically significant difference in EMG response from the vastus medialis, dependent on volume. Thirty-five percent (95% confidence interval [CI], 18–57) of the subjects had an affected vastus medialis after an ACB with 10 mL compared with 84% (95% CI, 62–94) following 20 mL (P = 0.03) and 100% (95% CI, 84–100) when 30 mL was used (P = 0.0001). No statistically significant differences were found between volume and effect on the vastus lateralis (P = 0.81) or in muscle strength (P = 0.15). CONCLUSIONS: For ACB, there is a positive correlation between local anesthetic volume and effect on the vastus medialis muscle. Despite the rather large differences in EMG recordings, there were no statistically significant differences in quadriceps femoris muscle strength. Subsequent clinical studies comparing different volumes in a surgical setting, powered to show differences not only in analgesic efficacy, but also in adverse events, are required.

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Pre-Hospital Anesthesia Handbook, 2nd ed.

No abstract available

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The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration: The Possible Global Public Health Implications

BACKGROUND: Universal access to pulse oximetry worldwide is often limited by cost and has substantial public health consequences. Low-cost pulse oximeters have become increasingly available with limited regulatory agency oversight. The accuracy of these devices often has not been validated, raising questions about performance. METHODS: The accuracy of 6 low-cost finger pulse oximeters during stable arterial oxygen saturations (SaO2) between 70% and 100% was evaluated in 22 healthy subjects. Oximeters tested were the Contec CMS50DL, Beijing Choice C20, Beijing Choice MD300C23, Starhealth SH-A3, Jumper FPD-500A, and Atlantean SB100 II. Inspired oxygen, nitrogen, and carbon dioxide partial pressures were monitored and adjusted via a partial rebreathing circuit to achieve 10 to 12 stable target SaO2 plateaus between 70% and 100% and PaCO2 values of 35 to 45 mm Hg. Comparisons of pulse oximeter readings (SpO2) with arterial SaO2 (by Radiometer ABL90 and OSM3) were used to calculate bias (SpO2 – SaO2) mean, precision (SD of the bias), and root mean square error (ARMS). RESULTS: Pulse oximeter readings corresponding to 536 blood samples were analyzed. Four of the 6 oximeters tested showed large errors (up to −6.30% mean bias, precision 4.30%, 7.53 ARMS) in estimating saturation when SaO2 was reduced

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Surveying the Literature: Synopses of Recent Key Publications

No abstract available

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Ventilation-Induced Modulation of Pulse Oximeter Waveforms: A Method for the Assessment of Early Changes in Intravascular Volume During Spinal Fusion Surgery in Pediatric Patients

BACKGROUND: Scoliosis surgery is often associated with substantial blood loss, requiring fluid resuscitation and blood transfusions. In adults, dynamic preload indices have been shown to be more reliable for guiding fluid resuscitation, but these indices have not been useful in children undergoing surgery. The aim of this study was to introduce frequency-analyzed photoplethysmogram (PPG) and arterial pressure waveform variables and to study the ability of these parameters to detect early bleeding in children during surgery. METHODS: We studied 20 children undergoing spinal fusion. Electrocardiogram, arterial pressure, finger pulse oximetry (finger PPG), and airway pressure waveforms were analyzed using time domain and frequency domain methods of analysis. Frequency domain analysis consisted of calculating the amplitude density of PPG and arterial pressure waveforms at the respiratory and cardiac frequencies using Fourier analysis. This generated 2 measurements: The first is related to slow mean arterial pressure modulation induced by ventilation (also known as DC modulation when referring to the PPG), and the second corresponds to pulse pressure modulation (AC modulation or changes in the amplitude of pulse oximeter plethysmograph when referring to the PPG). Both PPG and arterial pressure measurements were divided by their respective cardiac pulse amplitude to generate DC% and AC% (normalized values). Standard hemodynamic data were also recorded. Data at baseline and after bleeding (estimated blood loss about 9% of blood volume) were presented as median and interquartile range and compared using Wilcoxon signed-rank tests; a Bonferroni-corrected P value

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The Association Between Preoperative Frailty and Postoperative Delirium After Cardiac Surgery

Delirium is common after cardiac surgery, and preoperative identification of high-risk patients could guide prevention strategies. We prospectively measured frailty in 55 patients before cardiac surgery and assessed postoperative delirium using a validated chart review. The prevalence of frailty was 30.9%. Frail patients had a higher incidence of delirium (47.1%) compared with nonfrail patients (2.6%; P

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Perioperative Troponin Screening

Myocardial injury is the most common cause of death during the 30 days after noncardiac surgery. Only 14% of patients who are experiencing a perioperative myocardial infarction will have chest pain, and 65% are entirely clinically silent, which means that they will go undetected without routine troponin screening. Although it is tempting to dismiss asymptomatic troponin elevation, mortality is similar with and without symptoms. Furthermore, mortality at 30 days in patients who have postoperative troponin elevation is a concerning 10%, which represents a 5-fold increase from background risk. Among inpatients ≥45 years of age who are having noncardiac surgery, the number necessary to screen to detect myocardial injury after noncardiac surgery, that would otherwise be missed, is only about 15 patients. Thus, troponin screening seems appropriate for most surgical inpatients who are ≥45 years of age. Potential acute interventions include initiating therapy such as aspirin, statins, and angiotensin-converting enzyme (ACE) inhibitor antihypertensives, along with chronic lifestyle improvements such as smoking cessation, healthful eating, and exercise.

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A study of stress hyperglycemia and its relationship with the neurological outcome in patients presenting with acute ischemic stroke

2016-07-23T04-22-34Z
Source: International Journal of Advances in Medicine
Siva Ranganathan Green, Lokesh S., Tony Kadavanu Mathew, Jayasingh K., Ragupathy S..
Background: Cerebrovascular accident (CVA) continues to be the most common neurological disease in the developed and developing countries. It also stands as the 3rd more common cause of death after cardiovascular disease and cancer. Stroke related burden keeps rising among the patients, their relatives and treating consultants. The neurological outcome depends on various modifiable and non-modifiable risk factors. Among the modifiable risk factors, admission (stress) hyperglycemia has a deleterious effect on the neurological outcome. It is well known by various studies that diabetic patients have more severe outcome and neurological disability after acute stroke than the non-diabetic patients. Now stress hyperglycemia is also becoming a second serious marker to affect the neurological outcome of these stroke patients. The aim was to study the blood sugar level and it`s correlation with the neurological outcome among the acute ischemic stroke patients on admission and at third month of follow-up. Methods: It is a prospective and comparative study done in a tertiary care hospital. Adult patients (> 40 years) presenting with acute ischemic stroke were neurologically stratified based on National Institutes of Health Stroke Scale (NIHSS) and admission blood sugars were noted. They were subdivided into 3 groups. Group 1 consisting of 31 normoglycemic patients, group 2 consisting of 32 stress hyperglycemic patients and group 3 consisting of 40 Type 2 diabetes mellitus (T2DM) patients. They were again reassessed after 3 months with FBS, PPBS and neurological recovery by NHISS. Chi- square test / fischer exact test was used to compare between 3 groups. A p-value of


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Screening based on incidence of severe retinopathy of prematurity in a tertiary care center in India: are Indian infants different?

2016-07-23T03-57-49Z
Source: International Journal of Contemporary Pediatrics
Umamaheswari Balakrishnan, Shafi Jan Mohammad Shaik, Nivetha Manian*, Muthayya Muthukumar, Mary Thomas, Prakash Amboiram, Binu Ninan, Ashok Chandrasekaran, Saravanan Ramaswamy.
Background: Incidence of retinopathy of prematurity (ROP) and screening criteria among the preterm infants varies widely. The incidence of ROP and severe ROP in different Birth Weight (BW) and Gestational Age (GA) groups were studied. The aim of the study was to review the existing screening criteria for ROP based on the highest birth weight and or gestational age of infants who developed severe ROP. Methods: This is a retrospective descriptive study of neonates with GA of ≤ 34 weeks and/or BW of ≤ 1750 gm screened for ROP by experienced ophthalmologist from January, 2011 to December, 2015. End point was either complete vascularisation or need for laser therapy as per ETROP guidelines. Severe ROP was defined as ROP needing treatment. Highest BW and or GA of infants who developed severe ROP were taken as cut off points for revising the existing screening criteria for ROP. Results: Among 1366 infants included in this study, 252 (18.4%) and 86 (6.2%) developed ROP and severe ROP, respectively. Mean GA was 29.2±1.4 weeks and 28.7±2.3 among infants with ROP and severe ROP, respectively. Stratified analysis showed a significant increase in the incidence of ROP with decreasing BW and GA (p


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Evaluation of training program on knowledge of stroke among anganwadi workers in Chintamani taluk of Karnataka state, India

2016-07-23T03-16-18Z
Source: International Journal of Community Medicine and Public Health
Suman G., Lalitha K., Aravind B.A., Mahendra J.V., Arjunan I., Shivaraj N.S., Pruthvish S..
Background: Established population based disease registry provides data on incidence, risk factors, determinants and trends of the disease. Population based rural stroke registry was started on a pilot basis with an objective to evaluate the feasibility of establishing population-based stroke registry in Chintamani taluk of Karnataka state, India. Training of health care personnel was undertaken to facilitate reporting of case. The objective of the present communication is to evaluate the training conducted for anganwadi workers by trained investigators in 2012. Methods: Training was conducted using a validated training manual. Among the existing 438 anganwadi workers in the taluk, 405 (92.4%) attended the training. Pre and post-test questionnaire was administered before and after the training session to assess the improvement in the knowledge of stroke. Results: Only 362 (89.38%) with both pre and post-test answered were included for analysis. Overall there was statistical significant improvement in knowledge of anganwadi workers on symptoms, risk factors and prevention of stroke. Regarding Knowledge on symptoms of Stroke, 85 (95.5%) who scored poor, 81 (98.8%) who scored average in pre-test improved to good in post test. It was observed that 94 (100%) and 120 (94.4%) of the workers who scored poor regarding knowledge on prevention and risk factors of stroke respectively improved to good in the post-test. Conclusions: This endeavor substantiates the fact that anganwadi workers can be trained to identify suspects.


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Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea

The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.

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Mechanisms of the Immunological Effects of Volatile Anesthetics: A Review

Volatile anesthetics (VAs) have been in clinical use for a very long time. Their mechanism of action is yet to be fully delineated, but multiple ion channels have been reported as targets for VAs (canonical VA targets). It is increasingly recognized that VAs also manifest effects outside the central nervous system, including on immune cells. However, the literature related to how VAs affect the behavior of immune cells is very limited, but it is of interest that some canonical VA targets are reportedly expressed in immune cells. Here, we review the current literature and describe canonical VA targets expressed in leukocytes and their known roles. In addition, we introduce adhesion molecules called β2 integrins as noncanonical VA targets in leukocytes. Finally, we propose a model for how VAs affect the function of neutrophils, macrophages, and natural killer cells via concerted effects on multiple targets as examples.

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Risk assessment in poisoning with special reference to odollam and organophosphorous compounds

2016-07-23T02-33-29Z
Source: International Journal of Research in Medical Sciences
Meenu M. Tergestina, Sunitha Simon.
Background: Poisoning with organophosphorous compounds, odollam and other substances are common. Affected persons present with a wide variety of clinical features. Prognostic indicators of high mortality are important for management and to decide on intensive care unit admission. Methods: Admissions due to poisonings from April 2015 to March 2016 were assessed. The clinical features, electrocardiographic changes and laboratory investigations of 915 patients were obtained and statistically analysed. Results: The most commonly ingested poisons were odollam (26%) and organophosphorous compounds (22%). The overall mortality was 22%. Mortality was highest in organophosphorus compounds (38%) and odollam (33%) compared to other causes. Hyperkalemia, low systolic blood pressure, consumption of poison in powder or paste form, delayed presentation, bradycardia and extensive chest signs correlated with mortality in odollam and organophosphorous compound poisoning. Conclusions: Poisoning with odollam or organophosphorous compounds is an increasingly common life threatening condition. Markers of mortality identified in this study were incorporated into a simple scale for assessment of risk, namely the PoPPER scale: potassium level >5.5 mE/L, systolic blood pressure


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Decomposing mechanisms of abnormal saccade generation in schizophrenia patients: Contributions of volitional initiation, motor preparation, and fixation release

Abstract

Clinical and theoretical models suggest deficient volitional initiation of action in schizophrenia patients. Recent research provided an experimental model of testing this assumption using saccade tasks. However, inconsistent findings necessitate a specification of conditions on which the deficit may occur. The present study sought to detect mechanisms that may contribute to poor performance. Sixteen schizophrenia patients and 16 healthy control participants performed visually guided and two types of volitional saccade tasks. All tasks varied as to whether the initial fixation stimulus disappeared (fixation stimulus offset) or continued during saccade initiation, and whether a direction cue allowed motor preparation of the specific saccade. Saccade latencies of the two groups were differentially affected by task type, fixation stimulus offset, and cueing, suggesting abnormal volitional saccade generation, fixation release, and motor preparation in schizophrenia. However, substantial performance deficits may only occur if all affected processes are required in a task.

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Cardiac cycle time effects on selection efficiency in vision

Abstract

The effect of cardiac cycle time on attentional selection was investigated in an experiment in which participants classified target letters in a visual selection task. Stimulus onsets were aligned to the R wave of the electrocardiogram and stimuli presented either during the ventricular systole or diastole. Selection efficiency was operationalized as difference in target selection performance under conditions of homogeneous and heterogeneous distractors. Differences in performance (i.e., the impact selection difficulty had on the ability to select the target) were attenuated for stimuli presented during the ventricular systole compared to the diastole. Increased baroafferent signal transmission during the systole appears to reduce interference of highly distracting stimuli on visual selection efficiency.

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