Therapeutic Management of Ascites in a Bitch: A case report

2016-12-05T21-26-02Z
Source: International Journal of Livestock Research
Tukheswar Chutia, Santanu Ghorai, Kalyan Sarma, Gunjan Das, Suvendu Kumar Behera, Bedanga Konwar, Fazal Ali Ahmed, K. Lalrintluanga.
Three years old crossbred bitch was presented with distended abdomen. The bitch was spayed two weeks back. Based on abdominal palpation and ultrasonography, it was diagnosed as a case of ascites. The animal was treated with a combination of Lasix, Aldactone, D10, Hermin, Dexona and Intacef upon regular monitoring assisted in successful recovery.


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Modulation of respiratory output by cervical epidural stimulation in the anesthetized mouse

Respiration is produced and controlled by well-characterized brain stem nuclei, but the contributions of spinal circuits to respiratory control and modulation remain under investigation. Many respiratory studies are conducted in in vitro preparations (e.g., brain stem slice) obtained from neonatal rodents. While informative, these studies do not fully recapitulate the complex afferent and efferent neural circuits that are likely to be involved in eupnea (i.e., quiet breathing). To begin to investigate spinal contributions to respiration, we electrically stimulated the cervical spinal cord during unassisted respiration in anesthetized, intact mice. Specifically, we used epidermal electrical stimulation at 20 Hz and varied current intensity to map changes in respiration. Stimulating at 1.5 mA at cervical level 3 (C3) consistently caused a significant increase in respiratory frequency compared with prestimulation baseline and when compared with sham stimulations. The increase in respiratory frequency persisted for several minutes after epidural stimulation ceased. There was no change in tidal volume, and the estimated minute ventilation was increased as a consequence of the increase in respiratory frequency. Sigh frequency also increased during epidural stimulation at C3. Neither the increase in respiratory frequency nor the increase in sighing were observed after stimulation at other dorsal cervical levels. These findings suggest that the spinal circuits involved in the modulation of eupnea and sighing may be preferentially activated by specific endogenous inputs. Moreover, the cervical spinal cord may play a role in respiratory modulation that affects both eupneic respiration and sigh production in intact, adult mice.

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Green tea extract does not affect exogenous glucose appearance but reduces insulinemia with glucose ingestion in exercise recovery

We reported that supplementation with green tea extract (GTE) lowered the glycemic response to an oral glucose load following exercise, but via an unknown mechanism (Martin BJ, MacInnis MJ, Gillen JB, Skelly LE, Gibala MJ. Appl Physiol Nutr Metab 41: 1057–1063, 2016. Here we examined the effect of supplementation with GTE on plasma glucose kinetics on ingestion of a glucose beverage during exercise recovery. Eleven healthy, sedentary men (21 ± 2 yr old; body mass index = 23 ± 4 kg/m², peak O₂ uptake = 38 ± 7 ml·kg^–1·min^–1; means ± SD) ingested GTE (350 mg) or placebo (PLA) thrice daily for 7 days in a double-blind, crossover design. In the fasted state, a primed constant infusion of [U-¹³C₆]glucose was started, and 1 h later, subjects performed a graded exercise test (25 W/3 min) on a cycle ergometer. Immediately postexercise, subjects ingested a 75-g glucose beverage containing 2 g of [6,6-²H₂]glucose, and blood samples were collected every 10 min for 3 h of recovery. The rate of carbohydrate oxidation was lower during exercise after GTE vs. PLA (1.26 ± 0.34 vs. 1.48 ± 0.51 g/min, P = 0.04). Glucose area under the curve (AUC) was not different between treatments after drink ingestion (GTE = 1,067 ± 133 vs. PLA = 1,052 ± 91 mM/180 min, P = 0.91). Insulin AUC was lower after GTE vs. PLA (5,673 ± 2,153 vs. 7,039 ± 2,588 µIU/180 min, P = 0.05), despite similar rates of glucose appearance (GTE = 0.42 ± 0.16 vs. PLA = 0.43 ± 0.13 g/min, P = 0.74) and disappearance (GTE = 0.43 ± 0.14 vs. PLA = 0.44 ± 0.14 g/min, P = 0.57). We conclude that short-term GTE supplementation did not affect glucose kinetics following ingestion of an oral glucose load postexercise; however, GTE was associated with attenuated insulinemia. These findings suggest GTE lowers the insulin required for a given glucose load during postexercise recovery, which warrants further mechanistic studies in humans.

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Influence of training intensity on adaptations in acid/base transport proteins, muscle buffer capacity, and repeated-sprint ability in active men

McGinley C, Bishop DJ. Influence of training intensity on adaptations in acid/base transport proteins, muscle buffer capacity, and repeated-sprint ability in active men. J Appl Physiol 121: 1290–1305, 2016. First published October 14, 2016; doi:10.1152/japplphysiol.00630.2016.—This study measured the adaptive response to exercise training for each of the acid-base transport protein families, including providing isoform-specific evidence for the monocarboxylate transporter (MCT)1/4 chaperone protein basigin and for the electrogenic sodium-bicarbonate cotransporter (NBCe)1. We investigated whether 4 wk of work-matched, high-intensity interval training (HIIT), performed either just above the lactate threshold (HIIT20; n = 8), or close to peak aerobic power (HIIT90; n = 8), influenced adaptations in acid-base transport protein abundance, nonbicarbonate muscle buffer capacity (βm_{in vitro}), and exercise capacity in active men. Training intensity did not discriminate between adaptations for most proteins measured, with abundance of MCT1, sodium/hydrogen exchanger (NHE) 1, NBCe1, carbonic anhydrase (CA) II, and CAXIV increasing after 4 wk, whereas there was little change in CAIII and CAIV abundance. βm_{in vitro} also did not change. However, MCT4 protein content only increased for HIIT20 [effect size (ES): 1.06, 90% confidence limits x / ÷ 0.77], whereas basigin protein content only increased for HIIT90 (ES: 1.49, x / ÷ 1.42). Repeated-sprint ability (5 x 6-s sprints; 24 s passive rest) improved similarly for both groups. Power at the lactate threshold only improved for HIIT20 (ES: 0.49; 90% confidence limits ± 0.38), whereas peak O₂ uptake did not change for either group. Detraining was characterized by the loss of adaptations for all of the proteins measured and for repeated-sprint ability 6 wk after removing the stimulus of HIIT. In conclusion, 4 wk of HIIT induced improvements in each of the acid-base transport protein families, but, remarkably, a 40% difference in training intensity did not discriminate between most adaptations.

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Production traits optimization with polyherbal performance enhancer in layer birds

2016-12-05T20-22-43Z
Source: International Journal of Livestock Research
S. J. Manwar, D. H. Rekhate, M.V. Joshi, S. P. Waghmare, S.V. Kuralkar, M. J. Saxena, K. Ravikanth, S. Maini, A. Choudhary.
40 healthy, day old BV 300 layer chicks were randomly allotted into 2 treatment groups. Group T0 (n=20) control group birds were offered standard basal ration only from day 0 to week 38th and Group T1 (n=20) birds were offered basal feed along Xlivpro premix at 250g/tonne of feed (Excellent Performance Enhancer) (M/s Ayurvet Limited) regularly from day 0 to week 38th. Efficacy of product supplementation was evaluated on the basis of parameter viz. body weight, feed conversion ratio, hen housed egg production, age at first egg, serum biochemical parameters, egg quality traits and economics. Statistical analysis of results revealed that Xlivpro premix supplementation significantly improved the layer birds performance. Improvement in egg production and quality traits revealed beneficial effects of supplementing Xlivpro premix in treatment group over untreated control group.


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Effect of basal insulin dosage on blood glucose concentration in ambulatory surgery patients with type 2 diabetes

Among patients with type 2 diabetes treated with insulin, perioperative hyperglycemia and hypoglycemia may cause undesirable symptoms, surgery delay or cancellation, or unexpected hospitalization. Our objective was to compare preoperative glargine dosing regimens on perioperative glycemic control in patients undergoing ambulatory surgery.

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The effect of tramadol plus paracetamol on consumption of morphine after coronary artery bypass grafting

To compare the effects of oral tramadol+paracetamol combination on morphine consumption following coronary artery bypass grafting (CABG) in the patient-controlled analgesia (PCA) protocol.

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Minimum effective fluid volume of colloid to prevent hypotension during caesarean section under spinal anesthesia using a prophylactic phenylephrine infusion: An up-down sequential allocation study

The aim of this study was to de termine the minimum effective fluid volume (MEFV) of hydroxyethyl starch 130/0.4 (HES) infused in a preload fashion which would prevent hypotension in 50% of parturients undergoing caesarean section. A secondary objective was to measure the hemodynamic effect of fluid loading on the subjects.

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Polymorphisms in ten candidate genes are associated with conformational and locomotive traits in Spanish Purebred horses

Abstract

The Spanish Purebred horses, also known as Andalusian horses, compete to the highest standards in international dressage events. Gait and conformation could be used as early selection criteria to detect young horses with promising dressage ability. Although the genetic background of equine size variation has been recently uncovered, the genetic basis of horse conformational and locomotive traits is not known, hampered by the complex genetic architecture underlying quantitative traits and the lack of phenotypic data. The aim of this study was to validate the loci associated with size in 144 Spanish Purebred horses, and to seek novel associations between loci previously associated with the development of osteochondrosis (OC) lesions and 20 conformational and locomotive traits. Ten loci were associated with different conformational and locomotive traits (LCORL/NCAPG, HMGA2, USP31, MECR, COL24A1, MGP, FAM184B, PTH1R, KLF3 and SGK1), and the LCORL/NCAPG association with size in the Spanish Purebred horse was validated. Except for HMGA2, all polymorphisms seem to influence both the prevalence of OC lesions and morphological characters, supporting the link between conformation and OC. Also, the implication of most genes in either immune and inflammatory responses and cellular growth, or ossification processes, reinforces the role that these mechanisms have in the aetiology of OC, as well as their reflection on the general conformation of the individual. These polymorphisms could be used in marker-assisted selection (MAS) programmes to improve desirable conformational traits, but taking into account their possible detrimental effect on OC prevalence.

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Overexpression of Protein Phosphatase 1γ (PP1γ) Is Associated with Enhanced Cell Proliferation and Poor Prognosis in Hepatocellular Carcinoma

Abstract

Background

Protein phosphatase 1γ (PP1γ), as a member of the protein phosphatase 1 family, may be involved in regulation of multiple cellular processes, such as mitosis, cell survival, and apoptosis. However, little is known about the underlying mechanisms by which PP1γ regulates hepatocellular carcinoma development.

Aim

We investigated the expression profile of PP1γ in hepatocellular carcinoma (HCC) cell lines and human HCC specimens, as well as its potential prognostic significance in HCC.

Methods

PP1γ expression profile was detected in 94 HCC specimens using immunohistochemistry. PP1γ levels in HCC cells were downregulated by small interfering RNA (siRNA) transfection. Cell cycle progression and proliferation status of HCC cells and the effectiveness of doxorubicin were evaluated by flow cytometry and CCK-8 assay. The levels of PP1γ, CyclinD1, PCNA, Mdmx, p53, p21, and active caspase-3 were evaluated by Western blot analysis.

Results

PP1γ was upregulated in tumorous specimens, compared with adjacent nontumorous tissues. Univariate and multivariate survival analyses were conducted to determine the prognostic significance of PP1γ in HCC. The expression pattern of PP1γ was positively correlated with tumor size, histological grade, Ki-67 expression, and poor prognosis in HCC. In addition, depletion of PP1γ by siRNA could inhibit cell proliferation, resulted in G1 phase arrest, and attenuated resistance to doxorubicin in Huh7 cells.

Conclusions

PP1γ is upregulated in HCC cell lines and HCC specimens, promotes cancer cell proliferation through regulation of p53, and may be a potential target for treatment of HCC.

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Can electroencephalograms provide guidance for the withdrawal of antiepileptic drugs: A meta-analysis

Epilepsy is a very common chronic neurological disorder, and antiepileptic drugs (AEDs) remaina primary method of epilepsy control. Approximately 60% to 70% of patients become seizure-free after the commencement of antiepileptic drug therapy(Brodie and Kwan, 2002; Cockerell et al., 1995; Kwan and Brodie, 2000). However, the ideal timing for the withdrawal of medication remains unknown. For seizure-free patients, the issue of whether medication should be continued is controversial due to the side effects, costs and the inconveniences associated with antiepileptic drug therapy.

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‘Standard’ versus ‘nose reference’ electrode placement for measuring oVEMPs with air-conducted sound: test-retest reliability and preliminary patient results

Vestibular evoked myogenic potentials, abbreviated as 'VEMPs', were first described by Colebatch et al. (1992). VEMPs can be recorded in two ways: from tonically contracted cervical muscles (termed 'collic' or 'cervical' VEMPs (cVEMPs)) and from extra-ocular muscles (termed 'ocular' VEMPs (oVEMPs)). Both types are short-latency myogenic responses and can be elicited by air-conducted sound stimuli (ACS), bone-conducted vibrations (BCV), and galvanic stimuli. The cVEMP response to ACS is a manifestation of the vestibulo-collic reflex, initiated by excitation of the saccule and the inferior branch of the vestibular nerve (Rosengren et al., 2010) and recorded from the sternocleidomastoid muscles in the neck (Colebatch et al., 1994).

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Photosensitivity in Dravet syndrome is under-recognized and related to prognosis

Dravet syndrome (DS) is a severe epilepsy syndrome caused by heterozygous SCN1A mutations in at least 70% of cases (Depienne et al., 2009). Onset is in the first year of life with febrile or afebrile, generalized or unilateral seizures. Later on various other seizure types appear and psychomotor development slows. Eventually this results in intellectual disability, motor problems and therapy resistant epilepsy in the majority of cases (Dravet et al., 1992, 2005). Photosensitivity has been noticed as a characteristic of DS, since the first description of the syndrome by Charlotte Dravet in 1978 (Dravet, 1978).

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5 things to know about naloxone

It's no secret that the U.S. is suffering from an opioid overdose epidemic.

In fact, an average of 78 Americans die every day from an opioid overdose, according to the CDC. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled; deaths from prescription opioids have also quadrupled.

These troubling numbers have first responders scrambling to respond to an alarming amount of calls per day. One Wisconsin fire department is working to implement a regional approach between law enforcement and EMS to monitor overdoses.

Here's an overview of what naloxone is and how responders are helping curb this devastating epidemic.

1. What is naloxone"
Naloxone, which can also be sold under the name Narcan, blocks or reverses the effects of an opioid overdose. Naloxone was patented in 1961 and was approved for opioid overdose by the FDA in 1971. It's often included in an emergency overdose response kit and has been shown to reduce rates of deaths due to overdose.

2. How is naloxone administered"
Naloxone is injected into a muscle, which is usually given in the outer thigh, under the skin or into a vein through an IV. When given intravenously, it works within two minutes. When injected into a muscle, it works within five minutes. Naloxone can also be administered via intranasal.

The injection is most likely given by health care or emergency medical providers. However, naloxone is now being given to the public, family members and caregivers, and even addicts to administer. If a patient is not breathing or is unresponsive after a suspected overdose, give naloxone immediately by the administration route available to you.

You may need to give another dose every two to three minutes in some situations. If you are a layperson — a friend or family member — of someone who has overdosed, call 911 after administering naloxone or if naloxone is needed.

3. What are the signs of an opioid overdose"
Signs and symptoms of an opioid overdose may include slowed breathing, or no breathing at all, very small or pinpoint pupils in the eyes, a slow heartbeat or extreme drowsiness.

4. Roughly, how much does naloxone cost"
Boxed syringes cost $40-50 each — add $5 for a nasal adapter and about $15 per bag to make a naloxone administration kit. Prices for auto-injectors start at $250 and can be as much as $825 per unit. Remember to replace sealed naloxone vials every two-to-three years based on the stamped expiration date.

Naloxone, especially as an intranasal spray, may be available as an over-the-counter medication in your state. Naloxone is also sometimes distributed through public health programs.

5. First responders and civilians carrying naloxone
First responders, including some police officers, firefighters and EMS personnel, are being trained on how to administer naloxone.

Many, though not all states, allow the drug to be sold over the counter for lay rescuers. Some school districts and restaurants have also stocked up on the overdose-reversing drug.

Who do you think should be responsible for administering naloxone"

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#ambucover 'How to Save a Life'

Paramedic Mary Kate T. performs a cover of The Fray's "How to Save a Life" inside an ambulance.

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The molecular pathogenesis of schwannomatosis, a paradigm for the co-involvement of multiple tumour suppressor genes in tumorigenesis

Abstract

Schwannomatosis is characterized by the predisposition to develop multiple schwannomas and, less commonly, meningiomas. Despite the clinical overlap with neurofibromatosis type 2 (NF2), schwannomatosis is not caused by germline NF2 gene mutations. Instead, germline mutations of either the SMARCB1 or LZTR1 tumour suppressor genes have been identified in 86% of familial and 40% of sporadic schwannomatosis patients. In contrast to patients with rhabdoid tumours, which are due to complete loss-of-function SMARCB1 mutations, individuals with schwannomatosis harbour predominantly hypomorphic SMARCB1 mutations which give rise to the synthesis of mutant proteins with residual function that do not cause rhabdoid tumours. Although biallelic mutations of SMARCB1 or LZTR1 have been detected in the tumours of patients with schwannomatosis, the classical two-hit model of tumorigenesis is insufficient to account for schwannoma growth, since NF2 is also frequently inactivated in these tumours. Consequently, tumorigenesis in schwannomatosis must involve the mutation of at least two different tumour suppressor genes, an occurrence frequently mediated by loss of heterozygosity of large parts of chromosome 22q harbouring not only SMARCB1 and LZTR1 but also NF2. Thus, schwannomatosis is paradigmatic for a tumour predisposition syndrome caused by the concomitant mutational inactivation of two or more tumour suppressor genes. This review provides an overview of current models of tumorigenesis and mutational patterns underlying schwannomatosis that will ultimately help to explain the complex clinical presentation of this rare disease.

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#ambucover 'How to Save a Life'

Paramedic Mary Kate T. performs a cover of The Fray's "How to Save a Life" inside an ambulance.

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#ambucover 'How to Save a Life'

Paramedic Mary Kate T. performs a cover of The Fray's "How to Save a Life" inside an ambulance.

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DXE Medical acquires FASTEX AED to distribute AEDs nationwide

DUBLIN, Ohio — DXE Medical, Inc., a Sarnova company specializing in sales and service of cardiac care products, has acquired First Aid and Safety of Texas, Inc. (FASTEX AED). The acquisition enables DXE to expand its offering of cardiac care products, service and training through a dedicated field sales force, as well as through its online channels. DXE distributes new and recertified defibrillators ...

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Ceftaroline Activity Against Multidrug-Resistant Streptococcus pneumoniae from U.S. Medical Centers (2014) and Molecular Characterization of a Single Ceftaroline Nonsusceptible Isolate

Microbial Drug Resistance , Vol. 0, No. 0.


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#ambucover 'How to Save a Life'

Paramedic Mary Kate T. performs a cover of The Fray's "How to Save a Life" inside an ambulance.

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Leading the Way in Ambulance Crash Testing

Braun is leading the way in ambulance crash testing to build stronger, safer vehicles. Take the next step and let us educate you on the latest safety standards and ambulance design requirements. Click here to contact us http://ift.tt/2g1BwaJ

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Leading the Way in Ambulance Crash Testing

Braun is leading the way in ambulance crash testing to build stronger, safer vehicles. Take the next step and let us educate you on the latest safety standards and ambulance design requirements. Click here to contact us http://ift.tt/2g1BwaJ

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Left ventricular twist mechanics during incremental cycling and knee extension exercise in healthy men

Abstract

Purpose

The objective of the present study was to investigate left ventricular (LV) twist mechanics in response to incremental cycling and isometric knee extension exercises.

Methods

Twenty-six healthy male participants (age = 30.42 ± 6.17 years) were used to study peak twist mechanics at rest and during incremental semi-supine cycling at 30 and 60% work rate maximum (W _max) and during short duration (15 s contractions) isometric knee extension at 40 and 75% maximum voluntary contraction (MVC), using two-dimensional speckle tracking echocardiography.

Results

Data presented as mean ± standard deviation or median (interquartile range). LV twist increased from rest to 30% W _max (13.21° ± 4.63° to 20.04° ± 4.76°, p < 0.001) then remained unchanged. LV systolic and diastolic twisting velocities progressively increased with exercise intensity during cycling from rest to 60% W _max (twisting, 88.21° ± 20.51° to 209.05° ± 34.56° s⁻¹, p < 0.0001; untwisting, −93.90 (29.62)° to −267.31 (104.30)° s⁻¹, p < 0.0001). During the knee extension exercise, LV twist remained unchanged with progressive intensity (rest 13.40° ± 4.80° to 75% MVC 16.77° ± 5.54°, p > 0.05), whilst twisting velocity increased (rest 89.15° ± 21.77° s⁻¹ to 75% MVC 124.32° ± 34.89° s⁻¹, p < 0.01). Untwisting velocity remained unchanged from rest [−90.60 (27.19)° s⁻¹] to 40% MVC (p > 0.05) then increased from 40 to 75% MVC [−98.44 (43.54)° s⁻¹ to −138.42 (73.29)° s⁻¹, p < 0.01]. Apical rotations and rotational velocities were greater than basal during all conditions and intensities (all p < 0.01).

Conclusion

Cycling increased LV twist to 30% W _max which then remained unchanged thereafter, whereas twisting velocities showed further increases to greater intensities. A novel finding is that LV twist was unaffected by incremental knee extension, yet systolic and diastolic twisting velocities augmented with isometric exercise.

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Leading the Way in Ambulance Crash Testing

Braun is leading the way in ambulance crash testing to build stronger, safer vehicles. Take the next step and let us educate you on the latest safety standards and ambulance design requirements. Click here to contact us http://ift.tt/2g1BwaJ

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Leading the Way in Ambulance Crash Testing

Braun is leading the way in ambulance crash testing to build stronger, safer vehicles. Take the next step and let us educate you on the latest safety standards and ambulance design requirements. Click here to contact us http://ift.tt/2g1BwaJ

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STEP 2016 Exporter of The Year is Crestline Coach

Crestline is the proud recipient of the STEP 2016 Exporter of the Year Award, sponsored by Export Development Canada (EDC). Crestline is a world class manufacturer of ambulances and specialty vehicles, with exports to 32 countries globally and buses distributed across Canada.

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New ICON 2.0 Crestline Ambulance

We are excited to share a sneak peak of our new model, the ICON 2.0, Next Generation Ambulance. Advancing patient care through safety, ergonomics and flexibility.

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Pediatric Ambulance for Saskatchewan's Children

Crestline Coach was so pleased to be a part of the 2016 Drive for Kids Campaign, a true Saskatchewan collaboration. In partnership with Synergy 8, the Children's Hospital Foundation and many other sponsors, a custom designed state-of-the-art Pediatric Ambulance was built for the province of Saskatchewan.

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Are we working EMS providers to death?

By Michael Ward

There appears to be three factors in the EMS caregiver environment that contribute to the troubling increase in caregiver deaths by suicide.

1. Too many hours on the job
In Japan, researchers found that some workers who were putting in 100-hour work weeks were suffering from Karoshi, translated as "death by overwork." More Japanese died of Karoshi-induced cardiovascular failure, stroke or suicide than in motor vehicle accidents. According to the Japanese Health, Labour and Welfare Ministry's 2013 statistics, 8.8 percent of full-time employees at Japanese firms, or an estimated 4.74 million, worked more than 60 hours per week.

Many EMS caregivers are working the equivalent of two full-time jobs, caring for patients on an EMS unit for 72 to 90 hours a week. Including travel time from job A to job B, these caregivers are often putting in hours that approach the 100 hours a week linked to Karoshi. Even when assigned to EMS units with low workload, the caregiver is not off-duty and does not have the ability to decompress, rest or recover.

Peter Bungate, writing about his 2013 experience as a foreign attorney in Tokyo, shared this experience:

"Once at an 8:00 a.m. conference call, I was joined by a colleague who rushed into the room, apologized for not arriving earlier, and promptly opened a large can of Red Bull, which he placed on the table next to his laptop. From his briefcase he procured yet another can of Red Bull and two cans of coffee."

Most of us can probably recall a similar scene playing out at the station kitchen table or in the cab of the ambulance.

Caregivers are working these hours to obtain a middle class level of income. The EMS1.com, Fitch & Associates and NEMSMA 2016 EMS Trend Report shows that most EMTs annually earn between $25,001 and $30,000 (median of $13.22/hour) and paramedics earn between $35,001 and $40,000 a year (median of $18.03/hour). Using the Pew Research Center "Are you in the American middle class"" calculator, many EMS caregivers will determine they are part of the 29 percent of Americans in the lower-class income tier.

2. Compassion fatigue
Compassion fatigue is the emotional and physical exhaustion affecting health care providers, usually as a consequence of caring. It can be seen in those who repeatedly witness the emotional or physical suffering of others [1]. Compassion fatigue is linked to "vicarious traumatization," where the trauma or distress is witnessed but not actually experienced [2].

When compassion fatigue hits critical mass in the workplace, the organization itself suffers. Chronic absenteeism, spiraling workers' compensation costs, high turnover rates, friction between employees and friction between staff and management are among organizational symptoms that surface, creating additional stress on workers.

Often, the mistrust that caregivers feel towards management is justified. Most EMS caregivers have additional challenges such as low wages, lack of space, high management turnover rate and constantly shifting priorities. EMS leaders should consider organizational compassion fatigue when considering the root causes of [3]:

• Inability for teams to work well together.
• Desire among staff members to break company rules.
• Outbreaks of aggressive behaviors among staff.
• Inability of staff to respect and meet deadlines.
• Lack of flexibility among staff members.
• Inability of staff to believe improvement is possible.
• Lack of a vision for the future.

EMS agencies tend to be rule-driven and overly routinized. These organizational characteristics increase the risk of developing institutional compassion fatigue. EMS leaders need to examine how the organization operates to reduce the conditions leading to caregiver suicide and early disability or death. Recommended activities to reduce organizational compassion fatigue include [4]:

• Provide adequate training about caregiver stress.
• Encourage peer support, both formal and informal.
• Provide workplaces that allow for privacy, confidentiality and a calm and pleasant work environment.
• Offer employee assistance programs.
• Monitor caregiver workloads.
• Have an open-door policy and encourage feedback.
• Address and resolve staff conflict.

3. War in the streets
Caregivers are confronted with more challenging and demanding situations than earlier generations:

• Deaths from opioid overdoses have quadrupled since 1999, creating an epidemic of overdoses.
• The number of morbidly obese individuals (100 or more pounds over their ideal weight) increased by 70 percent [5].
• Lone-wolf terrorist attacks are becoming more common and the number of fatalities per attack has increased.
• Patient-initiated violence against EMS caregivers is becoming an area of significant concern and research.
• Distracted drivers account for almost 40 percent of vehicle collisions.

EMS leaders should consider the following organizational activities [4]:

• Regularly check in with first-line supervisors and caregivers — do not wait for them to approach you.
• Track significant incidents and follow-up with the involved caregivers.
• Engage in your own self-care program.
• Avoid stigmatizing staff who suffer from compassion fatigue or other stress-related issues.

Few other professions see the confluence of these three factors as often or as significantly as EMS. Failing to address them in individuals will lead to entire organizations suffering, which will only make it more difficult for individuals to escape the cycle. EMS leaders can no longer ignore or write-off these factors as inevitable, and must work with each other, with their employees and with other experts who can help agencies address these problems. If we don't, then we are failing ourselves, our colleagues and our profession — and the patients and communities that rely on us to be compassionate, caring and competent during their time of need.

About the author
Michael Ward, a senior associate with Fitch & Associates, has more than 40 years of experience in the emergency care industry. He retired as the acting EMS chief from a large fire and rescue department, has served as executive director of a hospital-based 911 paramedic and medical transportation service and was an assistant professor and program director at a university medical center. He lives in the Washington, D.C. suburbs.

References

1. 6. Compassion fatigue in emergency medicine. http://ift.tt/2gJ0kTI
2. What is Compassion Fatigue. http://ift.tt/2gvoZbs
3. Symptoms - Compassion Fatigue Awareness Project http://ift.tt/2gJ69R7
4. Teater, M. and Ludgate, J. (2014) Overcoming Compassion Fatigue: A Practical Workbook. Eau Claire, WI: PESI Publishing and Media. ISBN 978-937661-44-1
5. Strum, R. and Hattori A. "Morbid obesity rates continue to rise rapidly in the United States." International Journal of Obesity (London). 2013 Jun;37(6):889-91.

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STEP 2016 Exporter of The Year is Crestline Coach

Crestline is the proud recipient of the STEP 2016 Exporter of the Year Award, sponsored by Export Development Canada (EDC). Crestline is a world class manufacturer of ambulances and specialty vehicles, with exports to 32 countries globally and buses distributed across Canada.

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New ICON 2.0 Crestline Ambulance

We are excited to share a sneak peak of our new model, the ICON 2.0, Next Generation Ambulance. Advancing patient care through safety, ergonomics and flexibility.

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Pediatric Ambulance for Saskatchewan's Children

Crestline Coach was so pleased to be a part of the 2016 Drive for Kids Campaign, a true Saskatchewan collaboration. In partnership with Synergy 8, the Children's Hospital Foundation and many other sponsors, a custom designed state-of-the-art Pediatric Ambulance was built for the province of Saskatchewan.

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Diffusion-Weighted Genitourinary Imaging

Publication date: Available online 5 December 2016
Source:Radiologic Clinics of North America
Author(s): Martin H. Maurer, Kirsi Hannele Härmä, Harriet Thoeny

Teaser

This review article aims to provide an overview on of diffusion-weighted MR imaging (DW-MR imaging) in the urogenital tract. Compared with conventional cross-sectional imaging methods, the additional value of DW-MR imaging in the detection and further characterization of benign and malignant lesions of the kidneys, bladder, prostate, and pelvic lymph nodes is discussed as well as the role of DW-MR imaging in the evaluation of treatment response.


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Imaging in Urolithiasis

Publication date: Available online 5 December 2016
Source:Radiologic Clinics of North America
Author(s): William R. Masch, Kevin C. Cronin, Dushyant V. Sahani, Avinash Kambadakone

Teaser

Imaging plays an important role in the diagnosis of urolithiasis as well as its pre-treatment planning and post-treatment follow-up. Proper imaging technique is essential to provide appropriate clinical care to affected patients. This article reviews the clinically relevant imaging findings most likely to influence management decisions.


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Prostate MR Imaging

Publication date: Available online 4 December 2016
Source:Radiologic Clinics of North America
Author(s): Hiram Shaish, Samir S. Taneja, Andrew B. Rosenkrantz

Teaser

Improvements in prostate MR imaging techniques and the introduction of MR imaging-targeted biopsies have had central roles in prostate cancer (PCa) management. The role of MR imaging has progressed from largely staging patients with biopsy-proven PCa to detecting, characterizing, and guiding the biopsy of suspected PCa. These diagnostic advances, combined with improved therapeutic interventions, have led to a more sophisticated and individually tailored approach to patients' unique PCa profile. This review discusses the MR imaging, a standardized reporting scheme, and the role of fusion-targeted prostate biopsy.


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Image-Guided Renal Interventions

Publication date: Available online 4 December 2016
Source:Radiologic Clinics of North America
Author(s): Sharath K. Bhagavatula, Paul B. Shyn

Teaser

Image-guided renal biopsies have an increasing role in clinical practice. Renal mass and renal parenchymal biopsy indications, techniques, and other clinical considerations are reviewed in this article. Image-guided renal mass ablation shows significant promise and increasing clinical utility as more studies demonstrate its safety and efficacy. Renal mass ablation indications, techniques, and other considerations are also reviewed.


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STEP 2016 Exporter of The Year is Crestline Coach

Crestline is the proud recipient of the STEP 2016 Exporter of the Year Award, sponsored by Export Development Canada (EDC). Crestline is a world class manufacturer of ambulances and specialty vehicles, with exports to 32 countries globally and buses distributed across Canada.

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New ICON 2.0 Crestline Ambulance

We are excited to share a sneak peak of our new model, the ICON 2.0, Next Generation Ambulance. Advancing patient care through safety, ergonomics and flexibility.

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Pediatric Ambulance for Saskatchewan's Children

Crestline Coach was so pleased to be a part of the 2016 Drive for Kids Campaign, a true Saskatchewan collaboration. In partnership with Synergy 8, the Children's Hospital Foundation and many other sponsors, a custom designed state-of-the-art Pediatric Ambulance was built for the province of Saskatchewan.

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STEP 2016 Exporter of The Year is Crestline Coach

Crestline is the proud recipient of the STEP 2016 Exporter of the Year Award, sponsored by Export Development Canada (EDC). Crestline is a world class manufacturer of ambulances and specialty vehicles, with exports to 32 countries globally and buses distributed across Canada.

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New ICON 2.0 Crestline Ambulance

We are excited to share a sneak peak of our new model, the ICON 2.0, Next Generation Ambulance. Advancing patient care through safety, ergonomics and flexibility.

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Pediatric Ambulance for Saskatchewan's Children

Crestline Coach was so pleased to be a part of the 2016 Drive for Kids Campaign, a true Saskatchewan collaboration. In partnership with Synergy 8, the Children's Hospital Foundation and many other sponsors, a custom designed state-of-the-art Pediatric Ambulance was built for the province of Saskatchewan.

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Man arrested after stealing Texas ambulance

EMS personnel were taking a patient into a medical center when the ambulance was stolen

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Calif. paramedic airlifted after ambulance hit-and-run

The ambulance was responding to a call when it was struck by an SUV at an intersection

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Content Validity and Test-Retest Reliability of the Gujarati Version of the Central Sensitization Inventory

2016-12-05T10-24-33Z
Source: National Journal of Integrated Research in Medicine
Bid Dibyendunarayan D*, Soni Neela C**, Rathod Priyanshu V***, A. Thangamani Ramalingam****.
Background: Central sensitization (CS) is a state of heightened sensitivity of the central nervous system to both noxious and non-noxious stimuli. The Central Sensitization Inventory (CSI) is a sound screening tool to help clinicians to detect patients with CS. To date, no Gujarati version exists. Objectives: The aim of this study was to translate and cross-culturally adapt the CSI into Gujarati, and to check content validity, face validity, internal consistency, test-retest reliability, agreement and minimum detectable change (MDC) of CSI-G in chronic low back pain (CLBP) patients. Methods: Translation and cross-cultural adaptation of the original English version of the CSI-G was performed according to published guidelines. The content validity was ascertained by 23 healthcare professionals. The internal consistency, test-retest reliability, agreement and MDC was determined on CLBP patients (n=31) with a time interval of 7-days. Results: The content validity and Face validity was found to be excellent. The internal consistency was excellent (Cronbachs α=0.914) and MDC was found to be 5.092 points. The test-retest reliability showed very high correlation in CLBP patients (ICC = 0.971). Conclusion: The original CSI was translated into Gujarati and did not pose any problems during data acquisition. The CSI-G seems to be reliable instruments to measure CS in Gujarati patients with CLBP. [Bid D NJIRM 2016; 7(5):18-24]


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Reality Training: Unresponsive teen after intentional asphyxiation

How will you care for a teenager who intentionally asphyxiated himself and is now unresponsive with agonal respirations?

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Why EMS personnel need a valid physical abilities test

A valid physical abilities test specific to EMS is an elusive unicorn EMS leaders have been attempting to capture for as long as I can remember. Pre-hire physical abilities testing and a yearly incumbent PAT is something that EMS has long needed. With the cost of worker's compensation continuing to rise, we can no longer afford to hire the unfit and physically unable.

As a visionary risk manager once said to me, "We have to stop hiring our injuries. EMS will never get the respect it deserves as long as we hire unfit employees." Moving from sage advice from a risk specialist to designing and validating a PAT is a whole different set of hurdles.

As I look across the country at EMS departments, I consistently see injury rates continuing to increase, even as new technologies designed to make patient handling easier and more ergonomically correct. The continuing rise in on-the-job injuries is leading many EMS leaders to ask how an EMS department can design, validate and administer a PAT that is:

• Affordable to run in house
• Truly job specific
• Tests human power generation
• Assess anaerobic capacity
• Legally defensible

This is an issue many departments struggle with and there is not a consensus on how to solve. Some departments run a pre-hire PAT that they self-validate, which means there is often candidate and examiner bias in the test. In addition, the results are not compared to a national data set. Other departments borrow tests from other public safety disciplines. Many departments outsource pre-hire physical assessment to an occupational medicine clinic where the candidates are not tested using EMS gear.

Goal of physical abilities testing
Since overexertion injuries account for a large number of all work-related injuries in EMS, it is the goal of EMS departments to reduce the potential for overexertion by hiring physically capable employees. A valid PAT test is intended to reduce injuries for which high levels of strength, mobility and power are required.

For a PAT to be valid, it must be a job task simulation using standardized gear and weights. There must be no bias to candidate's age, gender, height or from the examiner. The PAT must be reviewed for biomechanical accuracy and statistically analyzed for expected completion times.

Don't hire your next injured employee
You can learn a lot from watching someone move. You can learn a lot more about them when you load them up with weight.

I recently completed five days of physical abilities testing for a large, urban fire department's EMS division, testing over 100 candidates. Watching over 100 candidates climb stairs with gear, lift, move, pull, squat to do CPR and lift cot's is eye-opening. The lack of job specific mobility — squatting, kneeling, stepping — was staggering and it's often these poor movement patterns that lead to injury.

EMS is a 100 percent physical job that requires a blend of job specific mobility, strength, power and anaerobic conditioning. Without the proper blend of physical ability, first responders are at a very high risk of injury. So it begs me to ask the following questions of EMS leaders and hiring managers:

• Are you hiring your department's next injured employee"
• Are you OK with risk and liability exposures because employee fitness is poor"
• How do you know if your current employees are still physically able to perform the job safely"
• How do field personnel know what the job has done to their body"

PAT effect on staffing
EMS departments that are using a validated job task simulation that has no bias to age, gender or from the examiner hire higher-caliber employees year after year. The physical ability and attitude of their potential employees has changed for the better, because the people who know they are out of shape or injured go somewhere else for a job. They usually go to a service that does not have a PAT, usually just using a static lift test or, even worse, out-sources testing to an occupational health clinic. Lifting milk crates doesn't simulate anything expected of EMS personnel.

For field providers, physical abilities testing is not about taking anyone's job away. In fact, it's all about keeping field personnel happy, healthy and uninjured. An annual physical abilities test informs field providers where they are in the physical spectrum. But before testing field providers annually, two things need to be in place.

1. Employees must have access to a fitness facility.

2. Employees should be given a scientifically accurate protocol to follow that is no less than eight weeks long to allow them to build the mobility and strength to pass the test.

Remember, our goal is a fit and injury free workforce. If field providers perceive that their employer is out to get them, then we have missed the point completely.

Risk in EMS is multifaceted
Field personnel are constantly facing risks from driving to assaults to infectious diseases to liability from ePCR documentation. I know fitness reduces risk. A fit employee:

• Gets hurt less
• Is more productive
• Has lower liability exposure, especially as it pertains to patient handling.

I also know a fit company has less turnover and better morale.

All of these are goals of forward leading EMS organizations and the first step for an employer is a physical abilities test. The first step for a field provider is to accept that the job is physical. After that, acceptance, a positive organization culture and individual change is possible. I have seen it happen.

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Prenatal management of cystic hygroma and long term outcomes

2016-12-05T06-28-18Z
Source: Medicine Science | International Medical Journal
Ahter Tanay Tayyar, Ahmet Tayyar, Mehmet Tayyar.
Cystic hygroma is a benign congenital malformation of the lymphatic system. The rate of incidence is 1-4/1000 and it can be inherited as an autosomal recessive. There is a 35-50 % chance of chromosomal abnormalities with cystic hygroma. Also euploid fetuses have 50 % structural malformation risk. The most common malformations are cardiac malformations. Theres a 15 % chance of live births for affected fetuses. If there is neither chromosomal abnormalities nor structural malformations, a 95 % normal short-term pediatric outcome can be estimated. However, the overall prognosis in fetuses with cystic hygroma is poor, and a healthy survival rate is less than 5 %. There are prenatal, natal and postnatal treatment methods.


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Targeted mutagenesis in rice using CRISPR-Cpf1 system

Publication date: Available online 5 December 2016
Source:Journal of Genetics and Genomics
Author(s): Xixun Hu, Chun Wang, Qing Liu, Yapiing Fu, Kejian Wang




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A cross sectional study on evaluation of satisfaction level of TB patients enrolled for directly observed treatment, short course chemotherapy in a district of Central India

2016-12-05T05-14-15Z
Source: International Journal of Community Medicine and Public Health
Neeraj Rai, S. P. Singh, S. S. Kushwah, Deepak Dubey.
Background: DOTS therapy has been recognized as the best cost effective approach to tuberculosis control. It is also a key strategy of Indias Revised National Tuberculosis Control Programme. Evaluating patients satisfaction is an important method of measuring the quality of health services. Satisfied patients are more likely to utilize health services and comply with medical treatment thus patients satisfaction is a key determinant in treatment success. Whereas there is a paucity of data regarding patients satisfaction with tuberculosis treatment services provided at different DMC cum DOTS centers in district Rewa. Thus present study is a small attempt to assess patients satisfaction level with DOTS services. Methods: A cross sectional study was carried out at 15 DMC cum DOTS Centers of Rewa district, Madhya Pradesh from 1st July 2007 to 30th June 2008. These centers were selected by simple random sampling. All patients who were registered from July to September 2007 and also receiving DOTS therapy at these DMC cum DOTS Centers were included in this study. Results: In the study, of all 337 patients, 241 (71.5%) were fully satisfied and remaining 96 (28.5%) were satisfied somewhat with the health services. majority of the patients expressed satisfaction with timing of DOTS Centres (93.17%) including waiting time for medical care (86.05%) as well as behavior of staff (90.20%). While most of the patients were dissatisfied due to frequent visits to DOTS centers (37.1%) and total duration of DOTS therapy (29.1%). Conclusions: In the study overall satisfaction with TB services is good. However there is some dissatisfaction particularly with frequent visits to DOTS centers and total duration of DOTS therapy. So there is an urgent need to address these issues by the concerned authorities.


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Systematic approach to understanding the pathogenesis of systemic sclerosis

Abstract

Systemic sclerosis (SSc) is a complex heterogeneous autoimmune disease. Progressive organ fibrosis is a major contributor to SSc mortality. Despite extensive efforts, the underlying mechanism of SSc remains unclear. Efforts to understand the pathogenesis of SSc have included genomics, epigenetics, transcriptomic, proteomic and metabolomic studies in the last decade.

This review focuses on recent studies in SSc research based on multi-omics. The combination of these technologies can help us understand the pathogenesis of SSc. This review aims to provide important information for disease identification, therapeutic targets and potential biomarkers.

Graphical Abstract

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Characterization of the global transcriptome and microsatellite marker information for spotted halibut Verasper variegatus

Abstract

The spotted halibut Verasper variegatus is an economically important flatfish species distributed in Japan, Korea and China. However, the genomic resources regarding this species were scarcity, which hindered our understanding of the genetics and biological mechanisms in spotted halibut. In this study, we examined the global transcriptome from six major tissues of spotted halibut. Approximately 40 million of high quality reads were generated using Illumina paired-end sequencing technology. More than 9 Gbp data were generated, and de novo assembled into 59,235 unigenes, with an N50 of 938 bp. Based on sequence similarity search with known protein database, 34,084 (57.5%) showed significant similarity to known proteins in Nr database, and 28,875 (48.7%) had BLAST hits in Swiss-Prot database. 19,562 and 23,037 unigenes were assigned into gene ontology categories and clusters of orthologous group, respectively. 9138 unigenes were mapped to 211 KEGG pathways. For functional marker development, 13,322 candidate simple sequence repeats were identified in the transcriptome and 7235 primer pairs were successfully designed. Among 72 primer pairs selected for validation, 67 (93.1%) were successful in PCR amplification and 14 (19.4%) exhibited obvious repeat length polymorphisms in a culture spotted halibut population. The transcriptomic data and microsatellite markers will provide valuable resources for future functional gene analyses, genetic map construction, and quantitative trait loci mapping in V. variegatus.

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Coagulopathy related to hemodilution and acidosis

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Gene therapy: In vivo gene editing in non-dividing cells

Nature Reviews Genetics. doi:10.1038/nrg.2016.158

Author: Denise Waldron

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Prevalence of peripheral vascular disease in high risk population using non-invasive techniques

2016-12-05T02-04-11Z
Source: International Journal of Advances in Medicine
Manan Anand, Maxima Anand.
Background: The term peripheral arterial disease (PAD) generally refers to a disorder that obtained the blood supply to lower or upper extremities. It is frequently associated with cerebral and coronary atherosclerosis. Methods: 200 patients coming to OPD and IPD in age group of 20-65 years with risk factors of HT, DM known CAD, known PAD, smokings were worked up. Results: Steep increase in prevalence of clinical PAD was found in 50 years or above, males predominated only slightly 32% than females 27.7% in clinical PAD. Every one patient was either hypertensive or diabetic, one-third had both Diabetes and hypertension, one third was dyslipidemic, and one fifth had CAD. CAD was more prevalent in patients with clinical PAD 40% than without PAD 11.4%. Elevated triglyceride levels >150 mg/dl was more in patients clinical PAD 33.3% than without PAD 14.2%. Elevated total cholesterol levels >200 mg/dl was more in patients with clinical PAD 26.6% than without PAD 20%. 80% of patients with clinical PAD had ABI


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Observation on relationship of hepatic and renal dysfunction with haemorrheological parameters in plasmodium falciparum malaria in Kosi region, Bihar, India

2016-12-05T02-04-11Z
Source: International Journal of Advances in Medicine
Md. Habibur Rahman, Pramod Kumar Agrawal.
Background: Malaria contribute to be one of the major public health problem in around 1.5 million contribute per year, of which about 52% due to Plasmodium falciparum. The study was designed to assess hepatic and renal dysfunction in plasmodium falciparum malaria, and evaluate if such abnormalities had any bearing with the haemorrheological dysfunction. Methods: Group A comprising 30 cases of plasmodium falciparum positive cases with jaundice or renal failure or both and Group B Comprising 30 cases of falciparum malaria and have no complication. Laboratory investigation was done for liver and renal function test, complete blood count and coagulation profile. The data collected was analysed to inter-correlate parameters of hepatic, renal and haemorrheological dysfunction. Results: Fever was the predominant feature in our study, present in 100% patient followed by chill and rigors which was present in 90% cases of both groups. Hepatomegaly was present in 53.33% cases in group A and 16.67% in group B, whereas spleenomegaly was present in 43.33% cases in group A and 26.67% in group B. Most common complication in group A was jaundice present in 100% cases followed by renal failure present in 53.33% cases. Overt bleeding was present in only 3.33% cases with complicated falciparum malaria. Anemia was present in 73.33% cases of group A and 50% cases in group B. Thrombocytopenia was present in 50% patient in group A and 23.33% in group B. Bleeding time, clotting time, PT with INR, APTT, FDP and LDH was much higher in group A than group B in our study. The biochemical parameters (serum urea, creatinine, bilirubin, AST, ALT, ALP) in both groups differed significantly. In group A Haemoglobin and platelet count significantly negatively correlated with hepatic and renal parameters where as FDP and LDH significantly positively correlated with all the hepatic and renal parameters. In group B the correlation between hematological and biochemical (hepatic and renal) parameters was not found to be statistically significant. Conclusions: Patients of complicated falciparum malaria have significant subclinical haemorrheological disorders even if they do not manifest as clinically overt DIC.


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Electrophysiology in Fisher syndrome

Publication date: January 2017
Source:Clinical Neurophysiology, Volume 128, Issue 1
Author(s): Satoshi Kuwabara, Yukari Sekiguchi, Sonoko Misawa
Fisher syndrome (FS), a variant of Guillain–Barré syndrome (GBS), is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia. The lesion sites for these unique clinical features include the oculomotor nerves and group 1a neurons in the dorsal root ganglion, and the presence of FS is determined by the expression of ganglioside GQ1b in the human nervous system. Neurophysiological findings suggest that ataxia and areflexia are due to an impaired proprioceptive afferent system. Typically, the soleus H-reflex is absent and a body-sway analysis using posturography shows a 1-Hz peak, which indicates proprioception dysfunction. Sensory nerve action potentials and somatosensory-evoked potentials are abnormal in approximately 30% of FS patients, indicating the occasional involvement of cutaneous (group 2) afferents. During the disease course, approximately 15% of FS patients suffer an overlap of axonal GBS with nerve conduction abnormalities that reflect axonal dysfunction. This review summarizes electrophysiological abnormalities and their clinical significance in FS.



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Sleep-related modifications of EEG connectivity in the sensory-motor networks in Huntington Disease: An eLORETA Study and Review of the Literature

Publication date: Available online 5 December 2016
Source:Clinical Neurophysiology
Author(s): Carla Piano, Claudio Imperatori, Anna Losurdo, Anna Rita Bentivoglio, Pietro Cortelli, Giacomo Della Marca
ObjectiveTo evaluate EEG functional connectivity in the sensory-motor network, during wake and sleep, in patients with Huntington Disease (HD).Methods23 patients with HD and 23 age- and sex-matched healthy controls were enrolled. EEG connectivity analysis was performed by means of exact Low Resolution Electric Tomography (eLORETA).ResultsIn wake, HD patients showed an increase of delta lagged phase synchronization (T= 3.60; p< 0.05) among Broadman's Areas (BA) 6-8 bilaterally; right BA 6-8 and right BA 1-2-3; left BA 1-2-3 and left BA 4. In NREM, HD patients showed an increase of delta lagged phase synchronization (T= 3.56; p< 0.05) among left BA 1-2-3 and right BA 6-8. In REM, HD patients showed an increase of lagged phase synchronization (T= 3.60; p< 0.05) among the BA 6-8 bilaterally (delta band); left BA 1-2-3 and right BA 1-2-3 (theta); left BA 1-2-3 and right BA 4 (theta); left BA 1-2-3 and right BA 1-2-3 (alpha).ConclusionsOur results may reflect an abnormal function of the motor areas or an effort to counterbalance the pathological motor output. Significance. Our results may help to understand the pathophysiology of sleep-related movement disorders in Huntington's Disease, and to define therapeutically strategies.



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Perioperative hypothermia in neonatal intensive care unit patients: effectiveness of a thermoregulation intervention and associated risk factors

Summary

Background

Hypothermia in neonatal intensive care unit patients is associated with morbidity. Perioperative normothermia is the standard of care.

Aims

We hypothesized that a quality improvement intervention (transport protocol, transport education, ongoing monitoring) would decrease the incidence of perioperative hypothermia. Secondarily, we hypothesized that patients undergoing surgery at a postmenstrual age of <37 weeks or at a weight of <1.5 kg would be at higher risk for perioperative hypothermia.

Methods

Lean Six Sigma methodology was used to institute a quality improvement intervention. In a retrospective chart review, we identified 708 cases for which the neonatal intensive care unit was the preoperative and postoperative destination and documented patient characteristics, including postoperative temperature. Cardiac surgical cases and cases with no postoperative temperature record were excluded.

Results

Patients in the postintervention group had a statistically significant decrease in hypothermia compared to those in the preintervention group (P < 0.001; OR: 0.17; 95% CI: 0.09–0.31). The absolute risk of hypothermia was 23% in the preintervention group and 6% in the postintervention group. Weight <1.5 kg on day of surgery (P = 0.45; OR: 0.63; 95% CI: 0.16–2.24) and postmenstrual age (P = 0.91; OR: 1.07; 95% CI: 0.33–3.98) were not risk factors. Odds of hypothermia were increased in patients undergoing interventional cardiology procedures (P = 0.003; OR: 17.77; 95% CI: 2.07–125.7).

Conclusions

Perioperative hypothermia is a challenge in the care of neonatal intensive care unit patients; however, a thermoregulation intervention can decrease the incidence with sustained results. Future studies can examine why certain procedures have a tendency toward increased perioperative hypothermia, determine the relative value of quality improvement interventions, and characterize the morbidity and mortality associated with perioperative hypothermia in neonatal intensive care unit patients.

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Effect of Recasting of Ni-Cr Base Metal Dental Casting Alloys on the Corrosion Rate, Compositional Changes and Ion Release in Artificial Saliva and Saline Solution

2016-12-05T01-18-27Z
Source: International Journal of Health and Rehabilitation Sciences (IJHRS)
K Jayaprakash, K Harish Kumar Shetty, A Nityananda Shetty, Bantarahalli Thopegowda Nandish, Sowmya Rao.
Background: Environmental concerns are increasing rapidly, and the industry and public are more concerned about natural resources and recycling. Today, it is equally important to take into account cost, ecological factors in production and recycling of materials used in various fields. Purpose: The aim of this study was to evaluate corrosion rate, compositional changes and ion release of recasted Ni-Cr dental casting alloy Materials and Methods: Commercially available Ni -Cr alloy (Bellabond) was used in the study. The recasting was done without any addition of new alloys and recasted up to six times. Corrosion rate was determined by Tafel extrapolation method in artificial saliva in pH 2.3, 6.7 and in 0.9% saline solution at pH 7.3. The compositional changes were studied by Inductively coupled Plasma Atomic emission Spectroscopy (ICP-AES) method. Ion release during storage in artificial saliva and saline solution for one week and four weeks was detected by using atomic absorption spectroscopy (AAS). Results: The corrosion rate was found slightly increased with recasting numbers up to six times. The quantities of ions released increased as the recasting number increases. These changes were not clinically significant. During recasting procedure, there was a change in their alloy compositions, which increases the corrosion rate in recasted alloys. Conclusion: The recasting technique can be accepted in dental practices. This study showed the possibilities of safe usage of recasted alloys up to certain generations in dentistry and in later stages if it is not suitable for dentistry it can be directed to other fields of industries, where the biocompatibility is not a major requirement. This lowers the environmental burden, health hazards and protects imbalance of natural resources


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Clinical profile and etiological spectrum of fever of unknown origin in children aged 2 months to 12 years

2016-12-05T00-44-32Z
Source: International Journal of Contemporary Pediatrics
Santhosh Govindarajulu, Kumarasamy Kalyanasundaram, Karamath S. Pyarejan, Seenivasan Venkatasamy.
Background: Fever of unknown origin is one of the leading etiologies for morbidity and mortality among children worldwide and their spectrum keeps changing constantly from time to time. The objective of this study was to study the clinical profile and etiological spectrum of fever beyond 2 weeks duration in children aged 2 months to 12 years admitted in a tertiary care hospital. Methods: A prospective observational study, done in tertiary care centre over six month period (May 2016 to October 2016). Children aged 2 months to 12 years presenting with fever beyond 2 weeks duration fulfilling the inclusion criteria were included in the study and evaluated further. Initial investigations include complete blood count including peripheral smear for MP/malignancy, urine routine, chest X-ray, mantoux, CRP, blood and urine cultures were done followed by specific serology tests and further relevant investigations. The etiological outcomes were mainly analysed. Results: The etiological outcomes of the study were classified into 5 groups as infections, malignancies, connective tissue disorder, miscellaneous and undiagnosed. Among the study population, infection emerged as the major etiological outcome constituting 69.1% followed by malignancies (16.7%), connective tissue disorder (5%), miscellaneous (5.8%) and undiagnosed (3.4%). Conclusions: Infections, especially enteric fever still remains the leading etiology of fever beyond 2 weeks duration or FUO in children aged 2months to 12 years. Irrational usage of antibiotics has been highlighted in general practice which needs to be amended by periodic discussions and epidemiological surveys to prevent the emergence of drug resistance.


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