Background and Objectives: Patients undergoing major elective ankle surgery often experience pain from the saphenous nerve territory persisting beyond the duration of a single-injection saphenous nerve block. We hypothesized that perineural dexamethasone as an adjuvant for the saphenous nerve block prolongs the duration of analgesia and postpones as well as reduces opioid-requiring pain. Methods: Forty patients were included in this prospective, randomized, controlled study. All patients received a continuous sciatic catheter and were randomized to receive a single-injection saphenous nerve block with 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine with addition of 1 mL of saline or 1 mL of 0.4% (ie, 4 mg) dexamethasone. The primary outcome was duration of saphenous nerve block estimated as the time until the first opioid request. Secondary outcomes were opioid consumption and pain. Results: The mean (SD) duration of the saphenous nerve block until first opioid request was 29.4 (8.4) hours in the dexamethasone group and 23.2 (10.3) hours in the control group (P = 0.048). The median opioid consumption [interquartile range] during the first 24 hours was 0 mg [0-0] versus 1.5 mg [0-14.2] in the dexamethasone and control groups, respectively. Nonparametric comparison of opioid consumption from 0 to 24 hours was statistically significant. The opioid consumption was similar in the two groups in the time interval 24 to 48 postoperative hours. Conclusion: Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong analgesia and reduce opioid-requiring pain after major ankle surgery. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.
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Πέμπτη 29 Δεκεμβρίου 2016
The internal representation of head orientation differs for conscious perception and balance control
KEY POINTS
- We tested perceived head-on-feet orientation and the direction of vestibular-evoked balance responses in passively- and actively-held head-turned postures
- The direction of vestibular-evoked balance responses was not aligned with perceived head-on-feet orientation while maintaining prolonged passively-held head-turned postures. Furthermore, static visual cues of head-on-feet orientation did not update the estimate of head posture for the balance controller
- A prolonged actively-held head-turned posture did not elicit a rotation in the direction of the vestibular-evoked balance response despite a significant rotation in perceived angular head posture
- It is proposed that conscious perception of head posture and the transformation of vestibular signals for standing balance relying on this head posture are not dependent on the same internal representation. Rather, the balance system may operate under its own sensorimotor principles, which are partly independent from perception
Abstract
Vestibular signals used for balance control must be integrated with other sensorimotor cues to allow transformation of descending signals according to an internal representation of body configuration. We explored two alternate models of sensorimotor integration that propose 1) a single internal representation of head-on-feet orientation is responsible for perceived postural orientation and standing balance or 2) conscious perception and balance control arxe driven by separate internal representations. During three experiments, participants stood quietly while passively or actively maintaining a prolonged head-turned posture (>10 min). Throughout the trials, participants intermittently reported their perceived head angular position and subsequently electrical vestibular stimuli to were delivered to elicit whole-body balance responses. Visual recalibration of head-on-feet posture was used to determine whether static visual cues are used to update the internal representation of body configuration for perceived orientation and standing balance. All three experiments involved situations in which the vestibular-evoked balance response was not orthogonal with perceived head-on-feet orientation, regardless of visual information provided. For prolonged head-turned postures, balance responses consistent with actual head-on-feet posture only occurred during the active condition. Our results indicate that conscious perception of head-on-feet posture and vestibular control of balance do not rely on the same internal representation, but instead treat sensorimotor cues in parallel and may arrive at different conclusions regarding head-on-feet posture. The balance system appears to bypass static visual cues of postural orientation and mainly use other sensorimotor signals of head-on-feet position to transform vestibular signals of head motion, a mechanism appropriate for most daily activities.
This article is protected by copyright. All rights reserved
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Exploring the possible mechanisms of blunted cardiac reactivity to acute psychological stress
Source:International Journal of Psychophysiology
Author(s): Ryan C. Brindle, Anna C. Whittaker, Adam Bibbey, Douglas Carroll, Annie T. Ginty
Blunted cardiovascular reactivity to acute psychological stress has been linked to a range of adverse health and behavioral outcomes. However, the origins of blunted reactivity remain unclear. The current study aimed to explore the following possibilities: different appraisals of task stressfulness and/or difficulty, diminished task effort, or reduced physiological capacity to respond. Individuals characterized, via pre-screening, as blunted (n=17) or exaggerated (n=16) heart rate (HR) reactors to acute psychological stress (socially evaluative mental arithmetic) were exposed to a psychological stress, cold pressor and exercise tasks during a follow-up testing session while HR and blood pressure (BP) were measured. At follow-up, groups again mounted significantly different HR reactions to psychological stress, despite reporting similar levels of subjective stress and difficulty, and achieving similar tasks scores (measure of task effort) at both testing sessions. In response to the cold pressor and exercise blunted and exaggerated reactors displayed similar HR and BP responses. Results indicated that blunted reactors do not differ from exaggerated reactors on appraisals of task stressfulness or difficulty, or objective task effort, and do possess the physiological capacity to respond to other laboratory challenges. Other sources of blunted stress reactivity remain to be explored.
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Small interfering RNA targeting NF-κB attenuates lipopolysaccharide-induced acute lung injury in rats
To investigate the anti-inflammatory effects of specific small interfering RNA targeting NF-κB on lipopolysaccharide (LPS)-induced acute lung injury (ALI) in rats.
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Esmolol infusion versus propranolol infusion: effects on heart rate and blood pressure in healthy volunteers
Despite its widespread clinical use, the β1 adrenergic receptor antagonist esmolol hydrochloride is not commonly used in human physiology research and the effective dose (compared to the nonselective β-blocker propranolol) is unclear. In four separate studies, we used cycle ergometry exercise and infusions of isoproterenol and epinephrine to test the heart rate (HR)- lowering effect of esmolol compared to propranolol and saline in healthy humans. In Cohort 1, both esmolol (HR: 57 ± 6) and propranolol (HR: 56 ± 7) attenuated exercise tachycardia compared to saline (HR: 88 ± 17). In Cohort 2, we found that HR to exercise was similar 5 minutes (HR: 57 ± 9) and 60 minutes (HR: 55 ± 9) after starting the esmolol maintenance infusion. In Cohort 3 we confirmed that the HR-lowering effect of esmolol disappears 45 minutes after stopping the maintenance infusion. In Cohort 4, changes in femoral blood flow and hematological parameters in response to epinephrine infusion were comparable between esmolol and saline infusion indicating that our esmolol infusion paradigm does not block β2 receptors. Collectively, our data indicate that infusing ~160 mg of esmolol (range 110 to 200 mg in the 5 minutes prior to exercise) acutely and selectively blocks β1 adrenergic receptors in healthy humans. Additionally, β1 receptors remain blocked 60 minutes later if a maintenance infusion of ~0.2 mg/kg total body mass/min continues. The current data lay the foundation for future studies to evaluate β1 versus β2 control of the circulation in humans.
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Circulating microRNAs in acute and chronic exercise: more than mere biomarkers
MicroRNAs (miRNAs) are short, non-coding RNAs that influence biological processes by regulating gene expression post-transcriptionally. It was recently discovered that miRNAs are released into the circulation (ci-miRNAs) where they are highly stable and can act as intercellular messengers to affect physiological processes. This review provides a comprehensive summary of the studies, to date, that have investigated the effects of acute exercise and exercise training on ci-miRNAs in humans. Findings indicate that specific ci-miRNAs are altered in response to different protocols of acute and chronic exercise in both healthy and diseased populations. In some cases, altered ci-miRNAs correlate with fitness and health parameters, suggesting causal mechanisms by which ci-miRNAs may facilitate adaptations to exercise training. However, strong data supporting such mechanisms are lacking. Thus, a purpose of this review is to guide future studies by discussing current and novel proposed roles for ci-miRNAs in adaptations to exercise training. In addition, there are substantial, fundamental gaps in the field that need to be addressed. The ultimate goal is that an understanding of ci-miRNAs roles in physiological adaptations to exercise training will one day translate to therapeutic interventions.
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Muscle damage and inflammation during recovery from exercise
Unaccustomed exercise consisting of eccentric (i.e., lengthening) muscle contractions often results in muscle damage characterized by ultrastructural alterations in muscle tissue, clinical signs and symptoms (e.g., reduced muscle strength and range of motion, increased muscle soreness and swelling, efflux of myocellular proteins). The time course of recovery following exercise-induced muscle damage depends on the extent of initial muscle damage, which in turn is influenced by the intensity and duration of exercise, joint angle/muscle length and muscle groups used during exercise. The effects of these factors on muscle strength, soreness and swelling are well characterized. By contrast, much less is known about how they affect intramuscular inflammation and molecular aspects of muscle adaptation/remodeling. Although inflammation has historically been viewed as detrimental for recovery from exercise, it is now generally accepted that inflammatory responses-if tightly regulated-are integral to muscle repair and regeneration. Animal studies have revealed that other cell types including mast cells, eosinophils, CD8 and T regulatory lymphocytes, fibro-adipogenic progenitors and pericytes also help to facilitate muscle tissue regeneration. However, more research is required to determine whether these cells respond to exercise-induced muscle damage. A large body of research has investigated the efficacy of physicotherapeutic, pharmacological and nutritional interventions for reducing the signs and symptoms of exercise-induced muscle damage, with mixed results. More research is needed to examine if/how these treatments influence inflammation and muscle remodeling during recovery from exercise.
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Case Studies in Physiology: Maximal Oxygen Consumption and Performance in a Centenarian Cyclist
The purpose of this study was to examine the physiological characteristics of an elite centenarian cyclist who, at 101 years old, established the one-hour cycling record for individuals ≥ 100 years old (24.25 km) and to determine the physiological factors associated with his performance improvement two years later at 103 years old (26.92 km; +11%). Before each record, he performed an incremental test on a cycling ergometer. For two years, he trained 5,000 km a year with a polarized training that involved cycling 80% of mileage at "light" RPE ≤ 12 and 20% at "hard" RPE ≥ 15 at a cadence between 50 and 70 rpm. Results: his bodyweight and lean body mass did not change, while his O2max increased (31 to 35 ml.kg-1.min-1; +13%). Peak power output increased from 90 to 125 W (+39 %), mainly due to increasing the maximal pedaling frequency (69 to 90 rpm; +30%). Maximal heart rate did not change (134 to 137 bpm) in contrast to the maximal ventilation (57 to 70 L.min-1, +23%), increasing with both the respiratory frequency (38 to 41 cycle.min-1; +8%) and the tidal volume (1.5 to 1.7 L; +13%). Respiratory Exchange Ratio increased (1.03 to 1.14) in the same extent as tolerance to CO2. In conclusion, it is possible to increase performance and O2max with polarized training focusing on a high pedaling cadence even after turning 100 years old.
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Assessment of airway response distribution and paradoxical airway dilation in mice during methacholine challenge
Detailed information on the distribution of airway diameters during bronchoconstriction in situ is required in order to understand the regional response of the lungs. Imaging studies using computed tomography (CT) have previously measured airway diameters and changes in response to bronchoconstricting agents, but the manual measurements used have severely limited the number of airways measured per subject. Hence, the detailed distribution and heterogeneity of airway responses is unknown. We have developed and applied dynamic imaging and advanced image-processing methods to quantify and compare hundreds of airways in vivo. The method, based on CT, was applied to house-dust-mite sensitized and control mice during intravenous methacholine infusion. Airway diameters were measured pre- and post-methacholine challenge, and the results compared to demonstrate the distribution of airway response throughout the lungs during mechanical ventilation. Forced oscillation testing was used to measure the global response in lung mechanics. We found marked heterogeneity in the response, with paradoxical dilation of airways present at all airway sizes. The probability of paradoxical dilation decreased with decreasing baseline airway diameter and was not affected by pre-existing inflammation. The results confirm the importance of considering the lung as an entire interconnected system, rather than a collection of independent units. It is hoped that the response distribution measurements can help to elucidate the mechanisms that lead to heterogeneous airway response in vivo.
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Alterations to mitochondrial fatty-acid use in skeletal muscle after chronic exposure to hypoxia depend on metabolic phenotype
We investigated the effects of chronic hypoxia on the maximal use of and sensitivity of mitochondrial to different substrates in rat slow-oxidative (soleus, SOL) and fast-glycolytic (extensor digitorum longus, EDL) muscles. We studied mitochondrial respiration in situ in permeabilized myofibers, using pyruvate, octanoate, palmitoyl-carnitine (PC) or palmitoyl-coenzyme A (PCoA). The hypophagia induced by hypoxia may also alter metabolism. We therefore used a group of pair-fed rats (reproducing the same caloric restriction as observed in hypoxic animals) in addition to the normoxic control fed ad libitum. The resting respiratory exchange ratio decreased after 21 days of exposure to hypobaric hypoxia (simulated elevation of 5,500 m). The respiration of pyruvate and octanoate were unaffected. By contrast, the maximal oxidative respiratory rate for PCoA, the transport of which depends on CPT-1, decreased in the rapid-glycolytic EDL and increased in the slow-oxidative SOL, although hypoxia improved affinity for this substrate in both muscle types. PC and PCoA were oxidized similarly in normoxic EDL, whereas chronic hypoxia limited transport at the CPT-1 step in this muscle. The effects of hypoxia were mediated by caloric restriction in the SOL, and by hypoxia itself in the EDL. We conclude that improvements in mitochondrial affinity for PCoA, a physiological long-chain fatty acid, would facilitate fatty-acid use at rest after chronic hypoxia independently of quantitative alterations of mitochondria. Conversely, decreasing the maximal oxidation of PCoA in fast-glycolytic muscles would limit fatty-acid use during exercise.
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Pediatric dextrose administration tips and tricks
Things you may not have known about Pediatric Dextrose administration?
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Isolated left brachiocephalic artery with the right aortic arch: A rare differential of large patent ductus arteriosus
Gajendra Dubey, Saurabh Kumar Gupta, Shyam Sundar Kothari
Annals of Pediatric Cardiology 2017 10(1):78-81
We report a case of isolation of the left brachiocephalic artery with the right aortic arch in a 9-year-old male child masquerading as large patent ductus arteriosus with left-to-right shunt. We have emphasized the subtle clinical findings which served as clues to the diagnosis.
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Annals of Pediatric Cardiology 2017 10(1):78-81
We report a case of isolation of the left brachiocephalic artery with the right aortic arch in a 9-year-old male child masquerading as large patent ductus arteriosus with left-to-right shunt. We have emphasized the subtle clinical findings which served as clues to the diagnosis.
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Spectrum of cyanotic congenital heart disease diagnosed by echocardiographic evaluation in patients attending a tertiary cardiac care center of South Rajasthan
Amit Kumar, Kapil Bhargava
Annals of Pediatric Cardiology 2017 10(1):97-98
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Annals of Pediatric Cardiology 2017 10(1):97-98
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Transcatheter pulmonary valve perforation using chronic total occlusion wire in pulmonary atresia with intact ventricular septum
Shweta Bakhru, Shilpa Marathe, Manish Saxena, Sudeep Verma, Rajan Saileela, Tapan K Dash, Nageswara Rao Koneti
Annals of Pediatric Cardiology 2017 10(1):5-10
Background: Perforation of pulmonary valve using radiofrequency ablation in pulmonary atresia with intact ventricular septum (PA IVS) is a treatment of choice. However, significant cost of the equipment limits its utility, especially in the developing economies. Objective: To assess the feasibility, safety, and efficacy of perforation of pulmonary valve using chronic total occlusion (CTO) wires in patients with PA IVS as an alternative to radiofrequency ablation. Methods: This is a single.center, nonrandomized, retrospective study conducted during June 2008 to September 2015. Twenty-four patients with PA IVS were selected for the procedure during the study period. The median age and weight of the study population were 8. days and 2.65 kg, respectively. Four patients were excluded after right ventricular angiogram as they showed right ventricular-dependent coronary circulation. The pulmonary valve perforation was attempted using various types of CTO wires based on the tip load with variable penetrating characteristics. Results: The procedure was successful in 16 of twenty patients using CTO wires: Shinobi in nine, Miracle in four, CROSS-IT in two, and Conquest Pro in one. Two patients had perforation of right ventricular outflow tract (RVOT). Pericardiocentesis was required in one patient to relieve cardiac tamponade. Later, the same patient underwent successful hybrid pulmonary valvotomy. The other patient underwent ductus arteriosus. (DA) stenting. Balloon atrial septostomy was needed in three cases with systemic venous congestion. Desaturation was persistent in five cases necessitating DA or RVOT stenting to augment pulmonary blood flow. There were two early and two late deaths. The mean follow-up was 22.66. ± 16 months. Three patients underwent one and half ventricle repair and one Blalock-Taussig shunt during follow-up. Conclusion: Perforation of the pulmonary valve can be done successfully using CTO wires in selected cases of pulmonary atresia with intact ventricular septum.
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Annals of Pediatric Cardiology 2017 10(1):5-10
Background: Perforation of pulmonary valve using radiofrequency ablation in pulmonary atresia with intact ventricular septum (PA IVS) is a treatment of choice. However, significant cost of the equipment limits its utility, especially in the developing economies. Objective: To assess the feasibility, safety, and efficacy of perforation of pulmonary valve using chronic total occlusion (CTO) wires in patients with PA IVS as an alternative to radiofrequency ablation. Methods: This is a single.center, nonrandomized, retrospective study conducted during June 2008 to September 2015. Twenty-four patients with PA IVS were selected for the procedure during the study period. The median age and weight of the study population were 8. days and 2.65 kg, respectively. Four patients were excluded after right ventricular angiogram as they showed right ventricular-dependent coronary circulation. The pulmonary valve perforation was attempted using various types of CTO wires based on the tip load with variable penetrating characteristics. Results: The procedure was successful in 16 of twenty patients using CTO wires: Shinobi in nine, Miracle in four, CROSS-IT in two, and Conquest Pro in one. Two patients had perforation of right ventricular outflow tract (RVOT). Pericardiocentesis was required in one patient to relieve cardiac tamponade. Later, the same patient underwent successful hybrid pulmonary valvotomy. The other patient underwent ductus arteriosus. (DA) stenting. Balloon atrial septostomy was needed in three cases with systemic venous congestion. Desaturation was persistent in five cases necessitating DA or RVOT stenting to augment pulmonary blood flow. There were two early and two late deaths. The mean follow-up was 22.66. ± 16 months. Three patients underwent one and half ventricle repair and one Blalock-Taussig shunt during follow-up. Conclusion: Perforation of the pulmonary valve can be done successfully using CTO wires in selected cases of pulmonary atresia with intact ventricular septum.
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Impact of Abernathy malformation on pulmonary circulatory hemodynamics in a univentricular heart
Vinoth Doraiswamy, Kothandam Sivakumar
Annals of Pediatric Cardiology 2017 10(1):90-91
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Annals of Pediatric Cardiology 2017 10(1):90-91
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Mechanism of valve failure and efficacy of reintervention through catheterization in patients with bioprosthetic valves in the pulmonary position
Ryan Callahan, Lisa Bergersen, Christopher W Baird, Diego Porras, Jesse J Esch, James E Lock, Audrey C Marshall
Annals of Pediatric Cardiology 2017 10(1):11-17
Background: Surgical and transcatheter bioprosthetic valves (BPVs) in the pulmonary position in patients with congenital heart disease may ultimately fail and undergo transcatheter reintervention. Angiographic assessment of the mechanism of BPV failure has not been previously described. Aims: The aim of this study was to determine the mode of BPV failure (stenosis/regurgitation) requiring transcatheter reintervention and to describe the angiographic characteristics of the failed BPVs and report the types and efficacy of reinterventions. Materials and Methods: This is a retrospective single-center review of consecutive patients who previously underwent pulmonary BPV placement. (surgical or transcatheter) and subsequently underwent percutaneous reintervention from 2005 to 2014. Results: Fifty-five patients with surgical. (41) and transcutaneous pulmonary valve. (TPV) (14) implantation of BPVs underwent 66 catheter reinterventions. The surgically implanted valves underwent fifty reinterventions for indications including 16 for stenosis, seven for regurgitation, and 27 for both, predominantly associated with leaflet immobility, calcification, and thickening. Among TPVs, pulmonary stenosis. (PS) was the exclusive failure mode, mainly due to loss of stent integrity. (10) and endocarditis. (4). Following reintervention, there was a reduction of right ventricular outflow tract gradient from 43 ± 16 mmHg to 16 ± 10. mmHg (P < 0.001) and RVp/AO ratio from 0.8 ± 0.2 to 0.5 ± 0.2 (P < 0.001). Reintervention with TPV placement was performed in 45. (82%) patients. (34 surgical, 11 transcatheter) with no significant postintervention regurgitation or paravalvular leak. Conclusion: Failing surgically implanted BPVs demonstrate leaflet calcification, thickness, and immobility leading to PS and/or regurgitation while the mechanism of TPV failure in the short- to mid-term is stenosis, mainly from loss of stent integrity. This can be effectively treated with a catheter.based approach, predominantly with the valve-in-valve technique.
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Annals of Pediatric Cardiology 2017 10(1):11-17
Background: Surgical and transcatheter bioprosthetic valves (BPVs) in the pulmonary position in patients with congenital heart disease may ultimately fail and undergo transcatheter reintervention. Angiographic assessment of the mechanism of BPV failure has not been previously described. Aims: The aim of this study was to determine the mode of BPV failure (stenosis/regurgitation) requiring transcatheter reintervention and to describe the angiographic characteristics of the failed BPVs and report the types and efficacy of reinterventions. Materials and Methods: This is a retrospective single-center review of consecutive patients who previously underwent pulmonary BPV placement. (surgical or transcatheter) and subsequently underwent percutaneous reintervention from 2005 to 2014. Results: Fifty-five patients with surgical. (41) and transcutaneous pulmonary valve. (TPV) (14) implantation of BPVs underwent 66 catheter reinterventions. The surgically implanted valves underwent fifty reinterventions for indications including 16 for stenosis, seven for regurgitation, and 27 for both, predominantly associated with leaflet immobility, calcification, and thickening. Among TPVs, pulmonary stenosis. (PS) was the exclusive failure mode, mainly due to loss of stent integrity. (10) and endocarditis. (4). Following reintervention, there was a reduction of right ventricular outflow tract gradient from 43 ± 16 mmHg to 16 ± 10. mmHg (P < 0.001) and RVp/AO ratio from 0.8 ± 0.2 to 0.5 ± 0.2 (P < 0.001). Reintervention with TPV placement was performed in 45. (82%) patients. (34 surgical, 11 transcatheter) with no significant postintervention regurgitation or paravalvular leak. Conclusion: Failing surgically implanted BPVs demonstrate leaflet calcification, thickness, and immobility leading to PS and/or regurgitation while the mechanism of TPV failure in the short- to mid-term is stenosis, mainly from loss of stent integrity. This can be effectively treated with a catheter.based approach, predominantly with the valve-in-valve technique.
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A novel technique for percutaneous closure of an atrial septal defect in a patient with interrupted inferior vena cava using a “modified” short sheath from an internal jugular vein approach
Tharakanatha R Yarrabolu, Andrew Robinson, Athar M Qureshi
Annals of Pediatric Cardiology 2017 10(1):102-103
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Annals of Pediatric Cardiology 2017 10(1):102-103
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Cardiac magnetic resonance feature tracking in Kawasaki disease convalescence
Konstantinos Bratis, Pauline Hachmann, Nicholas Child, Thomas Krasemann, Tarique Hussain, Sophie Mavrogeni, Rene Botnar, Reza Razavi, Gerald Greil
Annals of Pediatric Cardiology 2017 10(1):18-25
Objective: The objective of this study was to determine whether left ventricular (LV) myocardial deformation indices can detect subclinical abnormalities in Kawasaki disease convalescence. We hypothesized that subclinical myocardial abnormalities due to inflammation represent an early manifestation of the disease that persists in convalescence. Background: Myocardial inflammation has been described as a global finding in the acute phase of Kawasaki disease. Despite normal systolic function by routine functional measurements, reduced longitudinal strain and strain rate have been detected by echocardiography in the acute phase. Methods and Results: Peak systolic LV myocardial longitudinal, radial, and circumferential strain and strain rate were examined in 29 Kawasaki disease convalescent patients (15 males; mean [standard deviation] age: 11 [6.6] years; median interval from disease onset: 5.8 [5.4] years) and 10 healthy volunteers (5 males; mean age: 14 [3.8] years) with the use of cardiac magnetic resonance (CMR) feature tracking. Routine indices of LV systolic function were normal in both groups. Comparisons were made between normal controls and (i) the entire Kawasaki disease group, (ii) Kawasaki disease subgroup divided by coronary artery involvement. Average longitudinal and circumferential strain at all levels was lower in patients compared to normal controls. In subgroup analysis, both Kawasaki disease patients with and without a history of coronary involvement had similar longitudinal and circumferential strain at all levels and lower when compared to controls. There were lower circumferential and longitudinal values in Kawasaki disease patients with persisting coronary artery lesions when compared to those with regressed ones. Conclusion: In this CMR study in Kawasaki disease convalescent patients with preserved routine functional indices, we detected lower circumferential and longitudinal strain values compared to normal controls, irrespective of the coronary artery status.
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Annals of Pediatric Cardiology 2017 10(1):18-25
Objective: The objective of this study was to determine whether left ventricular (LV) myocardial deformation indices can detect subclinical abnormalities in Kawasaki disease convalescence. We hypothesized that subclinical myocardial abnormalities due to inflammation represent an early manifestation of the disease that persists in convalescence. Background: Myocardial inflammation has been described as a global finding in the acute phase of Kawasaki disease. Despite normal systolic function by routine functional measurements, reduced longitudinal strain and strain rate have been detected by echocardiography in the acute phase. Methods and Results: Peak systolic LV myocardial longitudinal, radial, and circumferential strain and strain rate were examined in 29 Kawasaki disease convalescent patients (15 males; mean [standard deviation] age: 11 [6.6] years; median interval from disease onset: 5.8 [5.4] years) and 10 healthy volunteers (5 males; mean age: 14 [3.8] years) with the use of cardiac magnetic resonance (CMR) feature tracking. Routine indices of LV systolic function were normal in both groups. Comparisons were made between normal controls and (i) the entire Kawasaki disease group, (ii) Kawasaki disease subgroup divided by coronary artery involvement. Average longitudinal and circumferential strain at all levels was lower in patients compared to normal controls. In subgroup analysis, both Kawasaki disease patients with and without a history of coronary involvement had similar longitudinal and circumferential strain at all levels and lower when compared to controls. There were lower circumferential and longitudinal values in Kawasaki disease patients with persisting coronary artery lesions when compared to those with regressed ones. Conclusion: In this CMR study in Kawasaki disease convalescent patients with preserved routine functional indices, we detected lower circumferential and longitudinal strain values compared to normal controls, irrespective of the coronary artery status.
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Pseudoaneurysm of the left atrium following infective endocarditis
Devi A Manuel, Bino John Sahayo, Viji Samuel Thomson, Jacob Jose
Annals of Pediatric Cardiology 2017 10(1):84-86
Transthoracic echocardiogram of a 3-year-old child showed a hypoechoic cavity in the posterior wall of the left atrium communicating with the left ventricle through an orifice in the mitral annulus, suggestive of pseudoaneurysm (Ps), probably the result of infective endocarditis. Three-dimensional echocardiography was helpful to confirm the diagnosis and assess the anatomical relationship of the Ps.
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Annals of Pediatric Cardiology 2017 10(1):84-86
Transthoracic echocardiogram of a 3-year-old child showed a hypoechoic cavity in the posterior wall of the left atrium communicating with the left ventricle through an orifice in the mitral annulus, suggestive of pseudoaneurysm (Ps), probably the result of infective endocarditis. Three-dimensional echocardiography was helpful to confirm the diagnosis and assess the anatomical relationship of the Ps.
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Elective nasal continuous positive airway pressure to support respiration after prolonged ventilation in infants after congenital cardiac surgery
Hemang Gandhi, Amit Mishra, Rajesh Thosani, Himanshu Acharya, Ritesh Shah, Jigar Surti, Alpesh Sarvaia
Annals of Pediatric Cardiology 2017 10(1):26-30
Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation.
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Annals of Pediatric Cardiology 2017 10(1):26-30
Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation.
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Transcatheter closure of aortopulmonary window with Amplatzer duct occluder II
Hemant Kumar Nayak, Nurul Islam, Bhanu Kumar Bansal
Annals of Pediatric Cardiology 2017 10(1):93-94
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Annals of Pediatric Cardiology 2017 10(1):93-94
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A pediatric echocardiographic Z-score nomogram for a developing country: Indian pediatric echocardiography study – The Z-score
Rajendra Kumar Gokhroo, Avinash Anantharaj, Devendra Bisht, Kamal Kishor, Nishad Plakkal, Rajeswari Aghoram, Nivedita Mondal, Shashi K Pandey, Ramsagar Roy
Annals of Pediatric Cardiology 2017 10(1):31-38
Background: Almost all presently available pediatric echocardiography Z-score nomograms are based on Western data. They may not be a suitable reference standard for assessing the sizes of cardiac structures of children from developing countries. Objective: This study's objective was to collect normative data of 21 commonly measured cardiovascular structures using M-mode and two-dimensional echocardiography in Indian children aged between 4 and 15 years and to derive Z-score nomograms for each. Subjects and Methods: The study was conducted at two centers in India . Ajmer, Rajasthan, and Mohali, Punjab. We studied a community-based sample involving healthy school going children. After excluding children with cardiovascular abnormalities on the screening echocardiogram, 746 children were included in the final analysis. Echocardiographic assessment was performed using a Philips iE33 system. Results and Analysis: For each parameter measured, seven models were evaluated to assess the relationship of that parameter with the body surface area and the one with the best fit was used to plot the Z-score chart for that parameter. Z score charts were thus derived. Conclusions: The Z-score nomograms derived by this study may be better alternatives to the Western nomograms for use in India and other developing countries for preprocedural decision making in the pediatric population. However, they will require validation in large-scale studies before they can become clinically applicable.
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Annals of Pediatric Cardiology 2017 10(1):31-38
Background: Almost all presently available pediatric echocardiography Z-score nomograms are based on Western data. They may not be a suitable reference standard for assessing the sizes of cardiac structures of children from developing countries. Objective: This study's objective was to collect normative data of 21 commonly measured cardiovascular structures using M-mode and two-dimensional echocardiography in Indian children aged between 4 and 15 years and to derive Z-score nomograms for each. Subjects and Methods: The study was conducted at two centers in India . Ajmer, Rajasthan, and Mohali, Punjab. We studied a community-based sample involving healthy school going children. After excluding children with cardiovascular abnormalities on the screening echocardiogram, 746 children were included in the final analysis. Echocardiographic assessment was performed using a Philips iE33 system. Results and Analysis: For each parameter measured, seven models were evaluated to assess the relationship of that parameter with the body surface area and the one with the best fit was used to plot the Z-score chart for that parameter. Z score charts were thus derived. Conclusions: The Z-score nomograms derived by this study may be better alternatives to the Western nomograms for use in India and other developing countries for preprocedural decision making in the pediatric population. However, they will require validation in large-scale studies before they can become clinically applicable.
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Massive pericardial effusion, yet no signs of tamponade!
Sunitha Vaidyanathan, Amol Gupta, Kothandam Sivakumar
Annals of Pediatric Cardiology 2017 10(1):100-101
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Annals of Pediatric Cardiology 2017 10(1):100-101
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Modified closed chamber sutureless technique for anomalous pulmonary venous connection
Sabarinath Menon, Thomas Mathew, Jayakumar Karunakaran, Baiju Sashidhar Dharan
Annals of Pediatric Cardiology 2017 10(1):58-60
Visibility continues to be a major problem during repair of obstructed total anomalous pulmonary venous connection (TAPVC) resulting in frequent use of deep hypothermia and low flow bypass. Sutureless technique for primary repair of anomalous pulmonary venous connection is fast becoming popular. In this described modification of sutureless technique through the lateral approach, the left atrium is marsupialized around the common pulmonary venous chamber, except on the right lateral aspect, providing a bloodless field with minimal retraction of heart facilitating the surgery at mild hypothermia. This technique can be particularly useful in small confluence obstructed TAPVC and in mixed TAPVC.
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Annals of Pediatric Cardiology 2017 10(1):58-60
Visibility continues to be a major problem during repair of obstructed total anomalous pulmonary venous connection (TAPVC) resulting in frequent use of deep hypothermia and low flow bypass. Sutureless technique for primary repair of anomalous pulmonary venous connection is fast becoming popular. In this described modification of sutureless technique through the lateral approach, the left atrium is marsupialized around the common pulmonary venous chamber, except on the right lateral aspect, providing a bloodless field with minimal retraction of heart facilitating the surgery at mild hypothermia. This technique can be particularly useful in small confluence obstructed TAPVC and in mixed TAPVC.
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Rheumatic heart disease screening: Current concepts and challenges
Scott Dougherty, Maziar Khorsandi, Philip Herbst
Annals of Pediatric Cardiology 2017 10(1):39-49
Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.
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Annals of Pediatric Cardiology 2017 10(1):39-49
Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.
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Should we close small ventricular septal defects?
Sangeetha Viswanathan, R Krishna Kumar
Annals of Pediatric Cardiology 2017 10(1):1-4
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Annals of Pediatric Cardiology 2017 10(1):1-4
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Pediatric cardiovascular care in Uganda: Current status, challenges, and opportunities for the future
Twalib Olega Aliku, Sulaiman Lubega, Judith Namuyonga, Tom Mwambu, Michael Oketcho, John O Omagino, Craig Sable, Peter Lwabi
Annals of Pediatric Cardiology 2017 10(1):50-57
In many developing countries, concerted action against common childhood infectious diseases has resulted in remarkable reduction in infant and under-five mortality. As a result, pediatric cardiovascular diseases are emerging as a major contributor to childhood morbidity and mortality. Pediatric cardiac surgery and cardiac catheterization interventions are available in only a few of Sub-Saharan African countries. In Uganda, open heart surgeries (OHSs) and interventional procedures for pediatric cardiovascular disease are only possible at the Uganda Heart Institute (UHI), having been started with the help of expatriate teams from the years 2007 and 2012, respectively. Thereafter, independent OHS and cardiac catheterization have been possible by the local team at the UHI since the year 2009 and 2013, respectively. The number of OHSs independently performed by the UHI team has progressively increased from 10 in 2010 to 35 in 2015, with mortality rates ranging from 0% to 4.1% over the years. The UHI pediatric catheterization team has independently performed an increasing number of procedures each year from 3 in 2013 to 55 in 2015. We herein describe the evolution and current status of pediatric cardiovascular care in Uganda, highlighting the unique aspects of its establishment, existing constraints, and future plans.
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Annals of Pediatric Cardiology 2017 10(1):50-57
In many developing countries, concerted action against common childhood infectious diseases has resulted in remarkable reduction in infant and under-five mortality. As a result, pediatric cardiovascular diseases are emerging as a major contributor to childhood morbidity and mortality. Pediatric cardiac surgery and cardiac catheterization interventions are available in only a few of Sub-Saharan African countries. In Uganda, open heart surgeries (OHSs) and interventional procedures for pediatric cardiovascular disease are only possible at the Uganda Heart Institute (UHI), having been started with the help of expatriate teams from the years 2007 and 2012, respectively. Thereafter, independent OHS and cardiac catheterization have been possible by the local team at the UHI since the year 2009 and 2013, respectively. The number of OHSs independently performed by the UHI team has progressively increased from 10 in 2010 to 35 in 2015, with mortality rates ranging from 0% to 4.1% over the years. The UHI pediatric catheterization team has independently performed an increasing number of procedures each year from 3 in 2013 to 55 in 2015. We herein describe the evolution and current status of pediatric cardiovascular care in Uganda, highlighting the unique aspects of its establishment, existing constraints, and future plans.
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Interventional therapy for partial anomalous pulmonary venous connection with dual drainage
Saurabh Kumar Gupta, Anita Saxena, Rajnish Juneja
Annals of Pediatric Cardiology 2017 10(1):82-83
A 6-year-old boy presented with dual drainage of left upper pulmonary vein, with connection to innominate vein inaddition to its normal connection to the left atrium. Despite relief of aortic stenosis at the age of 3 years, significant left to right shunt persisted. The dual drainage allowed successful percutaneous closure of the levoatriocardinal vein without obstruction to the pulmonary venous flow to the left atrium.
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Annals of Pediatric Cardiology 2017 10(1):82-83
A 6-year-old boy presented with dual drainage of left upper pulmonary vein, with connection to innominate vein inaddition to its normal connection to the left atrium. Despite relief of aortic stenosis at the age of 3 years, significant left to right shunt persisted. The dual drainage allowed successful percutaneous closure of the levoatriocardinal vein without obstruction to the pulmonary venous flow to the left atrium.
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A rare case of cardiac tumor in a child
Mallar Mukharjee, Jigna N Bathia, Apurba Ghosh, Anil Kumar Singhi
Annals of Pediatric Cardiology 2017 10(1):87-89
Pediatric cardiac tumors are rare and usually benign. An infectious etiology like tuberculosis invading myocardium and presenting as infiltrative mass is extremely rare. We present a case of a 15 month old girl with clinical feature of cardiac failure who had infiltrative multiple myocardial masses in echocardiogram. Advanced cardiac imaging by Cardiac Magnetic resonance imaging (MRI ) helped in tissue delineation. Therapeutic trial of anti-tubercular drugs in view clinical suspicion of Tuberculosis resulted in complete remission of symptom and disappearance of the cardiac mass.
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Annals of Pediatric Cardiology 2017 10(1):87-89
Pediatric cardiac tumors are rare and usually benign. An infectious etiology like tuberculosis invading myocardium and presenting as infiltrative mass is extremely rare. We present a case of a 15 month old girl with clinical feature of cardiac failure who had infiltrative multiple myocardial masses in echocardiogram. Advanced cardiac imaging by Cardiac Magnetic resonance imaging (MRI ) helped in tissue delineation. Therapeutic trial of anti-tubercular drugs in view clinical suspicion of Tuberculosis resulted in complete remission of symptom and disappearance of the cardiac mass.
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Surgical repair of tricuspid valve leaflet tear following percutaneous closure of perimembranous ventricular septal defect using Amplatzer duct occluder I: Report of two cases
Saatchi Mahesh Kuwelker, Devi Prasad Shetty, Bharat Dalvi
Annals of Pediatric Cardiology 2017 10(1):61-64
Tricuspid valve (TV) injury following transcatheter closure of perimembranous ventricular septal defect (PMVSD) with Amplatzer ductal occluder I (ADO I), requiring surgical repair, is rare. We report two cases of TV tear involving the anterior and septal leaflets following PMVSD closure using ADO I. In both the patients, the subvalvular apparatus remained unaffected. The patients presented with severe tricuspid regurgitation (TR) 6 weeks and 3 months following the device closure. They underwent surgical repair with patch augmentation of the TV leaflets. Postoperatively, both are asymptomatic with a mild residual TR.
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Annals of Pediatric Cardiology 2017 10(1):61-64
Tricuspid valve (TV) injury following transcatheter closure of perimembranous ventricular septal defect (PMVSD) with Amplatzer ductal occluder I (ADO I), requiring surgical repair, is rare. We report two cases of TV tear involving the anterior and septal leaflets following PMVSD closure using ADO I. In both the patients, the subvalvular apparatus remained unaffected. The patients presented with severe tricuspid regurgitation (TR) 6 weeks and 3 months following the device closure. They underwent surgical repair with patch augmentation of the TV leaflets. Postoperatively, both are asymptomatic with a mild residual TR.
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Isolated facial nerve palsy after arterial switch operation: A rarity
Manoj Kumar Sahu, Intekhab Alam, Sarvesh Pal Singh, Ramesh Menon, Sachin Talwar
Annals of Pediatric Cardiology 2017 10(1):92-93
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Annals of Pediatric Cardiology 2017 10(1):92-93
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Pediatric dextrose administration tips and tricks
Things you may not have known about Pediatric Dextrose administration?
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Pediatric dextrose administration tips and tricks
Things you may not have known about Pediatric Dextrose administration?
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Pediatric dextrose administration tips and tricks
Things you may not have known about Pediatric Dextrose administration?
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Criteria for Progressing Rehabilitation and Determining Return-to-Play Clearance Following Hamstring Strain Injury: A Systematic Review
Abstract
Background
Rehabilitation progression and return-to-play (RTP) decision making following hamstring strain injury (HSI) can be challenging for clinicians, owing to the competing demands of reducing both convalescence and the risk of re-injury. Despite an increased focus on the RTP process following HSI, little attention has been paid to rehabilitation progression and RTP criteria, and subsequent time taken to RTP and re-injury rates.
Objective
The aim of this systematic review is to identify rehabilitation progression and RTP criteria implemented following HSI and examine the subsequent time taken to RTP and rates of re-injury.
Methods
A systematic literature review of databases MEDLINE, CINAHL, SPORTDiscus, Cochrane Library, Web of Science and EMBASE was conducted to identify studies of participants with acute HSI reporting time taken to RTP and rates of re-injury after a minimum 6-month follow-up. General guidelines and specific criteria for rehabilitation progression were identified for each study. In addition, RTP criteria were identified and categorised as performance tests, clinical assessments, isokinetic dynamometry or the Askling H-test.
Results
Nine studies were included with a total of 601 acute HSI confirmed by clinical examination or magnetic resonance imaging within 10 days of initial injury. A feature across all nine studies was that the injured individual's perception of pain was used to guide rehabilitation progression, whilst clinical assessments and performance tests were the most frequently implemented RTP criteria. Mean RTP times were lowest in studies implementing isokinetic dynamometry as part of RTP decision making (12–25 days), whilst those implementing the Askling H-test had the lowest rates of re-injury (1.3–3.6%).
Conclusions
This systematic review highlights the strong emphasis placed on the alleviation of pain to allow HSI rehabilitation progression, and the reliance on subjective clinical assessments and performance tests as RTP criteria. These results suggest a need for more objective and clinically practical criteria, allowing a more evidence-based approach to rehabilitation progression, and potentially reducing the ambiguity involved in the RTP decision-making process.
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Effect of Exercise on Ovulation: A Systematic Review
Abstract
Background
Infertility has been described as a devastating life crisis for couples, and has a particularly severe effect on women, in terms of anxiety and depression. Anovulation accounts for around 30% of female infertility, and while lifestyle factors such as physical activity are known to be important, the relationship between exercise and ovulation is multi-factorial and complex, and to date there are no clear recommendations concerning exercise regimes.
Objectives
The objective of this review was to systematically assess the effect of physical activity on ovulation and to discuss the possible mechanisms by which exercise acts to modulate ovulation in reproductive-age women. This was done with a view to improve existing guidelines for women wishing to conceive, as well as women suffering from anovulatory infertility.
Search Methods
The published literature was searched up to April 2016 using the search terms ovulation, anovulatory, fertility, sport, physical activity and exercise. Both observational and interventional studies were considered, as well as studies that combined exercise with diet. Case studies and articles that did not report anovulation/ovulation or ovarian morphology as outcomes were excluded. Studies involving administered drugs in addition to exercise were excluded.
Results
In total, ten interventions and four observational cohort studies were deemed relevant. Cohort studies showed that there is an increased risk of anovulation in extremely heavy exercisers (>60 min/day), but vigorous exercise of 30–60 min/day was associated with reduced risk of anovulatory infertility. Ten interventions were identified, and of these three have studied the effect of vigorous exercise on ovulation in healthy, ovulating women, but only one showed a significant disruption of ovulation as a result. Seven studies have investigated the effect of exercise on overweight/obese women suffering from polycystic ovary syndrome (PCOS) or anovulatory infertility, showing that exercise, with or without diet, can lead to resumption of ovulation. The mechanism by which exercise affects ovulation is most probably via modulation of the hypothalamic-pituitary-gonadal (HPG) axis due to increased activity of the hypothalamic–pituitary–adrenal (HPA) axis. In heavy exercisers and/or underweight women, an energy drain, low leptin and fluctuating opioids caused by excess exercise have been implicated in HPA dysfunction. In overweight and obese women (with or without PCOS), exercise contributed to lower insulin and free androgen levels, leading to the restoration of HPA regulation of ovulation.
Conclusions
Several clear gaps have been identified in the existing literature. Short-term studies of over-training have not always produced the disturbance to ovulation identified in the observational studies, bringing up the question of the roles of longer term training and chronic energy deficit. We believe this merits further investigation in specific cohorts, such as professional athletes. Another gap is the complete absence of exercise-based interventions in anovulatory women with a normal body mass index (BMI). The possibly unjustified focus on weight loss rather than the exercise programme means there is also a lack of studies comparing types of physical activity, intensity and settings. We believe that these gaps are delaying an efficient and effective use of exercise as a therapeutic modality to treat anovulatory infertility.
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Prevalence of Back Pain in Sports: A Systematic Review of the Literature
Abstract
Background
Back pain is a frequent health problem in the general population. The epidemiology of back pain in the general population is well researched, but detailed data on the prevalence and risk factors of back pain in athletes are rare.
Objective
The primary objective was to review articles about back pain in athletes to provide an overview of its prevalence in different sports and compare its prevalence among various types of sports and the general population.
Data Sources
A comprehensive search of articles published through May 2015 was conducted. Two independent reviewers searched six databases from inception (PubMed®, Embase, MEDLINE®, Cochrane Library, PsycINFO and PSYNDEX), using specifically developed search strategies, for relevant epidemiological research on back pain in 14- to 40-year-old athletes of Olympic disciplines. The reviewers independently evaluated the methodological quality of reviewed articles meeting the inclusion criteria to identify potential sources of bias. Relevant data were extracted from each study.
Results
Forty-three articles were judged to meet the inclusion criteria and were included in the assessment of methodological quality. Of these, 25 were assessed to be of high quality. Lifetime prevalence and point prevalence were the most commonly researched episodes and the lower back was the most common localization of pain. In the high-quality studies, lifetime prevalence of low back pain in athletes was 1–94%, (highest prevalence in rowing and cross-country skiing), and point prevalence of low back pain was 18–65% (lowest prevalence in basketball and highest prevalence in rowing).
Conclusion
The methodological heterogeneity of the included studies showed a wide range of prevalence rates and did not enable a detailed comparison of data among different sports, within one discipline, or versus the general population. Based on the results of this review, however, it seems obvious that back pain requires further study in some sports.
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From Lab to Real World: Heat Acclimation Considerations for Elite Athletes
Abstract
As major sporting events are often held in hot environments, increased interest in ways of optimally heat acclimating athletes to maximise performance has emerged. Heat acclimation involves repeated exercise sessions in hot conditions that induce physiological and thermoregulatory adaptations that attenuate heat-induced performance impairments. Current evidence-based guidelines for heat acclimation are clear, but the application of these recommendations is not always aligned with the time commitments and training priorities of elite athletes. Alternative forms of heat acclimation investigated include hot water immersion and sauna bathing, yet uncertainty remains around the efficacy of these methods for reducing heat-induced performance impairments, as well as how this form of heat stress may add to an athlete's overall training load. An understanding of how to optimally prescribe and periodise heat acclimation based on the performance determinants of a given event is limited, as is knowledge of how heat acclimation may affect the quality of concurrent training sessions. Finally, differences in individual athlete responses to heat acclimation need to be considered. This article addresses alternative methods of heat acclimation and heat exposure, explores gaps in literature around understanding the real world application of heat acclimation for athletes, and highlights specific athlete considerations for practitioners.
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Action and function of Wnt/β-catenin signaling in the progression from chronic hepatitis C to hepatocellular carcinoma
Abstract
Hepatitis C virus (HCV) infection is one of the leading causes of hepatocellular carcinoma (HCC) worldwide but the mechanistic basis as to how chronic HCV infection furthers the HCC process remains only poorly understood. Accumulating evidence indicates that HCV core and nonstructural proteins provoke activation of the Wnt/β-catenin signaling pathway, and the evidence supporting a role of Wnt/β-catenin signaling in the onset and progression of HCC is compelling. Convincing molecular explanations as to how expression of viral effectors translates into increased activity of the Wnt/β-catenin signaling machinery are still largely lacking, hampering the design of rational strategies aimed at preventing HCC. Furthermore, how such increased signaling is especially associated with HCC oncogenesis in the context of HCV infection remains obscure as well. Here we review the body of contemporary biomedical knowledge on the role of the Wnt/β-catenin pathway in the progression from chronic hepatitis C to cirrhosis and HCC and explore potential hypotheses as to the mechanisms involved.
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Fla. paramedic rescues man, pays for his flight home
By EMS1 Staff
FORT LAUDERDALE, Fla. — A paramedic went above and beyond the call when he took a young drug addict under his wing and paid for his flight home.
Dusty Rousseau, 36, responded to a call to assist officers with a man who passed out on a sidewalk, reported the Bay Today.
"When they woke him up, he was laying on the streets in Fort Lauderdale. Fort Lauderdale sounds beautiful, with Florida and sandy beaches, but where I found him was not the best place," Rousseau said.
Rousseau told officers he would escort the man to the hospital, who had relapsed after leaving rehab. After officers told the man, named Ryan, to get up, Rousseau was overcome with emotion.
"That's where the emotion came for me. I felt bad for the kid right away, he said 'yes sir,' he's not a thug," Rousseau said.
The paramedic took the 21-year-old to the hospital, where he asked staff to keep him safe until his 12-hour shift ended.
"I talked to him for a while, and he's a good kid who struggled with an addiction, he was dressed well, he spoke well, he was respectful, he had played hockey and grew up in a small town like I did … I thought 'I've got to help this kid,'" Rousseau said.
When Rousseau returned to the hospital after his shift, he managed to contact Ryan's father, who lives in Wisconsin. Ryan's father said he could not afford transportation to get his son home.
"I talked to his dad on the phone, and his dad wanted nothing more than to get him home for Christmas," Rousseau said.
Instead, Rousseau paid for a flight to send Ryan home; he waited with him at the airport. Ryan contacted Rousseau after arriving home, and thanked him for the kind gesture.
"It felt pretty good to send him home for Christmas, he's doing pretty good right now and I'm trying to keep in touch with him, because he's a good kid," Rousseau said.
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FDNY ambulance hits, kills elderly man
Officials said the ambulance pulled over after the incident and EMS personnel provided aid to the 89-year-old man
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Lessons learned from EMS pioneers
If you've been following EMS Pioneers since its debut in January 2015, you know we've featured senior providers with several decades in EMS. On average, our 14 men and four women were 59 years old with 37 years in the industry. The 13 paramedics and five EMTs interviewed worked in 15 states, eight of which are west of the Mississippi.
Our Pioneers are many things: mothers, fathers, mentors, managers, caregivers, educators and innovators. What they aren't is shy. Getting them to opine and emote about all things EMS was easy; there was no dodging questions or contriving politically-correct answers. That's good news for the rest of us, because as we look back on the first two years of Pioneers, there are plenty of pearls worth remembering.
Lesson 1: The importance of people skills
To be successful in EMS, start with a patient-centric mentality.
Washington paramedic Doug Bair: "One of my heroes, Dr. Gregory Henry, calls emergency medicine 'the occasional application of scientific principles to meet human needs.' What he means is, if you think you'll be saving lives all the time, you're wrong; you're going to be meeting patients' basic needs, whether they're social, psychological or whatever. Occasionally you'll do something medical, but mostly you'll be helping citizens through crises whenever they decide they're having one."
Arkansas paramedic Sharon King: "There are calls where one person clicks and the other doesn't. When you have male and female partners, it broadens the possibilities of someone connecting with the patient."
Kentucky paramedic Carlos Coyle: "Most of our patients don't know how well-trained or highly skilled you are. What they do know is how you responded to their emergency. Did you look professional? Did you give them a pillow and a blanket? Did you treat them and everyone else at the scene with respect? We're the safety net of America. When everything else fails, people call 911 for an ambulance. They need our skills, but even more importantly, they want our compassion."
Lesson 2: The role of educators
When teaching others, be inclusive and realistic.
Minnesota paramedic Roger Swor: "You have to relate to people who are looking to tap into your experience and knowledge. Some skills instructors come across like Marine drill instructors, which causes more stress and makes it even harder for students to remember what they're supposed to do."
Delaware paramedic Barry Eberly: "There seems to be a mindset that succeed or fail, everyone deserves an award, but I think most people who work in medicine know that some are cut out for it and some aren't. Teachers are well-positioned to be part of that decision-making process."
Coyle: "You just never know when you're going to make that connection with someone who's trying to decide on a career path. We have to be seen; we have to tell people what we do because compared to law enforcement and fire, EMS is still very young."
Lesson 3: Patient assessment
In the classroom, EMS is mostly science; in the field it's mostly art.
California paramedic Jim Cuneo: "You have to keep your eyes wide open and make sense of what's going on, to think past what you see and ask really good questions. Mostly, you have to like talking to people."
Vermont AEMT Candy Hall: "Whether you're a nurse, a medic or an EMT, you need information to treat a patient. Being too intense about getting that information can make people feel you're dissing them. Starting with, 'Hi, how are you?' can make a huge difference."
Texas EMT Richard Ponikiewski: "Don't be so gung-ho about doing everything at once. Start with the basics. Understand what's going on before you start pushing drugs."
Coyle: "Sometimes it's not our diagnosis or skill set that makes a difference; it's holding their hand."
Lesson 4: Extreme EMS
"Train wrecks" are uncommon but inevitable.
Cuneo: "It's a challenge to see through the chaos and manage those crazy calls. You never know how you'll do until you're there. You just rely on your training and do the best you can."
Swor: "Emergency shows like Chicago Fire make everything seem so stressful and critical. Everybody's life is on the line all the time. You can't afford to think that way. You have to find a way to keep smiling. Don't get mad when an alarm comes in; bad feelings accumulate over the years and lead to burnout. Enjoy the calls you run. Try to learn from each one."
Ohio paramedic Susie Emmert: "It's exciting when you first get into it, but you have to keep it real. Don't do it for the lights and sirens and don't do it 24/7. Just concentrate on being the best you can be when it's your turn."
Louisiana paramedic Andy Bruch: "You'll have good days and bad days. Most days are good, just like most people in this world are good, but you'll have that one day from hell that will test you and try you and weigh on you heavily. You just have to understand that everything comes in cycles. Don't dwell on it — there are better times ahead."
Lesson 5: Balancing outlook and attitude
Don't let other people's hardships add to your own.
Swor: "Rule number one is people die. Rule number two is medics can't change rule number one."
New York EMT-CC Gary Stehr: "You can't go into EMS half-assed; it's a serious business. You have to be all in. If you don't have the time to do it properly, maybe it's better to wait until you can."
Louisiana paramedic Harry Murphy: "It's difficult to balance home life and the demands some EMS agencies put on you. I used to work 48 hours a week full time, 24 hours part time, then volunteer on top of that. I don't let my work define me anymore. I try to bring my principles and ethics to work and shape the job around that, rather than have the job shape me and my lifestyle. I don't imagine there are too many people on their deathbed who wish they'd spent more time working."
Keep reading in 2017 as we profile other EMS pioneers.
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The earliest long-distance obsidian transport: Evidence from the ∼200 ka Middle Stone Age Sibilo School Road Site, Baringo, Kenya
Source:Journal of Human Evolution, Volume 103
Author(s): Nick Blegen
This study presents the earliest evidence of long-distance obsidian transport at the ∼200 ka Sibilo School Road Site (SSRS), an early Middle Stone Age site in the Kapthurin Formation, Kenya. The later Middle Pleistocene of East Africa (130–400 ka) spans significant and interrelated behavioral and biological changes in human evolution including the first appearance of Homo sapiens. Despite the importance of the later Middle Pleistocene, there are relatively few archaeological sites in well-dated contexts (n < 10) that document hominin behavior from this time period. In particular, geochemically informed evidence of long-distance obsidian transport, important for investigating expansion of intergroup interactions in hominin evolution, is rare from the Middle Pleistocene record of Africa. The SSRS offers a unique contribution to this small but growing dataset. Tephrostratigraphic analysis of tuffs encasing the SSRS provides a minimum age of ∼200 ka for the site. Levallois points and methods of core preparation demonstrate characteristic Middle Stone Age lithic technologies present at the SSRS. A significant portion (43%) of the lithic assemblage is obsidian. The SSRS obsidian comes from three different sources located at distances of 25 km, 140 km and 166 km from the site. The majority of obsidian derives from the farthest source, 166 km to the south of the site. The SSRS thus provides important new evidence that long-distance raw material transport, and the expansion of hominin intergroup interactions that this entails, was a significant feature of hominin behavior ∼200 ka, the time of the first appearance of H. sapiens, and ∼150,000 years before similar behaviors were previously documented in the region.
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Lessons learned from EMS pioneers
If you've been following EMS Pioneers since its debut in January 2015, you know we've featured senior providers with several decades in EMS. On average, our 14 men and four women were 59 years old with 37 years in the industry. The 13 paramedics and five EMTs interviewed worked in 15 states, eight of which are west of the Mississippi.
Our Pioneers are many things: mothers, fathers, mentors, managers, caregivers, educators and innovators. What they aren't is shy. Getting them to opine and emote about all things EMS was easy; there was no dodging questions or contriving politically-correct answers. That's good news for the rest of us, because as we look back on the first two years of Pioneers, there are plenty of pearls worth remembering.
Lesson 1: The importance of people skills
To be successful in EMS, start with a patient-centric mentality.
Washington paramedic Doug Bair: "One of my heroes, Dr. Gregory Henry, calls emergency medicine 'the occasional application of scientific principles to meet human needs.' What he means is, if you think you'll be saving lives all the time, you're wrong; you're going to be meeting patients' basic needs, whether they're social, psychological or whatever. Occasionally you'll do something medical, but mostly you'll be helping citizens through crises whenever they decide they're having one."
Arkansas paramedic Sharon King: "There are calls where one person clicks and the other doesn't. When you have male and female partners, it broadens the possibilities of someone connecting with the patient."
Kentucky paramedic Carlos Coyle: "Most of our patients don't know how well-trained or highly skilled you are. What they do know is how you responded to their emergency. Did you look professional" Did you give them a pillow and a blanket" Did you treat them and everyone else at the scene with respect" We're the safety net of America. When everything else fails, people call 911 for an ambulance. They need our skills, but even more importantly, they want our compassion."
Lesson 2: The role of educators
When teaching others, be inclusive and realistic.
Minnesota paramedic Roger Swor: "You have to relate to people who are looking to tap into your experience and knowledge. Some skills instructors come across like Marine drill instructors, which causes more stress and makes it even harder for students to remember what they're supposed to do."
Delaware paramedic Barry Eberly: "There seems to be a mindset that succeed or fail, everyone deserves an award, but I think most people who work in medicine know that some are cut out for it and some aren't. Teachers are well-positioned to be part of that decision-making process."
Coyle: "You just never know when you're going to make that connection with someone who's trying to decide on a career path. We have to be seen; we have to tell people what we do because compared to law enforcement and fire, EMS is still very young."
Lesson 3: Patient assessment
In the classroom, EMS is mostly science; in the field it's mostly art.
California paramedic Jim Cuneo: "You have to keep your eyes wide open and make sense of what's going on, to think past what you see and ask really good questions. Mostly, you have to like talking to people."
Vermont AEMT Candy Hall: "Whether you're a nurse, a medic or an EMT, you need information to treat a patient. Being too intense about getting that information can make people feel you're dissing them. Starting with, 'Hi, how are you"' can make a huge difference."
Texas EMT Richard Ponikiewski: "Don't be so gung-ho about doing everything at once. Start with the basics. Understand what's going on before you start pushing drugs."
Coyle: "Sometimes it's not our diagnosis or skill set that makes a difference; it's holding their hand."
Lesson 4: Extreme EMS
"Train wrecks" are uncommon but inevitable.
Cuneo: "It's a challenge to see through the chaos and manage those crazy calls. You never know how you'll do until you're there. You just rely on your training and do the best you can."
Swor: "Emergency shows like Chicago Fire make everything seem so stressful and critical. Everybody's life is on the line all the time. You can't afford to think that way. You have to find a way to keep smiling. Don't get mad when an alarm comes in; bad feelings accumulate over the years and lead to burnout. Enjoy the calls you run. Try to learn from each one."
Ohio paramedic Susie Emmert: "It's exciting when you first get into it, but you have to keep it real. Don't do it for the lights and sirens and don't do it 24/7. Just concentrate on being the best you can be when it's your turn."
Louisiana paramedic Andy Bruch: "You'll have good days and bad days. Most days are good, just like most people in this world are good, but you'll have that one day from hell that will test you and try you and weigh on you heavily. You just have to understand that everything comes in cycles. Don't dwell on it — there are better times ahead."
Lesson 5: Balancing outlook and attitude
Don't let other people's hardships add to your own.
Swor: "Rule number one is people die. Rule number two is medics can't change rule number one."
New York EMT-CC Gary Stehr: "You can't go into EMS half-assed; it's a serious business. You have to be all in. If you don't have the time to do it properly, maybe it's better to wait until you can."
Louisiana paramedic Harry Murphy: "It's difficult to balance home life and the demands some EMS agencies put on you. I used to work 48 hours a week full time, 24 hours part time, then volunteer on top of that. I don't let my work define me anymore. I try to bring my principles and ethics to work and shape the job around that, rather than have the job shape me and my lifestyle. I don't imagine there are too many people on their deathbed who wish they'd spent more time working."
Keep reading in 2017 as we profile other EMS pioneers.
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Assess Features Cities Resilient To Disasters
2016-12-29T07-36-19Z
Source: National Journal of Integrated Research in Medicine
Mohammad Heidari*, Neda Eskandary**, Bahar Seifi***, Hamid Jafari****, Shahrzad Pakjouei******.
Building resilience is a forward looking, target driven approach to urban development that uses a wide range of measures addressing all elements of urban systems. Ensuring these targets are met demands all levels of communities and governments work together to ensure the safety of all people and protect the economic, social, environmental, and cultural assets and attributes which define the unique character of each city. In this literature review, the information in the field of health searched and extracted from the related databases including Web of science, Pub Med, Scopus, Google Scholar, conference papers and published papers in the last years about resilience cities by keywords of disaster, resilience, resilience cities. The focus on urban disaster risk has helped raise awareness of localized disasters that have devastating impacts on communities, especially poor households, and constitute a persistent drain on national and local budgets. For those at earlier stages of resilience building, the creation of a new committee or working group is often the first step. Also in Iran this task does every year but in practice it doesnt resulted in good news. [Mohammad H NJIRM 2016; 7(6): 74-78]
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Ethnobotanical Survey and Toxicity Evaluation of Medicinal Plants used for Fungal Remedy in the Southern Highlands of Tanzania
2016-12-29T07-25-36Z
Source: Journal of Intercultural Ethnopharmacology
Mourice Victor Nyangabo Mbunde, Ester Innocent, Faith Mabiki, Pher G Andersson.
Background/Aim: Some of the antifungal drugs used in current treatments regime are responding to antimicrobial resistance. In rural areas of Southern Tanzania, indigenous people use antifungal drugs alone or together with medicinal plants to curb the effects of antibiotic resistance. This study documented ethnobotanical information of medicinal plants used for managing fungal infections in the Southern highlands of Tanzania and further assess their safety. Methods: Ethnobotanical survey was conducted in Makete and Mufindi districts between July 2014 and December 2015 using semi-structured questionnaires followed by two focus group discussions to verify respondents information. Cytotoxicity study was conducted on extracts of collected plants using Brine Shrimp Lethality Test and analyzed by MS Excel 2013 programme. Results: During this survey about 46 plant species belonging to 28 families of angiosperms were reported to be traditionally useful in managing fungal and other health conditions. Among these, Terminalia sericea, Aloe nutii, Aloe lateritia, Zanthoxylum chalybeum, Zanthoxym deremense and Kigelia africana were frequently mentioned to be used for managing fungal infections. The preparation of these herbals was mostly by boiling plant parts especially the leaves and roots. Cytotoxicity study revealed that most of the plants tested were non-toxic with LC¬50¬ >100 which implies that most compounds from these plants are safe for therapeutic use. The dichloromethane extract of Croton macrostachys recorded the highest with LC¬¬¬¬¬¬50¬ value 12.94 μg/ml. The ethnobotanical survey correlated well with documented literature from elsewhere about the bioactivity of most plants. Conclusions: The ethnobotanical survey has revealed that traditional healers are rich of knowledge to build on for therapeutic studies. Most of the plants are safe for use; and thus can be considered for further studies on drug discovery.
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Gene-based analyses reveal novel genetic overlap and allelic heterogeneity across five major psychiatric disorders
Abstract
Studies using genome-wide association (GWA) single nucleotide polymorphism (SNP) level data have indicated genetic overlap across the five major disorders in the Psychiatric Genomics Consortium (PGC): attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BPD), major depressive disorder (MDD), and schizophrenia (SCZ). However, such SNP-level analyses reveal little about the underlying biology and are reliant on correlated SNP effects across disorders. In contrast to SNPs, genes are more closely related to biology and gene-based tests can incorporate allelic heterogeneity. This study aimed to extend genetic overlap analysis across the five disorders from SNP level to gene level using a novel gene-based approach. Gene-based tests for association were performed using PGC GWA summary results for the five disorders in samples including 33,332 cases and 27,888 controls of European ancestry. After accounting for non-independence of gene-based test results, we determined whether the proportion of genes with association across multiple disorders was more than expected by chance. Similar to previous SNP-level analyses, we observed significant pairwise genetic overlap between ASD, BPD, MDD and SCZ. However, our approach also produced evidence for genetic overlap between ADHD and ASD, ADHD and BPD, and ADHD and MDD. Combining gene-based association results across disorders, 36 genes produced genome-wide significant P values (<3.2 × 10−6). Pathway analysis of genes with P values <1.0 × 10−3 highlighted magnesium ion binding and transport, as well as signal peptide processing, and provide insight into the biological mechanisms underlying these major psychiatric disorders.
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Diabetics on Narcotics Are Less Likely to Achieve Excellent Bowel Preparation Than Are Patients with Either Condition
Abstract
Background
Diabetes and chronic narcotic use negatively affect the quality of bowel preparation before colonoscopy.
Aim
To investigate whether narcotic use and diabetes have an additive negative impact on bowel preparation.
Patients and Methods
We performed a retrospective study of 2841 patients (mean age 61 ± 10.2; 94% male) who received outpatient colonoscopies at our Veterans Affairs Medical Center between June 2012 and December 2014. We collected information related to demographics, body mass index, indications, and medical/surgical history (diabetes mellitus, stroke, cirrhosis, dementia, constipation, hypothyroidism, and use of narcotics or antidepressants/anxiolytics for more than three months). Patients were classified into four groups: (1) diabetics on narcotics, (2) diabetics only, (3) on narcotics only, and (4) neither diabetic nor using narcotics. Quality of the bowel preparation was scored using the Boston Bowel Preparation Scale (BBPS) and categorized as either excellent (BBPS ≥7, with no individual segment scoring <2) or not excellent (BBPS <7). Multivariate logistic regression analysis was performed to identify the combined impact of narcotic use and diabetes on bowel preparation.
Results
Bowel preparation quality was excellent in 49%. Thirty-eight percent of patients with diabetes who were using narcotics (adjusted OR 0.6, CI [0.4, 0.8]) achieved excellent bowel preparation compared with 44% (adjusted OR 0.7, CI [0.6, 0.9]) of patients on narcotics only, 48% (adjusted OR 0.8, CI [0.7, 0.9]) of diabetics only, and 54% of patients with neither condition.
Conclusion
Concomitant narcotic use and diabetes have a compounding effect on the quality of bowel preparation prior to colonoscopy.
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Small Gallstone Size and Delayed Cholecystectomy Increase the Risk of Recurrent Pancreatobiliary Complications After Resolved Acute Biliary Pancreatitis
Abstract
Introduction
Acute biliary pancreatitis (ABP) is a severe complication of gallstone disease with considerable mortality, and its recurrence rate is reported as 50–90% for ABP patients who do not undergo cholecystectomy. However, the incidence of and risk factors for recurrent pancreatobiliary complications after the initial improvement of ABP are not well established in the literature. The aims of this study were to determine the risk factors for recurrent pancreatobiliary complications and to compare the outcomes between early (within 2 weeks after onset of pancreatitis) and delayed cholecystectomy in patients with ABP.
Methods
Patients diagnosed with ABP at Yeungnam University Hospital from January 2004 to July 2016 were retrospectively reviewed. The following risk factors for recurrent pancreatobiliary complications (acute pancreatitis, acute cholecystitis, and acute cholangitis) were analyzed: demographic characteristics, laboratory data, size and number of gallstones, severity of pancreatitis, endoscopic sphincterotomy, and timing of cholecystectomy. Patients were categorized into two groups: patients with recurrent pancreatobiliary complications (Group A) and patients without pancreatobiliary complications (Group B).
Results
Of the total 290 patients with ABP (age 66.8 ± 16.0 years, male 47.9%), 56 (19.3%) patients developed recurrent pancreatobiliary complications, of which 35 cases were acute pancreatitis, 11 cases were acute cholecystitis, and 10 cases were acute cholangitis. Endoscopic sphincterotomy and cholecystectomy were performed in 134 (46.2%) patients and 95 (32.8%) patients, respectively. Age, sex, BMI, diabetes, number of stone, severity of pancreatitis, and laboratory data were not significantly correlated with recurrent pancreatobiliary complications. The risk of recurrent pancreatobiliary complications was significantly increased in the delayed cholecystectomy group compared with the early cholecystectomy group (45.5 vs. 5.0%, p < 0.001). Based on the multivariate logistic regression analyses, two factors, size of gallstone less than or equal to 5 mm and delayed cholecystectomy, were found as risk factors associated with recurrent pancreatobiliary complications.
Conclusion
The incidence of recurrent pancreatobiliary complications was 19.3% and was significantly increased in patients with size of gallstone less than or equal to 5 mm and in those who underwent delayed cholecystectomy.
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Rapid Alanine Aminotransferase Normalization with Entecavir and Hepatocellular Carcinoma in Hepatitis B Virus-Associated Cirrhosis
Abstract
Background
Sustained abnormal serum alanine aminotransferase (ALT) levels can increase the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B.
Aim
This study is aimed to confirm the impact of rapid ALT normalization (≤30 IU/L) on HCC risk in patients with hepatitis B virus (HBV)-associated cirrhosis after entecavir (ETV) commencement.
Methods
A total of 578 treatment-naïve patients with HBV-associated cirrhosis (mean age 51 ± 9 years, male sex 63.3%) were treated with ETV for more than 1 year. Serum ALT and HBV DNA levels were measured at three time points (baseline, 6, and 12 months after ETV commencement) and subjected to risk factor analysis.
Results
Median follow-up after ETV commencement was 43 (12–98) months. Cumulative incidences of HCC at 1, 3, 5, and 7 years were 0.3, 8.5, 19.5, and 30.6%, respectively. Univariate Cox regression analysis showed that older age, abnormal ALT at 6 months or 12 months, and lower platelet count were significant risk factors for HCC. However, gender, HBeAg positivity, abnormal ALT levels or HBV DNA levels at baseline, and detectable HBV DNA at 6 or 12 months were not risk factors. Multivariate analysis showed that older age (P < 0.001), abnormal ALT at 12 months (P = 0.006), and lower platelet count (P = 0.034) were the risk factors for HCC.
Conclusions
Abnormal serum ALT levels after ETV commencement are significant risk factor for HCC. Therefore, ALT should be rapidly normalized to minimize the risk of HCC development in patients with HBV-associated cirrhosis.
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Prevalence of Restless Legs Syndrome in Patients with Inflammatory Bowel Disease
Abstract
Background and Aim
There has been increased interest in sleep disorders in patients with inflammatory bowel disease (IBD). Studies in North America and Europe reported that the prevalence of restless legs syndrome (RLS) is much higher in patients with Crohn's disease (CD) than in the general population. The aim of this study was to reveal the prevalence and clinical features of RLS in Japanese patients with IBD and investigate the influence of RLS on sleep quality and quality of life (QOL).
Methods
The study included 80 outpatients with IBD who visited Nagasaki University Hospital between December 2012 and July 2014. All patients completed the international RLS study group rating scale, a validated measure of the presence of RLS. Sleep quality was assessed using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI), and health-related QOL was assessed using the Japanese version of the 36-item short form healthy profile (SF-36) version 2.
Results
The prevalence of RLS in patients with IBD was 20%, including rates of 21.7% in patients with ulcerative colitis (UC) and 17.6% in patients with CD. Among patients with CD, the proportion of women and serum level of CRP were higher in the RLS group than in the non-RLS group. Among those with UC, there were no differences in clinical characteristics between the RLS and non-RLS groups. Patients in the RLS group slept significantly less well than those in the non-RLS group (PSQI > 5; 62.5 vs. 34.4%, P < 0.05). No significant relationships were observed between QOL indices and the presence of RLS (SF-36 physical score, 46.8 vs. 50.1; mental score, 43.8 vs. 45.7; role/social score, 48.1 vs. 49.2).
Conclusions
RLS occurs frequently in Japanese patients with UC as well as CD. RLS affects sleep quality but not QOL, and it should be considered one of the causes of sleep disturbance in patients with IBD.
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Bleeding After Endoscopic Procedures in Patients With Chronic Hematologic Thrombocytopenia
Abstract
Background
Procedure-induced bleeding is a major complication after endoscopic intervention.
Aims
The aim of this study was to investigate the risk of endoscopy-related bleeding in patients with chronic hematologic thrombocytopenia.
Methods
We investigated endoscopy-related bleeding in 175 procedures performed on 108 patients with immune thrombocytopenic purpura or aplastic anemia. The outcomes were compared with those of 350 procedures on age-, sex-, and procedure-matched control subjects. Endoscopic interventions included low-risk procedures such as endoscopic biopsy and high-risk procedures including polypectomy, endoscopic resection, and endoscopic retrograde cholangiopancreatogram with sphincterotomy.
Results
Bleeding occurred in 17 (9.7%) procedures among the patients with thrombocytopenia. This rate was significantly higher than that in procedures on controls (3.1%, P = 0.003). About 60% of all bleeding events were observed within 24 h after the endoscopic procedure. Bleeding after endoscopic biopsy developed more frequently in the patient group than in the control group (7.1 vs. 0.7%; P < 0.001). Bleeding occurred after 20% of all high-risk procedures. The incidence of bleeding was significantly elevated in patients with a platelet count less than 50 × 103/μl. Multivariate analysis revealed that high-risk procedures and low platelet count (less than 50 × 103/μl) were significantly related to procedure-related bleeding. All bleeding events stopped spontaneously or were controlled with endoscopic hemostasis.
Conclusions
Endoscopic procedure-related bleeding develops frequently in patients with chronic hematologic thrombocytopenia. Post-procedural bleeding should be observed carefully in these patients, especially when the platelet count is less than 50 × 103/μl or high-risk endoscopic procedures are planned.
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AGY, a Novel Egg Yolk-Derived Anti-gliadin Antibody, Is Safe for Patients with Celiac Disease
Abstract
Background
Celiac disease (CD) is a gluten-triggered autoimmune disorder of the small intestine. A lifelong gluten-free diet (GFD) is the only approved treatment; however, strict adherence is difficult and many suffer from inadvertent gluten exposure. Oral egg yolk anti-gliadin antibody (AGY) is a novel treatment to neutralize gluten and may improve the efficacy of the GFD.
Aims
To determine the safety, tolerability, and potential efficacy of AGY in patients with CD.
Methods
This 6-week, open-label, single-arm study was conducted in adults with biopsy-proven CD on a GFD. Safety measures included adverse events, physical examination, and clinical laboratory tests. Additional measures included a daily Celiac Symptom Index, Health-Related Quality of life, anti-tissue transglutaminase and anti-gliadin IgA/IgG, and lactulose/mannitol excretion ratio (LMER). A 2-week run-in period to assess questionnaire compliance and acceptability of baseline safety laboratory results was followed by a 4-week treatment period with two AGY capsules taken before meals.
Results
Ten patients completed the study (mean age 43.4 years, nine female). All followed a GFD for at least 6 months (mean 5 years). No safety concerns were identified. Most patients had fewer celiac symptoms (especially tiredness, headache, and bloating), improved quality of life, lowered antibodies, and lowered LMER when taking AGY compared to the run-in period.
Conclusion
In our cohort, AGY was safe and potentially associated with improved CD-related outcome measures in patients on a GFD. A larger study powered for further safety and efficacy evaluation is planned.
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Peribiliary Gland Dilatation in Cirrhosis: Relationship with Liver Failure and Stem Cell/Proliferation Markers
Abstract
Background and Aims
Dilated peribiliary glands (PBG) in patients with cirrhosis are often an incidental finding although their significance and physiopathology remain unclear. We aimed to identify clinical factors associated with dilated PBG and to perform a detailed morphometric assessment of dilated PBG in cirrhotic patients undergoing liver transplantation (LT).
Methods
All consecutive cirrhotic patients undergoing LT at our institution between October 2006 and October 2011 were assessed for inclusion. Ten non-cirrhotic patients were included as controls. We performed morphometrical assessment of PBG, assessed baseline clinical factors associated with dilated PBG, immunohistochemistry staining with CK-19, MiB-1 and EpCAM, and radiological assessment of all available cases.
Results
Seventy-one patients met the inclusion criteria, 24% had PBG dilatation of >1000 µm. On multivariable analysis, MELD (OR 1.11 per unit increase in MELD, p = 0.004) was the only significant factor associated with dilated PBG. Compared to PBG < 1000 µm, large PBG had a higher proportion of EpCAM-positive (69 vs. 28%, p < 0.001) and MiB-1-positive lining cells (2.8 vs. 0.55%, p = 0.036). Computed tomography and magnetic resonance imaging had high specificity but low sensitivity for the diagnosis of dilated PBG > 1000 µm (specificity 90–100%, sensitivity 25–29%).
Conclusions
Dilated PBGs are a common finding in explants of cirrhotic subjects undergoing LT and are associated with liver failure although diagnostic performance of cross-sectional imaging is inconstant. The high number of proliferative and EpCAM-positive cells lining the PBG may suggest a role of PBG in organ repair during liver failure.
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Profile of adverse drug reactions in multiple drug resistant tuberculosis patients at drug resistant-tuberculosis center - Miraj, Maharashtra
2016-12-29T07-01-47Z
Source: International Journal of Medical Science and Public Health
Shivaji V Patil, Rajendra V Bhagwat, Rajsinh V Mohite, Shailesh S Barphe.
Background: Drug resistant tuberculosis (DR-TB) has been an emerging global public health threat and area of serious concern on to global efforts of TB control initiative. Objectives: To elucidate the profile of adverse drug reactions (ADRs) associated with antitubercular treatment regime for DR-TB. Materials and Methods: A retrospective, record-based, observational type of epidemiological study was conducted on multi DR (MDR)-TB patients. The sample size includes, total of 468 patients were admitted in DR-TB center Miraj during year 1st July 2013 to 30th June 2015. A structured pro forma was designed and utilized to collect the data that include variables on ADR profile of diagnosed MDR-TB cases on supervised DOTS-Plus regimen under programmatic management of DR-TB under Revised National Tuberculosis Control Program. The data were analyzed into frequency percentage distribution and presented in tabular form. Results: Out of total 468 MDR-TB patients, 12.82% were reported with ADRs. Out of total 109 ADRs, gastrointestinal upset was maximum, 5.98% followed by psychosis 4.91%, hearing impairment 2.99%, and rest were in between 0.21% and 1.49%, respectively. Max, 56.67% ADRs were seen in undernourished patients with major involvement pertained to central nervous system. Around, 50% ADRs were managed by symptomatically, whereas others were managed by changing the antitubercular drug (33.33%), use of vitamin B6 and use of antidepressant. Conclusion: Early detection, management and reporting of ADRs remain key factors in the management of MDR-TB with remarkable relevance to prevent emergence threat of global MDR-TB.
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Quality of life in patients on hemodialysis: A quasi-experiment with review of literature
2016-12-29T07-01-47Z
Source: International Journal of Medical Science and Public Health
Kavita J Rawat, Kavita S Joshi, Rahul D Arora.
Background: In patients who have a chronic kidney disease (CKD) for which cure is not a realistic goal. Maximizing functioning, well-being and improving quality of life (QOL) should be primary objectives of care. Objectives: Aim of this study was to assess the influence of end-stage renal disease (ESRD) on patients QOL and to compare the QOL in ESRD patients who were dialyzed and correction of anemia was done. Materials and Methods: A prospective observational study was conducted in tertiary care center, KEM Hospital, Parel, Mumbai, over 1 year. All newly diagnosed CKD patients >18 years of age who were first time initiated on dialysis were recruited for the study. Pregnant patients, patients on dialysis or known ischemic heart disease were excluded from the study. Patients QOL was evaluated using short form-36 (SF-36) questionnaires at initiation of hemodialysis and at the end of 1 year after standard line of care. Statistical analysis was performed with descriptive statistics with paired t-test. Results: SF-36 score at baseline and at 1 year was 50.01 ± 11.36 and 53.18 ± 12.51 with P
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Age-related morphological, histological and functional changes in teeth
Abstract
Throughout lifetime, the teeth are continuously exposed to numerous chemical and physical impacts, which cause the wear of the dental hard tissues, gingival recession and other oral changes with sometimes subsequent problems. Age-related wear of tooth surfaces reduce the dental enamel thickness and expose deeper layers of enamel, which have different physical and chemical properties than the surface enamel. Gingival recession is the main causal factor of root caries and dentine hypersensitivity. Age-related changes in dentine include the formation of secondary dentine and the reduction of tubular lumen diameter (dentine sclerosis), which lead to a reduction in the volume of the pulp chamber. In addition to the reduction of the volume of pulp chamber, changes to the dental pulp also include dental pulp calcifications. The age-related physiological changes to the teeth should be carefully distinguished from pathological changes, especially when they induce pain or a negative impact on the oral health related quality of life (OHRQoL) of the older individuals. Therefore, regular oral examinations coupled with early preventive measures should aim at maintaining oral health until old age.
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A comparative study of taste sensitivity to phenylthiocarbamide in pregnant and nonpregnant females
2016-12-29T06-48-57Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Pranjali Sameer Shinde, Pushpa A Pazare.
Background: Pregnancy is a condition where various neuroendocrinal changes occur. During pregnancy there are drastic changes especially in steroid hormone levels e.g. Estrogen and progesterone. Recent studies have shown that auditory, visual and olfactory sensitivities of a female increase during pregnancy. This increase in sensitivity is due to increase in hormone levels during pregnancy. Aims and Objectives: The aim of the present study was to compare the taste sensitivity in pregnant and non-pregnant females. Materials and Methods: The present study was done in 100 non-pregnant females and 300 pregnant females (100 females of each trimester) of age group 20-40yrs.13 solutions of different concentrations of phenylthiocarbamide (PTC) were prepared and taste sensitivity was checked. Result: Numbers of tasters are more in pregnant females as compared to non-pregnant females. There is significant increase in taste sensitivity in first trimester of pregnancy as compared to other trimesters. Conclusion: We conclude that there is increased taste sensitivity in pregnant females as compared to non-pregnant females and significant rise is seen in first trimester of pregnancy.
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Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery
Abstract
Background
Natural orifice transluminal endoscopic surgery developed for neck surgery become increasing popular. Herein, an innovative transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) was developed for primary hyperparathyroidism (PHPT) and renal hyperparathyroidism (rHPT).
Methods
Incisions were made at the oral vestibule under the inferior lip. A 10-mm trocar was inserted through the center of the oral vestibule with two 5-mm trocars laterally. The subplatysmal space was created down to the sternal notch, and carbon dioxide pressure was insufflated at 6 mmHg to maintain the working space. Parathyroidectomy was performed using laparoscopic instruments. Intraoperative parathyroid hormone level and frozen section were conducted. Autotransplantation of the parathyroid gland was performed at the non-dominant forearm in an rHPT patient.
Results
From March 2015 to June 2016, TOEPVA was successfully performed in 12 patients (six PHPT and six rHPT). The mean operative time for parathyroidectomy in PHPT patients was 107.5 min (range 88–127) and 185.8 min in rHPT patients (range 155–214). One patient experienced a transient recurrent laryngeal nerve injury which was spontaneously resolved within 1 month. No permanent recurrent laryngeal nerve injury was found. Serum calcium level returned to normal range in all patients. The serum parathyroid hormone level of the PHPT and the rHPT group at 30 days was 36.38 ± 7.1 pg/mL (range 27.7–46.5) and 60.35 ± 15.94 pg/mL (range 38.7–87.2), respectively. The postoperative cosmetic outcome was excellent. No mental nerve injury or infection was found.
Conclusions
TOEPVA is a feasible, safe, and reasonable surgical option for patients with hyperparathyroidism, especially those with cosmetic concerns.
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Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis
Abstract
Introduction
Laparoscopic sleeve gastrectomy (LSG) is becoming an increasingly popular form of bariatric surgery, accounting for more than 50% of these procedures performed in the USA. Given this popularity, more is being understood about the complications associated with LSG, which, though uncommon, include the formation of strictures and stenosis. The purpose of this study is to establish a safe and effective protocol for the treatment of stenosis post-LSG using endoscopic balloon dilatation.
Materials and methods
This is a prospective review of 26 patients who had undergone LSG in Kuwait, followed by sleeve gastrectomy stenosis (SGS) and were then referred to Amiri Hospital for endoscopic balloon dilatation from October 2008 up to June 2016.
Results
A total of 26 patients (four males; 22 females) presented with symptoms of stenosis post-LSG during the study period. The mean age of the patients was 34.6 ± 10.8 years. The mean body mass index at the time of surgery was 43 ± 1.6 kg/m2. The median interval from the initial LSG surgery was 95 days. Nine patients had an early presentation (≤3 months from surgery), while 17 presented late (>3 months). The patients were followed for a mean duration of 156 ± 20 days from the last endoscopic balloon dilatation. A total of 23 (88.5%) patients had complete resolution of their symptoms. Adverse events were observed in one patients, who was removed from the study.
Conclusions
Gastric stenosis is a rare but potentially serious complication of LSG. Serial dilatation of SGS employing endoscopic balloons is a safe method of treatment, with high efficacy rates. This new method may offer a less invasive alternative to surgical revision. However, if endoscopic treatment fails, surgery is necessary.
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