Δευτέρα 14 Μαρτίου 2016

Seeking Asylum: Challenges Faced by the LGB Community

Abstract

A retrospective chart review was completed of patients self-identified as lesbian, gay, or bisexual seen through a program for survivors of torture between June 9, 2009 and December 31, 2014 (n = 50). Almost all (98 %) experienced persecution due to their sexual orientation and 84 % were survivors of torture. The circumstances under which the disclosure of sexual orientation took place in the country of origin were often traumatic. In several, efforts were made to change their sexual orientation often through forced marriage. Those in same sex relationships had relationships often marred by tragedy. Women were more likely to be forced to move from place to place, experience rape/sexual assault and threats whereas men were more likely to be persecuted by people on the street. All presented with symptoms of depression and anxiety. Providers need to be attuned to the potential traumatic histories of those fleeing persecution due to sexual orientation, and the medical, social, psychological, and legal implications.



from Health via xlomafota13 on Inoreader http://ift.tt/1QTSkuv
via IFTTT

Differences in Clinical Fertility State Relate to Intracellular Gene Expression of Thyroid Hormone Receptors and Thyroid Function

Clinical Thyroidology Mar 2016, Vol. 28, No. 3: 85-88.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/1XrxmUm
via IFTTT

Computed Tomography Is the Best Predictor of Whether Sternotomy Is Required for Resection of Substernal Goiter

Clinical Thyroidology Mar 2016, Vol. 28, No. 3: 72-74.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/1LnunLZ
via IFTTT

Weight-Related Eating Among Less-Acculturated Latina College Students

Abstract

Less-acculturated Latinos have been found to have unique patterns of weight-related eating attitudes and behaviors. This study examined body mass index (BMI), body image, and various facets of emotional distress as contributors to weight-related eating among less-acculturated female Latina college students. It was hypothesized that unique combinations of BMI, body image, depression, anxiety, and stress would predict routine restraint, compensatory restraint, susceptibility to external cues, and emotional eating in less-acculturated Latina college students. Participants were 141 college students from a rural region in southeastern California who completed questionnaires. Preoccupation with being overweight, a body-image variable, significantly predicted routine and compensatory restraint whereas stress was an important correlate of reasons for eating other than hunger. Implications of the findings include the potential to inform models of weight-related eating among less-acculturated Latina college students. Limitations include homogeneity of sample pertinent to Latino descent. Future directions are discussed.



from Health via xlomafota13 on Inoreader http://ift.tt/1QTSkL3
via IFTTT

A Girl and Her Father Have Resistance to Thyroid Hormone Due to a Mutation of the Thyroid Hormone Receptor α1

Clinical Thyroidology Mar 2016, Vol. 28, No. 3: 68-71.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/1V7XEfy
via IFTTT

A Qualitative Study of the Integration of Arab Muslim Israelis Suffering from Mental Disorders into the Normative Community

Abstract

This study focuses on the process of the integration of Arab Muslim Israelis suffering from mental disorders into the normative community, addressing perspectives of both people with mental disorders and the community. This qualitative-constructivist study seeks to understand the dynamics of face-to-face meetings by highlighting the participants' points of view. The main themes of the findings included stereotypes and prejudices, gender discrimination, and the effect of face-to-face meetings on integration of people with mental disorders (PMD) into the community. The findings support former studies about the integration of PMD into the normative community, but add a unique finding that females suffer from double discrimination: both as women in a conservative society and as PMD. The study findings indicate a perception of lack of self-efficacy of PMD as a key barrier preventing integration into the community, which also prevents community members and counselors from accepting them or treating them as equals. We recommend on a social marketing campaign to be undertaken with the Arab Muslim community to refute stigmas and prejudices, particulary with double gender discrimination suffered by women with mental disorders in the Muslim community and training of community center counselors who have contact with the PMD population.



from Health via xlomafota13 on Inoreader http://ift.tt/24ZQMVX
via IFTTT

Is the Absence of Suspicious Features on Ultrasound Sufficiently Reliable That No Biopsy Is Needed for an 18FFDG-Positive Thyroid Nodule Found Incidentally on PET–CT?

Clinical Thyroidology Mar 2016, Vol. 28, No. 3: 65-67.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/1XrxnaI
via IFTTT

Depression and Chronic Health Conditions Among Latinos: The Role of Social Networks

Abstract

The purpose of this study was to examine the "buffering hypothesis" of social network characteristics in the association between chronic conditions and depression among Latinos. Cross-sectional self-report data from the San Diego Prevention Research Center's community survey of Latinos were used (n = 393). Separate multiple logistic regression models tested the role of chronic conditions and social network characteristics in the likelihood of moderate-to-severe depressive symptoms. Having a greater proportion of the network comprised of friends increased the likelihood of depression among those with high cholesterol. Having a greater proportion of women in the social network was directly related to the increased likelihood of depression, regardless of the presence of chronic health conditions. Findings suggest that network characteristics may play a role in the link between chronic conditions and depression among Latinos. Future research should explore strategies targeting the social networks of Latinos to improve health outcomes.



from Health via xlomafota13 on Inoreader http://ift.tt/1nK7wPh
via IFTTT

Falling Levels of Thyroglobulin Antibody After Treatment for DTC Predict No Structural Recurrence

Clinical Thyroidology Mar 2016, Vol. 28, No. 3: 79-81.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/1nK8qLt
via IFTTT

Diabetes Among United States-Bound Adult Refugees, 2009–2014

Abstract

We reported diabetes prevalence among all US-bound adult refugees and assessed factors associated with disease. We analyzed overseas medical evaluations of US-bound refugees from 2009 through 2014 by using CDC's Electronic Disease Notification System. We identified refugees with diabetes by searching for diabetes-related keywords and medications in examination forms with text-parsing techniques. Age-adjusted prevalence rates were reported and factors associated with diabetes were assessed by using logistic regression. Of 248,850 refugees aged ≥18 years examined over 5 years, 5767 (2.3 %) had diabetes. Iraqis had the highest crude (5.1 %) and age-adjusted (8.9 %) prevalence of disease. Higher age group and body mass index were associated with diabetes in all regions. Diabetes prevalence varied by refugee nationality. Although the absolute rates were lower than rates in the United States, the prevalence is still concerning given the younger age of the population and their need for health services upon resettlement.



from Health via xlomafota13 on Inoreader http://ift.tt/1nK7zKH
via IFTTT

Subclinical Hyperthyroidism Is Associated with Decreased Risk for Recurrent Venous Thromboembolism

Clinical Thyroidology Mar 2016, Vol. 28, No. 3: 82-84.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/1Lnulni
via IFTTT

Emotional and Behavioral Disorders in 1.5th Generation, 2nd Generation Immigrant Children, and Foreign Adoptees

Abstract

Existing theories (e.g., acculturative stress theory) cannot adequately explain why mental disorders in immigrants are less prevalent than in non-immigrants. In this paper, the culture-gene co-evolutionary theory of mental disorders was utilized to generate a novel hypothesis that connection to heritage culture reduces the risk for mental disorders in immigrant children. Four groups of children aged 2–17 years were identified from the 2007 United States National Survey of Children's Health: 1.5th generation immigrant children (n = 1378), 2nd generation immigrant children (n = 4194), foreign adoptees (n = 270), and non-immigrant children (n = 54,877). The 1.5th generation immigrant children's connection to their heritage culture is stronger than or similar to the 2nd generation immigrants, while the foreign adoptees have little connection to their birth culture. Controlling for age, sex, family type and SES, the odds for having ADD/ADHD, Conduct Disorder, Anxiety Disorder, and Depression diagnosis were the lowest for the 1.5th generation immigrant children, followed by the 2nd generation immigrant children and the foreign adoptees. The foreign adoptees and non-adopted children were similar in the odds of having these disorders. Connection to heritage culture might be the underlying mechanism that explained recent immigrants' lower rates of mental disorders.



from Health via xlomafota13 on Inoreader http://ift.tt/21r5Kj5
via IFTTT

Follicular Variant of Papillary Thyroid Carcinoma (PTC) Has a Better Prognosis Than Classic or Tall-Cell PTC

Clinical Thyroidology Mar 2016, Vol. 28, No. 3: 77-78.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/1V7XEfK
via IFTTT

The Feasibility of Recruiting and Retaining Perinatal Latinas in a Biomedical Study Exploring Neuroendocrine Function and Postpartum Depression

Abstract

This study evaluates the feasibility of enrolling and retaining perinatal immigrant and U.S.-born Latinas in a laboratory-based study that includes the collection of biomarkers implicated in the development of postpartum depression. This prospective study followed Latinas from third trimester of pregnancy to 12 weeks postpartum. Women were enrolled during pregnancy and interviewed at 4, 8 and 12 weeks postpartum. Demographic information, depression status and breastfeeding practices were ascertained using validated Spanish- and English-measures. Blood samples were collected at the 8-week postpartum laboratory visit during infant feeding and pain testing. Feasibility was demonstrated with 85 % retention of the original 34 prenatal women enrolled in the study. The majority (88 %) of women enrolled attended the 8-week laboratory visit regardless of depression status. This is the first study to demonstrate feasibility of enrolling and retaining depressed and nondepressed perinatal immigrant and U.S.-born Latinas in biomedical research.



from Health via xlomafota13 on Inoreader http://ift.tt/1nK7wPd
via IFTTT

Substernal Thyroidectomy Is More Common in Patients with Certain Demographic Factors and Leads to Increased Complications and Death

Clinical Thyroidology Mar 2016, Vol. 28, No. 3: 75-76.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/1MjkZ71
via IFTTT

Health and Socio-Cultural Experiences of Refugee Women: An Integrative Review

Abstract

Approximately half of the global refugee population are women, yet they remain largely understudied from the perspective of gender. The aim of this review was to investigate the impact of refugee women's resettlement and socio-cultural experiences on their health. This review also explored factors promoting resilience in refugee women. Eight databases were searched for peer-reviewed manuscripts published from 2005 to 2014. Grey literature was also reviewed. Data were extracted for population, data collection methods, data analysis, and findings. The Resource-Based Model was used as an overarching framework for data synthesis. Following the screening of titles and abstracts, 20 studies met the study inclusion criteria. Cultural factors, social and material factors, personal factors, and resilience factors were identified as main themes influencing the health of refugee women. Promotion of factors that enables resettlement is important in promoting the health and wellbeing of refugee women.



from Health via xlomafota13 on Inoreader http://ift.tt/1QTSi5Q
via IFTTT

Investigating Preterm Care at the Facility Level: Stakeholder Qualitative Study in Central and Southern Malawi

Abstract

Objectives Malawi is estimated to have one of the highest preterm birth rates in the world. However, care of preterm infants at facility level in Malawi has not been explored. We aimed to explore the views of health stakeholders about the care of preterm infants in health facilities and the existence of any policy protocol documents guiding the delivery of care to these infants. Methods We conducted 16 in-depth interviews with health stakeholders (11 service providers and 5 policy makers) using an interview guide and asked for any existing policy protocol documents guiding care for preterm infants in the health facilities in Malawi. The collected documents were reviewed and all the interviews were digitally recorded, transcribed and translated. All data were analysed using content analysis approach. Results We identified four policy protocol documents and out of these, one had detailed information explaining the care of preterm infants. Policy makers reported that policy protocol documents to guide care for preterm infants were available in the health facilities but majority (63.6 %) of the service providers lacked knowledge about the existence of these documents. Health stakeholders reported several challenges in caring for preterm infants including lack of trained staff in preterm infant care, antibiotics, space, supervision and poor referral system. Conclusions Our study highlights that improving health care service provider knowledge of preterm infant care is an integral part in preterm child birth. Our findings suggests that policy makers and health decision makers should retain those trained in preterm new born care in the health facility's preterm unit.



from Health via xlomafota13 on Inoreader http://ift.tt/1nK8smJ
via IFTTT

Contactable Non-responders Show Different Characteristics Compared to Lost to Follow-Up Participants: Insights from an Australian Longitudinal Birth Cohort Study

Abstract

Objective This research aims to identify predictors of attrition in a longitudinal birth cohort study in Australia and assess differences in baseline characteristics and responses in subsequent follow-up phases between contactable non-responders and uncontactable non-responders deemed "lost to follow-up (LTF)". Methods 3368 women recruited from three public hospitals in Southeast Queensland and Northern New South Wales during antenatal visits in 2006–2011 completed a baseline questionnaire to elicit information on multiple domains of exposures. A follow-up questionnaire was posted to each participant at 1 year after birth to obtain mother's and child's health and development information. Multivariate logistic regression was used to model the association between exposures and respondents' status at 1 year. The effect of an inverse-probability-weighting method to adjust for non-response was studied. Results Overall attrition at 1-year was 35.4 %; major types of attrition were "contactable non-response" (27.6 %) and "LTF" (6.7 %). These two attrition types showed different responses at the 3-year follow-up and involved different predictors. Besides shared predictors (first language not English, higher risk of psychological distress, had smoked during pregnancy, higher levels of family conflict), distinguishable predictors of contactable non-responders were younger age, having moved home in the past year and having children under 16 in the household. Attrition rates increased substantially from 20 % in 2006 to 54 % in 2011. Conclusions This observed trend of increased attrition rates raises concern about the use of traditional techniques, such as "paper-based" questionnaires, in longitudinal cohort studies. The supplementary use of electronic communications, such as online survey tools and smart-device applications, could provide a better alternative.



from Health via xlomafota13 on Inoreader http://ift.tt/1pHRnLB
via IFTTT

Fast Food Intake in Relation to Employment Status, Stress, Depression, and Dietary Behaviors in Low-Income Overweight and Obese Pregnant Women

Abstract

Objective This study explored fast food intake as a potential mediator of the relationships among employment status; stress; depression; and fruit, vegetable, and fat intakes by race (African American vs. Non-Hispanic White) and body mass index (BMI category: overweight vs. obesity). Methods Low-income overweight and obese pregnant women (N = 332) were recruited from the Special Supplemental Nutrition Program for Women, Infants and Children in Michigan. Path analysis was performed to explore mediation effects by race and BMI category. Results Fast food intake mediated the relationship between employment status and fat intake (p = 0.02) in Non-Hispanic White women, but no mediation effect was detected in African American women. For overweight women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04) and the relationship between depression and vegetable intake (p = 0.01). Also, fast food intake partially mediated the relationship between depression and fat intake (p = 0.003). For obese women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04). Conclusion Fast food is an important topic for nutrition education for overweight and obese pregnant women. Future interventions may be more successful if they address issues associated with employment status (e.g., lack of time to plan and cook healthy meals) and depressive mood (e.g., inability to plan meals or shop for groceries when coping with negative emotions).



from Health via xlomafota13 on Inoreader http://ift.tt/1nK8qeC
via IFTTT

The Impact of WIC on Birth Outcomes: New Evidence from South Carolina

Abstract

Objectives To investigate the impact of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) on a variety of infant health outcomes using recent South Carolina Vital Statistics data (2004–2012). Methods To account for non-random WIC participation, the study relies on a maternal fixed effects estimation, due to the availability of unique maternally linked data. Results The results indicate that WIC participation is associated with an increase in birth weight and length of gestation, decrease in the probability of low birth weight, prematurity, and Neonatal Intensive Care Unit admission. Additionally, addressing gestational bias and accounting for the length of gestation, WIC participation is associated with a decrease in the probability of delivering a low weight infant and a small for gestational age infant among black mothers. Conclusions for Practice Accounting for non-random program participation, the study documents a large improvement in birth outcomes among infants of WIC participating mothers. Even in the context of somewhat restrictive gestation-adjusted specification, the positive impact of WIC remains within the subsample of black mothers.



from Health via xlomafota13 on Inoreader http://ift.tt/1QZ7z1P
via IFTTT

COMPARISON OF KINESIO TAPING WITH MCKENZIE AND ONLY MCKENZIE TECHNIQUE IN THE TREATMENT OF MECHANICAL LOW BACK PAIN

2016-03-14T18-12-47Z
Source: International Journal of Therapies and Rehabilitation Research
Sathya P., Ramakrishnan K. S., Shweta S D Phadke, Risi Jena.
The study is aimed to see the effect of Kinesio Taping and McKenzie technique in patients with Mechanical low back pain. Method: This study was conducted on 30 mechanical low back pain patients, 15 under each group to see the effect of Kinesio taping and McKenzie technique (group 2) and only McKenzie technique (group 1). The patients under both the groups underwent treatment for 3 weeks. The VAS and Oswestry low back disability Questioner were used as outcome measure. Result: Considerable reduction of pain is seen in group 2 in which the patients received Kinesio Taping and McKenzie than the group1 were the patients received only McKenzie technique, when both the groups were compared the p-value was 0.0361, which shows that group 2 is more effective than group 1. There was considerable reduction in disability according to Oswestry low back disability Questioner in group 2 when compared to group 1, when between groups were compared it showed group 2 is more effective than group 1 with the p value of 0.0480 . Conclusion: Individuals with mechanical low back pain experienced significant improvements in pain as well as improvement in activity after the application of Kinesio Taping with Mckenzie technique.


from Scope via xlomafota13 on Inoreader http://ift.tt/1pknL6L
via IFTTT

Low-Dose or High-Dose Rocuronium Reversed with Neostigmine or Sugammadex for Cesarean Delivery Anesthesia: A Randomized Controlled Noninferiority Trial of Time to Tracheal Intubation and Extubation.

BACKGROUND: Rocuronium for cesarean delivery under general anesthesia is an alternative to succinylcholine for rapid-sequence induction of anesthesia because of the availability of sugammadex for reversal of neuromuscular blockade. However, there are no large well-controlled studies in women undergoing general anesthesia for cesarean delivery. The aim of this noninferiority trial was to determine whether rocuronium and sugammadex confer benefit in time to tracheal intubation (primary outcome) and other neuromuscular blockade outcomes compared with succinylcholine, rocuronium, and neostigmine in women undergoing general anesthesia for cesarean delivery. METHODS: We aimed to enroll all women undergoing general anesthesia for cesarean delivery in the 2 participating university hospitals (Brno, Olomouc, Czech Republic) in this single-blinded, randomized, controlled study. Women were randomly assigned to the ROC group (muscle relaxation induced with rocuronium 1 mg/kg and reversed with sugammadex 2-4 mg/kg) or the SUX group (succinylcholine 1 mg/kg for induction, rocuronium 0.3 mg/kg for maintenance, and neostigmine 0.03 mg/kg for reversal of the neuromuscular blockade). The interval from the end of propofol administration to tracheal intubation was the primary end point with a noninferiority margin of 20 seconds. We recorded intubating conditions (modified Viby-Mogensen score), neonatal outcome (Apgar score

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/1U1YfjS
via IFTTT

Intrathecal Hydromorphone and Morphine for Postcesarean Delivery Analgesia: Determination of the ED90 Using a Sequential Allocation Biased-Coin Method.

BACKGROUND: Intrathecal (IT) morphine is considered the "gold standard" for analgesia after cesarean delivery under spinal anesthesia, most commonly administered at a dose of 100 to 200 [mu]g. There is less experience with IT hydromorphone for postcesarean analgesia and limited information on its optimal analgesic dose. We conducted this study to determine the effective analgesic dose for 90% patients (ED90) of IT hydromorphone that provides effective analgesia for women undergoing elective cesarean delivery and its potency ratio to IT morphine. METHODS: In this dose-finding trial, 80 patients received spinal anesthesia for cesarean delivery. Participants were randomized to receive IT morphine or IT hydromorphone at a dose determined using up-down sequential allocation with a biased-coin design to determine ED90. All patients received standardized multimodal analgesia postoperatively in addition to IT opioid. An effective dose was defined as a numeric response score for pain of

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/1YSxQUI
via IFTTT

Transcranial direct current stimulation over the left dorsolateral prefrontal cortex modulates auditory mismatch negativity

S13882457.gif

Publication date: May 2016
Source:Clinical Neurophysiology, Volume 127, Issue 5
Author(s): Michael Weigl, Axel Mecklinger, Timm Rosburg
ObjectiveTo investigate the contribution of the left dorsolateral prefrontal cortex (DLPFC) to attentive and pre-attentive stimulus discrimination via transcranial direct current stimulation (tDCS).MethodsNovelty- and target-P3 as indexes of attentive stimulus discrimination and the mismatch negativities (MMNs) for duration, intensity, and frequency deviants as indexes of pre-attentive stimulus discrimination were recorded before and after delivering anodal and cathodal tDCS to the left DLPFC.ResultsMMN amplitudes for all kinds of deviants decreased from pre- to post-tDCS measurement. For duration and intensity deviants, this pre-post reduction was stronger after anodal tDCS, as compared to the decrease after sham stimulation. No such modulation was found for the MMN to frequency deviants. Neither the novelty-P3 nor the target-P3 was modulated by tDCS.ConclusionThe selective MMN decrease after anodal (excitatory) stimulation of the left DLPFC suggests that this region either inhibits the processing of specific auditory changes or modulates the habituation of the MMN to certain kinds of deviances.SignificanceOur finding that left frontal anodal tDCS reduces the MMN to duration and intensity deviants further highlights the contribution of frontal brain regions to MMN generation and extends previous reports of reduced MMNs to frequency deviants after right frontal anodal tDCS.



from Physiology via xlomafota13 on Inoreader http://ift.tt/1RK3ApD
via IFTTT

Amtrak Train Derails in Kansas

More than 20 people were sent to the hospital after the train derailed near Dodge City, Kansas.

from EMS via xlomafota13 on Inoreader http://ift.tt/1SN9ZVX
via IFTTT

Amtrak Train Derails in Kansas

More than 20 people were sent to the hospital after the train derailed near Dodge City, Kansas.

from EMS via xlomafota13 on Inoreader http://ift.tt/1SN9ZVX
via IFTTT

A study on knowledge of animal bite victims regarding animal bite and rabies attending tertiary care hospital of Rewa City, Madhya Pradesh

2016-03-14T13-00-25Z
Source: International Journal of Medical Science and Public Health
Sanjeev Kumar, Rohit Trivedi, Manoj Saxena, Anjana Niranjan, Manish Kumar.
Background: Rabies is an acute fatal viral encephalitis that usually transmitted from animals to man followed by domestic and wild animal bites. Objective: To identify the level of general awareness and knowledge of wound management and rabies among the cases of animal bite and to study the awareness of people about antirabies vaccines and health service utilization. Materials and Methods: Cross-sectional institutional study was conducted in 406 animal bite victims presenting to the tertiary care hospital, Rewa, Madhya Pradesh. A pretested and structured oral questionnaire was used to elicit the required information regarding knowledge of animal bite victims about animal bite and rabies, its transmission, prevention, and control. Data were analyzed using graphpad software. Result: All 406 animal bite victims knew about injury after animal bite. 54.9% victims knew about fatality of rabies, 63.7% victims knew that rabies is caused by biting of animal, and 17.4% knew that rabies is transmitted by saliva. Source of information was health facility for 48% victims. 85.5% victims knew about application of antiseptic solution on animal bite wound. 34% victims knew about correct number of injection, 40.4% knew about correct site, and 33.3% knew that ARV should be taken immediately. 57.9% victims knew that observation should be done in animal. 33.1% victims knew that local treatment should be taken as soon as possible. Conclusion: This study has shown that the community level knowledge is satisfactory about rabies, its prevention, and control. Knowledge found to be low for the modes of rabies transmission, prevention methods after suspected animal bite, the first action taken in the home after bitten by a suspected animal and for ARV.


from Scope via xlomafota13 on Inoreader http://ift.tt/1QSkpB6
via IFTTT

Study of alcohol consumption and its sociodemographic determinants in a tribal village in Mandla district

2016-03-14T13-00-25Z
Source: International Journal of Medical Science and Public Health
Shashi Prabha Tomar, Pradeep Kumar Kasar, Rajesh Tiwari, Surjeet Singh Rajpoot, Shubhangi Nayak.
Background: Alcohol consumption is considered a serious public health problem in many countries including India because of the associated health hazards and antisocial consequences. Nearly 70% of Indian population resides in villages, and the main occupation is farming which belongs to lower and lower-middle class. Gender differences in alcohol use have been recognized, but socioeconomic differences remain underresearched. It is, therefore, important in certain population groups such as tribal village population to find the extent of alcohol consumption and its sociodemographic determinants. Objective: To find the prevalence of alcohol consumption and its sociodemographic determinants. Materials and Methods: A community-based cross-sectional study was carried out in a tribal village Meera Tola, Madhya Pradesh, during the months of October 14January 15. A total of 214 villagers were interviewed. The study was conducted by personal house-to-house visits with a pretested oral questionnaire method. The data were collected on sociodemographic profile, occupation, and literacy status of each member of family. Result: Overall prevalence of alcohol use was 8.26% among male and 0.95% among female subjects. Maximum consuming population was found in the age groups of 60 years and older, followed by 3039 years. Alcohol consumption was more prevalent among illiterate (6.7%) when compared with literate (5.3%). Alcohol consumption pattern according to occupational status was found to be most prevalent among farmers and laborers (13%), followed by unemployed population (8.3%). Conclusion: Socioeconomic class and education pose direct impact on alcohol consumption in rural tribes. Efforts must be directed toward educational intervention for quitting alcohol among lower class and illiterates.


from Scope via xlomafota13 on Inoreader http://ift.tt/1Rhvgbe
via IFTTT

Short-duration increases in intraluminal pressure improve vasoconstrictor responses in aged skeletal muscle feed arteries

Abstract

Purpose

We tested the hypothesis that exposure to a short-duration (1 h) increase in intraluminal pressure, to mimic pressure associated with a bout of exercise, would attenuate age-induced impairments of vascular smooth muscle (VSM) constrictor responses in soleus muscle feed arteries (SFA) via the Rho pathway.

Methods

SFA from young (4 months) and old (24 months) Fischer 344 rats were cannulated and pressurized to 90 or 130 cmH2O for 1 h. Following the 1-h treatment, pressure in P130 arteries was lowered to 90 cmH2O for examination of vasoconstrictor responses to norepinephrine (NE), angiotensin II (Ang II), and phenylephrine (PE). To assess the role of the Rho pathway, vasoconstrictor responses were assessed in the absence or presence of a RhoA-kinase inhibitor (Y27632) or RhoA-kinase activator (LPA).

Results

Vasoconstrictor responses to NE, Ang II, and PE were impaired in old P90 SFA. Pretreatment of old SFA with increased pressure improved vasoconstrictor responses to NE, PE and Ang II. The beneficial effect of the pressure pretreatment in old SFA was eliminated in the presence of Y27632. In the presence of LPA, vasoconstrictor responses to Ang II were improved in old SFA such that responses were not different than young P90 SFA.

Conclusion

These results indicate that a short-duration exposure to increased intraluminal pressure, to mimic pressure associated with a bout of exercise, attenuates or reverses the age-related decrement in VSM constrictor responses in SFA and that the beneficial response is mediated through Rho kinase.



from Physiology via xlomafota13 on Inoreader http://ift.tt/1Wlrvj3
via IFTTT

Environmental Enteric Dysfunction in Children: A Review.

Diarrheal diseases are a major cause of childhood death in resource-poor countries, killing about 760, 000 children under age 5 each year. While deaths due to diarrhea have declined dramatically, high rates of stunting and malnutrition have persisted. Environmental Enteric Dysfunction (EED) is a subclinical condition caused by constant fecal-oral contamination with resultant intestinal inflammation and villous blunting. These histological changes were first described in the 1960's but the clinical impact of EED is only just being recognized in the context of failure of nutritional interventions and oral vaccines in resource-poor countries. We review the existing literature regarding the underlying causes of and potential interventions for EED and poor growth in children, highlighting the epidemiology, clinical and histologic classification of the entity, as well as discussing novel biomarkers and possible therapies. Future research priorities are also discussed. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1U1VE9S
via IFTTT

Amtrak Train Derails in Kansas

More than 20 people were sent to the hospital after the train derailed near Dodge City, Kansas.

from EMS via xlomafota13 on Inoreader http://ift.tt/1SN9ZVX
via IFTTT

Amtrak Train Derails in Kansas

More than 20 people were sent to the hospital after the train derailed near Dodge City, Kansas.

from EMS via xlomafota13 on Inoreader http://ift.tt/1SN9ZVX
via IFTTT

6 GI emergencies you should know

EMS providers need to understand a few critical, potentially life-threatening GI presentations that require rapid identification and early management.

Multiple organ systems lie within or pass through the abdomen, but the majority of abdominal cavity is filled with the organs of digestion, absorption and excretion. Because there are so many organs and structures involved, there are a large number of GI conditions. By understanding the anatomy and physiology, as well as specific knowledge about potentially critical conditions, EMS providers can differentiate serious medical emergencies from minor belly pain complaints.

Anatomy and physiology
Beginning with mouth and ending with the anus, the GI tract is responsible for the intake of nutrients, water and other raw materials the body needs to grow and maintain itself. Teeth and the muscles of the oral cavity begin the mastication process, using teeth to mechanically break apart the food we eat. Saliva contains several enzymes that begin to break down complex carbohydrates such as starch. The tongue then maneuvers the food bolus posteriorly past the glottis opening, where it enters the esophagus, a muscular tube that rhythmically contracts to push the bolus toward the stomach. Chemical and mechanical breakdown of the food continues there, where hydrochloric acid begins the destruction of proteins and other compounds.

The resulting slurry of chyme is released into the small intestine, passing through the pyloric sphincter and into the first section called the duodenum. Additional enzymes are secreted from the pancreas and liver via the gall bladder to further extract key nutrients from the chyme. Most of the water is absorbed through the intestinal walls and back into the bloodstream; microvilli buried inside the intestinal tract absorb nutrients. Over a period of eight to 12 hours, the slurry becomes increasingly more solid, collecting in the large intestines. Most of the remaining water is absorbed and eventually the anal sphincter releases the feces from the GI tract.

The large and small intestines receive their blood supply through the mesentery, a membrane that begins at the posterior abdominal wall and attaches to the intestinal tract. The major GI organs have their own blood supply.

Due to the large number of structures involved, numerous medical conditions can arise from the GI system. Most of them are not life-threatening; however there are several presentations that warrant an immediate medical evaluation and possible intervention to reduce poor outcomes.

GI bleeding
There are several causes for bleeding in the GI tract, including peptic ulcers (local erosion of the mucosal lining), gastritis (inflammation of the inner stomach lining), esophageal varices (swelling of the esophageal veins secondary to liver disease) and cancer.

An especially dangerous condition is a Mallory-Weiss tear that occurs in the esophagus or stomach. These can occur after severe vomiting, forced coughing or seizures and is associated with excessive alcohol use [1]. Depending upon the size and location of the tear, bleeding can be minor or massive requiring immediate surgery. Blood, if vomited by the patient can become a significant airway obstruction, especially if the worsening hypovolemia causes a reduction in level of consciousness.

Occult blood from a slow bleed in the gastrointestinal tract cannot be seen by the eye in the patient's feces and can go undetected for some time. A fecal occult blood test is used to determine if there is blood in feces. Obvious or frank blood in either feces or emesis indicates more rapid bleeding is taking place. Blood that is very loose or bright red in color indicates bleeding happening closer to either end of the GI tract. Hemorrhoids are an example of bright red bleeding from the veins surrounding the anus and lower rectum.

Blood that has been sitting in the GI tract long enough to be partially digested by the various GI enzymes and acids is darker in color (dark red to black) and can take on a tar-like appearance in feces or coffee-ground texture in emesis. There is a unique odor with digested GI blood resembling a mixture of metal and rotten eggs.

If GI bleeding is significant, the patient can initially appear in compensated shock and may require fluid resuscitation. A patient may have orthostatic or postural vital signs variation. When a patient is moved from a supine to standing position, there is a change in blood pressure or pulse consisting of one or more of the following [2]:

  • A decrease of systolic blood pressure 20 mm Hg or more
  • A decrease in diastolic blood pressure of 10 mm Hg or more
  • An increase in heart rate of 20 beats per minute or more

However, there is evidence to show that performing orthostatic vital signs may not detect volume depletion of 1000 mL or less [3].

Field treatment for GI bleeding is supportive. Maintain airway patency for patients who may be vomiting large amounts of blood through positioning and suctioning.

An advanced airway may be needed to minimize aspiration if basic procedures fail. Patients who present in shock may need rapid fluid resuscitation in large amounts to maintain perfusion [4]. Large bore, short length catheters should be used to deliver volume quickly. Crystalloids such as normal saline or lactated ringers should be administered at a 3:1 ratio, i.e. replacing each mL of blood loss with 3 mL of fluid.

Peritonitis
The peritoneum is a membrane that lines the inner wall of the abdomen and covers most of the abdominal organs. This lining can become infected with bacteria or fungi, causing peritonitis. In turn this can cause life-threatening sepsis if untreated.

There are several causes for peritonitis. Liver disease can cause ascites, a build up of fluid in the abdominal cavity. This fluid can become infected.

Patients receiving peritoneal dialysis due to kidney failure can introduce infection into the abdominal cavity. Rupture of a GI organ such as an appendix, stomach or diverticulum (a weak spot or sac in the intestinal wall) can introduce acids, enzymes and bacteria. Other conditions include pelvic inflammatory disease, pancreatitis and Crohn's disease (chronic inflammation of the intestines).

Peritonitis generally starts with vague signs and symptoms, such as loss of appetite, nausea and a dull, aching feeling in the abdomen. The discomfort can rapidly turn into severe pain that is constant and changes with movement and palpation. Fever can develop, along with vomiting, chills and aches. Urinary frequency and amount diminish, as well as bowel movements.

In severe cases or peritonitis bacteremia, which is infection of the blood, develops and can cause sepsis, affecting the entire body. Septic shock can be fatal and requires rapid identification, fluid replacement and possibly the administration of a vasopressor such as dopamine to maintain perfusion to critical organs. Pain medication may be administered to provide comfort care and some EMS systems authorize their paramedics to initiate antibiotic administration in the field.

Acute mesenteric ischemia
Although rare, a drop in blood flow to the mesenteric arteries can result in ischemia, injury or infarct of the intestinal tract. This may result from a sudden blockage via a thrombus or embolus, a dissection of the superior mesenteric artery, or systemic hypotension. Patients will most likely feel a rapid onset of pain that becomes quite severe, as well as nausea, vomiting and diarrhea.

Depending on the location of the arterial block, large sections of the intestines may infarct and die, requiring surgical removal and resection of the bowel. If left untreated, gangrene (tissue decomposition) may occur, resulting in sepsis and septic shock.

Bowel obstruction
The intestines can become partially or completely blocked, causing its contents to back up and cause inflammation. The blockage may be the result of tumors, adhesions within the intestinal walls, foreign bodies or impacted stool, which is a large lump of feces that becomes stuck. This results in abdominal swelling, pain and cramping; the patient may experience severe constipation or diarrhea. Vomiting is likely. In severe cases of obstruction, patients may experience fecal vomiting.

Another cause of bowel obstruction is known as paralytic ileus, or a dramatic slowing of the normal peristaltic motions of the intestines. This can be caused by bacterial or fungal infections, mesenteric ischemia, appendicitis, kidney or lung disease, and certain medications such as narcotics.

Most cases of bowel obstruction are not life-threatening. However, necrosis of the intestines at the site of the blockage, or a perforation can develop, causing systemic infection, sepsis and possibly septic shock.

Pancreatitis
The pancreas is located posterior to the stomach, deep inside the abdominal cavity. As described earlier, the digestive function of the pancreas is to form digestive enzymes that break down carbohydrates, proteins and lipids in the intestinal chime and secrete them through the pancreatic duct into the intestines. It also has the function of forming the hormone insulin used in regulating glucose levels in the blood and cells.

Pancreatitis occurs when the pancreas becomes inflamed, usually caused by gallstones (clumps of cholesterol and pigments leaving the gall bladder and blocking the pancreatic duct) or heavy alcohol use. Other causes include infection, cancer, trauma, surgery and certain metabolic disorders such as hypercalcemia or hypertriglyceridemia.

Patients with acute pancreatitis will experience pain that is usually located in the upper abdominal quadrants, with radiation to the back. The abdomen may be tender to palpation and the patient may experience, nausea and vomiting. Some patients will report a close association of pain onset with food intake, especially food with a high fat content.

Pancreatitis is usually not immediately life-threatening. However it can become infected which can lead to sepsis. It can also cause pseudocysts (fluid-filled pouches) to form in the pancreas itself; these can burst can cause infection. Severe pancreatitis cases can result in Systemic Inflammatory Response Syndrome (SIRS), causing high fevers and systemic shock.

Summary
Most gastrointestinal disorders are not immediately life-threatening and require routine monitoring and transport of patients from the field to in hospital care. However, in a few cases, identifying significant GI problems and providing initial care may help improve the chances of recovery for patients who experience true GI emergencies.



from EMS via xlomafota13 on Inoreader http://ift.tt/1XqlB0j
via IFTTT

Fire and EMS readiness: What it means and why it matters

Twenty years ago, if you asked firefighters why they chose their profession they would have most likely responded with: "to fight fire."

Nowadays, most departments' fire calls account for less than 10 percent while emergency medical service responses make up over 70 percent. Those numbers dictate that the role of the fire service must change.

And as Chief Gary Ludwig has witnessed in his 30-plus year career, that change can sometimes come slowly, but eventually becomes engrained in the fire service's culture.

"In the 1920s, the fire service tried to switch from using horses to motorized apparatus. The firefighters fought that back then and didn't want to switch. They even did studies to show the horses were faster than motorized apparatus," Chief Ludwig said. "But change eventually comes, and if you were to ask somebody today if we should go back to the horses, they would tell you that you're crazy."

Like the motorized fire apparatus, EMS will eventually be seen as a normal component of what the fire service provides.

"You're always going to have pockets of the country that are slow to embrace EMS, but that's not reflective of the fire service as a whole," Chief Ludwig said.

In his presentation at International Association of Fire Chief's Fire-Rescue Med conference in May, Chief Ludwig, along with Ed Racht, MD and chief medical officer with American Medical Response and Mike Ragone, director of EMS System Design at American Medical Response, will discuss the critical role the fire department plays in the fast-changing health care system.

Ludwig's seminar, "Fire and EMS Readiness and Resiliency: Focusing on What Really Matters," will be held May 22; the early registration discount is available until April 21.

Chief Ludwig, with the Champaign (Ill.) Fire Department, has 31 years of fire and rescue experience. He started his career in St. Louis, where he retired as chief paramedic from the St. Louis Fire Department. He is chairman for the EMS Section of the IAFC, has lectured at more than 225 fire and EMS conferences in 42 states and serves on the FireRescue1 and Fire Chief editorial advisory board.

The fire service, he says, is becoming an integral player in delivering health care.

Fire-EMS readiness
Departments evolving into a fire-based EMS system must take on an all-hazards approach.

That means when the bell hits, firefighters must be ready for everything — and that includes EMS.

"I'm a strong proponent of training. We have to be ready and prepared for whatever happens," Chief Ludwig said. "If you look at any call you've ever been on, anywhere from 25 to 30 percent of what you show up on, anticipate or prepare for is going to be different than what you expected."

As a result, crews must be adaptable enough to deal with whatever happens.

"We have to continually train. It's amazing when you do show up on a call and you just go into automatic mode because your training kicks in and gets you through it."

Training and having the proper equipment in place is important, but ensuring crews get there safely continues to be the number one best practice to be fully prepared and ready.

Why fire-EMS performance measures matter
What's not changed since the days of horse-drawn fire rigs is that no matter if your department runs a fire-based EMS system or not, all first responders are in the people business.

One hundred percent of fire, rescue and EMS calls is taking care of people and that means personnel have to be committed to providing a certain level of customer service.

"Customer satisfaction is important because we're obviously here to take care of people," Chief Ludwig said. "We might have done everything correct medically, but did we take care of them properly" And that means treating patients with respect, dignity and like a person."

One department Chief Ludwig collaborated with surveyed patients who had experienced chest pain and asked if their fire-EMS department took care of their pain.

More than 50 percent said that by the time they got to the hospital they still had chest pain and discomfort.

Based on the survey, the department revised its protocols. They got more liberal with their use of IVs and surveyed their patients again. The response was overwhelming that pain and discomfort had been addressed before arriving at the hospital.

"That was a key measurement for that department to make sure they were taking care of their customers," Chief Ludwig said. "We have a tendency of measuring how many IVs we started, how many were successful, how many patients we have, but we never choose to measure the satisfaction of the customer.

"And that's why we're there at the end of the day — to take care of the people. It's a key measurement that we should be paying attention to in fire and EMS."

Another performance measure Chief Ludwig pays attention to is response times. Some will say that response times don't matter, but he argues against that point.

"Response times definitely do matter. That's why people are calling us — they want us there. Response time is always a performance measure that we want to pay attention to. It might not matter medically in some cases, but it matters to the person who calls. When they call, they want someone to show up to take care of their needs."

As an example, response times make a difference in cardiac arrest patients.

"If we can get someone there in four minutes, then we can start resuscitation procedures and even include mechanical CPR devices and drug therapies," Chief Ludwig said. "And because of that, what used to be a 1 to 2 percent survival rate is now in some communities greater than 15 to 20 percent in cardiac arrest patients."

And because fire and EMS make a difference in patient care and outcome, departments need to starting thinking non-linear versus linear.

Hitting roadblocks
One quality about being resilient is that departments must remember to remain adaptable, flexible and move out of old deployment models to create ones based on patients and their needs.

"We need to get out of this 50-year-old model of taking everyone to the emergency room no matter how small their complaint is," Chief Ludwig said.

At the end of the session, he hopes attendees will not only be armed with best practices in readiness and resilience but also take the facts discussed back to their departments and municipal leadership.

However, Chief Ludwig has seen how difficult it can be for attendees to implement those ideas within their own departments.

The majority of attendees, he said, walk away enthused, motivated and looking to change things at their department. But when they get back into the real world, they face roadblocks to implementing those ideas.

"If you follow the path of the idea to its fruition, there are many steps along the way that are designed to block it from being implemented," he said. "And eventually you just give up because it's too hard and something else comes up.

"But that's also why Fire-Rescue Med is a great place for support. You have chief officers who are running fire-based EMS systems so you have an opportunity to network, learn from them on what they're doing and maybe they've hit some of those roadblocks that you've hit and they can give you some tips on how to get through those."

And barriers to change is clearly one thing in the fire service that hasn't changed in 20 years.



from EMS via xlomafota13 on Inoreader http://ift.tt/1M2ot2O
via IFTTT

Improve CPR success with systems thinking

There are ten cellular processes that must continue to function in order for the human body to survive cardiac arrest. While each of these processes is critically important, all require intra- and inter-organizational systems to be in place in order to guarantee success.

The chain of survival exists for a reason. As a representation of the links that are required to connect an unfortunate start to a celebratory finish. While out-of-hospital cardiac arrest survival rates hover below 6 percent nationally, the successes that are seen require not only adequate clinical interventions, but the seamless functioning of health systems at a regional level [1].

CPR is one of the most resource-heavy processes EMS professionals undertake. It is done with the best of intentions, with an end goal that requires outsmarting the laws of nature. Ensuring success requires that every link in the chain receives appropriate resources and focus.

Bystander CPR saves lives
Training over 10,000 bystanders in the same day to perform hands-only CPR is a product of modern communication technologies. Large CPR training sessions have become so common it exists as a category in the Guinness Book of World Records and attempts to break the current record have been used as a way to increase awareness and engagement within the community. Laerdal has created a webpage dedicated to the concept given the significant logistics required for such an undertaking.

Children that are comfortable with the process have saved the lives of their parents. The idea of training children has become so common that some states are starting to require it in schools.

Even those without training have been able to rely on dispatchers for the encouragement and necessary instructions to bring loved ones back to life. In some cities, total strangers are responding via smartphone apps to assist until providers arrive.

But remember bystander CPR is only one step in the process. When performed, it increases the chance of survival significantly, but if any other links break, is the effort to train and promote bystanders worth the hype"

Access to AEDs
As with bystander CPR, access to AEDs increases survival. While the presence of AEDs has been popularized in schools, churches and public buildings, those locations are often inaccessible in the moment of need.

Researchers in Toronto showed 8 percent of OHCA weren't within 100 meters of an AED during the day. After the work day, this number jumped to 28 percent in the evening and 48 percent at night. Research has also shown that the vertical distance between a patient and the AED may matter since those that live in high rise buildings are less likely to survive.

Every publically available AED should be celebrated, but their placement should be scrutinized such that those with the greatest need have the most access. Single deaths can drive structural changes that are resource heavy yet outcome light. Although stories of unnecessary deaths are tragic, those with the most to gain may see the least publicity for their survival.

The locations of AEDs are typically pronounced. The actual units are designed in a way that makes their use as simplistic as possible, but the turmoil associated with cardiac arrests can cause many bystanders to fluster. Potentially resulting in a failure to access the AEDs or focusing so much on their functionality that compressions are inadvertently abandoned. Avoiding these downfalls is only possible with repeated exposure and training of the lay public.

Experienced EMS providers
Practice makes permanent. If perfection is possible, it is only acquired if what is being practiced is done in a way that mirrors the end goal. This can be achieved by simulating the chaos surrounding most cardiac arrests until it is no longer chaotic or participating in enough of them to gain the experience necessary.

In communities where exposure to cardiac arrest patients is limited, simulation becomes even more vital. In communities where cardiac arrest patients are plentiful, agencies must balance access to exposure with the recognition experienced providers likely have the muscle memory and institutional knowledge necessary to perform in a more efficient and effective manner.

As with any other process, proficiency with the procedures performed during cardiac arrest increases with experience. But the average EMS provider exits the field after five years, and those that stay likely receive promotions forcing them to spend more time on administrative duties and less on clinical care. This results in a substantial loss of experience and knowledge caring for time-critical emergencies.

Dissemination of the science
Given the complicated clinical requirements of CPR, the best way to perform it in a given environment will likely remain unknown for decades; and as with any other process, the best way to perform will also depend heavily on the resources available to the community at a specific point in time.

The debate will continue over manual versus mechanical compressions, video versus direct laryngoscopy, epinephrine and its dosage and even the need for any advanced interventions at all.

It is our job to support and foster these debates. To continue the tradition of the current work in Arizona, as well as the recently concluded ROC trials, in a way that allows for the progressive moving of the needle.

Science may move at a snail's pace, but progress within the science is only as good as its ability to be shared within the entire community. On average, it takes 17 years for an accepted process to become integrated within a scientific community [2].

This explains much of the variation within EMS; however it also means that some communities are practicing in a way that clinical experts condemned over a decade ago. Efforts must be made to influence the speed at which we transfer knowledge so that all agencies, regardless of funding or access to the newest technologies are able to provide their patients with the right type and level of care.

Systems thinking saves lives
Survival requires more than a solid clinical foundation; it requires the system to work as seamlessly as the providers with their hands on the patient. It requires full integration between all the links in the chain. It requires recognizing that saving lives goes beyond a single pair of providers in a single agency. It requires creating processes that make success more easily attainable than failure.

References

  1. Nichol, G. et al. Regional Systems of Care for Out-of-Hospital: Cardiac Arrest: A Policy Statement from the American Heart Association. Circulation 2010;121:709-729.
  2. Balas EA. From appropriate care to evidence-based medicine. Pediatr Ann. 1998;27:581–4.


from EMS via xlomafota13 on Inoreader http://ift.tt/1Mi39Bg
via IFTTT

DC shooting victim waits almost 30 minutes before an ambulance arrives

DELAYED RESPONSE: It is yet another delayed ambulance response to an emergency in D.C. With no ambulance in sight, a man suffering from multiple gunshot wounds reportedly had to wait 30 minutes before he was transported to the hospital.

from EMS via xlomafota13 on Inoreader http://ift.tt/1pGLC0O
via IFTTT

Predictability of biomarkers in diagnosis of neonatal sepsis: a cross sectional study

2016-03-14T07-32-15Z
Source: International Journal of Contemporary Pediatrics
Rajeev D., Honnumurthy J. B., Avinash S. S..
Background: There is lack of sensitive and specific markers for diagnosis of early neonatal sepsis. Procalcitonin and CRP are known sensitive marker of sepsis and CRP is known to be affected by other independent variables. Hence this study was conducted to compare their predictability for diagnosis of early neonatal sepsis and to assess the effect of variables on them. Methods: It is a cross sectional study. Study group comprised of neonates with definitive (n=09) and probable (n=24) signs, symptoms and laboratory markers of sepsis compared with no sepsis (n=67). Procalcitonin and CRP were measured by immunofluoroscence and immunoturbidometric methods respectively in serum of neonates admitted to intensive care unit on their first day of admission. Fishers test, median test, ROC curve and multiple regressions were used for statistical analysis. Results: Procalcitonin (p=0.007) and CRP (p


from Scope via xlomafota13 on Inoreader http://ift.tt/1Mi1eMW
via IFTTT

DC shooting victim waits almost 30 minutes before an ambulance arrives

DELAYED RESPONSE: It is yet another delayed ambulance response to an emergency in D.C. With no ambulance in sight, a man suffering from multiple gunshot wounds reportedly had to wait 30 minutes before he was transported to the hospital.

from EMS via xlomafota13 on Inoreader http://ift.tt/1pGLC0O
via IFTTT

Effectiveness of early clinical assessment and bilirubin estimation for prediction of neonatal hyperbilirubinemia

2016-03-14T07-32-15Z
Source: International Journal of Contemporary Pediatrics
Sharanabasappa S. Dhanwadkar, Christo S. Rasalam, Zakaulla Masood.
Background: Neonatal hyperbilirubinemia is common cause of neonatal morbidity seen in 60% term and 80% preterm neonate. Early clinical assessment and bilirubin estimation is important in preventing long term sequale of hyperbilirubinemia, preventable cause of neurological sequale (kernicterus). Methods: Clinical assessments of all preterm and term neonate born in our medical college were studied for effectiveness of early clinical assessment (Kramers index) compared to it gold standard test serum bilirubin (TB). Results: A total of 500 neonates were studied in which 11.4 % developed significant hyperbilirubinemia. Cord blood bilirubin has a PPV-63.9% and specificity-99.1%. Kramers index is less effective clinically if serum bilirubin is in lower range, comparatively Kramers index effectiveness increases as serum bilirubin increases with p value 0.001. Conclusions: 11.4% of neonates had significant hyperbilirubinemia requiring treatment. Umbilical cord bilirubin >3 mg/dl showed a good predictor for early detection of hyperbilirubinemia. Kramers index at 48 hours correlates significantly with higher levels of serum bilirubin with p value of 0.001.


from Scope via xlomafota13 on Inoreader http://ift.tt/1Rh9WT9
via IFTTT

DC shooting victim waits almost 30 minutes before an ambulance arrives

DELAYED RESPONSE: It is yet another delayed ambulance response to an emergency in D.C. With no ambulance in sight, a man suffering from multiple gunshot wounds reportedly had to wait 30 minutes before he was transported to the hospital.

from EMS via xlomafota13 on Inoreader http://ift.tt/1pGLC0O
via IFTTT

Study of clinical, biochemical evaluation and outcome in hypertrophic pyloric stenosis

2016-03-14T07-32-15Z
Source: International Journal of Contemporary Pediatrics
Anil Kumar, Umesh K. Gupta, Prashant Gupta, Somendra Pal Singh, Mohit Gupta, Praveen Singh, Manas Prakash.
Background: Gastric outlet obstruction (GOO) in infancy and childhood may result from congenital causes, antral diaphragm, pyloric atresia, heterotrophic pancreas, and infantile hypertrophic pyloric stenosis (IHPS), or acquired causes (peptic ulcer, caustic ingestion, tumour, chronic granulomatous disease and Eosinophilic gastroenteritis). Infantile hypertrophic pyloric stenosis (IHPS) is among the most common surgical disorders in infancy and presents in approximately 3:1000 live births in the United States. In India it is estimated to be 1 in 3,500 live births The objective of the study was to analyse the age and sex of presentation, try to compare preoperative and postoperative biochemical alteration and find out how to reduce the incidence of complications of infantile hypertrophic pyloric stenosis (IHPS). Methods: Children attending at surgery OPD or emergency UP RIMS & R for no bilious vomiting during 15 March 2015 to 15 February 2016 less than 1 Year of age of both sex. Results: we found that IHPS was more common among first born male child in more commonly in Hindus and most common time of presentation is first 8 weeks dyselectronemia was a common feature. Conclusions: Infantile hypertrophic pyloric stenosis (IHPS) which is caused by thickened antropyloric muscle is a disease which causes gastric outlet obstruction. It is the most common surgical condition in infants within two month of postnatal life. This disease is presented with projectile non-bilious vomiting which may be blood tinged if it is prolonged without correction may cause hypochloremic hypokalemic alkalosis and death in more than 50% of the affected patients.


from Scope via xlomafota13 on Inoreader http://ift.tt/1Mi1ewp
via IFTTT

To withhold or not withhold EMS treatment: That is the question

Actually, the real question is, "Is withhold even the word we should be using""

Merriam-Webster defines withhold as, "to refrain from granting, giving, or allowing."

In medical applications, it is implicit that withholding is to "refrain from granting, giving, or allowing" a needed and indicated medication, procedure or intervention.

Not doing something because it isn't indicated isn't withholding anything. It's simply practicing good medicine. Imagine this conversation:

"Sir, I'd like to apply this synchronized shock to your chest at 100 Joules."

"I dunno, does that hurt""

"Considerably, yes."

"Do I need it""

"Not at the moment, no. But you do have a history of ventricular tachycardia, and it may come back between here and the emergency department. I'd rather be safe than sorry."

"In that case, hell no."

"But your wife called, said your heart was racing again."

"My wife is a sales clerk, not a doctor. She panicked and called 911. I'm not having a repeat of my v-tach."

"But I'd like to shock you anyway, just in case. Besides, it's synchronized. Unlikely to kill you."

If that conversation sounds a bit ludicrous to you, then imagine similar conversations many of us engage in every single day when we justify high-flow oxygen or spinal immobilization.

I see 'withhold' in comment threads on clinical scenarios, even in headlines on EMS1's Facebook page: "Your patient has ischemic chest pain, a 12-lead ECG that looks like he may soon be eating his salads from the roots up, normal vital signs and a room-air oxygen saturation of 98 percent. Would you withhold oxygen for this patient""

Um, no, I wouldn't withhold oxygen. Withholding implies I'm denying him something he needs that could potentially benefit his condition. I'm just not going to give it because it isn't indicated.

Ditto for the guy walking around at the scene of a motor vehicle collision complaining of neck pain. I'm not going to withhold a cervical collar and long spine board. I'm just not going to apply a device far more likely to cause harm than good.

If my pediatric patient with the broken wrist is deathly afraid of needles, I'm not going to stick him with one if my only reason is to avoid getting snide looks and catty comments from the ED nurses for not getting a line.

My self-esteem can handle their disapproval, and I'm confident enough in my skills to know that if I needed a line quickly, I could get one.

I'll give the kid fentanyl intranasally and make his ambulance ride less scary and uncomfortable. I'm not withholding vascular access, I'm simply administering medication in the most appropriate route for the patient and deferring a painful procedure until it can be done, if needed, under better conditions.

While all this focus on a word may seem like we're quibbling over semantics, I'd say it has much broader implications as to how we define ourselves, the job we do and the worth of our interventions. I've said before that EMS, as a profession, has wrongly defined itself by a patch and skill set, rather than by a unique body of knowledge. We measure our worth not by what we know, but by what we do.

And that's just wrong.

Reason and restraint
When we measure our effectiveness by how much stuff we do to a patient, then withhold smacks of shoddy care, as if we haven't done all we could: "Darn it, I didn't get to the fourth-line drug in the protocol. I'm such a failure."

If we instead defined ourselves by what we know, then not doing something takes on an entirely different meaning. Very often, the most important interventions are the ones we don't perform: "I rock. I turned that crashing CHF'er around without intubating him. Go Team Me!"

Voltaire once said, "The art of medicine consists of amusing the patient while nature cures the disease."

Wise man, Voltaire. Even in the 1700s he knew that a physician's most valuable tools were reason and restraint.

So rather than give high-flow oxygen because "it can't hurt," start focusing on knowing more about physiology. You'll soon learn that high-flow oxygen is not a benign drug. It's a potent vasoconstrictor, reducing coronary artery flow by upwards of 30 percent. It worsens neurological outcomes in stroke. There's good evidence that it doesn't do normoxic trauma patients any good, either. Even the crashing pulmonary edema patient that you put on CPAP might be able to do without oxygen. The pressure is the important thing and that CPAP can be just as effective powered by compressed air.

Instead of doing a standing takedown of your ambulatory wreck victim, or escorting him over to your cot and laying him down on the long plastic torture device, learn more about the indications for prehospital spinal motion restriction. A five-minute Google search and a little light reading will demonstrate that those indications are damned few and ambulatory patients aren't among them.

Become a student of your profession, expand your knowledge beyond that of rote memorization of protocols and algorithms and you'll soon realize that the only thing you'll ever have to withhold is the urge to express your disdain of those EMTs who still practice monkey-see, monkey-do medicine.



from EMS via xlomafota13 on Inoreader http://ift.tt/1M28OQW
via IFTTT

Frequent Flyers: Preparing for the AEMT test

See all of Lenwood Brown's comics.



from EMS via xlomafota13 on Inoreader http://ift.tt/1LmgjlQ
via IFTTT

Improve CPR success with systems thinking

Progress on one link in the Chain of Survival doesn't guarantee success of the other links in the chain of survival

from EMS via xlomafota13 on Inoreader http://ift.tt/1Lmor5I
via IFTTT

Morphological Continuum of mucocele like tumor with its Diagnostic Dilemmas – A Case Report with Cytohistological Correlation

2016-03-14T03-30-38Z
Source: The Southeast Asian Journal of Case Report and Review
Dr.Neelam Sood, Dr.Priyanka Bhatia Soni.
Introduction: A Mucocele-like tumor is a rare breast lesion, characterized by mucin-filled cysts and extravasated mucin present in the adjacent stroma. First described by Rosen as a benign entity, it is now considered as a continuum of different pathological lesions, ranging from benign ductal hyperplasias , atypical ductal hyperplasia , ductal carcinoma in situ and mucinous carcinomas. Case presentation: We describe a case of Mucocele like tumor of the breast showing a morphologic and biologic continuum between a benign and malignant mucocele like tumor in a 60 year old female. This patient presented with a lump breast , in the upper outer quadrant, with ill defined margins. The lump was suspected clinicoradiologically as malignant. Fine needle aspiration cytology was suspicious of colloid carcinoma, however subsequent mastectomy showed Mucocele like tumor with spectrum of pathological lesions. Conclusion: This case is being presented for its rarity and is the first case being reported from India.


from Scope via xlomafota13 on Inoreader http://ift.tt/1THSB60
via IFTTT

Acute trauma factor associations with suicidality across the first 5 years after traumatic brain injury

Publication date: Available online 14 March 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Matthew R. Kesinger, Shannon B. Juengst, Hillary Bertisch, Janet P. Niemeier, Jason W. Krellman, Mary Jo Pugh, Raj G. Kumar, Jason L. Sperry, Patricia M. Arenth, Jesse R. Fann, Amy K. Wagner
ObjectiveTo determine whether severities of head and extra-cranial injuries (ECI) were associated with suicidal ideation (SI) or suicide attempt (SA) after traumatic brain injury (TBI).DesignFactors associated with SI and SA were assessed in this inception cohort study using data collected 1, 2, and 5 years post-TBI from the National Trauma Databank (NTDB) and TBI model system (TBI-MS) databases.SettingLevel I Trauma, Inpatient Rehabilitation Centers, the communityParticipants3,575 participants with TBI from 15 TBI-MS Centers with linked NTDB trauma data.InterventionsNot applicable.Main Outcome Measures(s): SI was measured via the Patient Health Questionnaire 9 (PHQ-9, question #9). SA in the past year was assessed via interview. ECI was measured by Injury Severity Scale (non-head) and categorized as none, mild, moderate, and severe.Results293 (8.2%) participants had SI without SA and 109 (3.0%) had SA at least once in the first 5 years post-injury. Random effects logit modeling showed a higher likelihood of SI when ECI was severe (OR: 2.730; 95%CI: 1.55–4.82, p=0.001). Drug use at time of injury was also associated with SI (OR: 1.69; 95%CI: 1.11–2.86; p=0.015). Severity of ECI was not associated with SA.ConclusionsSevere ECI carried a nearly 3-fold increase in the odds of SI after TBI, but was not related to SA. Head injury severity and less severe ECI were not associated with SI or SA. These findings warrant additional work to identify factors associated with severe ECI that make individuals more susceptible to SI after TBI.



from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/1RZfgrh
via IFTTT

A hepatitis C virus envelope polymorphism confers resistance to neutralization by polyclonal sera and broadly neutralizing monoclonal antibodies

Journal of Virology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1pGbASe
via IFTTT

Efficacy of direct-acting antiviral combination for patients with HCV genotype 1 infection and severe renal impairment or end-stage renal disease

Gastroenterology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/22f0nWK
via IFTTT

Elevated serum gamma-glutamyltransferase predicts advanced histological liver damage in chronic hepatitis b

Discovery Medicine

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1pGbAS8
via IFTTT

Colectomy rates in patients with ulcerative colitis following treatment with infliximab or ciclosporin: a systematic literature review

European Journal of Gastroenterology & Hepatology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/22f0nWw
via IFTTT

Multidrug resistance protein 4 is a critical protein associated with the antiviral efficacy of nucleos(t)ide analogues

Liver International

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1pGbARX
via IFTTT

Shedding of hepatitis C virus in semen of HIV-infected men

Open Forum Infectious Diseases

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/22f0lOq
via IFTTT

Utility of a molecular pre-screening program in advanced colorectal cancer for enrollment on biomarker-selected clinical trials

Annals of Oncology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1pGbABz
via IFTTT

Prevalence, characteristics, and survival of children with esophageal atresia: A 32-year population-based study including 1,417,724 consecutive newborns

Birth Defects Research Part A: Clinical and Molecular Teratology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/22f0ktT
via IFTTT

Patient-reported outcomes in Asian patients with chronic hepatitis c treated with ledipasvir and sofosbuvir

Medicine

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1pGbABv
via IFTTT

Therapy with proton-pump inhibitors for gastroesophageal reflux disease does not reduce the risk for severe exacerbations in COPD

Respirology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/22f0kdp
via IFTTT

The recommended treatment algorithms of the BCLC and HKLC staging systems: does following these always improve survival rates for HCC patients?

Liver International

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1pGbxFV
via IFTTT

Confocal laser endomicroscopy in ulcerative colitis: a longitudinal study of endomicroscopic changes and response to medical therapy

Gastrointestinal Endoscopy

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/22f0l14
via IFTTT

Faecal chitinase 3-like 1 is a reliable marker as accurate as faecal calprotectin in detecting endoscopic activity in adult patients with inflammatory bowel diseases

Alimentary Pharmacology and Therapeutics

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1pGbzh3
via IFTTT

Mesalazine modified-release tablet in the treatment of ulcerative colitis in the active phase: a chinese, multicenter, single-blind, randomized controlled study

Advances in Therapy

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/22f0l0O
via IFTTT

Diabetic biomarkers and the risk of proximal or distal gastric cancer

Journal of Gastroenterology and Hepatology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1pGbxpw
via IFTTT

Coeliac disease in adolescence: Coping strategies and personality factors affecting compliance with gluten-free diet

Appetite

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/22f0hOM
via IFTTT

Should surveillance for liver cancer be modified in hepatitis C patients after treatment-related cirrhosis regression?

Liver International

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1pGbz0A
via IFTTT

Percutaneous cryoablation of hepatic tumors: Long-term experience of a large U.S. series

Abdominal Imaging

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/22f0iSG
via IFTTT

Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish Prospective Multicenter Study (GECMP-CCR)

Annals of Oncology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1MhqoLI
via IFTTT

Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer

Journal of Clinical Oncology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/1QRYFGQ
via IFTTT

The genetics of drug efficacy: opportunities and challenges

Nature Reviews Genetics. doi:10.1038/nrg.2016.12

Authors: Matthew R. Nelson, Toby Johnson, Liling Warren, Arlene R. Hughes, Stephanie L. Chissoe, Chun-Fang Xu & Dawn M. Waterworth



from Genetics via xlomafota13 on Inoreader http://ift.tt/1nIgPPI
via IFTTT

Molecular evolution: Friends with benefits — sex speeds up adaptation

Nature Reviews Genetics. doi:10.1038/nrg.2016.32

Author: Ross Cloney



from Genetics via xlomafota13 on Inoreader http://ift.tt/1nIgPPE
via IFTTT

Disease mechanisms: Epigenetic modulators, modifiers and mediators in cancer aetiology and progression

Nature Reviews Genetics. doi:10.1038/nrg.2016.13

Authors: Andrew P. Feinberg, Michael A. Koldobskiy & Anita Göndör



from Genetics via xlomafota13 on Inoreader http://ift.tt/1nIgOeC
via IFTTT

Causes of molecular convergence and parallelism in protein evolution

Nature Reviews Genetics. doi:10.1038/nrg.2016.11

Author: Jay F. Storz



from Genetics via xlomafota13 on Inoreader http://ift.tt/1V5PBjv
via IFTTT