Hepatic encephalopathy (HE) is a debilitating complication of advanced chronic liver disease (ACLD), which severely impacts on health-related quality of life and survival [1,2]. Since there are no universally accepted standards, clinical management of HE is often dependent on local guidelines and personal views.
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Δευτέρα 25 Απριλίου 2016
Hepatic encephalopathy: A call to action to optimize patient outcomes
Gluten-free diet does not influence the occurrence and the Th1/Th17-Th2 nature of immune-mediated diseases in patients with coeliac disease
Coeliac disease (CD) is the most common Th1-mediated enteropathy, frequently associated with other immune-mediated disorders (IMD).
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The essential functions of endoplasmic reticulum chaperones in hepatic lipid metabolism
The endoplasmic reticulum (ER) is an essential organelle for protein and lipid synthesis in hepatocytes. ER homeostasis is vital to maintain normal hepatocyte physiology. Perturbed ER functions causes ER stress associated with accumulation of unfolded protein in the ER that activates a series of adaptive signalling pathways, termed unfolded protein response (UPR). The UPR regulates ER chaperone levels to preserve ER protein-folding environment to protect the cell from ER stress. Recent findings reveal an array of ER chaperones that alter the protein-folding environment in the ER of hepatocytes and contribute to dysregulation of hepatocyte lipid metabolism and liver disease.
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The tragedy and disgrace of bullying in EMS and fire
Since the body of Nicole Mittendorff was found in the Shenandoah National Park on April 21, allegations of bullying and harassment by her co-workers have surfaced on social media, in the news and in private messages to EMS1.
It's a profound tragedy, and the bullying angle in particular has struck a nerve among many in fire and EMS after it was confirmed that Mittendorff had taken her own life.
We don't know whether bullying was a primary factor in her suicide, but we do know that starting in December 2015 lewd comments and rumors about Mittendorff's personal life were posted online by people claiming to be Fairfax County Fire and Rescue Department firefighters, the department where she worked as a firefighter-paramedic. The despicable nature of the language in the online posts certainly points to the strong possibility that the bullying had an impact on Mittendorff's mental health.
Bullying: No Reason. No Excuse.
This is not the first time bullying and harassment has potentially been a contributing factor to a first responder suicide. The availability of seemingly anonymous message boards and other social media channels have made it easy for lewd comments and rumors to spread rapidly.
Since the comments and postings about Mittendorff have been reported, the common phenomenon that is "victim blaming" has surfaced on social media and even in messages to the EMS1 editor-in-chief. People are quick to try and justify the online harassment by claiming there is more to the story or that the victim somehow brought it on themselves.
Whether or not bullying was a direct cause in her suicide, it forces us to engage in discussion about one unequivocal truth: There is no excuse for bullying in the workplace.
Repeat after me.
There. Is. No. Excuse. For. Bullying.
The truth or falsity of rumors is completely irrelevant; nothing excuses bullying and harassment. It is not your place to publicly humiliate and shame a co-worker.
As any kid who wears glasses can tell you, true statements can still be used in a tortuous manner. Being a first responder can be traumatic enough without one's peers adding to the stress and trauma.
Workplace bullying is real and women are disproportionately impacted
Bullying in the workplace is not a new or uncommon issue. In the 2013 WBI Industry report, the two fields with the most bullying reported were hospital-based health care and public services, which included fire and EMS [1].
The 2014 Workplace Bullying Survey showed that 27 percent of workers have experienced bullying at work [2]. In that survey, 69 percent of bullies were male, while 60 percent of the targets of bullying were female.
In the fire service, bullying and harassment have been identified as ongoing problems, especially among female firefighters. According to the NPFA in 2012, the most recent year available, only 3.4 percent of career firefighters in the United States were female [3].
Female firefighters have expressed that they do not feel like they are treated as equals with their male peers and report significantly higher rates of workplace bullying and harassment than their male co-workers [4]. In a study of 339 firefighters, 54 percent of female firefighters indicated they were not treated as equals, however 84 percent of female firefighters said they would still enter the fire service [5, 6].
The 2008 National Report Card on Women in Firefighting interviewed 675 firefighters in 48 states, 175 of which were female firefighters. Eighty-five percent of the females surveyed reported that they had been treated differently due to their gender versus 12.4 percent of the males surveyed. Fifty-one percent of females reported being shunned versus two percent of males. Forty-three percent of females reported experiencing verbal harassment versus three percent of males [4].
Females also reported experiencing exposure to pornography, unwanted sexual advances, and hostile notes at rates at least 15 times greater than the male respondents reported [4].
A study in Norway found that adult victims of workplace bullying were twice as likely to have suicidal ideations than those who were not bullied [7].
What is being done to stop workplace bullying
There do not appear to be any studies directly looking at what affects workplace bullying and harassment of first responders may have on their mental health. However, I feel safe saying that adding an additional stressor to someone who is already a member of a high-risk profession is not likely to have a positive effect on their mental health.
In an effort to curb bullying and particularly cyberbullying, laws have been passed making it easier to find the identities of online attackers and to prosecute them. As of 2014, 48 states had anti-bullying or anti-harassment legislation that mentions the use of electronic communication methods.
Virginia law calls a time out on the statute of limitations on defamation cases if the investigators have something like a username or IP address of a harasser, but don't have the bully's real identity yet. Virginia also has a law clearly outlining what is considered online harassment, and people found to be in violation may be guilty of a class 1 misdemeanor.
What you can do in your fire department or EMS agency
The 2014 Workplace Bullying Survey showed that 72 percent of people were aware workplace bullying happens [2]. This means there are a significant percentage of employees who are witnessing bullying. If you are a witness to bullying behavior, here are some things you can do to help:
- Let the victim of the bullying know that you're aware of what is going on and are willing to make a report.
- Encourage the victim of the bullying to stand up for themselves.
- Talk to the person doing the bullying. Explain why their behavior is not OK.
- Discourage people from spreading rumors.
- If the bullying is on social media, use the website's report function to notify administrators about it so it can be removed.
- Report it to a supervisor, human resources or via another appropriate avenue.
What chiefs and leaders must do
Chiefs, owners, managers and supervisors of fire departments and EMS agencies need to foster an environment where mistreatment will not be tolerated and where complaints are evaluated in a fair manner. The fire service, and to a lesser extent EMS, have a reputation as a 'good ol' boys club', and where that culture dictates mistreatment of those not fitting the standard mold, it must be aggressively addressed and corrected. Here is what we should expect from every public safety workplace:
- Make it clear during the initial hiring process that bullying and harassment of any kind is not permitted.
- Have comprehensive policies outlining how bullying and harassment should be reported and investigated.
- Educate employees annually on bullying and harassment policies. Make sure bullying and harassment are specifically covered in workplace violence. Look to national professional associations and training vendors for bullying prevention training programs.
- Do not dismiss complaints of bullying without investigating. The behavior you see from the accused employee may not be the behavior everyone else sees.
- Calls to toughen up, that is how things have always been, it's just men being men and other similar excuses should never be used to dismiss a complaint or justify behavior.
- Even if a rumor is deemed truthful that does not mean it is appropriate for workplace discussion.
- If permitted, consider bringing in a neutral 3rd party to conduct investigations of workplace bullying and harassment.
As mental health becomes a more common topic of discussion among first responders, it stands to reason that discussions of bullying and harassment are going to follow since we know there is a link.
As part of changing first responder culture to destigmatize mental health, we also need to work on eliminating bullying and harassment. Having a mentally healthy workplace cannot happen if we only focus on the traumatic calls and not the trauma we inflict on each other.
References
1. Namie, Gary, PhD, Daniel Christensen, and David Phillips. 2013 WBI Bullying By Industry Survey. Rep. Workplace Bullying Institute, 2013. Web. 24 Apr. 2016.
2. Namie, Gary, PhD, Daniel Christensen, and David Phillips. 2014 WBI US Workplace Bullying Survey. Rep. Workplace Bullying Institute, 2014. Web. 24 Apr. 2016.
3. Firefighting occupations by women and race. http://ift.tt/1SnPGxO
4. Hulett, Denise M., Marc Bendick, Jr., Sheila Y. Thomas, and Francine Moccio. A National Report Card on Women in Firefighting. Rep. International Association of Women in Fire & Emergency Services, Apr. 2008. Web. 24 Apr. 2016.
5. Does the Fire Station Have a Glass Ceiling (Griffith, Schultz, M. C., Schultz, J. T., & Wakeham, 2015)
6. Bullying on the job: A new threat to the fire service http://ift.tt/1XSwSqN
7. Morten Birkeland Nielsen, Geir Høstmark Nielsen, Guy Notelaers, and Ståle Einarsen. Workplace Bullying and Suicidal Ideation: A 3-Wave Longitudinal Norwegian Study. American Journal of Public Health: November 2015, Vol. 105, No. 11, pp. E23-e28.
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Clinical Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma of the Esophagogastric Junction
Abstract
Background and Aims
Endoscopic submucosal dissection (ESD) for adenocarcinoma in the esophagogastric junction (EGJ) is a technically difficult procedure. We analyzed the long-term clinical outcomes of ESD for adenocarcinoma in the EGJ to determine the feasibility of this treatment approach.
Methods
Subjects who underwent ESD for Siewert type II adenocarcinoma between December 2004 and December 2011 were eligible for this study. Clinical features and treatment outcomes were retrospectively reviewed using medical records.
Results
A total of 88 subjects underwent ESD at our institute. The median patient age was 66 years (interquartile range [IQR] 59–71 years), and the male-to-female ratio was 10.0:1. The median tumor diameter was 20 mm (IQR 14–25 mm), and the median procedure time was 40 min (IQR 30–60 min). Adverse events occurred in nine patients (10.2 %), namely bleeding (n = 6) and suspicious microperforation (n = 3). En bloc, complete, and curative resection rates were 88.6 % (78/88), 83.0 % (73/88), and 60.2 % (53/88), respectively. In multivariate analysis, undifferentiated histology (P = 0.009) and elevated lesions (P = 0.011) were factors associated with noncurative resection. During a median follow-up period of 68.5 months, local tumor recurrence was detected in two patients (2.4 %), and the 5-year overall and disease-specific survival rates were 96.6 and 100.0 %, respectively.
Conclusions
ESD for the treatment of EGJ cancer may be an effective and safe treatment strategy based on favorable long-term outcomes.
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Bi-phasic anaphylactic reaction to fish
Video shows return of symptoms and treatment with epinephrine for an 11-year-old boy who had already received two epi injections.
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Study of hepatic dysfunction in type 2 diabetes mellitus accessing healthcare services in an urban tertiary care hospital
2016-04-25T06-55-16Z
Source: International Journal of Advances in Medicine
Shilpa P. Karande, Santosh G. Gosavi, Chinmayee P. Mishra.
Background: Diabetes mellitus (DM) is an extensively researched and studied subject mainly because of two factors: its, often silent spread among the community and the wide range of complications associated with it. This includes hepatic dysfunction, the spectrum of which ranges from clinically asymptomatic with steatosis to NASH, NAFLD, cirrhosis and rarely, hepatocellular carcinoma. Methods: This cross-sectional study was carried out in 50 patients from the general medicine OPD of a tertiary care hospital were selected based on certain inclusion and exclusion criteria, by routine haematological and radiological investigations in type 2 diabetic patients, mainly liver function tests, CBC, sonography of the abdomen, ECG, urine analysis, anthropometric measurements, etc. Data was analyzed by using statistical package of social sciences (SPSS) version-17.0. Results: The duration of diabetes was compared with the count of USG abdomen which came positive for fatty liver. Approximately 28% of the total study group was detected having fatty liver. Prevalence studies on this study group shows that 24.14% of the patients having diabetes less than 5 years, 40% of the patients having diabetes for more than 10 years, and 31.25% of patients in the duration range of 6-10 years show evidence of fatty liver on ultrasound of abdomen. Conclusions: There is a positive prevalence of liver dysfunction as detected on sonography of the abdomen, in patients with type 2 DM. A significant correlation was obtained between fasting blood sugar and BMI. This signifies that glycemic control management plays an important role in preventing complications of diabetes like central obesity.
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Study the efficacy of intralesional formic acid-80% in verruca vulgaris
2016-04-25T06-55-16Z
Source: International Journal of Advances in Medicine
Shantiprasad A. Tippanawar, Manish N. Kadam, Sangita R. Phatale, Pranita M. Kadam.
Background: Warts have been recognized for thousands of years. A wart an epidermal outgrowth develops due to infection with human papilloma virus (HPV) belongs to the papova viridae group. Various treatment modalities have been tried for warts but none are uniformly effective. The present experimental study with formic acid 80% was undertaken. The objective was to study the verruca vulgaris in relation to age, sex and site and efficacy of intraregional formic acid 80% in verruca vulgaris. Methods: Patients were treated with formic acid - 80% intralesionally on every alternate day till lesions become flat. But the number of application was restricted to ten, after which the treatment was considered as a failure. Then follow up every monthly. Failure was considered if there was recurrence of any lesion and if lesions did not respond to intraregional formic acid. Results: In the present study, out of 67 patients of verruca vulgaris, 64 patients showed complete disappearances of verruca vulgaris before the period of 10 application of formic acid 80%. The overall success rate of treatment of verruca vulgaris with 80% formic acid is 82%. Conclusions: The overall success rate of treatment of verruca vulgaris with formic acid was 82%. Thus the formic acid-80% is effective in the treatment of verruca vagaries.
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Study of anemia in geriatric population: a hospital based study in Marathwada region, Maharashtra, India
2016-04-25T06-55-16Z
Source: International Journal of Advances in Medicine
Pravin N. Soni, Rahul B. Jawale, Seema P. Soni.
Background: In geriatric population, anemia is not only the common problem, but it may present as severe complications in this group compared with anemia in younger group. According to WHO criteria, level of hemoglobin less than 13 gm% in case of males and less than 12 gm% in females are considered as anemia.The main objective of the study was to study the various pattern of anemia in the geriatric population. Methods: The study was carried out at JIIUs IIMSR Medical College and Noor Hospital, Badnapur, Jalna, Maharashtra, India from January 2014 to June 2015. Total number of patients taken for the study are 550 (>60 years) who attending geriatric and clinical OPD at Noor Hospital, Badnapur. Detailed haematological examination was carried out in each patient. Results: Out of 550 cases, 369 (67.09%) patients were found to be anemic. Proportions of anemia in males was 64.74% and in females 70.58%. On peripheral smear examination normocytic being the commonest and constituting 78.86%. Conclusions: Diagnosis of anemia in geriatric age group, and further to know its pattern, which thus helps in etiological diagnosis of anemia which ultimately helps in the treatment.
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Relationship between spatial organization and biological function, analyzed using gene ontology and chromosome conformation capture of human and fission yeast genomes
Abstract
Cells regulate functionally related genes cis- and trans-contacts in order to perform specific biological roles. To understand the cryptic spatial genomic contexts underlying these biological functions, we analyzed the gene association data from the gene ontology (GO) database and the genomic spatial organization data obtained by analysis of chromosome conformation capture (3C)-based data from the Sequence Read Archive, where GO and 3C-based data were used to measure functional similarity and spatial proximity, respectively, between genomic loci. In the human genome and the fission yeast genome, we observed that correlation between the two measures was statistically significant on a genome-wide scale. Specifically, it is also confirmed that the genomic spatial architecture is affected by functional similarity of genes by showing better correlation of functional similarities with spatial distances estimated by contact frequencies than those estimated by genomic distances for cis-contacts. Furthermore, we analyzed distances between the genomic segments sharing the same GO term using the two-sample t test, found that the genomic segments identified by various GO terms are spatially located closer than the average distance over statistically-valid contacts, and provided a list of the GO terms. The results suggested that genomic loci with similar biological functions are situated in close proximity to each other in the nuclear space by aggregating functionally related genes in a short spatial range.
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Functional mechanisms for diabetic nephropathy-associated genetic variants
Abstract
Diabetic nephropathy (DN) is one of the major complications of diabetes. A tremendous amount of genetic variations have been identified to be associated with DN. However, most of them only generate from statistical associations at the DNA level, generally without direct functional evidence regarding their association mechanisms underlying DN. Based on the publicly available datasets and resources, this study performed integrative analyses (expression quantitative trait loci analysis, differential gene expression analysis and functional prediction analysis) to detect the molecular functional mechanisms underlying the associations for DN. Among 150 selected (P < E-4) genetic associations that were archived in the public databases, two single nucleotide polymorphisms (SNPs) (rs3135377 and rs9469220) have been found to act as cis-effect regulators of the "identified" gene (HLA-DRA and HLA-DRB1). These eQTL genes have differential expression signals in the DN-associated cell groups. These SNPs were predicted as regulatory sites by utilizing online prediction tools. Our data suggest potential mechanistic links underlying the association between DN and two identified SNPs. These results could help us to have a deeper understanding of the functional relevance of genetic variants with susceptibility to DN, which is useful for pursuit of in-depth validation studies to dissect their involvements and molecular functional mechanisms in DN.
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Construction Site Paramedic / EMT - Medcor
Job Summary Job Summary: We are looking for a talented Paramedic to work fulltime as a Medical Administrator at our worksite clinic located in The Dalles, OR. The days/hours for this position will be: Monday – Friday (Saturdays as needed) from 7:00am-5:00pm. Duties and Responsibilities: Participate in daily operations at Medcor's on-site clinic Triage, Assessment, & Treatment of workplace ...
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An adjuvant therapy in cervical necrotising fasciitis: hyperbaric oxygen treatment
2016-04-25T06-00-28Z
Source: Medicine Science | International Medical Journal
Nuray Ensari, Ozer Erdem Gur, Mehmet Turker Ozturk, Irem Tezer, Oguzhan Ilden, Mustafa Deniz Yilmaz.
Cervical necrotising fasciitis is a rapidly progressing, life-threatening deep neck infection. In the majority of patients there are comorbidities which affect the immune system such as diabetes mellitus, advanced age, acute or chronic renal failure, post-partum status, alcoholism, use of intravenous drugs, malnutrition, malignancy, peripheral vascular disease or exposure to radiation. Standard treatment is emergency surgical debridement and intravenous antibiotic treatment. As a supportive treatment, the application of hyperbaric oxygen (HBO) has been shown to provide significant recovery and shorten the period of hospitalisation. In this study, the results are presented of the application of HBO treatment as an adjuvant to the standard treatment of patients diagnosed with cervical necrotising fasciitis, and this is discussed in the light of relevant literature.
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An odontogenic cyst causing facial asymmetry: a case report
2016-04-25T06-00-28Z
Source: Medicine Science | International Medical Journal
Nuray Ensari, Ozer Erdem Gur, Mehmet Turker Ozturk, Ustun Osma, Omer Tarik Selcuk.
Radicular cysts are inflammatory in character and the most frequently seen of odontogenic cysts. As they are generally seen to grow painlessly, the first finding may be facial asymmetry. Although seen in every age group, they are most often seen in males aged 20-60 years. The patient reported here presented with complaints of swelling in the right cheek. On the paranasal sinus computed tomography, a cyst appeared to be completely filling the maxillary sinus and this was totally excised with a Caldwell-Luc approach. In the differential diagnosis of cystic masses of the maxillary sinus, there may be confusion with odontogenic cysts. Imaging methods can clearly define the localisation of cystic lesions within the sinus cavity, growth direction, bone tissue loss associated with lysis and osteocondensation. To prevent recurrence, it is necessary to completely remove regenerated mucosa and the residual cyst epithelium.
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Clear Cell Sarcoma of Cervical Cord Region: An Unusual Anatomical location
2016-04-25T05-01-43Z
Source: The Southeast Asian Journal of Case Report and Review
Sweety Gupta, Ravi Shankar, Nitin Leekha, Prekshi Choudhary, Sudarsan De.
Introduction: Clear cell sarcoma of soft tissue (CCSST) is a rare tumor accounting for less than 1% of all sarcomas. The most common location is extremities. We report an extremely rare case of CCSST of cervical cord region. Case Presentation: A 44 year old male patient presented with complaints of right neck swelling and pain cervical spine region radiating to right arm. Lymph node biopsy showed metastatic clear cell sarcoma of soft part (melanoma of soft part). Whole body PET CT scan reported metabolically active enlarged right posterior cervical lymph node and hypermetabolic focal lesion in right side of spinal canal The intraspinal tumor was unresectable so patient received External Beam Radiotherapy. Follow up MRI after six months reported stable disease. Conclusion: CCSST is a rare tumor and our patient had tumor location in cervical cord region which is an unusual location. In surgically inoperable case like this, radiotherapy may be considered as treatment option and it has resulted in symptom-free survival in this patient till date.
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Utility of screening questionnaire, obesity, neck circumference, and sleep polysomnography to predict sleep-disordered breathing in children and adolescents
Summary
Background
Polysomnography (PSG) remains the gold standard for diagnosing obstructive sleep apnea (OSA) and sleep-disordered breathing in children. Yet, simple screening tools are needed as it is not feasible to perform PSG in all patients with possible OSA.
Aim
The study adapted questions from the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder (SRBD) Questionnaire to develop a predictive scale for OSA identified on PSG. We also tested whether adding anthropometric measurements (body mass index and neck circumference) improved prediction of OSA.
Methods
After IRB approval, OSA questionnaires and anthropometric measurements were collected on 948 consecutive patients scheduled for PSG, aged 4 months to 24.5 years (median = 8.5 years). The sample was reduced to 636 patients in the age range (6–18 years old) where normative values for neck circumference are defined. OSA was characterized using the obstructive apnea–hypopnea index (AHI). After identifying questions related to OSA in univariate logistic regression, multivariable models were fitted to select questions for a short scale, and points for exceeding body mass or neck circumference cutoffs were added to assess improvement in predictive value.
Results
A long scale of 16 questionnaire items was constructed using univariate models, while six items were selected for the short scale by multivariable regression. The short scale was associated with greater odds of moderate/severe OSA (OR = 1.964; 95% CI = 1.620, 2.381; P < 0.001) and attained good predictive value (area under receiver operating characteristics curve [AUC] = 0.74), which was not significantly improved by addition of BMI and neck circumference data (AUC = 0.75).
Conclusions
We developed a six-question scale with good predictive utility for OSA. These findings may contribute to developing a preoperative clinical tool to help clinicians identify children with OSA for determining risk stratification and postoperative disposition.
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Anesthetic management of 877 pediatric patients undergoing muscle biopsy for neuromuscular disorders: a 20-year review
Summary
Background
The objectives are to review the anesthetic management and anesthetic-related adverse events in patients undergoing muscle biopsy for a broad spectrum of neuromuscular disorders (NMD).
Aim
The study aims to assess the hypothesis that perceived awareness of potential anesthesia-induced hyperkalemia and MH in patients with NMD reduces the frequency of such events.
Methods
A 20-year retrospective review of 877 consecutive patients undergoing muscle biopsy to establish diagnoses of NMD has been performed. Patients were categorized prebiopsy into six groups: M (myopathy and muscular dystrophy), MM (mitochondrial or metabolic myopathy), N (neurodegenerative, peripheral neuropathy or spinal muscular atrophy disorder), D (dermatomyositis), C (cardiomyopathy), or S (seizure disorder). Data were collected for demographics, anesthetic management, pre- and postoperative anesthesia-induced muscle injury, postbiopsy histopathologic diagnosis, and concordance comparisons between pre- and postbiopsy diagnoses.
Results
There were 513 males (58.5%) and 364 females (41.5%) (1.4:1) with 137 individuals (15.6%) operated on under 1 year of age and two-thirds by 6 years of age. NMD diagnosis was reached in 409 (46.6%) while 468 (53.4%) had no specific pathology. No patients exhibited signs of anesthesia-induced muscle injury (malignant hyperthermia, rhabdomyolysis, cardiac arrest, or postoperative deterioration of weakness). MM was the largest group pre biopsy (367, 41.8%). Anesthetic agents were: nitrous oxide in 657 (74.9%); volatile agents in 139 (15.8%); intravenous agents in 836 (95.3%) (primarily propofol, midazolam, and fentanyl); nondepolarizing muscle relaxants in 404 (46.1%); and regional anesthesia in 112 (12.8%) [most commonly spinal anesthesia in 80 (71.4%)]. Comparing preoperative diagnostic category with postoperative diagnosis, there was a concordance of 78% (319/409) between the two for cases with a definitive diagnosis and 89.7% (787/877) for all cases.
Conclusions
In this retrospective study, no patient exhibited signs or symptoms of hyperkalemia or MH probably because the incidence is very low and becomes even less likely due to the selection of the various anesthetic agents and strategies administered.
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Evaluation of the Explorer Endoscopy Mask© for esogastroduodenoscopy in children: a retrospective study of 173 cases
Summary
Aims
The aim of this study was to evaluate the usability and safety of the Explorer Endoscopy Mask® (EM) as an alternative to endotracheal intubation in children undergoing elective esogastroduodenoscopy (EGD) under general anesthesia (GA).
Methods
This study was a retrospective observational study. The study was undertaken at the pediatric digestive endoscopy suite in the Cliniques universitaires Saint-Luc, Brussels, Belgium. We retrospectively analyzed the occurrence of minor and major airway-related adverse effects during pediatric EGD procedures performed under GA with the EM between June 2014 and March 2015.
Results
During the study period, 173 patients underwent EGD. Their mean age was 8.4 years (median: 9.1 years, range 4 months to 16 years). Mean duration of endoscopy (from insertion to removal of the endoscope) was 12.6 min (median: 12 min, range 3–47 min). The use of EM was uneventful in 159 (92%) cases. There were 24 airway-related adverse events in 14 children. Hypoxemia (SpO2 <90%) (13 events, 7.5%) was the most commonly encountered complication followed by laryngo- or bronchospasm (five events, 2.89%), cough (five events, 2.89%), and intubation (one event, 0.58%). No cases of regurgitation/aspiration were observed.
Conclusions
Our data support the EM use in pediatric EGD. There were few transient respiratory adverse events which were easily solved with minor interventions.
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Amyand’s hernia: a need for greater surgical awareness
2016-04-25T03-04-56Z
Source: International Journal of Advances in Medicine
Ketan Vagholkar, Amish Pawanarkar, Suvarna Vagholkar, Kashmoorvalishah Pathan.
Amyands hernia is typically described as a inguinal hernia containing the appendix in its sac. The true incidence of this hernia is still not discernible in view of its rarity. However the chances of complications in this type of hernia are extremely high. The clinical presentation of Amyands hernia is variable making the diagnosis challenging. This paper describes the pathophysiology and surgical approaches to Amyands hernia to create awareness of this occasional surprise.
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Evaluation of radiocesium concentrations in new leaves of wild plants two years after the Fukushima Dai-ichi Nuclear Power Plant accident
Source:Journal of Environmental Radioactivity, Volume 160
Author(s): Yuki Sugiura, Michihiro Shibata, Yoshimune Ogata, Hajime Ozawa, Tsutomu Kanasashi, Chisato Takenaka
Radiocesium (137Cs) transfer to plants immediately after the Fukushima Dai-ichi Nuclear Power Plant accident was investigated by collecting newly emerged leaf and soil samples between May 2011 and November 2012 from 20 sites in the Fukushima prefecture. Radiocesium concentrations in leaf and soil samples were measured to calculate concentration ratios (CR). Woody plants exhibited high CR values because 137Cs deposited on stems and/or leaves were transferred to newly emerging tissues. The CR values in 2012 declined as compared to that in 2011. Exchangeable 137Cs rates in soil (extraction rate) samples were measured at five sites. These rates decreased at four sites in 2012 and depended on environmental conditions and soil type. Both CR values and extraction rates decreased in 2012. However, CR values reflected the changes in extraction rates and characteristics of each species. Amaranthaceae, Chenopodiaceae, and Polygonaceae, which had been identified as Cs accumulators, presented no clear 137Cs accumulation ability. In 2012, the perennial plant Houttuynia cordata and deciduous trees Chengiopanax sciadophylloides and Acer crataegifolium displayed high CR values, indicating that these species are 137Cs accumulators and may be considered as potential species for phytoremediation.
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Determination of 226Ra in produced water by liquid scintillation counting
Publication date: August 2016
Source:Journal of Environmental Radioactivity, Volume 160
Author(s): José Marcus Godoy, Lucas M. Vianna, Maria Luiza D.P. Godoy, Ana Cristina Almeida
It is proposed a method for the determination of 226Ra in offshore platform liquid effluent samples (produced water). The method is based on a two-phase liquid scintillation counting system and allows for the direct and simple determination of 226Ra content. Samples with high barium content may also have high 226Ra concentration. Therefore, the sample volume is based on the barium concentration and ranges from 10 mL to 100 mL. Our new method was tested using multiple real samples and was compared with the BaSO4 precipitation method. The results based on the LSC were 30% higher than the precipitation method, which is attributed to the self-absorption of alpha particles in the BaSO4 precipitate. The determination of both 226Ra and 228Ra in the liquid effluent of offshore oil platforms is mandatory in Brazil. Thus, a second method of accurately assessing 228Ra content remains necessary.
Graphical abstract
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Clinico-demographic profile of hyperbilirubinemia in neonates admitted to a tertiary care hospital
2016-04-25T02-26-51Z
Source: International Journal of Contemporary Pediatrics
Rohit Chib, Bharti Bhandari.
Background: The purpose of this study was to find etiological and other associated factors of neonatal hyperbilirubinemia at a tertiary care hospital SGRRIM&HS Patel Nagar Dehradun Uttrakhand, India. Jaundice is a common problem in neonatology. Early recognition of the cause of jaundice is very important as delay in management may lead to serious complications or even death. Methods: In present study, newborns with jaundice were evaluated during a 12 months period between January 2015 December 2015. 195 newborns with jaundice were enrolled in the study. Data regarding demographic profile of new born, physical examination and laboratory investigations were gathered and analyzed to interpret the common etiologies giving rise to neonatal hyperbilirubinemia. Results: Out of 195 cases of neonatal hyperbilirubinem, 40 cases belonged to physiological jaundice. Breast feeding jaundice-121 cases, breast milk jaundice-5 cases, jaundice due to prematurity-8 cases and pathological jaundice-21 cases (6 were of ABO incompatibility, 4 neonatal sepses, 4 Rh incompatibility, 4 G6PD deficiencies, 2 neonatal hypothyroidism and 1 congenital biliary atresia). Conclusions: Present study concludes that breast feeding jaundice forms the bulk of cases of neonatal hyperbilirubinemia in our hospital, followed by physiological jaundice, jaundice of prematurity, ABO Incompatibility, breast milk jaundice, neonatal sepsis, Rh incompatibility, G6PD Deficiency, neonatal hypothyroidism and congenital biliary atresia.
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