Δευτέρα, 23 Μαΐου 2016

Immunogenetic Pathogenesis of Celiac Disease and Non-celiac Gluten Sensitivity

Abstract

Celiac disease is the most common oral intolerance in Western countries. It results from an immune response towards gluten proteins from certain cereals in genetically predisposed individuals (HLA-DQ2 and/or HLA-DQ8). Its pathogenesis involves the adaptive (HLA molecules, transglutaminase 2, dendritic cells, and CD4+ T-cells) and the innate immunity with an IL-15-mediated response elicited in the intraepithelial compartment. At present, the only treatment is a permanent strict gluten-free diet (GFD). Multidisciplinary studies have provided a deeper insight of the genetic and immunological factors and their interaction with the microbiota in the pathogenesis of the disease. Similarly, a better understanding of the composition of the toxic gluten peptides has improved the ways to detect them in food and drinks and how to monitor GFD compliance via non-invasive approaches. This review, therefore, addresses the major findings obtained in the last few years including the re-discovery of non-celiac gluten sensitivity.



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Approximate total Fe content determined by Mössbauer spectrometry: Application to determine the correlation between gamma-ray-emitter activities and total content of Fe phases in soils of the Province of Buenos Aires, Argentina

S0265931X.gif

Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): M.L. Montes, P.C. Rivas, M.A. Taylor, R.C. Mercader
Pearson correlation coefficients between 40K, 226Ra and 232Th activities and the total Fe phase fractions yielded by Mössbauer spectroscopy have been calculated for soils of the Province of Buenos Aires, Argentina. Total fractions of Fe phases have been obtained from the relative fractions reported in previous works weighted by the Fe soil content and the recoilless-fraction of each Fe phase. An approximate method based on the relationship between the Mössbauer spectral absorption area (obtained from the 57Fe Mössbauer data) and the total Fe concentration (determined by colorimetric methods, after microwave assisted acid digestion of soil samples) has been used for the first time to determine the Fe concentration in soils with an accuracy of 15%. Protocol to extend the method for unknown samples is also discussed. The determined new coefficients differ from those reported previously. A significant and positive correlation between the total fraction of Fe2+ and the 40K activity values has been obtained. This result validates the hypothesis put forward in a previous work, i.e., that illite captures the 40K existing in the soil. In addition, with the new approximation, the Pearson correlation coefficients for the other natural radionuclides give values that indicate that the methodology reported here is appropriate to study the correlations between the activity values with the total fractions of Fe phases.



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Single-stage resection and microwave ablation for bilobar colorectal liver metastases

British Journal of Surgery

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Treatment as prevention - targeting people who inject drugs as a pathway towards hepatitis C eradication

Alimentary Pharmacology and Therapeutics

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Recent updates of precision therapy for gastric cancer: Towards optimal tailored management

World Journal of Gastroenterology

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Why Are American Health Care Costs So High?

Just some fun facts...

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Use of proton pump inhibitors and risks of fundic gland polyps and gastric cancer: Systematic review and meta-analysis

Clinical Gastroenterology and Hepatology

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Entry Level Firefighter EMT and Firefighter Paramedic - Springdale Fire Department

SPRINGDALE FIRE DEPARTMENT P.O. BOX 1521 SPRINGDALE, ARKANSAS 72765 Updated: May 17, 2016 Classification: Entry Level Firefighter/EMT and Firefighter/Paramedic The Springdale Fire Department is currently hiring for Entry Level Firefighter/EMT and Firefighter/Paramedic. Applicants must have successfully passed the NTN (National Testing Network) test, received their CPAT certification and submitted a ...

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Patient safety and risk management in EMS

The Center for Patient Safety works across the health care continuum to improve care and minimize risk. Lee Varner, EMS Project Manager, discusses the dangers of ambulance collisions and other types of adverse events. Varner also describes the work done by the Center for Patient Safety. After watching, read the EMS Forward report.

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Should total gastrectomy and total colectomy be considered for selected patients with severe tumor burden of pseudomyxoma peritonei in cytoreductive surgery?

European Journal of Surgical Oncology

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Getting to the root of the fire services' misogynistic weed

A couple of weeks ago, I was flipping channels and landed on a PBS show about a biblical scholar who was looking for the Garden of Eden. In doing so, she theorized that the Judeo-Christian societies have used the story of Eve's tempting Adam as an excuse to blame women for mankind's separation from God, and thus all of what's wrong in the world.

That program had no fire service connection for me until I read the string of anonymous posts by presumed Fairfax County, Va. firefighters on Fairfax Underground before and following Nicole Mittendorff's suicide.

We may never know to what extent bullying and humiliation by her peers played in her suicide — it may have had no bearing at all. We do know that Mittendorff and other female firefighters and medics were subjected to some incredibly hateful remarks posted to the site.

Shockingly, some of the most vile remarks were posted after her remains were found.

If we think this attitude toward our sister firefighters is something that lives quarantined in Fairfax, we are grossly mistaken. It may not express itself as publically and to the extreme that it did in Fairfax, but it's there. Talk to almost any female firefighter long enough and you'll hear stories.

So the $60,000 question is: What's the fix"

At the organizational level there are clear steps — leading by example, sensitivity training and zero tolerance for infractions — to name a few.

But really fixing the problem can't be done by simply adding pages to the SOG book. It is a deeply individual issue.

What is at the root of misogyny" Why do so many men harbor varying levels of hatred for women"

Mittendorff's suicide pushed me to read up on this topic and I found no easy answers. One male psychotherapist and expert on the subject wrote a book attributing it to "mommy issues." In short, men never really get over being pushed away from the ultimate female love.

Others chalk it up to society's permissions and expectations in how men behave. Others blame religions for casting women and their sexuality in a subservient role.

Still others hold that it's our, men that is, inability to cope with women's sexuality. And it's not a huge leap to say men struggle to cope with sexuality in general — look how heterosexual men have treated homosexual men.

One idea floated takes it down to the species level. Basically, the idea is that males in the animal kingdom places great importance on ensuring their offspring are truly theirs and control the females' opportunities to mate with others. And humans fall into that mix.

However you look at it, misogyny goes way, way back. And that, of course, makes it doubly difficult to overcome. Again, you need training, policy and enforcement — but don't expect that alone to work.

In a recent Secret List mailing, Chief Goldfeder rightly urged men to behave toward women as though their spouses, mothers, sisters, daughters, etc. were standing at their side.

That individual behavior, that choice of behavior, is where the rubber meets the road. These issues may run back to our infancy, to centuries of cultural and religious messaging or to a time when we walked on all fours. Yet we have the intellectual wherewithal to decide how we behave.

The ideal outcome would be for all men to take a hard look in the mirror and come to terms with and eradicate misogynistic feelings, no matter how subtle or extreme they are.

But the expected minimum outcome has to be that we identify these feelings and check them at the door when we walk into the fire station.



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Patient safety and risk management in EMS

The Center for Patient Safety works across the health care continuum to improve care and minimize risk. Lee Varner, EMS Project Manager, discusses the dangers of ambulance collisions and other types of adverse events. Varner also describes the work done by the Center for Patient Safety. After watching, read the EMS Forward report.

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Efficacy of a “contact center-based communication” in optimizing the care of inflammatory bowel diseases

Digestive and Liver Diseases

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Patient safety and risk management in EMS

The Center for Patient Safety works across the health care continuum to improve care and minimize risk. Lee Varner, EMS Project Manager, discusses the dangers of ambulance collisions and other types of adverse events. Varner also describes the work done by the Center for Patient Safety. After watching, read the EMS Forward report.

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Inguinal hernias associated with a single strenuous event

Hernia

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Patient safety and risk management in EMS

The Center for Patient Safety works across the health care continuum to improve care and minimize risk. Lee Varner, EMS Project Manager, discusses the dangers of ambulance collisions and other types of adverse events. Varner also describes the work done by the Center for Patient Safety. After watching, read the EMS Forward report.

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Community paramedic program cuts mental health patient call volume

The Grady EMS Upstream Crisis Intervention Group launched in January 2013 and is the brainchild of Michael Colman, vice president of EMS operations. While reviewing call volume data, Colman noticed that about 6 percent, or 6,410, of GEMS 911 calls were NAEMD triaged as category 25, which means psychiatric/suicide attempt.

Upon further analysis, Colman realized that an overwhelming portion of their frequent users — callers using EMS at least five times a month — suffered from a psychiatric illness. A financial analysis using a sample of 156 patients from this group determined that it cost Grady EMS over $100 more than they received in reimbursement for each of these transports.

In addition, the emergency department spent over $400 more on each patient than they received in reimbursement. It quickly became obvious to Colman that caring for these patients in the current manner was unsustainable.

A community paramedic project focusing on the care and transport of patients with a psychiatric complaint was launched. And room for improved patient care was quickly noticed.

Patients experiencing mental health crisis were routinely subject to unplanned physical restraint, chemical restraint, police restraint and even arrest. Grady EMS wanted to find a way to better meet the needs of this special group of patients.

Pilot community paramedic program
In late 2012, a pilot program was developed and began operation on Jan. 14, 2013. The Grady EMS crisis response team consists of a paramedic, a Grady Health System licensed counselor, a Behavioral Health Link clinical social worker and in some cases a third-year psychiatry resident.

During the pilot phase, the Grady EMS crisis group co-responded with ambulances, self-dispatched or responded at the request of Grady EMS caregivers on scene. The role of the team paramedic is to provide a medical evaluation and assessment. During the pilot phase, the GEMS crisis group did not respond as an independent unit and was only available during the day Monday through Friday.

Full program launches
The pilot phase concluded at the end of April and the Crisis Intervention Group began responding as the sole unit — without other co-responding ambulances or personnel — based on CAD data and proximity. The unit's hours changed to reflect the demand of EMD category 25 calls and were doubled from 40 to 80 hours per week.

All Grady EMS paramedics were provided in-service training on the Georgia Crisis Action Line system and were able to access that system from the field when the crisis unit was not available.

The paramedics would call the GCAL number and then hand the phone to the patient. The average time to determine a disposition for a patient was 7 to 10 minutes.

This process allows for a mental health professional to evaluate the patient and determine the level of risk over the phone. The mental health professional stays on the phone with the patient and completes a safety plan after the paramedic obtains a patient refusal.

The crisis action line professional can also dispatch a mobile crisis team to the location within one to two hours or inform the paramedic of the necessity to transport the patient to an emergency psychiatric receiving facility.

Grady EMS has been allowing crews in some cases to transport patients to places other than an emergency department for many years now. As an extension of this program, the crisis response team transports some patients directly to in-patient psychiatric facilities.

For the patient, this process completely avoids unnecessary emergency department visits as it is essentially a direct admit into an in-patient mental health facility. Online Grady EMS medical direction is consulted prior to patient transport in the crisis team's SUV.

In addition to on scene crisis team referring psychiatric patients to out-patient services, Grady EMS established an agreement to allow 911 call takers to directly transfer some callers who met NAEMD 25-alpha/omega criteria to the crisis action hotline. This transfer process is similar to the process used for the nurse advice and poison control lines. No ambulance responds unless GCAL calls Grady EMS back.

Aside from the program's process changes, training throughout EMS fire and police organizations has resulted in much better care for Atlanta residents with mental illness. Today, many patients who in the past would likely have been arrested are de-escalated and helped by the techniques learned from Behavioral Health Link and its staff.

When restraint or arrest are unavoidable, the joint training and relationships developed between the police and EMS providers helps remove stress from the process for all involved.

Cost savings of the community paramedic program
In 2013, Grady EMS dispatch transferred 175 calls directly to Behavioral Health Line saving Grady EMS about $13,000. The Grady EMS Upstream Crisis Intervention Group responded to 20 percent of EMD category 25 calls totaling 1,250 responses.

The team obtained 275 refusals/no transports. Many of those patients were provided with safety plans and outpatient appointments, which prevented unnecessary emergency department visits totaling about 1,925 bed hours.

Grady EMS Community Paramedicine

Paramedic Matt Thornton and DeAnn Bing, MD (Photo courtesy Grady EMS)

Colman reported the financial impact of these non-transports saved the emergency department and EMS system over $140,000. To put this in perspective, imagine a 24-bed ER being empty for more than 3 days.

Combined with these non-transport referrals, the group generated other cost savings totaling just over $248,000 for FY2013.

In 2014 the psych unit responded to 1,778 calls, potentially saving EMS over $100,000. In 2015, Grady EMS received 7,668 calls that were psychiatric in nature. Of those, the psych unit handled over 20 percent, again saving EMS over $100,000.

Increased job satisfaction for Grady EMS paramedics
Many EMTs and paramedics are initially attracted to EMS as a way to earn a living while helping people. Almost inevitably, that newness wears away and becomes a grim realization that EMS in its most common form does not typically offer a long-term solution to the patient's underlying problem. When that happens, the patient becomes a frequent flyer that no one wants to hear from.

Program director Tina Wright describes members of Grady EMS Upstream Crisis Intervention Group as problem solvers. She makes no illusion that the work is easy. Wright reports that the providers working on this unit are normally busier than their colleagues on the transport units.

Grady EMS Community Paramedic

Paramedic Tennyson and mental health social worker Candace respond to patients with psychiatric illness (Photo courtesy Grady EMS)

Still the group members report higher-than-normal job satisfaction. In fact, some have even turned down promotion to field training officer in order to stay assigned to the crisis team.

Wright says that members of this team know they are having a huge long-term impact on the lives of virtually every patient they encounter. Critical thinking and solution driven decision-making are key abilities. All team members are empowered to do nearly whatever needs to be done to help meet the needs of their patients.

Wright reports that the 911 call volume generated by their mental health frequent users has decreased by well over 50 percent, which translates into thousands of calls.

For Grady EMS providers answering 911 calls, the success of the Upstream Crisis Intervention Group means they answer fewer calls generated by patients not necessarily experiencing a life-threatening emergency. It goes nearly without saying that the Upstream Crisis Intervention Group is well-loved by the paramedics and EMTs who prefer acute 911 calls from traumatic injury or medical illness.

Employee fulfillment is one of the most important keys to reducing turnover. Allowing paramedics to specialize and focus on their area of passion, like responding to patients with psychiatric illness, can have a huge impact on attrition rates. Allowing paramedics to grow and expand their area of interests while staying with the organization keeps experience and hard-earned knowledge from being lost.

Encouragement for other organizations
Wright, Colman, and Eric Eason of Behavioral Health Link want other organizations to know about the Upstream Crisis Intervention group. They also wanted to encourage other EMS organizations to evaluate the users in their system and learn what needs are not being met.

Wright challenged any organization to grow its services and personnel. "We stepped back and asked: Is there a different way of doing what we are doing," Wright said.

Eason encourages other organizations to reach out to potential mental health service providers near them. "If you don't find anyone with the vision it takes to do what you want, have them call us here at BHL, we'll gladly consult with them and see if there's anything we can do to support their efforts." Eason said.

Colman regularly receives calls about the program. He is glad to help other organizations.



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Grady EMS crisis intervention unit provides field-based behavioral care

By triaging patients with mental illness, especially repeat users, the Grady EMS Upstream Crisis Intervention Group provider has improved care, saved significant money and boosted morale

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Randomized controlled trial for evaluation of the routine use of nasogastric tube decompression after elective liver surgery

Journal of Gastrointestinal Surgery

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Grady EMS crisis intervention unit provides field-based behavioral care

By triaging patients with mental illness, especially repeat users, the Grady EMS Upstream Crisis Intervention Group provider has improved care, saved significant money and boosted morale

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Diagnosis and treatment of eosinophilic esophagitis in adults

American Journal of Medicine

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Gutachtenfälle – Schadensfälle in der Anästhesie – Erfahrungen aus der Begutachtung

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 326-327
DOI: 10.1055/s-0042-106924

Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie sind „gefahrengeneigte Tätigkeitsbereiche". Fast jeder von uns, der nur lange genug diesen Beruf ausübt, ist irgendwann involviert – sei es durch Anfragen von Patienten oder Anwälten, als Beteiligter, Zeuge oder Gutachter bei den Schlichtungsstellen oder vor Gericht. Häufig sind es zum Glück „heilbare Bagatellen", wie Zahnschäden etc. Gelegentlich sind es jedoch leider auch Fälle, die weitreichende Folgen für die uns anvertrauten Patienten haben und die uns weit über die juristischen oder ökonomischen Konsequenzen hinaus beschäftigen.
[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Community paramedic program cuts mental health patient call volume

The Grady EMS Upstream Crisis Intervention Group launched in January 2013 and is the brainchild of Michael Colman, vice president of EMS operations. While reviewing call volume data, Colman noticed that about 6 percent, or 6,410, of GEMS 911 calls were NAEMD triaged as category 25, which means psychiatric/suicide attempt.

Upon further analysis, Colman realized that an overwhelming portion of their frequent users — callers using EMS at least five times a month — suffered from a psychiatric illness. A financial analysis using a sample of 156 patients from this group determined that it cost Grady EMS over $100 more than they received in reimbursement for each of these transports.

In addition, the emergency department spent over $400 more on each patient than they received in reimbursement. It quickly became obvious to Colman that caring for these patients in the current manner was unsustainable.

A community paramedic project focusing on the care and transport of patients with a psychiatric complaint was launched. And room for improved patient care was quickly noticed.

Patients experiencing mental health crisis were routinely subject to unplanned physical restraint, chemical restraint, police restraint and even arrest. Grady EMS wanted to find a way to better meet the needs of this special group of patients.

Pilot community paramedic program
In late 2012, a pilot program was developed and began operation on Jan. 14, 2013. The Grady EMS crisis response team consists of a paramedic, a Grady Health System licensed counselor, a Behavioral Health Link clinical social worker and in some cases a third-year psychiatry resident.

During the pilot phase, the Grady EMS crisis group co-responded with ambulances, self-dispatched or responded at the request of Grady EMS caregivers on scene. The role of the team paramedic is to provide a medical evaluation and assessment. During the pilot phase, the GEMS crisis group did not respond as an independent unit and was only available during the day Monday through Friday.

Full program launches
The pilot phase concluded at the end of April and the Crisis Intervention Group began responding as the sole unit — without other co-responding ambulances or personnel — based on CAD data and proximity. The unit's hours changed to reflect the demand of EMD category 25 calls and were doubled from 40 to 80 hours per week.

All Grady EMS paramedics were provided in-service training on the Georgia Crisis Action Line system and were able to access that system from the field when the crisis unit was not available.

The paramedics would call the GCAL number and then hand the phone to the patient. The average time to determine a disposition for a patient was 7 to 10 minutes.

This process allows for a mental health professional to evaluate the patient and determine the level of risk over the phone. The mental health professional stays on the phone with the patient and completes a safety plan after the paramedic obtains a patient refusal.

The crisis action line professional can also dispatch a mobile crisis team to the location within one to two hours or inform the paramedic of the necessity to transport the patient to an emergency psychiatric receiving facility.

Grady EMS has been allowing crews in some cases to transport patients to places other than an emergency department for many years now. As an extension of this program, the crisis response team transports some patients directly to in-patient psychiatric facilities.

For the patient, this process completely avoids unnecessary emergency department visits as it is essentially a direct admit into an in-patient mental health facility. Online Grady EMS medical direction is consulted prior to patient transport in the crisis team's SUV.   

In addition to on scene crisis team referring psychiatric patients to out-patient services, Grady EMS established an agreement to allow 911 call takers to directly transfer some callers who met NAEMD 25-alpha/omega criteria to the crisis action hotline. This transfer process is similar to the process used for the nurse advice and poison control lines. No ambulance responds unless GCAL calls Grady EMS back. 

Aside from the program's process changes, training throughout EMS fire and police organizations has resulted in much better care for Atlanta residents with mental illness. Today, many patients who in the past would likely have been arrested are de-escalated and helped by the techniques learned from Behavioral Health Link and its staff.

When restraint or arrest are unavoidable, the joint training and relationships developed between the police and EMS providers helps remove stress from the process for all involved.

Cost savings of the community paramedic program
In 2013, Grady EMS dispatch transferred 175 calls directly to Behavioral Health Line saving Grady EMS about $13,000. The Grady EMS Upstream Crisis Intervention Group responded to 20 percent of EMD category 25 calls totaling 1,250 responses.

The team obtained 275 refusals/no transports. Many of those patients were provided with safety plans and outpatient appointments, which prevented unnecessary emergency department visits totaling about 1,925 bed hours.

Grady EMS Community Paramedicine

Paramedic Matt Thornton and DeAnn Bing, MD (Photo courtesy Grady EMS)

Colman reported the financial impact of these non-transports saved the emergency department and EMS system over $140,000. To put this in perspective, imagine a 24-bed ER being empty for more than 3 days.

Combined with these non-transport referrals, the group generated other cost savings totaling just over $248,000 for FY2013.

In 2014 the psych unit responded to 1,778 calls, potentially saving EMS over $100,000. In 2015, Grady EMS received 7,668 calls that were psychiatric in nature. Of those, the psych unit handled over 20 percent, again saving EMS over $100,000.

Increased job satisfaction for Grady EMS paramedics
Many EMTs and paramedics are initially attracted to EMS as a way to earn a living while helping people. Almost inevitably, that newness wears away and becomes a grim realization that EMS in its most common form does not typically offer a long-term solution to the patient's underlying problem. When that happens, the patient becomes a frequent flyer that no one wants to hear from.

Program director Tina Wright describes members of Grady EMS Upstream Crisis Intervention Group as problem solvers. She makes no illusion that the work is easy. Wright reports that the providers working on this unit are normally busier than their colleagues on the transport units.

Grady EMS Community Paramedic

Paramedic Tennyson and mental health social worker Candace respond to patients with psychiatric illness (Photo courtesy Grady EMS)

Still the group members report higher-than-normal job satisfaction. In fact, some have even turned down promotion to field training officer in order to stay assigned to the crisis team.

Wright says that members of this team know they are having a huge long-term impact on the lives of virtually every patient they encounter. Critical thinking and solution driven decision-making are key abilities. All team members are empowered to do nearly whatever needs to be done to help meet the needs of their patients.

Wright reports that the 911 call volume generated by their mental health frequent users has decreased by well over 50 percent, which translates into thousands of calls.

For Grady EMS providers answering 911 calls, the success of the Upstream Crisis Intervention Group means they answer fewer calls generated by patients not necessarily experiencing a life-threatening emergency. It goes nearly without saying that the Upstream Crisis Intervention Group is well-loved by the paramedics and EMTs who prefer acute 911 calls from traumatic injury or medical illness.

Employee fulfillment is one of the most important keys to reducing turnover. Allowing paramedics to specialize and focus on their area of passion, like responding to patients with psychiatric illness, can have a huge impact on attrition rates. Allowing paramedics to grow and expand their area of interests while staying with the organization keeps experience and hard-earned knowledge from being lost.

Encouragement for other organizations
Wright, Colman, and Eric Eason of Behavioral Health Link want other organizations to know about the Upstream Crisis Intervention group. They also wanted to encourage other EMS organizations to evaluate the users in their system and learn what needs are not being met.

Wright challenged any organization to grow its services and personnel. "We stepped back and asked: Is there a different way of doing what we are doing," Wright said.

Eason encourages other organizations to reach out to potential mental health service providers near them. "If you don't find anyone with the vision it takes to do what you want, have them call us here at BHL, we'll gladly consult with them and see if there's anything we can do to support their efforts." Eason said.

Colman regularly receives calls about the program. He is glad to help other organizations. 



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Internet, Recht, Personalia& Co

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 357-358
DOI: 10.1055/s-0042-107060

Kurz & bündig - was gibt es Neues rund ums Fachgebiet AINS? Die wichtigsten Meldungen auf einen Blick finden Sie hier. In dieser Ausgabe mit den folgenden Themen:
[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Nachrichten aus der internationalen Fachliteratur

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 292-294
DOI: 10.1055/s-0042-107061

In dieser Rubrik werden Nachrichten aus der Wissenschaft kurz und prägnant für Sie zusammengefasst. In dieser Ausgabe mit folgenden Themen:
[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Gutachtenfälle – Gutachtenbeispiele aus der Regionalanästhesie

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 344-351
DOI: 10.1055/s-0041-101906

Arzthaftungsfälle aus dem Bereich Regionalanästhesie spielen zahlenmäßig bei den Gutachterkommissionen und Schlichtungsstellen der Ärztekammern eine große Rolle. Ein Grund ist die zunehmende Anwendung rückenmarksnaher und peripherer Verfahren bei traumatologisch/orthopädischen Eingriffen. Nur in rund einem Viertel der Fälle lagen Behandlungs- oder Aufklärungsfehler mit darauf zurückzuführenden Schäden vor. In der Mehrzahl waren die Patientenansprüche unbegründet, da der entstandene Schaden angesichts des gutachterlich festgestellten sorgfältigen Vorgehens als Folge einer unvermeidbaren Komplikation anzusehen war, über die aufgeklärt wurde.
[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  CME online  |  Full text



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Patient Blood Management – Ist das Konzept auch bei Kindern sinnvoll?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 296-306
DOI: 10.1055/s-0041-103204

Patient Blood Management beschreibt ein interdisziplinäres Konzept, welches den adäquaten und rationalen Einsatz von Fremdblut unter Ausschöpfen von validierten Strategien zur Prävention, Diagnostik und Therapie von Anämien, die Reduktion von Blutverlusten und Alternativen zur Fremdblutgabe zum Ziel hat. Während Patient Blood Management in der Erwachsenenmedizin schon verbreitet ist, sind Konzepte für die Behandlung von Kindern noch rar. Die Grundsätze der präoperativen Evaluation mit Optimierung des Erythrozytenvolumens, der perioperativen Minimierung von Blutverlusten, sowie des differenzierten Einsatzes von Blutprodukten gelten bei Erwachsenen wie bei Kindern. Wesentliche Unterschiede bestehen hinsichtlich der Physiologie des Hämoglobin- und des kardiovaskulären Systems vor allem bei Kindern im ersten Lebensjahr. Die zuverlässige Detektion einer drohenden anämischen Hypoxie kann bei Kindern erschwert sein, standardisierte Hämoglobin-Schwellenwerte als Indikation zur Transfusion sollten immer durch eine zusätzliche an den klinischen Befunden orientierte individuelle Risiko-Nutzen-Analyse gestützt werden.
[...]

© Georg Thieme Verlag Stuttgart · New York

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Pssst ... AINS-Secrets! – Heute aus der individualisierten Anästhesie bei Kindern mit schwierigem Atemweg

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 322-325
DOI: 10.1055/s-0041-109977



© Georg Thieme Verlag Stuttgart · New York

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Hypernatriämie – Diagnostik und Therapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 308-315
DOI: 10.1055/s-0041-107265

Bei der Hypernatriämie handelt es sich um eine häufige Elektrolytstörung, die ein Ungleichgewicht im Wasserhaushalt des Körpers reflektiert und häufig aus einem im Vergleich zur Natriumausscheidung erhöhten Verlust freien Wassers resultiert. Nur selten liegt ihr eine übermäßige Natriumaufnahme zugrunde. Das klinische Bild ist oft von einer Vigilanzstörung und einem (bei wachen Patienten) ausgeprägten Durstgefühl gekennzeichnet. Neben der Anamnese sind bei der Differentialdiagnose der Volumenstatus des Patienten und die Osmolalität des Urins wegweisend. In der Regel besteht die Behandlung der Hypernatriämie neben der Therapie der zugrundeliegenden Ursache im Ausgleich des (absoluten oder relativen) Wasserdefizits durch hypotone Infusionslösungen, im Fall eines zentralen Diabetes insipidus in der Applikation von Desmopressin (Minirin). Da zu schnelle Änderungen der Serumnatriumkonzentration desaströse Folgen haben können (osmotisches Demyelinisationssyndrom), sollte bei länger (>48h) bestehenden Hypernatriämien die Natriumkonzentration um nicht mehr als 8-10 mmol/l/Tag gesenkt werden. Wichtig sind dabei engmaschige laborchemische Kontrollen. Für akute Hypernatriämien (<24h) steht mit der Hämodialyse ein effektives Verfahren zur raschen Normalisierung der Serumnatriumwerte zur Verfügung, was jedoch auch zum Beginn einer Nierenersatztherapie bei Patienten mit einer chronischen Hypernatriämie beachtet werden muss um einen zu schnellen Abfall der Natriumwerte bei diesen Patienten zu vermeiden.
[...]

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Gutachtenfälle – Juristische Besonderheiten bei der Begutachtung anästhesiologischer Fälle der Norddeutschen Schlichtungsstelle

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 338-343
DOI: 10.1055/s-0041-101907

Die Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern Hannover (Norddeutsche Schlichtungsstelle) führt im Gebiet Anästhesiologie etwa 100 Verfahren im Jahr durch. In Arzthaftpflichtverfahren liegt die Beweislast grundsätzlich auf der Patientenseite: Der Patient muss beweisen, dass der von ihm geklagte Gesundheitsschaden durch einen Behandlungsfehler verursacht worden ist. Allerdings kann unter bestimmten Voraussetzungen eine Beweislasterleichterung zugunsten der Patientenseite eintreten. In diesem Artikel werden beispielhaft Entscheidungen der Norddeutschen Schlichtungsstelle vorgestellt, bei denen Beweislasterleichterungen zur Feststellung eines Schadensersatzanspruchs führten.
[...]

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The hnRNP family: insights into their role in health and disease

Abstract

Heterogeneous nuclear ribonucleoproteins (hnRNPs) represent a large family of RNA-binding proteins (RBPs) that contribute to multiple aspects of nucleic acid metabolism including alternative splicing, mRNA stabilization, and transcriptional and translational regulation. Many hnRNPs share general features, but differ in domain composition and functional properties. This review will discuss the current knowledge about the different hnRNP family members, focusing on their structural and functional divergence. Additionally, we will highlight their involvement in neurodegenerative diseases and cancer, and the potential to develop RNA-based therapies.



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Kasuistik – 40-jährige Patientin mit Massivblutung im Rahmen einer Sectio caesarea

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 316-320
DOI: 10.1055/s-0041-106580

Eine 40-jährige Patientin wird im Kreißsaal der Klinik im Rahmen ihrer dritten Schwangerschaft betreut. Nachdem die Geburt zunächst problemlos verlaufen war, kommt es zu einer Verschlechterung des kindlichen Cardiotokogramms, weshalb die Kollegen der Gynäkologie die Indikation zur Notsectio bei Plazenta praevia stellen.Nach der Sectio kommt es wiederholt zu schweren Blutungen und die Patientin muss mehrfach erneut operiert werden. Nach einem intraabdominellenKompartmentsyndrom und einem ARDS wird eine posttransfusionelle Purpura als Ursache identifiziert. Diese kann erfolgreich mit einem Zyklus Plasmapherese behandelt werden.
[...]

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Ethikvisiten – Was hat sich bewährt?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 352-356
DOI: 10.1055/s-0042-107382

Das Konzept klinischer Ethikvisiten auf Intensivstationen ist ein strukturiertes Vorgehen bei ethisch problematischen Sachverhalten und ethischen Konflikten. Es wird sowohl vom Intensivteam als auch von Patienten, Stellvertretern und Angehörigen als Angebot und als Hilfestellung in der gemeinsamen Entscheidungsfindung bei der Lösung von wertbehafteten Fragen und Problemen wahrgenommen und trägt zur Zufriedenheit aller Beteiligten bei.
[...]

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Buchtipps

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 359-359
DOI: 10.1055/s-0042-104545

Für Sie gelesen: In dieser Rubrik stellen wir Ihnen Neuerscheinungen aus Ihrem Fachbereich vor. In dieser Ausgabe:
[...]

© Georg Thieme Verlag Stuttgart · New York

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Patientensicherheit – eine gemeinsame Aufgabe von Anästhesisten und Chirurgen

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 289-289
DOI: 10.1055/s-0042-105753



© Georg Thieme Verlag Stuttgart · New York

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Q&A: Jay Fitch, PhD, on what lies ahead for EMS leaders

This year, the Pinnacle EMS Leadership Forum enters its second decade. Pinnacle, held this year from July 18-22 outside of San Antonio, brings together EMS leaders to learn from each other and share innovative ideas.

Not only does this year's Pinnacle mark ten years since the first conference, it is also the 50th anniversary of the whitepaper, Accidental Death and Disability, that launched modern EMS; and the 20th anniversary of the landmark report, the EMS Agenda for the Future. These milestones, along with the announced revision of the Agenda, have renewed discussions about the future of the profession — discussions that will certainly be on everyone's mind in San Antonio.

Pinnacle Program Chair Jay Fitch, founder and president of the emergency services consulting firm Fitch & Associates, spoke with EMS1 about Pinnacle 2016 and the issues facing EMS leaders today and in the future.

EMS1: If someone's never been to Pinnacle before, what can they expect?

Jay Fitch: Pinnacle brings together leaders who understand that EMS provides health care and has a responsibility to our patients and communities. We sit at the crossroads between public safety and health care, and our systems are often organized around a paramilitary model. Having Lt. Gen. Mark Hertling, someone who understands the military, and also how to educate clinicians, is going to create a powerful keynote.

But Pinnacle is also about creating and renewing friendships. It's a place where people who lead EMS programs come to get renewed, to renew their spirit as well as their knowledge base. For a first-time attendee, it's like being challenged and encouraged and slapped in the face with the things that are coming. The ideas and innovation discussed at Pinnacle can be overwhelming, but mostly I think they inspire leaders to go home and find ways to be better at what we do.

EMS1: The first Pinnacle was held in 2006. Could you have predicted at all what we would be discussing at Pinnacle 2016?

JF: I think while there was some thought that health care reform and reimbursement reform might be coming down the road, but no one understood the depth of what the changes would look like. We're still adjusting to the idea of reimbursement based on outcomes or perceived value. At the time we started Pinnacle that was not high on the radar screen — or even visible at all.

But in other ways, the first Pinnacle foreshadowed today's conversations. This year, for example, we have several sessions related to technology and data. Back then, the dialogue centered on using technology and information to make educated decisions about deployment and operations. While that hasn't changed, the sessions now focus more on how technology and data can impact patient care, and the importance of sharing and integrating data with partners in healthcare and public safety.

Using hospital data is one of the things I'm excited to hear more about this year. We're on the verge of being able to do some fascinating things, and we'll hear from a number of people who are out there on the cutting edge.

EMS1: You also have a session titled "What keeps you up at night?" Are the things keeping leaders up at night now the same as at the first Pinnacle, or when you started your career?

JF: When I look at what we'll be discussing in that session, I see issues that we knew about in the past but didn't worry about nearly as much. As a young EMS chief more than three decades ago, I was aware of media coverage, but the media landscape has changed so much, and now anything any of your employees says on Twitter can quickly spread on the Internet and become national news.

Certainly, the safety of our caregivers has been an issue that has always kept us up at night. The way that's different today has to do with the incredible increase in awareness about caregiver suicides. While there were suicides in that time frame, I don't think we recognized the connectivity to stress and the way our work impacts our mental health.

The stigma associated with mental health issues in the public safety community remains, but the veil is finally being lifted. This year at Pinnacle, we have several faculty members addressing this epidemic, including Monique Rose and Amy Young, co-founders of RevivingResponders.com; Jim Marshall from the 911 Wellness Foundation, who will address developing resilience in the workforce; and Dr. Marshal Isaacs, who will discuss drug and alcohol addiction in EMS.

EMS1: Several sessions address the relationship between public safety leaders and the city and county officials they report to. Why is this such a critical topic?

JF: It's more important than ever for EMS and fire service leaders to have a good relationship with city and county officials, and to make sure those officials have a solid foundation on which to base decisions. We are thrilled to have Dr. Bruce Moeller, who been both a city manager as well as a fire chief, an EMS chief and a director of public safety, teamed with Andrew Rand, who is the CEO of a multi-state community based ambulance system, and also chairs his county commission. I think the insights they have in terms of how to work with local officials are going to be very instructive.

EMS1: Last year, you addressed the "elephants in the room" during your Pinnacle talk, including diversity in the workforce, patient safety and accountability. This year your talk is titled "Looking Beyond the Yellow Brick Road." What can we expect to hear?

JF: With a topic like "Beyond the Yellow Brick Road," you might assume that I'm going to talk about what we can learn from some of the characters in the "Wizard of Oz." I don't want to give away the rest you'll have to come to Pinnacle to find out.



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Grady EMS crisis intervention unit provides field-based behavioral care

By triaging patients with mental illness, especially repeat users, the Grady EMS Upstream Crisis Intervention Group provider has improved care, saved significant money and boosted morale

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The predictors of the severity of ischaemic colitis: A systematic review of 2,823 patients from 22 studies

Colorectal Disease

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Rogue Capno Waves: Confirm and monitor alternative airway placement

End-tidal carbon dioxide is an irrefutable indication for any type of airway adjunct

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The accuracy of spleen stiffness measurement to predict varices in chronic hepatitis B cirrhotic patients with or without taking non-selective beta-blockers

Journal of Digestive Diseases

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Serum I-FABP detects gluten responsiveness in adult celiac disease patients on a short-term gluten challenge

The American Journal of Gastroenterology

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4 ways to find funding for an operations management system

There are plenty of federal, state and private grants available for EMS agencies technology upgrades. Here are four of the best.

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Pharmacological Management of Nonalcoholic Fatty Liver Disease

Metabolism

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Rogue Capno Waves: Confirm and monitor alternative airway placement

A 56-year-old male collapsed at a restaurant and received several minutes of dispatcher-assisted CPR. A civilian responding to a mobile phone alerting system retrieved an AED from an adjacent business and administered one shock prior to arrival of EMS.

Initial assessment revealed the morbidly obese patient had a pulse and blood pressure but was unresponsive and apneic. Bag-valve-mask ventilations were difficult due to the patient's size, so the ALS transport crew elected to intubate. After two unsuccessful oral endotracheal intubation attempts, a King LT-D supraglottic airway was inserted and manual ventilation was continued.

Consistent with protocol, waveform capnography was attached; the following tracing was obtained.

The ALS providers believed the supraglottic airway was placed properly. They theorized that the zero value ETCO2 and absence of a discernable capnography waveform resulted from the use of monitoring equipment designed for endotracheal tubes with an alternative (supraglottic) airway.

In fact, the supraglottic airway was not in place; the patient shortly thereafter became bradycardic, rearrested and subsequently died.

Comparing waveforms from different airway adjuncts
There are some studies that compare ETCO2 waveforms and measurements obtained from endotracheally intubated patients to those using supraglottic or other alternative airways. In the mid 1990s, supraglottic airways began to gain popularity as an alternative to endotracheal intubation for short duration surgical procedures requiring general anesthesia.

In that era, multiple papers were published comparing capnography waveforms and values obtained from multiple types of airways and using a wide variety of ventilation modes. It was during that same period when comparisons were made using nasal cannula derived end-tidal values.

Those studies established two findings unequivocally. First, ETCO2 values obtained from measurements made in-line with any airway device, including bag-valve-mask devices and nasal cannulas, are equivalent to those obtained from an endotracheal tube. Second, waveforms obtained from any airway device, including BVMs and nasal cannulas, are identical to those obtained from an endotracheal tube.

The implications of these earlier and innumerable studies from the anesthesia world were significant. Capnography was a safe and reliable means of assessing the adequacy of ventilation in endotracheally intubated patients, of patients being ventilated with all types of airways and of patients being ventilated with no airway adjuncts at all.

Research studies also demonstrated that capnographic waveforms could be used with alternative airways to evaluate a wide variety of conditions such as cuff leaks, ventilator dyssychrony, bronchospasm, air trapping and low cardiac output with equal efficacy regardless of the type of airway they were attached to. These findings should not be lost on EMS.

There are no differences
While there remain some questions about proper sampling and use of capnography in certain high-flow gas therapies such as jet ventilation in neonates and high-flow nasal cannula therapy for adults, neither of these therapies are currently used by EMS.

Continuous waveform capnography is an EMS standard of care and must be used to monitor placement and adequacy of ventilation with any artificial airway. The voluminous anesthesia and prehospital literature tells us that the waveforms and values obtained from any alternative airway will be identical to those obtained from an endotracheal tube.

There are no differences. If you place supraglottic airways and fail to see a four-phase capnographic waveform, the airway is not in place and ventilation is not occurring.

The incidence of misplaced supraglottic airways may not be low nor is the number of ALS providers who mistakenly attribute lack of a clearly observable capnography waveform to use of an alternative airway. An abstract presented in January by Vithalani et al, reported a 13.9 percent incidence of unrecognized misplaced King airways by paramedics in a large urban 911 EMS system.

ETCO2 is irrefutable indication of airway placement and ventilation
There are many reasons why an alternative airway may not be properly placed, some related to operator error and some to variations in patient anatomy.

Regardless of why, the absence of a clearly discernable four-phase capnography waveform and the presence of measureable CO2 is a clear and irrefutable indication that the airway is not in place and ventilation is not occurring.

Finally, EMS providers should use capnography waveforms obtained during ventilation — regardless of the type of airway in place — to assess the effectiveness of ventilation and troubleshoot airway and ventilatory issues such as cuff leaks, air trapping, airway resistance and dyssychrony.

References reviewed:

  1. Gottschalk A, Mirza N, Weinstein GS, Edwards MW. Capnography during jet ventilation for laryngoscopy. Anesth Analg. 1997;85:155-159.
  2. Chhibber AK, Kolano JW, Roberts WA. Relationship between end-tidal and arterial carbon dioxide with laryngeal mask airways and endotracheal tubes in children. Anesth Analg. 1996;82:247-250.
  3. Chhibber AK, Fickling K, Kolano JW, Roberts WA. Comparison of end-tidal and arterial carbon dioxide in infants using laryngeal mask airway and endotracheal tube. Anesth Analg. 1997;84:51-53.
  4. Fukuda K, Ichinohe T, Kaneko Y. Is measurement of end-tidal CO2 through a nasal cannula reliable" Anesth Prog. 1997;44:23-26.
  5. Lee JS, Nam SB, Chang CH, Han DW, Lee YW, Shin CS. Relationship between arterial and end-tidal carbon dioxide pressures during anesthesia using a laryngeal tube. Acta Anaesthesiologica Scandinavica. 2005;49: 759-762.
  6. Casati A, Fanelli G, Cappelleri G, Albertin A, Anelati D, Magistris L, Torri G. Arterial to end-tidal carbon dioxide tension difference in anaesthetized adults mechanically ventilated via a laryngeal mask or a cuffed oropharyngeal airway. Eur J Anaesthesiol. 1999;16:534-538.
  7. Freeman JF, Ciarallo C, Rappaport L, Mandt M, Bajaj L. Use of capnographs to assess quality of pediatric ventilation with 3 different airway modalities.
  8. Vithalani VD, Richmond N, Davis SQ, Hejl L, Howerton D, Gleason W, Emergency Physicians Advisory Board, MedStar Mobile Healthcare. Unrecognized failed airway management using a blind-insertion supraglottic device. Abstracts for the 2016 NAEMSP Scientific Assembly. Prehospital Emergency Care. 2016;20:144.


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West Virginia pharmacies to dispense Narcan without a prescription

The new law to sell Narcan over-the-counter also calls for patient counseling and educational materials

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Evaluation of Cow Factors and Milk Composition on Freezing Point Depression of Cow Milk

2016-05-23T11-12-44Z
Source: International Journal of Livestock Research
P.G.N.D. Senevirathne, U.L.P. Mangalika, A.M.J.B. Adikari, W.A.D. Nayananjalie.
This study was aimed to determine the effect of cow factors; breed, age, nutritional status, lactation number and stage of the cow and milk composition on freezing point depression (FPD) of milk. Unadulterated individual milk samples were collected from different cow breeds. All milk samples were tested for FPD, Milk Urea Nitrogen (MUN) and its composition. Results revealed that FPD was significantly differed (P

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Higher plasma orexin A levels in children with Prader–Willi syndrome compared with healthy unrelated sibling controls

Prader–Willi syndrome (PWS) is a rare genetic neurodevelopmental disorder associated with maladaptive social behavior, hyperphagia, and morbid obesity. Orexin A is a hypothalamic neuropeptide important as a homeostatic regulator of feeding behavior and in energy metabolism through actions in the lateral hypothalamus. Dysregulation of orexin signaling may contribute to behavioral problems and hyperphagia seen in PWS and we sought to assess orexin A levels in PWS relative to controls children. Morning fasting plasma orexin A levels were analyzed in 23 children (aged 5–11 years) with genetically confirmed PWS and 18 age and gender matched healthy unrelated siblings without PWS. Multiplex immune assays utilized the Milliplex Human Neuropeptide Magnetic panel and the Luminex platform. Natural log-transformed orexin A data were analyzed using general linear model adjusting for diagnosis, gender, age, total body fat and body mass index (BMI). Plasma orexin A levels were significantly higher (P < 0.006) in children with PWS (average ±SD = 1028 pg/ml ± 358) compared with unrelated siblings (average ±SD = 609 pg/ml ± 351; P < 0.001). Orexin A levels correlated with age in females and were significantly elevated in PWS even after these effects were controlled. These findings support the hypothesis that dysregulation of orexin signaling may contribute to behavioral problems and hyperphagia in PWS. Further studies are warranted to better understand the complex relationship between orexin A levels and the problematic behaviors consistently found in individuals with PWS. © 2016 Wiley Periodicals, Inc.



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CLINICAL MANAGEMENT OF PENDULOUS CROP IN A TURKEY

2016-05-23T11-12-44Z
Source: International Journal of Livestock Research
BS REDDY.
A 32 months age old tom turkey with oedema at the ventral part of the neck region was presented to the clinic. Clinical examination, electrocardiographic evolution, analysis of faecal sample and whole blood was done. While palpation of the oedematous region, crop contents were expelling out through the mouth. Based on the history, clinical signs and laboratory findings it was suggestive of pendulous crop. It was treated with course of antibiotic along with emptying of the crop was done by the bird upside down. After therapy bird was free from the oedematous enlargement and it was active.


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Protein-losing enteropathy with entestinal lymphangiectasia in skeletal dysplasia with Lys650Met mutation

Protein-losing enteropathy is a primary or secondary manifestation of a group of conditions, and etiologies which are broadly divisible into those with mucosal injury on the basis of inflammatory and ulcerative conditions, mucosal injury without erosions or ulcerations, and lymphatic abnormalities. We describe the first case of protein-losing enteropathy in a pediatric patient, with severe skeletal dysplasia consistent with thanatophoric dysplasia type I and DNA analysis that revealed a c.1949A>T (p.Lys650Met) in exon 15 of the FGFR3 gene. She presented with protein-losing enteropathy in her 6th month. Post-mortem examination revealed lymphangiectasia in the small intestine. To our knowledge, this is the first report of intestinal lymphangiectasia as a complication of skeletal dysplasia resulting in severe protein-losing enteropathy. © 2016 Wiley Periodicals, Inc.



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Comparison of the combination of dexmedetomidine and ketamine to propofol or propofol/sevoflurane for drug-induced sleep endoscopy in children

Summary

Aim

Examination of dynamic airway collapse in patients with obstructive sleep apnea (OSA) during drug-induced sleep endoscopy (DISE) can help identify the anatomic causes of airway obstruction. We hypothesized that a combination of dexmedetomidine and ketamine (Group DK) would result in fewer oxygen desaturations and a higher successful completion rate during DISE in children with OSA when compared to propofol (Group P) or sevoflurane/propofol (Group SP).

Methods

In this retrospective study, we reviewed the records of 59 children who presented for DISE between October 2013 and March 2015. Data analyzed included demographics, OSA severity, and hemodynamics (heart rate and blood pressure). The primary outcomes were airway desaturation during DISE to <85% and successful completion of DISE; these were compared between the three groups: DK, P, and SP.

Results

Preoperative polysomnography was available for 49 patients. There were significantly more patients with severe OSA in Group P as compared to the other two groups. The mean (±sd) bolus dose for ketamine, dexmedetomidine, and propofol were 2.0 ± 0.6 mg·kg−1, 1.9 ± 0.9 mcg·kg−1, and 1.8 ± 1.1 mg·kg−1, respectively. The mean (±sd) infusion rate for dexmedetomidine was 1.6 ± 0.7 mcg·kg−1·h−1 and for propofol was 248 ± 68 mcg·kg−1·min−1 in Group P and 192 ± 48 mcg·kg−1·min−1 in Group SP. Patients in Group DK had significantly fewer desaturations to <85% during DISE compared to Group P. Patients in Group DK had significantly more successful completion of DISE (100% Group DK, 92% Group P, and 79% Group SP) as compared to Group SP.

Conclusions

These results suggest that the described dose regimen of propofol used alone or in combination with sevoflurane appears to be associated with more oxygen desaturations and a lower rate of successful completion than a combination of dexmedetomidine and ketamine during DISE in children with OSA.

Thumbnail image of graphical abstract

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