Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026: 06/06/16

Δευτέρα 6 Ιουνίου 2016

My love-hate relationship with EMS

A full life weighs more than an empty one, but who I have become because of my EMS experience has made me a better friend and caregiver

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Association of high-grade serous ovarian carcinoma with intraepithelial carcinoma of fallopian tube

2016-06-06T08-47-40Z
Source: International Journal of Medical Science and Public Health
Vijay Kumar Chaudhary, Ranjana Solanki.
Background: The cumulative evidences, both clinicopathological and molecular in the past decade that high-grade serous ovarian carcinoma results from clonal expansion of secretory cells of the distal fallopian tube, rather than ovary. We explored this relationship based on morphological and immunohistochemical studies of a lesion designated serous tubal intraepithelial carcinoma (STIC), which closely resembles high-grade ovarian serous carcinoma. This tubal lesion is the plausible origin for pelvic serous carcinomas. Objective: To study the association between ovarian serous carcinoma and STIC. Material and Methods: We studied 44 consecutive cases of epithelial ovarian carcinomas from February 2013 to January 2015, including 29 serous, 12 mucinous, and 3 endometrioid. Complete examination of fallopian tubes from each case was done according to SEEFIM protocol. All the cases were grouped into high-grade serous (27 cases), and non-high-grade serous (17 cases) groups. Immunostaining for p53 and MIB-1 was done on the sections from ovary and fallopian tube. Results: STIC lesion was identified in fallopian tubes from 10 cases of high-grade serous group (37%) while no STIC was identified in non-high-grade serous group. Eighty percent% of the STIC identified were confined to the fimbria of fallopian tube. Results from both groups were compared using chi square test. A statistically significant association was found between high-grade serous carcinoma group and STIC (P = 0.013). Conclusion: STIC coexists with a significant number of high-grade serous carcinoma cases and further studies are needed to elucidate etiological significance of STIC in high-grade serous carcinoma.

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Clinicopathological correlation of severe anemia in children below 5 years of age in the region of Kutch district, Gujarat

2016-06-06T08-47-40Z
Source: International Journal of Medical Science and Public Health
Kalpesh B Kubavat, Niraj A Bharadva, Shreyash R Mehta.
Background: About 24.8% of world population is affected by anemia. Because of low monthly income and more incidences of communicable and noncommunicable diseases, the prevalence and severity of anemia is higher in developing countries. Children and pregnant women are the most vulnerable groups to anemia. The brain, which is the fastest developing organ in infancy and early childhood, is the most affected organ and children as they are developing as well are the most affected age group. Objective: To determine the magnitude of severe anemia and its socioeconomic, nutritional, and biological risk factors among children aged below 5 years who visited GK General Hospital (GH), Gujarat Adani Institute of Medical Sciences, Bhuj, Gujarat, India, from November 2014 to November 2015. Materials and Methods: A total number of 100 children aged below 5 years attending pediatric clinic at GKGH with hemoglobin level of 7 g/dL and below were included in this study. Detailed history and thorough clinical examination was done for each case. This was followed by investigations such as complete blood count with red cell indices, peripheral blood film smear, erythrocyte sedimentation rate, serum iron, total iron binding capacity, and serum ferritin. Result: A total of 3,000 children had participated in the study. The overall prevalence of severe anemia was 100 (3.33%). Education and occupation of both father and mother are significantly associated with childrens anemia. Low consumption of all the three foodstuffs was significantly associated with anemia, with vegetable showing the highest OR of 6.49. Intestinal parasitic infection is also significantly associated with anemia with OR of 6.4. Conclusion: Severe anemia in children aged below 5 years of age is more prevalent in children of multigravida mother, low education of parents, and low socioeconomic status of family. Anemia was more common among children who consumed low dairy products and fruits and vegetables with intestinal parasitic infection.

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Mental health among adolescent girls – An effort to know the association of mental disorders with socio-demographic variables

2016-06-06T08-47-40Z
Source: International Journal of Medical Science and Public Health
Smitha Malenahalli Chandrashekarappa, Narayana Murthy Mysore Ramakrishnaiah, Dushad Ram, Renuka Manjunath.
Background: Adolescents constituting 21% of Indias population (Census, 2011) form the major chunk of adolescents in the world. Most mental disorders begin during youth (1224 years), though they are often first detected later in life. Less described in the literature is the association between common life stressors and a wide range of psychopathology in adolescents especially among late adolescent girls and henceforth this study was conducted to know the extent and spectrum of psychiatric disorders and its association with sociodemographic variables. Objective: (1)To determine the prevalence of mental health disorders among adolescent girls. (2) To determine the association of mental disorders with various sociodemographic variables. Materials and Methods: It was a cross-sectional study conducted in pre-university and Degree Colleges belonging to JSS Mahavidyapeeta in Mysore city. Sample size was estimated to be 683. Adolescent girls between 16 and 19 years were included. The study was conducted from June 2013 to November 2013. Mini International Neuropsychiatric Interview, Version 6.0 was used to diagnose psychiatric morbidity. Data collected were analyzed using SPSS V. 22. Proportions were calculated using Chi-square analysis and regression model was used. Results: Among the 664 adolescent girls, the overall prevalence of mental health disorders was found to be 15.5% with major depressive disorder being the most common disorder amounting to 37% followed by dysthymia (12.3%), panic disorder and social phobia (15.7%), posttraumatic stress disorder (10%), obsessive compulsive disorder (7.8%), and generalized anxiety disorder (6.7%). Age, place of residence, birth order, education of father, education of mother, and socioeconomic status were significantly associated with mental disorders (p

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Community-based cross-sectional study to determine depression among elderly persons residing in urban area of north Karnataka

2016-06-06T08-47-40Z
Source: International Journal of Medical Science and Public Health
Kanishk Deep Sharma, Deepti M Kadeangadi, Maheshwar DM Mallapur.
Background: Depression is one of the most common treatable illnesses affecting individuals after the age of 60 years. In India, 39.04% of elderly persons are estimated to experience depression, whose prevalence is higher in slum areas and old age homes. Objective: To assess the prevalence of depression among elderly persons residing in urban households and various factors contributing to it. Materials and Methods: It is a community-based cross-sectional study where urban households of Ashok Nagar and Ram Nagar areas of Belagavi city, Karnataka, India, were selected randomly. A total of 150 elderly persons were interviewed using pretested and predesigned questionnaire from GDS-30. Data were analyzed using percentages and χ2-test. Result: The prevalence of depression in elderly persons was 37.1%; among these, 24.7% were mildly depressed and 9.3% severely depressed. Depression was more prevalent in those who were not physically active (46%) than those who were active (54%) (χ2 = 6.902, p = 0.032). About 75.3% of illiterates were found to be depressed than literate ones (24.7%) (χ2 = 9.391, p = 0.009). Conclusion: Four of ten individuals suffered from depression after 60 years of age. Depression was seen higher in illiterates and individuals leading sedentary lifestyle and was found to be statistically significant.

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A sociodemographic profile and outcome of burn patients admitted in a tertiary-care hospital

2016-06-06T08-47-40Z
Source: International Journal of Medical Science and Public Health
Santosh Kumar Verma, Shobha Chaturvedi, Shubhanshu Gupta.
Background: Burns are a global public health problem. Every year a substantial proportion of deaths in India occur due to burn injuries. Burn injuries constitute a serious medical, social, and psychological problem along with severe economic loss to individual and their family and hence the need for various sociodemographic factors to understand the problem in our region. Objectives: To study the sociodemographic factors of burn patients in Bundelkhand region and find out the cause and outcome of burn patients and to draw conclusion about preventive aspects of burn injuries. Materials and Methods: A record-based cross-sectional study was conducted at a tertiary-care hospital, and the medical records of all the patients admitted to surgery department from January 2013 to December 2013 were reviewed and 354 cases included as study subjects. Data were recorded on predesigned and pretested questionnaire and analyzed by statistical software using 2-test and percentages. Result: Of 354 burn patients, 52.5% were female and 47.5% were male subjects showing female predominance. Most of the burn patients belonged to 2140 years, rural areas, Hindu, unemployed or housewife, and married. Thermal or flame burn was common and accidental in nature (64.5%) with male predominance, while suicidal attempts more in female subjects which was found to be significant (P 0.05). Conclusion: Sociodemographic aspects are important in raising knowledge, awareness, and applying preventive measures in community.

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Whole Exome Sequencing Identifies Multiple Diagnoses in Congenital Glaucoma with Systemic Anomalies

ABSTRACT

The genetic basis of congenital glaucoma with systemic anomalies is largely unknown. Whole exome sequencing (WES) in ten probands with congenital glaucoma and variable systemic anomalies identified pathogenic or likely pathogenic variants in three probands; in two of these, a combination of two Mendelian disorders was found to fully explain the patients' features while in the third case only the ocular findings could be explained by the genetic diagnosis. The molecular diagnosis for glaucoma included two cases with compound heterozygous or homozygous pathogenic alleles in CYP1B1 and one family with a dominant pathogenic variant in FOXC1; the second genetic diagnosis for the additional systemic features included compound heterozygous mutations in NPHS1 in one family and a heterozygous 18q23 deletion in another pedigree. These findings demonstrate the power of WES in the analysis of complex conditions and emphasize the importance of CYP1B1 screening in patients with congenital glaucoma regardless of the presence/absence of other systemic anomalies.

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Seroprevalence of Zika virus in Cambodia: a preliminary report

2016-06-06T06-50-55Z
Source: Advance Laboratory Medicine International
Kim San, Veera Rajadhan.
Zika virus is the present global health problem. It presently widely spreads in America. The information on its epidemiology in other areas is limited but very interesting. Here, the authors report an interesting preliminary data on the seroprevalence of Zika virus in Cambodia, a tropical country with high prevalence of dengue in Southeast Asia.

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Screening for Helicobacter pylori in Cambodia: economical analysis

2016-06-06T06-50-55Z
Source: Advance Laboratory Medicine International
Kim San, Veera Rajadhan.
Gastric cancer is an important kind of gastrointestinal carcinoma. Presently, it is accepted that gastric cancer has a strong relationship to Helicobacter pylori infection. Screening for H. pylori becomes a new issue in gastric cancer prevention. Here, the author studies and discusses on the use of H. pylori screening as a strategy for gastric cancer prevention based on economical analysis in a scenario of a tropical developing country, Cambodia. According to this study, The finalized cost per unit utility (in 1,000,000 people scale) is equal to 4,950,496 and 4,255,320 US dollars for males and females. For individual scale (1 case), the unit cost is equal to 4.96 and 4.32 US dollars.

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A study of cholelithiasis in adolescent children attending a tertiary care hospital

2016-06-06T04-55-43Z
Source: International Journal of Contemporary Pediatrics
Dinesh Kumar J., Anitha P., Divyashree V. S., Ramachandran P..
Background: Cholelithiasis is relatively rare in children and there is paucity of information about cholelithiasis in adolescent children. There is no consensus among pediatricians and pediatric surgeons regarding the management of cholelithiasis in adolescents. Cholelithiasis is increasingly diagnosed due to wide spread use of ultrasound. This has led to increased detection of asymptomatic cholelithiasis. The profile of cholelithiasis in adolescents is analyzed in this study. Methods: Medical records of patients with the discharged diagnosis of cholelithiasis from January 2010 to March 2015 were analyzed. Sixty children were enrolled in the study. Patients were divided into symptomatic and asymptomatic group depending upon the clinical presentation. Results: Among the 60 children, 43 (71.7%) patients had no identifiable risk factor for cholelithiasis. Predominant identifiable risk factor was ceftriaxone use in 7 (11.7%) patients. Forty four (73%) were nutrionally normal, fifty one (85%) patients were symptomatic and nine (9%) patients were asymptomatic. Anemia was noticed in 46 (76.7%) patients. Laparoscopic cholecystectomy was done for 29 (48.3%) patients, other surgical procedures in 7 (11.6%) patients and 23 (38.3%) patients were treated conservatively. Seven out of 9 patients in the asymptomatic group and 14 of symptomatic group treated conservative management had spontaneous resolution of cholelithiasis. Conclusions: Gallstones need not be always present with symptoms and there is a significant number of children who were asymptomatic. Majority of the patients do not have identifiable risk factors. Most of the children were underweight. Laparoscopic cholecystectomy was advised for majority of symptomatic cholelithiasis.

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Oxidative stress in childhood steroid sensitive nephrotic syndrome and its correlation with DNA damage

2016-06-06T04-55-43Z
Source: International Journal of Contemporary Pediatrics
Priyanka Reddy, Seema Pavaman Sindgikar, Rathika Damodar Shenoy, Vijaya Shenoy.
Background: Imbalance in oxidative state has been hypothesized as causative factor in renal injury. Oxidant stress can result in DNA damage which can be measured by comet assay. The aim of the study was to assess the oxidative stress and DNA damage in children with NS. Methods: Children of NS during first episode/relapse and remission were recruited. Blood malondialdehyde (MDA), reduced-glutathione (GSH) and superoxide dismutase (SOD) levels were done to assess oxidative state and compared with controls. DNA damage was assessed by comet assay. Percentage DNA in tail, tail length and olive tail moment (OTM) were calculated. Comparison of various groups was done and correlation determined by appropriate statistical tests. Results: Study group consisted of 38 children in each group. MDA levels were high in NS group compared to remission and controls with statistical significance (p

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Quality of life of type 2 diabetes patients in a tertiary care hospital in southern part of India, Shimoga, Karnataka: a cross-sectional study

2016-06-06T04-30-34Z
Source: International Journal of Community Medicine and Public Health
Santosh Kumar A, Raghavendraswamy Koppad, Chandrashekar SV, Revathy.
Background: Diabetes mellitus is a non-communicable disease which has reached epidemic proportions. According to World Health Organization (WHO) there is an apparent epidemic of diabetes, which is strongly related to lifestyle and economic change. Objective of the study was to measure the quality of life (QOL) of diabetic patients and to study the various factors influencing the QOL of diabetic patients. Methods: A hospital based cross sectional study was conducted using medical outcomes study short form version 2 (MOS SF36 v2) to measure the QOL of diabetic patients aged >20 years. 100 diabetics, including 55 males and 45 females were selected. Results: Mean age of respondents was 54.4 years, with maximum number of subjects in the age group of 40-59 years. 68% of subjects were form urban area. 63% of the respondents were having diabetes since 5 years. 91% of subjects were taking oral hypoglycemic agents (OHA) and 9% of them were taking both OHA and insulin. Overall, SF 36 scores were lower in females (55.0) than in males (58.47) and this difference was found to be statistically significant. Treatment for diabetes, compliance for treatment, physical activity and follow up with doctor was found to be significantly associated with various domains and total SF-36 scores. Among the eight domains physical functioning and vitality are the domains which were found to be significantly affected. Conclusions: Diabetes had an adverse effect on QOL of diabetic subjects. With respect to eight domains, males had better scores in almost all domains. Physical functioning (PF), vitality (VT) and overall social functioning (SF)-36 scores were found to be significant.

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Surgical intervention during a Can't Intubate Can't Oxygenate (CICO) event: Emergency Front-of-neck Airway (FONA)?

http:--media.wiley.com-assets-7315-19-Wi

Surgical intervention during a Can't Intubate Can't Oxygenate (CICO) event: Emergency Front-of-neck Airway (FONA)?

Clin Otolaryngol. 2016 May 30;

Authors: Pracy JP, Brennan L, Cook TM, Hartle AJ, Marks RJ, McGrath BA, Narula A, Patel A

PMID: 27241316 [PubMed - as supplied by publisher]

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Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics.

Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics.

Anaesthesia. 2015 Nov;70(11):1286-306

Authors: Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, Quinn AC, Obstetric Anaesthetists' Association, Difficult Airway Society

Abstract
The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.

PMID: 26449292 [PubMed - indexed for MEDLINE]

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Indications and results of emergency surgical airways performed by a physician-staffed helicopter emergency service.

http:--linkinghub.elsevier.com-ihub-imag

Indications and results of emergency surgical airways performed by a physician-staffed helicopter emergency service.

Injury. 2015 May;46(5):787-90

Authors: Peters J, Bruijstens L, van der Ploeg J, Tan E, Hoogerwerf N, Edwards M

Abstract
BACKGROUND: Airway management is essential in critically ill or injured patients. In a "can't intubate, can't oxygenate" scenario, an emergency surgical airway (ESA), similar to a cricothyroidotomy, is the final step in airway management. This procedure is infrequently performed in the prehospital or clinical setting. The incidence of ESA may differ between physician- and non-physician-staffed emergency medical services (EMS). We examined the indications and results of ESA procedures among our physician-staffed EMS compared with non-physician-staffed services.
METHODS: Data for all forms of airway management were obtained from our EMS providers and analyzed and compared with data from non-physician-staffed EMS found in the literature.
RESULTS: Among 1871 patients requiring a secured airway, the incidence of a surgical airway was 1.6% (n=30). Fourteen patients received a primary ESA. In 16 patients, a secondary ESA was required after failed endotracheal intubation. The total prehospital ESA tracheal access success rate was 96.7%.
CONCLUSION: The incidence of ESA in our patient population was low compared with those reported in the literature from non-physician-staffed EMS. Advanced intubation skills might be a contributing factor, thus reducing the number of ESAs required.

PMID: 25496855 [PubMed - indexed for MEDLINE]

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The 'Can't intubate can't oxygenate' scenario in pediatric anesthesia: a comparison of the Melker cricothyroidotomy kit with a scalpel bougie technique.

The 'Can't intubate can't oxygenate' scenario in pediatric anesthesia: a comparison of the Melker cricothyroidotomy kit with a scalpel bougie technique.

Paediatr Anaesth. 2015 Apr;25(4):400-4

Authors: Prunty SL, Aranda-Palacios A, Heard AM, Chapman G, Ramgolam A, Hegarty M, Vijayasekaran S, von Ungern-Sternberg BS

Abstract
BACKGROUND: While the majority of pediatric intubations are uncomplicated, the 'Can't intubate, Can't Oxygenate' scenario (CICO) does occur. With limited management guidelines available, CICO is still a challenge even to experienced pediatric anesthetists.
OBJECTIVES: To compare the COOK Melker cricothyroidotomy kit (CM) with a scalpel bougie (SB) technique for success rate and complication rate in a tracheotomy on a cadaveric 'infant airway' animal model.
METHODS: Two experienced proceduralists repeatedly attempted tracheotomy in eight rabbits, alternately using CM and SB (4 fr) technique. The first attempt was performed at the level of the first tracheal cartilage with subsequent experimental trials of insertion progressively more caudad. Success was defined as intratracheal placement of cannula as seen on bronchoscope. Complications were assessed both by bronchoscopic and macropathological appearance.
RESULTS: 32 attempts were made at tracheotomy. CM had an overall success rate of 100% compared to a 75% success rate for SB. Success rate for the first attempt was dependent on the level of the tracheotomy (Level 1 100%, level 2 62.5% and level 3 & 4 25%). While CM was associated with lateral and/or posterior wall damage on bronchoscopy/macropathology in 6% of 19% and 25% of 50% respectively, the damage observed was greater and more frequent with SB (19%/44% and 31%/50%, respectively).
CONCLUSIONS: At level 1, the first attempt success rate was 100% for both devices. Overall CM showed a better success rate than SB; however, both techniques were associated with significant complication rates, which were more pronounced following the scalpel bougie technique.

PMID: 25370783 [PubMed - indexed for MEDLINE]

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Cricothyrotomy performed with the Melker™ set or the QuickTrach™ kit: procedure times, learning curves and operators' preference.

Cricothyrotomy performed with the Melker™ set or the QuickTrach™ kit: procedure times, learning curves and operators' preference.

G Chir. 2014 Jul-Aug;35(7-8):165-70

Authors: Buonopane CE, Pasta V, Sottile D, Del Vecchio L, Maturo A, Merola R, Panunzi A, Urciuoli P, D'Orazi V

Abstract
BACKGROUND: Cricothyroidotomy is a surgical airway technique in which an airway device is inserted into the trachea through an incision made at the cricothyroid membrane. It is used for the management of the "difficult airways" and may be a lifesaving procedure in "can't intubate, can't oxygenate" situations. However, many healthcare professionals working in emergency settings have little of no experience with this procedure. Achievement of theoretical and practical knowledge of different cricothyrotomy techniques is therefore a fundamental prerequisite for those healthcare professionals.
MATERIALS AND METHODS: In this study, 40 volunteers representative of different categories of healthcare professionals were enrolled for the theoretical and practical 1-day training course on cricothyrotomy. Two commercially available device for cricothyrotomy were used during the course, the Melker™ set, which involves the Seldinger technique, and the QuickTrach™ kit, which does not rely on the use of a guide-wire. Each participant performed a series of 5 attempts on a manikin with each kit. Procedure time was recorded, and satisfaction with the course, preference for each cricothyrotomy kit and self-rating of cricothyrotomy skills were assessed by a self-administered questionnaire.
RESULTS: Mean procedure time significantly decreased from the first to the last attempt (48.7±21.9 and 27.8±13.7 seconds, respectively; p<0.0001). The Melker™ set was the most preferred, being rated as "excellent" by 62% of participants. This preference was even more pronounced among anaesthesiologists, that are more familiar with the Seldinger technique. Participants' satisfaction was high: the course was rated as "excellent" by 66.7% of attendees, the theoretical and practical knowledge achieved was rated as "very useful" by 94% of all attendees and by 100% of the anaesthesiologists.
CONCLUSIONS: A systematic approach to teach healthcare professionals in the application of various devices for the management of the socalled "difficult airways" may maximize intubation success and minimize complication. The present study provides evidence for the efficacy of training courses in Emergency Departments aimed at improving theoretical and practical cricothyrotomy skills in emergency situations.

PMID: 25174290 [PubMed - indexed for MEDLINE]

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Percutaneous transtracheal ventilation in an obstructed airway model in post-apnoeic sheep.

Percutaneous transtracheal ventilation in an obstructed airway model in post-apnoeic sheep.

Br J Anaesth. 2014 Dec;113(6):1039-45

Authors: Berry M, Tzeng Y, Marsland C

Abstract
BACKGROUND: Temporizing oxygenation by percutaneous transtracheal ventilation (PTV) is a recommended emergency technique in 'can't intubate, can't oxygenate' (CICO) situations. Barotrauma risk increases if expiration is obstructed. The Ventrain(®) is a new PTV device that assists expiration. Our aim was to compare key physiological outcomes after PTV with the Ventrain and the Manujet(®) in a large animal obstructed airway model.
METHODS: Five anaesthetized sheep had post-apnoea PTV performed for 15 min using the Ventrain or Manujet with the proximal airway completely or critically obstructed, yielding four ventilation protocols per sheep. After apnoeic desaturation ([Formula: see text]70%), a 4 s rescue breath was delivered. Subsequent 2 s breaths were delivered whenever the airway pressure fell <10 cm H2O.
RESULTS: Both devices achieved rapid re-oxygenation. There were marked device differences (Ventrain vs Manujet) in peak airway pressures with rescue (16 vs 40 cm H2O) breaths, minute ventilation (4.7 vs 0.1 litre min(-1)), and end-protocol pH (7.34 vs 7.01). There was no clinical evidence of barotrauma in any sheep after any ventilation protocol. An equilibration phase prevented large subatmospheric intrathoracic pressure development with Ventrain ventilation.
CONCLUSIONS: The Ventrain provided stable oxygenation and effective ventilation at low airway pressures during emergency PTV in critically obstructed airways. The Manujet provided effective temporizing oxygenation in this situation with hypoventilation necessary to minimize barotrauma risk. The nature and extent of airway obstruction may not be known in a CICO emergency but an understanding of device differences may help inform optimal ventilation device and method selection.

PMID: 24980421 [PubMed - indexed for MEDLINE]

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The effects of a displayed cognitive aid on non-technical skills in a simulated 'can't intubate, can't oxygenate' crisis.

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The effects of a displayed cognitive aid on non-technical skills in a simulated 'can't intubate, can't oxygenate' crisis.

Anaesthesia. 2014 Jul;69(7):669-77

Authors: Marshall SD, Mehra R

Abstract
Guidelines outlining recommended actions are difficult to implement in the stressful, time-pressured situation of an airway emergency. Cognitive aids such as posters and algorithms improve performance during some anaesthetic emergencies; however, their effects on team behaviours have not been determined. In this study, 64 participants were randomly assigned into control (no cognitive aid) and intervention (cognitive aid provided) groups before a simulated 'can't intubate, can't oxygenate' scenario. Video analysis was undertaken of the non-technical skills and technical performance during the scenarios. All categories had higher Anaesthetists' Non-Technical Skills (ANTS) scores when a cognitive aid was supplied (mean (SD) total ANTS score 10.4 (3.1) vs. 13.2 (2.4), p < 0.001). The number of times the cognitive aid was used was associated with higher ANTS scores (ρ = 0.383, p = 0.002). A trend towards the establishment of an infraglottic airway within 3 min was also noted (control group 55.3% vs. intervention 76.9%, p = 0.076). Non-technical skills are improved when a cognitive aid is present during airway emergencies.

PMID: 24917333 [PubMed - indexed for MEDLINE]

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Low-cost high-fidelity anaesthetic simulation.

Low-cost high-fidelity anaesthetic simulation.

Anaesth Intensive Care. 2014 May;42(3):371-7

Authors: Hartwell DA, Grayling M, Kennedy RR

Abstract
Simulation has been advocated as a useful training tool, and specific manikin simulators have been developed for use in this role. Debriefing and repetition have been identified as key to achieving educational goals and, while the technical features of manikin simulators can influence simulation outcomes, their cost and infrastructure requirements reduce their suitability for smaller healthcare facilities. We describe a local solution using biomedical calibration machines and modified basic manikins already available in our institution to form a high-fidelity anaesthetic simulator at minimal cost. This was effective in running high-fidelity, team-based in situ simulations and 'can't intubate, can't oxygenate' assessments for anaesthetic trainees. Though equipment in other centres may differ both in availability or suitability for simulation, the option we describe or similar may offer a low-cost solution for peripheral centres to run limited high-fidelity scenarios on a regular basis.

PMID: 24794478 [PubMed - indexed for MEDLINE]

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The effect of high-fidelity simulation on the confidence and decision-making ability of anaesthesia trainees in managing subsequent simulated 'can't intubate, can't oxygenate' scenarios.

The effect of high-fidelity simulation on the confidence and decision-making ability of anaesthesia trainees in managing subsequent simulated 'can't intubate, can't oxygenate' scenarios.

Anaesth Intensive Care. 2014 Mar;42(2):207-12

Authors: McCrossin K, White HT, Sane S

Abstract
The decision to attempt a percutaneous airway in a recognised 'Can't Intubate, Can't Oxygenate' (CICO) situation may occur too late to avoid a poor outcome. Our study was designed to investigate the effect of high-fidelity simulation on the confidence and decision-making ability of anaesthesia trainees in managing CICO scenarios in subsequent simulation. Nine anaesthesia trainees from Logan Hospital participated. Pre-study questionnaires surveying confidence levels in various anaesthetic crises were completed. All participants underwent an education session based on algorithms developed for failed intubation and ventilation, and techniques for securing percutaneous airway access. However, only four of the nine participated in a high-fidelity simulation session. All nine participants were then filmed during 'mini-simulation' assessment sessions and completed post-study questionnaires identical to those at the commencement of the study. The four trainees who had undertaken the initial high-fidelity simulation had a lower median time to laryngeal mask airway attempt (60 versus 115 seconds) and time to percutaneous airway attempt (111 versus 172 seconds) in the subsequent simulation. The median number of deviations from the Difficult Airway Society algorithm was 0 for the simulation group compared to 1 for the non-simulation group. This small study suggests that high-fidelity simulation shortens the decision-making time of anaesthesia trainees in subsequent simulated CICO scenarios. This observation warrants follow-up in larger prospective trials.

PMID: 24580386 [PubMed - indexed for MEDLINE]

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Failed intubation and failed oxygenation in a child.

Failed intubation and failed oxygenation in a child.

Anaesth Intensive Care. 2012 Nov;40(6):1056-8

Authors: Santoro AS, Cooper MG, Cheng A

Abstract
A 'can't intubate, can't oxygenate' scenario in a child is fortunately extremely rare. We report a case of this life-threatening event in a four-year-old boy suffering from a rare genetic disorder, fibrodysplasia ossificans progressiva. He presented for manipulation of his dislocated jaw and was identified preoperatively as having a difficult airway. Despite extensive preparation, a catastrophic loss of airway control occurred minutes after induction of general anaesthesia, necessitating a life saving emergency tracheostomy. This report highlights the small evidence base and lack of definitive algorithms relating to how best to rescue a paediatric 'can't intubate, can't oxygenate' situation. Paediatric anatomical factors dictate that immediate procession to a tracheal surgical airway may be the optimal management.

PMID: 23194217 [PubMed - indexed for MEDLINE]

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The 'Can't Intubate Can't Oxygenate' scenario in Pediatric Anesthesia: a comparison of different devices for needle cricothyroidotomy.

The 'Can't Intubate Can't Oxygenate' scenario in Pediatric Anesthesia: a comparison of different devices for needle cricothyroidotomy.

Paediatr Anaesth. 2012 Dec;22(12):1155-8

Authors: Stacey J, Heard AM, Chapman G, Wallace CJ, Hegarty M, Vijayasekaran S, von Ungern-Sternberg BS

Abstract
BACKGROUND: Little evidence exists to guide the management of the 'Can't Intubate, Can't Oxygenate' (CICO) scenario in pediatric anesthesia.
OBJECTIVES: To compare two intravenous cannulae for ease of use, success rate and complication rate in needle tracheotomy in a postmortem animal model of the infant airway, and trial a commercially available device using the same model.
METHODS: Two experienced proceduralists repeatedly attempted cannula tracheotomy in five postmortem rabbits, alternately using 18-gauge (18G) and 14-gauge (14G) BD Insyte(™) cannulae (BD, Franklin Lakes, NJ, USA). Attempts began at the first tracheal cartilage, with subsequent attempts progressively more caudad. Success was defined as intratracheal cannula placement. In each rabbit, an attempt was then made by each proceduralist to perform a cannula tracheotomy using the Quicktrach Child(™) device (VBM Medizintechnik GmbH, Sulz am Neckar, Germany).
RESULTS: The rabbit tracheas were of similar dimensions to a human infant. 60 attempts were made at cannula tracheotomy, yielding a 60% success rate. There was no significant difference in success rate, ease of use, or complication rate between cannulae of different gauge. Successful aspiration was highly predictive (positive predictive value 97%) and both sensitive (89%) and specific (96%) for tracheal cannulation. The posterior tracheal wall was perforated in 42% of tracheal punctures. None of 13 attempts using the Quicktrach Child(™) were successful.
CONCLUSION: Cannula tracheotomy in a model comparable to the infant airway is difficult and not without complication. Cannulae of 14- and 18-gauge appear to offer similar performance. Successful aspiration is the key predictor of appropriate cannula placement. The Quicktrach Child was not used successfully in this model. Further work is required to compare possible management strategies for the CICO scenario.

PMID: 23066666 [PubMed - indexed for MEDLINE]

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Likelihood of experiencing 'can't intubate, can't oxygenate'.

Likelihood of experiencing 'can't intubate, can't oxygenate'.

Anaesth Intensive Care. 2012 Jul;40(4):722-3

Authors: Riley DP

PMID: 22813508 [PubMed - indexed for MEDLINE]

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Persistent 'can't intubate, can't oxygenate' crisis despite reversal of rocuronium with sugammadex: the importance of timing.

Persistent 'can't intubate, can't oxygenate' crisis despite reversal of rocuronium with sugammadex: the importance of timing.

Anaesth Intensive Care. 2012 Jul;40(4):722

Authors: Curtis RP

PMID: 22813507 [PubMed - indexed for MEDLINE]

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A persistent 'can't intubate, can't oxygenate' crisis despite rocuronium reversal with sugammadex.

A persistent 'can't intubate, can't oxygenate' crisis despite rocuronium reversal with sugammadex.

Anaesth Intensive Care. 2012 Mar;40(2):344-6

Authors: Kyle BC, Gaylard D, Riley RH

Abstract
A 'can't intubate, can't oxygenate' airway crisis is a rare event which most anaesthetists will never experience during their career(1,2). This report highlights the outcome of time-critical decisions in a potential airway catastrophe. Rocuronium was used as an alternative muscle relaxant for rapid sequence induction. The use of sugammadex in 'can't intubate, can't oxygenate' crises is discussed and highlights how, despite adequate reversal of neuromuscular blockade, the 'can't intubate, can't oxygenate' situation failed to resolve. An asymptomatic vallecular cyst was the causal factor in this scenario. Anaesthetic issues surrounding this pathology are discussed.

PMID: 22417032 [PubMed - indexed for MEDLINE]

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Emergency surgical airway in life-threatening acute airway emergencies--why are we so reluctant to do it?

Emergency surgical airway in life-threatening acute airway emergencies--why are we so reluctant to do it?

Anaesth Intensive Care. 2011 Jul;39(4):578-84

Authors: Greenland KB, Acott C, Segal R, Goulding G, Riley RH, Merry AF

Abstract
'Can't intubate, can't oxygenate' scenarios are rare but are often poorly managed, with potentially disastrous consequences. In our opinion, all doctors should be able to create a surgical airway if necessary. More practically, at least all anaesthetists should have this ability. There should be a change in culture to one that encourages and facilitates the performance of a life-saving emergency surgical airway when required. In this regard, an understanding of the human factors that influence the decision to perform an emergency surgical airway is as important as technical skill. Standardisation of difficult airway equipment in areas where anaesthesia is performed is a step toward ensuring that an emergency surgical airway will be performed appropriately Information on the incidence and clinical management of 'can't intubate, can't oxygenate' scenarios should be compiled through various sources, including national coronial inquest databases and anaesthetic critical incident reporting systems. A systematic approach to teaching and maintaining human factors in airway crisis management and emergency surgical airway skills to anaesthetic trainees and specialists should be developed: in our opinion participation should be mandatory. Importantly, the view that performing an emergency surgical airway is an admission of anaesthetist failure should be strongly countered.

PMID: 21823373 [PubMed - indexed for MEDLINE]

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The use of ultrasound to guide time-critical cannula tracheotomy when anterior neck airway anatomy is unidentifiable.

http:--pt.wkhealth.com-pt-pt-core-templa

The use of ultrasound to guide time-critical cannula tracheotomy when anterior neck airway anatomy is unidentifiable.

Eur J Anaesthesiol. 2011 Jul;28(7):506-10

Authors: Dinsmore J, Heard AM, Green RJ

Abstract
BACKGROUND AND OBJECTIVE: Transtracheal or transcricothyroid placement of a cannula is a practice used in a number of aspects of airway management in anaesthesia and intensive care. In this study, we aimed to investigate whether the use of ultrasound will facilitate cannula placement in a time-critical situation in patients with difficult anterior neck airway anatomy.
METHOD: Fifty anaesthetists were randomised to either ultrasound-guided or conventional unguided attempts, at cannula insertion into a model simulating a patient with unidentifiable anterior neck anatomy. Endpoints were the success, and time to success, of cannula placement.
RESULTS: There was a significant increase in success rate (83 vs. 43%, P = 0.011) and a significant decrease in time to successful placement (median time to successful cannulation 57 vs. 110 s, P = 0.008) using ultrasound guided compared to unguided cannula placement.
CONCLUSION: If a 'can't intubate, can't oxygenate' scenario occurs in a patient with unidentifiable anterior neck airway anatomy in a location where an ultrasound machine is immediately available, we recommend that consideration is given to the use of ultrasound-guided cannula tracheotomy as the first-line rescue technique.

PMID: 21423020 [PubMed - indexed for MEDLINE]

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Emerging role of transesophageal echocardiography in severe chronic obstructive pulmonary disease

2016-06-06T03-14-12Z
Source: International Journal of Research in Medical Sciences
Ashwin Songara, Nikhilesh Pasari, Arpita Ajmera, Kapil Jangid, Divya Malpani, Mriganka Madhab Misra.
Background: Pulmonary hypertension (PH) secondary to chronic obstructive pulmonary disease (COPD) has a prevalence from 20 to 91% depending on the definition of PH (mPAP >20 versus >25 mmHg). Pulmonary vasoconstriction, pulmonary vascular remodeling, endothelial dysfunction, inflammation and destruction of the pulmonary vascular bed being the common mechanisms behind. Transthoracic echocardiograms (TTE) though the most important non-invasive tool to measure degree of PH, may give false negative results in severe COPD cases due to poor echo window. This could be overcome by doing transesophageal echocardiograms (TEE) in those cases, which is, though invasive but gives good results. The aim of the study was to evaluate the role of transesophageal echocardiography in COPD patients. Methods: Total 100 patients of COPD were evaluated for PH via TTE and TEE was performed in all those 33 patients whose TTE were non-confirmatory due to poor echo window. Results: There were 0% patient with poor echo window in COPD grade 1, 18.18% in grade 2, 42.2% and 39.39% in grade 3 and grade 4 respectively. P-value obtained was statistically significant P

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To assess the role fiberoptic bronchoscopy in the evaluation of hemoptysis

2016-06-06T03-14-12Z
Source: International Journal of Research in Medical Sciences
Ashwin Songara, Rohit Mukherjee, Swapnil Shikha, Awadesh P. S. Solanki, Tanay Joshi, Deepika Patel.
Background: To prospectively evaluate the efficiency of the fiberoptic bronchoscopy (FOB) examination in the evaluation of patients with hemoptysis. Methods: We prospectively reviewed 50 patients who underwent FOB for hemoptysis. There were 39 male and 11 female. The mean age was 46 years with a range from 21 to 83 years. The patients were divided between two groups on the basis of their chest roentograms (46% with normal and 54% with abnormal findings). Results: Hemoptysis in normal and abnormal chest roentograms was respectively attributed to bronchiectasis in 5 (21.7%) and 3 (11.1%) cases, bronchogenic carcinoma in 2 (8.6%) and 9 (33.3%) cases, bronchitis in 2 (8.6%) and 3 (11.1%) cases, tuberculosis in 2 (8.6%) and 5 (18.5%) cases, cryptogenic causes in 8 (34.7%) and 4 (14.8%) cases and pseudohemoptysis in 2 (8.6%) cases (bleeding from upper respiratory tract). Conclusions: Fob plays a pivotal role in the evaluation of hemoptysis. It was found that left upper lobe followed by right upper lobe was the site most consistent with the findings, with bronchogenic carcinoma being the most common non- infectious cause. Infectious etiology was the most common pathology behind hemoptysis and bronchiectasis was the most important risk factor.

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Simultaneous anterior and posterior serosal mapping of gastric slow wave dysrhythmias induced by vasopressin

Background: High-resolution (HR) mapping enables mechanistic insights into gastric slow wave dysrhythmias and is now achieving clinical translation. However, previous studies have focused mainly on dysrhythmias occurring on the anterior gastric wall. The present study simultaneously mapped the anterior and posterior gastric serosa during episodes of dysrhythmias induced by vasopressin to aid understanding of dysrhythmia initiation, maintenance and termination. Methods: HR mapping (8×16 electrodes on each serosa; 20–74 cm²) was performed in anesthetized subjects. Baseline recordings (21 ± 8 min) were followed by intravenous vasopressin infusion (0.1-0.5 IU ml⁻¹ at 60–190 ml h⁻¹) and further recordings (22 ± 13 min). Slow wave activation maps, amplitudes, velocity, interval, and frequency were calculated, and differences compared between baseline and post-infusion. Results: All subjects demonstrated and increased prevalence of dysrhythmic events following infusion of vasopressin (17% vs 51%).Both amplitude and velocity demonstrated significant differences (baseline vs. post-infusion: 3.6 vs. 2.2 mV; 7.7 vs. 6.5 mm s⁻¹; P < 0.05 for both). Dysrhythmias occurred simultaneously or independently on anterior and posterior serosa, and then interacted according to frequency dynamics. A number of persistent dysrhythmias were compared, including: ectopic activation (n = 2 subjects), conduction block (n = 1), rotor (n = 2), retrograde (n = 3), collision/merge of wavefronts (n = 2). Conclusions: Infusion of vasopressin induces gastric dysrhythmias, which occurred across a heterogeneous range of frequencies and patterns. The results demonstrated that different classes of gastric dysrhythmias may arise simultaneously or independently in one or both surfaces of the serosa, then interact according to their relative frequencies. These results will help inform clinical dysrhythmia interpretations.

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The dynamic relationship between cerebellar Purkinje cell simple spikes and complex spike spikelet number

Purkinje cells are central to cerebellar function as they form the sole output of the cerebellar cortex. They exhibit two distinct types of action potential: simple spikes and complex spikes, and it is widely accepted that interaction between these two types of impulse is central to cerebellar cortical information processing. Previous investigations of the interactions between simple spikes and complex spikes have mainly considered complex spikes as unitary events. However, complex spikes are composed of an initial large spike followed by a number of secondary components, termed spikelets. The number of spikelets within individual complex spikes is highly variable and the extent to which differences in complex spike spikelet number affects simple spike activity (and vice versa) remains poorly understood. In anaesthetized adult rats we have found that Purkinje cells recorded from the posterior lobe vermis and hemisphere that have high simple spike firing frequencies precede complex spikes with greater numbers of spikelets. This finding was also evident in a small sample of Purkinje cells recorded from the posterior lobe hemisphere in awake cats. In addition, complex spikes with a greater number of spikelets were associated with a subsequent reduction in simple spike firing rate. We therefore suggest that one important function of spikelets is the modulation of Purkinje cell simple spike firing frequency, which has implications for controlling cerebellar cortical output and motor learning.

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Peritoneal dissemination in early gastric cancer: Importance of the lymphatic route

Virchows Archiv

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Effectiveness of Sofosbuvir, Ledipasvir/Sofosbuvir, or Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir Regimens for Treatment of Patients With Hepatitis C in the Veterans Affairs National Healthcare System

Gastroenterology

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Comparing health care utilization among three treatment regimens provided to commercially-insured patients with chronic hepatitis C virus genotype 1

Value in Health

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Similar fecal microbiota signatures in patients with diarrhea-predominant irritable bowel syndrome and patients with depression

Clinical Gastroenterology and Hepatology

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Is preoperative distinction between complicated and uncomplicated acute appendicitis feasible without imaging?

Surgery

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Phase I study of lenalidomide and sorafenib in patients with advanced hepatocellular carcinoma

The Oncologist

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Outcome of hypovascular hepatic nodules with positive uptake of gadoxetic acid in patients with cirrhosis

European Radiology

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Real-world sustained virologic response rates of sofosbuvir-containing regimens in patients coinfected with hepatitis C and HIV

Clinical Infectious Diseases

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Survival outcome of salvage hepatectomy in patients with local, recurrent hepatocellular carcinoma who underwent radiofrequency ablation as their first treatment

Surgery

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Hepatitis E virus (HEV) ORF2 antigen levels differentiate between acute and chronic HEV infection

The Journal of Infectious Diseases

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Systemic inflammatory markers as prognostic factors in stage IIA colorectal cancer

Journal of Surgical Oncology

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Cost-effectiveness of doxorubicin-eluting beads versus conventional trans-arterial chemo-embolization for hepatocellular carcinoma

Digestive and Liver Diseases

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Low serum vitamin D during remission increases risk of clinical relapse in patients with ulcerative colitis

Clinical Gastroenterology and Hepatology

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Randomized controlled trial of prophylactic negative-pressure wound therapy at ostomy closure for the prevention of delayed wound healing and surgical site infection in patients with ulcerative colitis

Digestive Surgery

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Clinical outcomes of pancreatic ductal adenocarcinoma resection following neoadjuvant chemoradiation therapy vs. chemotherapy

Surgery Today

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Combined medical and surgical approach improves healing of septic perianal Crohn's disease

Journal of the American College of Surgeons

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Elucidation of the metabolic network of Helicobacter pylori J99 and Malaysian clinical strains by phenotype microarray

Helicobacter

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High fecal IgA is associated with reduced Clostridium difficile colonization in infants

Microbes and Infection

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Achieving synergy: Linking an internet-based inflammatory bowel disease cohort to a community-based inception cohort and multicentered cohort in inflammatory bowel disease

Journal of Medical Internet Research

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Clinical practice guideline for the treatment of pediatric acute gastroenteritis in the outpatient setting

Journal of Pediatric Health Care

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Reactive arthritis

2016-06-06T01-42-56Z
Source: Medicine Science | International Medical Journal
Mustafa Serdar Sag, Ibrahim Tekeoglu, Sinem Sag.
Reactive arthritis (ReA) frequently as sequelae of gastrointestinal or genitourinary tract infections previously had been identified as developing sterile inflammatory arthritis. ReA, most definitive evidence on the role of microbial agents is based on the demonstration of microbial antigens in the synovial fluid. In terms of clinical and immunological responses after infection are large individual differences. Biochemical reactions at the cellular level, reflecting the addition of host- microorganism relationship is such advances in understanding. ReA, patients are usually young adults, the average age is 30-40. The most obvious involvement of the disease in the joints. Joint involvement can create clinical spectrum goes from arthralgia to severe polyarthritis.

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