Perioperative morbidity in children with elastin arteriopathy

Summary

Background

Children with elastin arteriopathy (EA), the majority of whom have Williams–Beuren syndrome, are at high risk for sudden death. Case reports suggest that the risk of perioperative cardiac arrest and death is high, but none have reported the frequency or risk factors for morbidity and mortality in an entire cohort of children with EA undergoing anesthesia.

Aim

The aim of this study was to present one institution's rate of morbidity and mortality in all children with EA undergoing anesthesia and to examine patient characteristics that pose the greatest risk.

Methods

We reviewed medical records of children with EA who underwent anesthesia or sedation for any procedure at our institution from 1990 to 2013. Cardiovascular hemodynamic indices from recent cardiac catheterization or echocardiography were tabulated for each child. The incidence, type, and associated factors of complications occurring intraoperatively through 48 h postoperatively were examined.

Results

Forty-eight patients with confirmed EA underwent a total of 141 anesthetics. There were seven cardiac arrests (15% of patients, 5% of anesthetics) and nine additional intraoperative cardiovascular complications (15% of patients, 6% of anesthetics). Extracorporeal life support was initiated in five cases. There were no perioperative deaths. All children having a cardiac arrest or complication were <3 years old and had biventricular outflow tract obstruction (BVOTO). Subgroup analysis demonstrated high rates of cardiac arrest in two groups: children with BVOTO (44%) and age <3 years old (21%).

Conclusions

We have confirmed that the rate of cardiac arrest and complications is significantly elevated in children with EA undergoing anesthesia. Children <3 years old and with BVOTO were at the greatest risk in our population.

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Feasibility and pharmacokinetics of caudal blockade in children and adolescents with 30–50 kg of body weight

Summary

Background

Caudal blockade, although an important technique of pediatric regional anesthesia, is rarely used in children heavier than 30 kg. This reservation is due to anatomical concerns and lack of pharmacokinetic data. We therefore set out to evaluate, in pediatric patients weighing 30−50 kg, the feasibility of ultrasound-guided caudal blockade and the pharmacokinetics of caudally administered ropivacaine.

Methods

Twenty consecutive children were included. General anesthesia was used to ensure a secured airway. For the caudal punctures, we applied the same clinical standards as in smaller children, administering ropivacaine 3.1 mg·ml^-1 for a volume of 1 ml·kg⁻¹ via ultrasound guidance. Pharmacokinetic analysis was based on total plasma ropivacaine levels and included maximum concentration (C_max), time to C_max (t_max), terminal elimination half-life, area under the concentration–time curve for the 4-h sampling period, apparent total body clearance, and apparent volume of distribution.

Results

In all 19 cases of successful puncture, we identified the relevant anatomical structures (sacral cornua, sacral hiatus, dura mater) and verified correct administration of the local anesthetic by visualizing its cranial spread. Surgical blockade was successful in 18 of 20 cases (90%; one puncture was technically not possible and one child received intraoperatively 50 μg fentanyl). The pharmacokinetic profile of the administered ropivacaine 3.1 mg·ml⁻¹ indicated plasma levels within safe ranges in pediatric patients weighing 30−50 kg.

Conclusions

Based on our pharmacodynamic and pharmacokinetic results, we suggest that the body weight of 50 kg it is feasible to perform effective and safe caudal blockade in children up to 50 kg body weight.

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Early childhood exposure to short periods of sevoflurane is not associated with later, lasting cognitive deficits

Summary

Background

A detrimental effect of commonly used anesthetics on the neurodevelopmental and behavioral parameters has long been shown in young animals subjected to early childhood anesthesia. Epidemiologic studies suggest the possibility of a modestly elevated risk of adverse neurodevelopmental outcomes in children exposed to anesthesia during early childhood. However, these results are still preliminary and inconclusive.

Aim

To further elucidate the probability of occurrence of such adverse outcomes, we evaluated cognitive performance of children who underwent general anesthesia early in their childhood.

Method

One hundred and fifteen children aged 5‒16 years with established glaucoma were included in the study. Of these, 68 children had a history of at least one general anesthesia with sevoflurane before age 3. Phonemic and semantic verbal fluency, and forward and backward digit span tests were performed to evaluate cognitive function in the study subjects.

Results

The two-way anova revealed that all these variables showed significant changes in various age groups, but they were comparable among subjects with no, single, or multiple childhood anesthesia.

Conclusion

It can be concluded that brief periods of anesthesia with single anesthetic sevoflurane may be safe for children under age 3.

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Pain after discharge following head and neck surgery in children

Summary

Background

It is well established that children experience significant pain for a considerable period following adenotonsillectomy. Less is known, however, about pain following other common head and neck operations.

Aim

The aim of this study was to describe the severity and duration of postoperative pain experienced by children undergoing elective head and neck procedures (primary outcomes). Behavioral disturbance, nausea and vomiting, parental satisfaction, and medical reattendance rates were also measured (secondary outcomes).

Method

Parents of children (0–18 years) undergoing common head and neck operations were invited to participate. Pain scores on the day of surgery and each day post discharge were collected via multiple telephone interviews. Data collected included pain levels, analgesia prescribed and given, behavioral disturbance rates, and nausea and vomiting scores. Follow-up was continued until pain resolved.

Results

Two hundred and fifty-one patients were analyzed (50 adenoidectomy, 51 adenotonsillectomy, 19 myringoplasty, 52 myringotomy, 43 strabismus, and 36 tongue tie divisions). On the day of surgery myringoplasty, strabismus surgery, and adenotonsillectomy patients on average had moderate pain, whereas adenoidectomy, tongue tie, and myringotomy patients had mild pain. Adenotonsillectomy patients continued to have moderate pain for several days with pain lasting on average 9 days. From day 1 postoperatively mild pain was experienced in the other surgical groups with the average duration of pain varying from 1 to 3 days depending on the surgery performed. Frequency of behavioral issues closely followed pain scores for each group. Analgesic prescribing and regimes at home varied widely, both within and between the different surgical groups. Rates of nausea and vomiting following discharge were low in all groups. The overall unplanned medical reattendance rate was 16%.

Conclusion

Adenotonsillectomy patients represent the biggest challenge in postoperative pain management of the head and neck surgeries evaluated. The low rates of pain, nausea, and vomiting reported in the days following surgery for the other procedures suggests that children can be cared for at home with simple analgesia. Discharge information and analgesia prescribing on discharge should be tailored to the operation performed.

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Respiratory depression detected by capnography among children in the postanesthesia care unit: a cross-sectional study

Summary

Background

Children are at risk for respiratory depression while recovering from anesthesia. Currently, monitoring children in the postanesthesia care unit (PACU) with pulse oximetry is recommended. However, pulse oximetry does not reliably recognize hypoventilation or apnea, particularly in the presence of supplemental oxygen. Capnography is a sensitive monitor of ventilation that is not often used in the PACU.

Aim

To determine the frequency of hypoventilation and apnea as detected by capnography among children in the PACU.

Methods

In a cross-sectional study, capnography monitoring was applied to healthy children of age 1–17 years in the PACU of a tertiary care hospital. Staff was blinded to the capnography monitor; alarms were disabled. Staff provided routine care and monitoring with pulse oximetry to all patients. Vital signs, patient interventions, and medication administration were recorded by a research assistant every 30 s until all monitoring was discontinued by staff. Outcome measures included frequency of hypoventilation and apnea as measured by capnography and oxygen desaturations as measured by pulse oximetry, as well as staff interventions for these events.

Results

Data from 194 children were analyzed. Capnography detected hypoventilation or apnea in 45.5% (95% CI 38.5%, 52.5%) of patients. Oxygen desaturations occurred in 19% (95% CI 13%, 24%) of patients. Interventions occurred in 9% (95% CI 5%, 13%) of patients. Patients who received narcotic medications were more likely to experience hypoventilation (OR 2.3, 95% CI 1.02, 5.3) and apnea (OR 2.7, 95% CI 1.1, 7). Hypoventilation was seen more often among children who received supplemental oxygen (OR 3.1, 95% CI 1.1, 12).

Conclusions

Hypoventilation and apnea are common among children in the PACU; however, few interventions occur to address these events. Routine monitoring with capnography may improve recognition of respiratory depression and enhance patient safety in the PACU.

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Effects of Ionizing Radiation on the Heart

Publication date: Available online 10 July 2016
Source:Mutation Research/Reviews in Mutation Research
Author(s): Marjan Boerma, Vijayalakshmi Sridharan, Xiao-Wen Mao, Gregory A. Nelson, Amrita K. Cheema, Igor Koturbash, Sharda P. Singh, Alan J. Tackett, Martin Hauer-Jensen
This article provides an overview of studies addressing effects of ionizing radiation on the heart. Clinical studies have identified early and late manifestations of radiation-induced heart disease, a side effect of radiation therapy to tumors in the chest when all or part of the heart is situated in the radiation field. Studies in preclinical animal models have contributed to our understanding of the mechanisms by which radiation may injure the heart. More recent observations in human subjects suggest that ionizing radiation may have cardiovascular effects at lower doses than was previously thought. This has led to examinations of low-dose photons and low-dose charged particle irradiation in animal models. Lastly, studies have started to identify non-invasive methods for detection of cardiac radiation injury and interventions that may prevent or mitigate these adverse effects. Altogether, this ongoing research should increase our knowledge of biological mechanisms of cardiovascular radiation injury, identify non-invasive biomarkers for early detection, and potential interventions that may prevent or mitigate these adverse effects.



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Reality Training: Severe head wound behind home plate

How would you treat a baseball umpire's significant head laceration as players, fans and television viewers watch your every move?

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Reality Training: Severe head wound behind home plate

Incident Date: June 23, 2016

Department: Athletic trainers and Paramedics Plus, the standby medical service for the Oakland A's

What happened: Home plate umpire Paul Emmel was hit in the head when Angels' pinch-hitter Jefry Marte lost control of his bat. Emmel immediately fell to the ground. When he removed his hat, blood cascaded into the sand. The sound of the bat hitting Emmel's head was startling to players, and the blood streaming out of a laceration was surely just as frightening for television viewers.

Read more about the incident and watch the video of the injury.

Discussion points: Control of severe bleeding, patient assessment and working in a high-visibility venue
As you watch the video ask yourself or discuss with your partner, company or squad the following questions:

1. Many EMS agencies provide standby services for athletes at all levels of competition. What are some of the challenges unique to athletic event standby and how are you specifically prepared to meet those challenges"

2. What is your treatment plan for controlling severe bleeding from a significant head laceration" Does your agency stock hemostatic gauze" Could it have been used on this patient"

3. What other injuries should you consider after an official or athlete has sustained a significant blow to the head, such as contact from the swing of a baseball bat" How do those potential injuries change your treatment plan for the patient, including your transport destination"

4. How has your department prepared to cooperate with athletic trainers" Have you completed joint training sessions and agreed upon protocols for athletic-specific injuries such as spinal cord injury, traumatic brain injury, and head, face or neck injuries sustained from contact with bats, balls and skate blades"

Athlete standby, especially at professional sporting events, is one of the most coveted assignments for EMS crews. Paramedics are rarely called upon for assistance, but when they are, it is because a significant, potentially life-threatening injury has halted play. In these critical moments, with thousands of fans in the stadium and perhaps millions more watching on television or online, paramedics must be prepared to respond with the highest level of competence and professionalism.

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RESEARCH ON MIDWIFERY STUDENT’S ETHICAL SUSCEPTIBILITY ON PATIENT CARE PRACTICES

2016-07-10T18-38-49Z
Source: Journal of Contemporary Medicine
Yasemin AYDIN, Yurdanur Dikmen, Sare Cansu Kalkan.
Objective: Objective of this research is examining last grade students ethical susceptibility includes their susceptibility towards ethics, ethical codes and ethical dilemmas who are candidates to midwifery profession. Method: The research which is planned as descriptive one was carried out with intern students who study at Health College Midwifery Department of a public university between January-February 2016. Sample of the research contains 52 volunteer students. Questionnaire form which comprise of two parts was used in order to collect data. Students characteristics and opinions about ethics are asked in the first part. Ethical Susceptibility Questionnaire Findings: Students average age is 22.36±1.75. That are detected that 48.1 percent of students do not know occupational ethic codes, and 40.4 percent of students stated that ethics education does not suffice in curriculum, and 63.5 percent of students need ethics education. 57.7 percent of students stated that they experienced ethical problems during internship, and 46 percent of students who experienced ethical problems stated that they could not solve the ethical problems that they have faced. It is detected that students total point of ethical susceptibility is 86.81±20.86 (between 30-210 points). Results and Suggestions: It is found out that midwifery students ethical susceptibility is at medium level. It can be suggested that their curriculum before graduation should be enhanced in terms of augmentation of candidate midwifery students ethical susceptibility and recognition and providing a solution of ethical problems.


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Ambulance destroyed after intersection collision

Surveillance video shows a car drive past a stop sign and into a Twin Township Ambulance on June 23, 2016. The broadside collision completely destroyed the patient care compartment.

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Ambulance destroyed after intersection collision

Surveillance video shows a car drive past a stop sign and into a Twin Township Ambulance on June 23, 2016. The broadside collision completely destroyed the patient care compartment.

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Ambulance destroyed after intersection collision

Surveillance video shows a car drive past a stop sign and into a Twin Township Ambulance on June 23, 2016. The broadside collision completely destroyed the patient care compartment.

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Ambulance destroyed after intersection collision

Surveillance video shows a car drive past a stop sign and into a Twin Township Ambulance on June 23, 2016. The broadside collision completely destroyed the patient care compartment.

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Literature-based knowledgebase of pancreatic cancer gene to prioritize the key genes and pathways

Publication date: Available online 9 July 2016
Source:Journal of Genetics and Genomics
Author(s): Yining Liu, Jingchun Sun, Min Zhao




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Paranasal sinuses: A problematic proxy for climate adaptation in Neanderthals

Publication date: Available online 9 July 2016
Source:Journal of Human Evolution
Author(s): Marlijn L. Noback, Elfriede Samo, Casper H.A. van Leeuwen, Niels Lynnerup, Katerina Harvati




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Bacteriological Profile Of Nosocomial Pneumonia Patients In A Superspeciality Hospital

2016-07-10T05-40-59Z
Source: National Journal of Integrated Research in Medicine
Urvashi Tiwari*, Poonam Loomba**, Vinita Dogra**, Bibhabati Mishra***.
Background: To ascertain the bacteriological profile of patients with nosocomial pneumonia in endotracheal cultures and correlation with blood cultures. Methodology: 559 endotracheal aspirates were collected using mucous traps from 180 patients of suspected nosocomial pneumonia patients over 2 years. The samples were processed and a colony count of 104cfu/ml was taken as the cut-off to differentiate between pathogens and colonizers. Identification and sensitivity of bacterial isolates was done with the help of Vitek 2. Blood for culture was processed as per standard techniques. Results & Conclusion: Klebsiella sp.(33%) was the commonest bacteria isolated, followed by Acinetobacter baumanii, Pseudomonas sp., Escherichia coli and Staphylococcus aureus. 25% of Acinetobacter spp. and 40% of Pseudomonas spp were pandrug resistant. Mostly non-fermenters were sensitive to Tigecycline and Colistin. Enterobacteriaceae showed highest resistance for Cephalosporins and Cotrimoxazole but were mostly sensitive to Tigecycline. Staphylococcus aureus was uniformly sensitive to Linezolid and Teicoplanin. Blood cultures were positive in 52(9.3%) patients of which pulmonary origin bacteremia was present in 33 patients while non-pulmonary origin bacteremia was present in 19 patients. The pulmonary care bundle along with rational use of antibiotics will go a long way to improve treatment outcome, patient morbidity and mortality. [Tiwari U NJIRM 2016; 7(3):60 - 63]


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Retracted Papers from the Journal “Medical Archives”

2016-07-10T03-14-49Z
Source: Medical Archives
Editoral Board.
Concerning of un-ethical behaviors of some authors of the papers published in previous issues of the journal Medical Archives Editorial Board and me as Editor-in-Chief decided to retract several papers. We follow COPE Retraction Guidelines (http://ift.tt/1FsfhBy) and publish a separately citation for retracted article. The first case is: Ahmed QA, El Sayed FS, Emad H, Mohamed E, Ahmed B, Heba P. Urinary biomarkers of acute kidney injury in patients with liver cirrhosis. Med Arch. 2014;68(2):132-6. PubMed PMID: 24937940; (RETRACTED) Changed with the article:  Masic I, Hodzic A, Karcic E, Mulic S. Comparison of the Quality Assessment of the Medical Education by students of Bologna and the Old System of Studying. Med Arch. 2014;68(2):132-6. http://ift.tt/29Fwtqy The second case is: Latifi-Popovci, H. Association Between Autoantibodies Against Thyroid Stimulating Hormone Receptor and Thyroid Diseases Med Arch. 2014; 68(2): 79-81.(RETRACTED), doi: 10.5455/medarh.2014.68.79-81  Changed with the article:  Zvizdic Z, Milisic E, Halimic A, Zvizdic D, Zubovic SV. Testicular volume and testicular atrophy index as predictors of functionality of unilaterally cryptorchid testis. Med Arch. 2014;68(2):79-82.  http://ift.tt/29M03h6 The third case is: Sahin C, Aras HI. The Effect of Nasal Packing Removal on Patients Anxiety. Med Arh. 2015 Dec; 69(6): 393-395. (RETRACTED). Changed with the article: El-Ardat MA, Gavrankapetanovic F, Dekovic S, Kozaric M, Rakocevic M, El-Ardat KA, Zunic L. Buscopan Application as an Analgesic in Primiparas. Med Arh. 2015 Dec; 69(6): 393-395. http://ift.tt/1ME1QSC


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FUS -linked essential tremor associated with motor dysfunction in Drosophila

Abstract

Essential tremor (ET) is one of the most common adult-onset neurological disorders which produce motor and non-motor symptoms. To date, there are no gold standard pathological hallmarks of ET, and despite a strong genetic contribution toward ET development, only a few pathogenic mutations have been identified. Recently, a pathogenic FUS-Q290X mutation has been reported in a large ET-affected family; however, the pathophysiologic mechanism underlying FUS-linked ET is unknown. Here, we generated transgenic Drosophila expressing hFUS-WT and hFUS-Q290X and targeted their expression in different tissues. We found that the targeted expression of hFUS-Q290X in the dopaminergic and the serotonergic neurons did not cause obvious neuronal degeneration, but it resulted in motor dysfunction which was accompanied by impairment in the GABAergic pathway. The involvement of the GABAergic pathway was supported by rescue of motor symptoms with gabapentin. Interestingly, we observed gender specific downregulation of GABA-R and NMDA-R expression and reduction in serotonin level. Overexpression of hFUS-Q290X also caused an increase in longevity and this was accompanied by downregulation of the IIS/TOR signalling pathway. Our in vivo studies of the hFUS-Q290X mutation in Drosophila link motor dysfunction to impairment in the GABAergic pathway. Our findings would facilitate further efforts in unravelling the pathophysiology of ET.

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