System-Wide Implementation of Routine Outcome Monitoring and Measurement Feedback System in a National Network of Operational Stress Injury Clinics

Abstract

This manuscript reviews the development and implementation process of the Client Reported Outcome Monitoring Information System in the VA Canada Operational Stress Injury National Network, and reports on outcomes of an evaluation to assess usage, barriers, and facilitators to implementation. The majority of clinicians reported regular use of routine outcomes monitoring, although objective data suggested somewhat lower actual use. In general, clinicians endorsed all barriers and most facilitators as influencing their use of routine outcomes monitoring in a minor way. However, users and non-users differed in their endorsement of facilitators and barriers. Implications for research and implementation efforts are discussed

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Full title with Editorial board members

Publication date: August 2016
Source:International Journal of Psychophysiology, Volume 106





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Instructions to Authors

Publication date: August 2016
Source:International Journal of Psychophysiology, Volume 106





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IOP-details

Publication date: August 2016
Source:International Journal of Psychophysiology, Volume 106





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Erratum to: Eicosapentaenoic and docosahexaenoic acids-rich fish oil supplementation attenuates strength loss and limited joint range of motion after eccentric contractions: a randomized, double-blind, placebo-controlled, parallel-group trial

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Erratum to: Maximal aerobic power and anaerobic capacity in cycling across the age spectrum in male master athletes

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Victorian Institute of Sport Assessment (VISA) Questionnaire, Patellar Tendon

Link to instrument: VISA-P PDF Form

Acronym:

VISA-P

Purpose:

Symptoms of jumper's knee (patellar tendinosis) are not easily quantified and this may explain why there are no evidence-based guidelines for managing the condition. A simple, practical questionnaire-based index of severity would facilitate jumper's knee research and subsequently, clinical management.

Description:

A questionnaire containing 8 questions about patellar tendinosis

• Assesses symptoms, simple tests of function, and ability to play sports
• 6 of 8 questions are scored on a VAS from 0-10 (10 is optimal health)
• Question 7 has 4 categories that can be scored at 0, 4, 7 or 10
• Question 8 is dependent on patient's current pain level and scored based on how long they can train
• Max score for asymptomatic individual is 100; theoretical minimum is 0

Area of Assessment: Functional Mobility, Life Participation, Pain

Body Part: Lower Extremity

ICF Domain: Body Function, Activity, Participation

Domain: ADL, Motor

Assessment Type: Patient Reported Outcomes

Length of Test: 05 Minutes or Less

Time to Administer:

3 minutes

Number of Items: 8 questions

Equipment Required: Writing utensil

Training Required: None

Type of training required: no training

Cost: Free

Actual Cost: Printing costs for form.

Age Range: Adult: 18-64 years

Administration Mode: Paper/Pencil

Diagnosis: Knee Dysfunction, Pain

Populations Tested:

Visentini et al (1998)

• Asymptomatic University students
• Sports medicine clinic patients with symptoms unrelated to knees
• Sports medicine clinic patients who presented with jumper's knee
• Elite basketball players who competed in the national league(current or past history of jumper's knee were not exclusion criteria)
• Patients before and after surgery for chronic jumper's knee.

Frohm et al (2004)

• Healthy students
• Members of Swedish male national basketball team (at-risk population)
• Non-surgically treated patients with clinically diagnosed patellar tendinopathy

Zwerver et al (2009)

• Healthy students
• Competitive volleyball players (at-risk population)
• Patients with patellar tendinopathy
• Patients who had surgery for patellar tendinopathy
• Patients with knee injuries other than patellar tendinopathy
• Patients with symptoms unrelated to their knees
• * Participants completed the Dutch VISA-P

Hernandez-Sanchez (2011)

• Healthy students
• Athletes who participated in sports such as volleyball, basketball, and handball (at-risk population for patellar tendinopathy)
• Athletes diagnosed with patellar tendinopathy who played for professional sports clubs in Spain
• Patients with knee injuries other than patellar tendinopathy

Wilgen et al (2011)

• Asymptomatic male and female volleyball players
• Athletes with symptomatic patellar tendinopathy who specifically had activity-related anterior knee pain and palpation tenderness
• * Participants completed the Dutch VISA-P

Hernandez-Sanchez et al (2012)

• Athletes with patellar tendinopathy from 10 sports physiotherapy clinics across Spain

Maffulli et al (2008)

• 25 male athletes with diagnosis of classic patellar tendinopathy between ages 18-32
• * Participants completed the Italian VISA-P

Standard Error of Measurement (SEM):

Visentini et al (1998)

• 90% MDC for test-retest
  • All subjects = 1.39
  • Only tendons with VISA <80 = 1.49
  • Inter-tester all subjects tested = 1.49
  • Inter-tester for only tendons with VISA <80 = 3.33
  • Stability = 3.94

Hernandez-Sanchez et al (2012)

• SEM = 4.0

Minimal Detectable Change (MDC):

Hernandez-Sanchez et al (2012)

• MDC using a 95% CI= 11.1

Minimally Clinically Important Difference (MCID):

Hernandez-Sanchez et al (2012)

• > 13 point on the VISA-P score or 15.4-27% of relative change achieved MCID
• Probability of clinical change 98% when threshold was achieved
• Probability of clinical change 45% when MCID not achieved

Cut-Off Scores:

Hernandez-Sanchez (2012)

• Cut-off score of ≥3 on the Global Rating of Change scale (GROC) to define MCID level

Normative Data:

Visentini et al (1998)

• The maximal VISA-P score for an asymptomatic, fully-performing individual is 100 points

Frohm et al (2004)

• Scores of these populations:
  • Patients had a mean score of 47.76 (SD=20.26)
  • Healthy Students had a mean score of 79.00 (SD=24.18)
  • Basketball players had a mean score of 83.06 (SD=12.60)

Wilgen et al (2011)

("Athletes without knee complaints score the maximal score of 100, whereas athletes with PT usually score 50-75")

• 54 athletes with patellar tendinopathy: mean 60 (SD=13.1)
• 48 athletes with patellar tendinopathy: mean 58 (SD=17.1)

Zwerver et al (2009)

	VISA-P Score
Healthy Students	95.3 (SD = 8.8)
At-risk population	88.6 (SD = 11.1)
Injury other than knee	76.6 (SD = 24.3)
Knee Injury	61.9 (SD = 24.1)
Patellar Tendinopathy	58.2 (SD = 18.9)
Surgery for patellar tendinopathy	56.0 (SD = 20.9)

Hernandez-Sanchez et al (2011)

• First VISA-P-Spanish (0-100)--at baseline
  • Healthy Population: Mean 95.4 (SD=2.5)
  • At Risk: Mean 90.0 (SD=9.7)
  • Patellar Tendinopathy: Mean 54.8 (SD=13.2)
  • Other Knee Injuries: Mean 56.4 (SD=11.3)
• Second VISA-P-Spanish (0-100)--1 week after baseline
  • Healthy Population: Mean 95.8 (SD=2.4)
  • At Risk: Mean 89.8 (SD=9.4)
  • Patellar Tendinopathy: Mean 56.3 (SD=12.9)
  • Other Knee Injuries: Mean 56.3 (SD=11.4)

Maffulli et al (2008)

• First mean VISA-P-I score = 44.3 (range of 33-61)
• Second mean VISA-P-I score taken 30 min later = 45.2 (range of 31-61)
• No significant difference between test-retest assessments

Test-retest Reliability:

Visentini et al (1998)

• Excellent test-retest reliability (r > 0.95)

Frohm et al (2004)

• Excellent test-retest reliability (ICC = 0.97)

Zwerver et al (2009)

• Adequate to excellent test-retest reliability (ICC = 0.74, p < 0.001)

Wilgen et al (2011)

• Adequate to excellent test-retest reliability (ICC = 0.74)

Hernandez-Sanchez et al (2011)

• Excellent test-retest reliability ICC = 0.994

Interrater/Intrarater Reliability:

Visentini et al (1998)

Interrater Reliability (same as Test-retest Reliability)

• Excellent interrater reliability (r > 0.95)

Internal Consistency:

Frohm et al (2004)

• 1st assessment:
  • Excellent internal consistency (Cronbach's alpha = 0.83)
• 2nd assessment
  • Excellent internal consistency (Cronbach's alpha = 0.82)

Zwerver et al (2009)

• 1st assessment
  • Adequate internal consistency (Cronbach's alpha = 0.73)
• 2nd assessment
  • Adequate internal consistency (Cronbach's alpha = 0.71)

Hernandez-Sanchez et al (2011)

• 1st assessment
  • Excellent internal consistency (Cronbach's alpha = 0.885)
• 2nd assessment
  • Excellent internal consistency (Cronbach's alpha = 0.880)

Maffulli et al (2008)

• Adequate internal consistency (Kappa = 0.78, range of 0.7 - 0.86 with p < 0.05)

Criterion Validity (Predictive/Concurrent):

Not Established

Construct Validity (Convergent/Discriminant):

Frohm et al (2004)

• Differences between scores of the patients, healthy students, and basketball players were statistically significant: p<0.001

Wilgen et al (2011)

• Significant difference between PPT results of "symptomatic group" (with scores less than 80) and participants classified as "normal group" (scores above 80)--symptomatic group's PPTs were lower: x² p< 0.001

Hernandez-Sanchez et al (2011)

• Differences between the healthy and the at-risk groups were statistically significant with respect to the participants with tendinopathy (37.9 points, P<.01) and other knee injuries (36.3 points, P<.01)
• However, no differences were found between scores of participants in the tendinopathy group and those in the other knee injury group (1.6 points, P>.05) or between the healthy and the at-risk groups (5.45 points, P>0.05)

Zwerver et al (2009)

• ANOVA revealed a significant difference between the six groups (F = 10.7, p < 0.001). See normative data for the six groups.

Content Validity:

Not Established

Face Validity:

Not Established

Floor/Ceiling Effects:

Hernandez-Sanchez et al (2011)

• Ceiling and floor effects were not observed in this study further supporting the validity of the VISA-P

Responsiveness:

Hernandez-Sanchez et al (2012)

• We combined anchor-based (MCS and ROC curve) and distribution-based approaches (SEM and MDC) to study responsiveness
• AUC represents responsiveness, AUC between 0.7 and 0.8 were considered acceptable discrimination. Values higher than 0.8 have excellent discrimination
• To interpret the VISA-P changes, alternative methods of studying responsiveness are required alongside further studies

Hernandez-Sanchez et al (2011)

• In athletes with tendinopathy, VISA-P (spanish) score changes were observed in those who were able to return to sports participation. The mean SD change in scores for this group was 15.23 +/- 13.01 points between the first and third applications of the questionnaire
• The effect size (less than 0.8) provides evidence that the VISA-P (spanish) can detect changes in symptom severity at 2 different time points in the clinical course of tendinopathy

Considerations:

Time, mental status, fatigue. The VISA-P is not a diagnostic test. The test is inappropriate for individuals who cannot perform functional tests due to other limitations.

 

Frohm et al (2004)

• The VISA-P score has not been validated for pathological knee conditions other than patellar tendinopathy
• The VISA-P score could be abbreviated to two or three items without losing significant clinical information

Zwerver et al (2009)

• A limitation of this study is that the test-retest reliability was investigated in asymptomatic students. One could argue that testing reliability in athletes with patellar tendinopathy would have been more appropriate

Hernandez-Sanchez et al (2012)

• The estimated MCID for the VISA-P is dependant on baseline scores and the interpretation of the relevant change on GROC
• The MCID values vary depending on intervention type therefore further studies are needed to assess whether these values differ after surgical treatment

Hernandez-Sanchez et al (2011)

• The sample in this study consisted primarily of male participants, which may limit the generalization for the results. Further research is necessary to better establish the responsiveness of the scale
• The VISA-P should not be considered a diagnostic tool, because there were no significant differences between the scores of athletes with tendinopathy and those of patients with other knee injuries

Maffulli et al (2008)

• The VISA-P-I was only validated for classic patellar tendinopathy as it is more common than tendinopathy of the main body of the patellar tendon
• The VISA-P-I was not administered to any patients scheduled for surgery

Bibliography:

Frohm A, Saartok T, Edman G, Renström P. Psychometric properties of a Swedish translation of the VISA-P outcome score for patellar tendinopathy. BMC Musculoskelet Disord. 2004;5:49.

Hernandez-Sanchez S, Hildalgo MD, Gomez A. Cross-cultural adaptation of VISA-P score for patellar tendinopathy in Spanish population. Journal of Orthopaedic and Sports Physical Therapy. 2011; 41(8):581-91.

Hernandez-Sanchez, S., Hidalgo, M., & Gomez, A. (2012). Responsiveness of the VISA-P scale for patellar tendinopathy in athletes. British Journal of Sports Medicine Br J Sports Med, 453-457.

Maffulli N, Longo UG, Testa V, Oliva F, Capasso G, Denaro V. VISA-P score for patellar tendinopathy in males: Adaptation to Italian. Disability and Rehabilitation. 2008;30(20-22):1621-1624.

Van wilgen P, Van der noord R, Zwerver J. Feasibility and reliability of pain pressure threshold measurements in patellar tendinopathy. J Sci Med Sport. 2011;14(6):477-81.

Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD. The VISA score: an index of severity of symptoms in patients with jumper's knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group. J Sci Med Sport. 1998;1(1):22-8.

Zwerver J, Kramer T, Van den akker-scheek I. Validity and reliability of the Dutch translation of the VISA-P questionnaire for patellar tendinopathy. BMC Musculoskelet Disord. 2009;10:102.

Year published: 1998

Instrument in PDF Format: Yes

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Victorian Institute of Sports Assessment - Achilles

Link to instrument: PDF Form

Acronym:

VISA-A

Purpose:

VISA-A serves as a disease-specific questionnaire for measurement of Achilles tendinopathy severity. The questionnaire is meant to be self-administered, uncomplicated, and relatively quick for both subjects and healthcare professionals.

Description:

• Self-reported questionnaire based instrument
• Provides an index of achilles tendinopathy
• Consists of eight questions that address the following domains:
  • pain, function in daily living, and sporting activity
• Scores range from 0 - 100, with 0 being the worst

Area of Assessment: Activities of Daily Living, Functional Mobility, Gait, Life Participation, Pain

Body Part: Lower Extremity

ICF Domain: Body Structure, Body Function, Activity, Participation, Environment

Domain: ADL

Assessment Type: Patient Reported Outcomes

Length of Test: 05 Minutes or Less

Time to Administer:

< 5 Minutes

Number of Items: 8 questions

Equipment Required: None

Training Required: None

Type of training required: no training

Cost: Free

Actual Cost: Free

Age Range: Adolescent: 13-17 years, Adult: 18-64 years

Administration Mode: Paper/Pencil

Diagnosis: Movement Disorders, Pain

Populations Tested:

Maffulli, et al (2008)

• 50 male athletes with unilateral tendinopathy of the main body of the Achilles (average age 26.4, range 18-49 years)
  • Sports participation of the athletes included soccer, track and field, volleyball, basketball, rugby, martial arts, and ballet

JM Robinson, et al (2001)
4 populations were tested:

• Group 1: 45 non-surgical patients in a primary care sports medicine clinic, with a diagnosis of Achilles tendinosis, paratendinitis, or partial rupture
• Group 2: 14 pre-surgical patients referred to a sports orthopaedist for tendon surgery, with a diagnosis of Achilles tendinosis, paratendinitis, or partial rupture
• Group 3: 63 university students ("young normally active people")
• Group 4: 24 active, non-injured members of a running club

Silbernagel, et al (2005)

• 15 healthy individuals, 20-40 years old
• 51 patients with achilles tendinopathy, 39-47 years old

Lohrer, et al (2009)

• All native German speakers, >18 y.o, unilateral involvement
• Excluded: complete ruptures, pregnant/nursing subjects, insertional Achilles tendinopathy, previous surgeries on involved LE, Haglund's disease, LE radicular symptoms
• Total n = 109, divided into 4 groups:
  • Group 1: 15 preoperative achilles tendinopathy patients
  • Group 2: 15 achilles tendinopathy patients conservatively treated
  • Group 3: 48 Frankfort University students with no tendinopathy
  • Group 4: 31 members of local running group without tendinopathy

Standard Error of Measurement (SEM):

Silbernagel, et al (2005):

• SEM = 7.96 (Calculated with available statistics)

Minimal Detectable Change (MDC):

Silbernagel, et al (2005):

• 18.5 (90% MDC)
• 22.1 (95% MDC)

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Not Established

Normative Data:

Maffulli, et al (2008)

• At first examination:
  • Mean = 51.8; SD = 18.2
• 30 minutes after examination:
  • Mean = 51.1; SD = 19

JM Robinson, et al (2001)

• Group 1, non-surgical patients
  • Mean = 64; SD = 17; 95% CI 59 to 69
• Group 2, pre-surgical patients
  • Mean = 44; SD = 28; 95% CI 28 to 60
• Group 3, university students
  • Mean =96; SD = 7; 95% CI 94 to 98
• Group 4, running club ○ Mean = 98; SD = 3; 95% CI 97 to 99

Silbernagel, et al (2005)

• Mean = 50
• SD = 24 (reliability group) and 23 (validity group)

Lohrer, et al (2009)

• Group 1, preoperative Achilles tendinopathy patients
  • Mean = 44.9; SD = 14.2; 95% CI
• Group 2, Achilles tendinopathy patients conservative treatment
  • Mean= 73.1; SD = 13.5; 95% CI
• Group 3, Frankfort University students with no tendinopathy
  • Mean= 98.0; SD= 7.1; 95% CI
• Group 4, members of local running group without tendinopathy
  • Mean= 99.2 ; SD= 2.0; 95% CI

Test-retest Reliability:

Maffulli, et al (2008)

• Questionnaire completed at first examination and 30 minutes after examination for test-retest evaluation
• Excellent test-retest reliability (Kappa = 0.80, p < 0.05)

JM Robinson, et al (2001)

• Group 1, non-surgical patients
  • Excellent test-retest reliability (r = 0.93)
  • Excellent short term (one week) reliability (r = 0.81)
• Group 4, running club
  • Excellent test-retest reliability (r = 0.98)
  • Excellent short term (one week) reliability (r = 0.98)

Silbernagel, et al (2005)

• Excellent test-retest reliability (r = 0.89)

Lohrer, et al (2009)

• Group 1, not established
• Group 2
  • Excellent test-retest reliability (Spearman's rho = 0.66, p < 0.05)
  • Excellent test-retest reliability (ICC = 0.87, p < 0.05)
• Group 3
  • Excellent to adequate test-retest reliability (Spearman's rho = 0.60, p < 0.05)
  • Excellent test-retest reliability (ICC = 0.97, p < 0.05)
• Group 4
  • Excellent test-retest reliability (Spearman's rho = 0.70, p < 0.05)
  • Adequate test-retest reliability (ICC = 0.60, p < 0.05)

Interrater/Intrarater Reliability:

JM Robinson, et al (2001)

• Group 1, non-surgical patients
  • Excellent Intrarater Reliability [3 trials] (r = 0.90)
  • Excellent Interrater Reliability (r = 0.90)
• Group 4, running club
  • Excellent Interrater Reliability (r = 0.97)

Internal Consistency:

Silbernagel, et al (2005)

• Adequate internal consistency (Cronbach's Alpha=0.77)

Lohrer, et al (2009)

• Adequate internal consistency (Cronbach's Alpha=0.74)

Criterion Validity (Predictive/Concurrent):

Not Established

Construct Validity (Convergent/Discriminant):

Maffulli, et al (2008)

• Construct validity of the VISA-A Italian version was tested according to the original article on the VISA-A English version (see Robinson, et al 2001)

JM Robinson, et al (2001)

• Group 1 completed the VISA-A and 2 other generic tendon grading systems at one visit:
  • Percy and Conochie's grade of severity: Adequate construct validity (r = 0.58; p<0.01)
  • Curwin and Stanish: Adequate construct validity (r = -0.57; p<0.001)
• VISA-A scale was tested in both Group 2 who are generally considered to have the most significant degree of disease and the two control populations (groups 3 and 4)
  • Patients with Achilles tendinopathy (both groups 1 and 2) had significantly lower (p<0.001) scores than those of the control groups (groups 3 and 4)
  • Patients in group 1 also had a significantly higher mean VISA-A score than those in group 2 (p = 0.02)

Silbernagel, et al (2005)

• Construct validity of the Swedish version of VISA-A (VISA-A-S) was tested according to the original article on the VISA-A English version (see Robinson, et al 2001)
• Results from the 51 patients who completed the VISA-A-S were compared with the results from a tendon grading system by Stanish et al. (1984)
• Results from patients with Achilles tendinopathy were compared to results from healthy individuals in the VISA-A-S

Lohrer, et al  (2009)

• VISA-A-G compared to  Percy and Conchoie tendon classification
  • Excellent construct validity (Spearman's rho=.95, p<.05)
• VISA-A-G compared  to classification system  for the Effect of pain on Athletic performance
  • Excellent construct validity (Spearman's rho = -.95  p<.05)

Content Validity:

Maffulli, et al (2008)

"To establish good face validity and content validity, the translation and cultural adaptation of the VISA-A questionnaire into Italian was performed in several steps. The English version was translated into Italian by a bilingual orthopaedic surgeon. The back translation of the Italian version into English was performed by another bilingual orthopaedic surgeon. The authors of this article compared the original version with the back translation."

 

JM Robinson, et al (2001)

First, a focus group consisting of the principal questionnaire developer, a primary care sports medicine doctor, and two physiotherapists reviewed the items generated. Then, a group of 15 clinicians (including 8 physiotherapists, 4 primary care doctors, 1 orthopaedic surgeon, and 1 rehabilitation specialist) were asked to identify questions they felt were important in assessing the severity of Achilles tendon disorders. They were then shown the VISA-A to evaluate the questionnaire and asked if there were any questions they would add, delete, or modify. 14 had no questions to add, and none wanted any questions deleted or modified.

 

Silbernagel, et al (2005)

The English version of VISA-A was translated by three people (all of whom worked in the medical field and had English as their second language) into the Swedish version. Next, those three translations were "synthesized into one Swedish version" by a panel of four physical therapists who specialized in musculoskeletal disorders. Finally, a pre-final version of the Swedish VISA-A (VISA-A-S) was pilot tested on five patients and five healthy subjects.

 

Lohrer, et al (2009)

To establish content validity of the VISA-A-G based on the VISA-A questionnaire there were six steps followed: translation involving three translators and an orthopedic surgeon, synthesis of the translations, back translation into English, committee review with health and language professionals, pre-testing, final review.

Face Validity:

Maffulli, et al (2008)

"To establish good face validity and content validity, the translation and cultural adaptation of the VISA-A questionnaire into Italian was performed in several steps. The English version was translated into Italian by a bilingual orthopaedic surgeon. The back translation of the Italian version into English was performed by another bilingual orthopaedic surgeon. The authors of this article compared the original version with the back translation."

Floor/Ceiling Effects:

Not Established

Responsiveness:

Not Established

Considerations:

Pros: Being that there is a need for a quantitative index of pain and function in patients with Achilles tendinopathy, the VISA-A questionnaire scale can be easily administered in clinical practice & quantitative research to gain insight into the severity of Achilles Tendinopathy.

Cons: The test is not designed to be diagnostic. Further studies needed to determine whether the VISA-A score actually predicts prognosis.

Bibliography:

Maffulli N, Longo UG, Testa V, Oliva F, Capasso G, Denaro V. Italian translation of the VISA-A score for tendinopathy of the main body of the Achilles tendon. Disability and Rehabilitation. 2008; 30(20-22):1635.

Robinson JM, Cook JL, Purdam C, et al. The VISA-A questionnaire : a valid and reliable index of the clinical severity of Achilles tendinopathy. 2001:335-341.

Silbernagel KG, Thomee R, Karlsson J. Cross-cultural adaptation of the VISA-A questionnaire, an index of clinical severity for patients with Achilles tendinopathy, with reliability, validity, and structure evaluations. BMC Musculoskelet Disord. 2005; 6:12

Lohrer H, Nauck T. Cross-cultural adaptation and validation of the VISA-A questionnaire for German-speaking Achilles tendinopathy patients. 2009;9:1-9. doi:10.1186/1471-2474-10-134.

Year published: 2001

Instrument in PDF Format: Yes

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The prebiotic inulin as a functional food – a review

The newborn digestive tract is rapidly colonized right after birth. The type of feeding could significantly influence this colonization process. Infant formulas like inulin try to mimic the bifidogenic effects of human milk by addition of prebiotics. Moreover, studies in the recent past have evidenced important effects of inulin during early infant life. The present review article will highlight recent updates about the use of inulin in the pediatric clinical setting.

L'articolo The prebiotic inulin as a functional food – a review sembra essere il primo su European Review.

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Phenotypic variability and diffuse arterial lesions in a family with Loeys-Dietz syndrome type 4

Abstract

Syndromic thoracic aortic aneurysm and dissection (TAAD) can suggest Marfan, vascular Ehlers-Danlos or Loeys-Dietz (LDS) syndromes. Several of the TGFβ-pathway related genes predispose to different types of LDS. Heterozygous loss-of-function variations in TGFβ2 have been shown to be responsible for a novel form of syndromic TAAD associated with an impairment of the mitral valve and cerebrovascular disease called Loeys-Dietz syndrome type 4 (LDS4).

We report the clinical characterization of a LDS4 French family with sudden deaths and diffuse vascular lesions, caused by a frameshift mutation in TGFβ2 gene: c.[995del] ; p.(Leu332TrpfsTer27). Clinical characteristics include aneurysm of aortic sinus, skeletal and cutaneous features compatible with a syndromic form of TAAD (joint hypermobility, scoliosis, easy bruises), intracranial aneurysms and rare mitral valve involvement. Iliac aneurysms, systemic medium caliber arteries dissections, and mild developmental delay were present in the family, and have not been described in LDS4. Phenotypic variability was also an important finding, including absence of clinical vascular events at advanced age in one case.

Our data expand the phenotype of LDS4: we confirm that TGFβ2 mutations are responsible for true LDS syndrome with non-specific features of connective tissue disorders and diffuse vascular lesions. Adapted vascular follow-up and prevention has to be proposed for these patients.

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Iron status in chronic kidney disease patients

2016-07-21T04-47-06Z
Source: International Journal of Research in Medical Sciences
Rumi Deori, Bedanta Bhuyan.
Background: In developing countries, chronic kidney disease (CKD) associated with anaemia is one of the major public health problems. With the progression of the disease, development of haematological abnormalities including iron deficiency increases. Renal anaemia may further increase the morbidity in these patients. Therefore, earlier detection and correction of anaemia may be helpful in preventing the progression of the diseases and its other adverse outcomes. Methods: The present study was designed to observe the iron status in diagnosed CKD patients (pre-dialysis). For this purpose, 50 adult diagnosed CKD subjects who were not on any haematinics were randomly selected from the Departments of Medicine and Nephrology in a tertiary care hospital in Assam, India. 50 age and sex matched healthy controls were also included. Haemoglobin concentration, serum iron, TIBC, transferrin saturation (TSAT) and serum creatinine were estimated by standard laboratory techniques. Statistical data were analyzed by using SPSS 21. Results: All the CKD subjects were anaemic with haemoglobin concentration below 11g/dl and 48% of them showed moderate degree of anaemia. Their serum creatinine level were >3mg/dl. The primary aetiologies of CKD were diabetes (44%) and hypertension (36%). Serum creatinine and total iron binding capacity (TIBC) were significantly (P


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Stress response to laryngoscopy and ease of intubation:comparison between macintosh and (levering) mccoys type laryngoscope

2016-07-21T04-47-06Z
Source: International Journal of Research in Medical Sciences
Kamlesh Gotiwale, Smita Lele, Sushma Setiya.
Background: Laryngoscopy and intubation is known to cause exaggerated hemodynamic response and increased intracranial pressure. The aim of the study was to compare the hemodynamic response following intubation with mccoys and macintosh blades, to evaluate intubating conditions and to evaluate glottic view during laryngoscopy. Methods: It is a prospective, comparative stody. 100 patients were taken as sample size. Patients undergoing various surgery of age group 20-50 years of both sexes with ASA 1 and ASA 2 were chosen. For odd number patients mccoy laryngoscope blade was used whereas for even number patients macintosh laryngoscope blade for orotracheal intubation. After induction and neuromuscular blockade preintubation pulse and blood pressure was recorded. Orotracheal intubation was attempted at this stage using laryngoscope blade assigned to respective group. Pulse and blood pressure was recorded while the blade was being inserted in vallecula. Similar pulse and blood pressure was taken at 1 minute, 3 minute and 10 minute after laryngoscopy. Ease of intubation was noted by knowing total time required for intubation , need for burp maneuver and occurrence of any complication. Results: Both groups were comparable in terms of age, sex, ASA grade, mallampatti grade. At 3 minutes pulse, systolic and diastolic blood pressures were significantly high with macintosh group as compared to mccoys group. Regarding ease of intubation, it was found that time required for laryngoscopy was significantly longer with the use of macintosh blade as compared to mccoys blade. 34% of patients with macintosh blade required burp manuver as compared to none with mccoys blade. There was no complication with mccoys blade. Conclusions: Less hemodynamic changes was associated with use of mccoys blade. Intubating conditions were better with mccoys blade group as compared with macintosh group.


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Functional outcome of open reduction and internal fixation of clavicle fracture

2016-07-21T04-47-06Z
Source: International Journal of Research in Medical Sciences
Manju G. Pillai.
Background: Clavicle fracture is one of common bony injury; which is more common in young active individual. It has been traditionally treated with non-operative method. This present study was undertaken to study the role of the surgical management in the fresh middle third clavicle fracture. Methods: 30 adult patients (21 male and 9 female) of average age of 32 years presented with fresh middle third clavicle fracture and treated surgically with open reduction and internal fixation with plate and screws and followed. Study conducted between November 2011 to November 2012. Results: In 27 patients fracture were united at end of 12 weeks, in 2 patients fracture were united at end of 24 weeks and 1 patient went for non-union. One patient had superficial infection. None had deep infection. One patient had plate loosening at 4week but fracture was united at the end of 24 weeks. 2 patients had persistent pain which is controlled with occasional analgesic but not effecting ordinary work. One patient had gross restriction of shoulder movement. Functional outcome assessed according to near shoulder scoring system. 24 patients had excellent result, 4 patients had satisfactory result, 1 patient had unsatisfactory result and 1patients had failure. Conclusions: The study showed rigid fixation with plate and screw for fresh middle third clavicle fracture especially displaced and comminuted give immediate pain relief and prevent the development of shoulder stiffness &non-union and give good functional outcome.


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Drug utilisation in medical intensive care unit: a retrospective analysis from a tertiary care teaching hospital

2016-07-21T02-54-44Z
Source: International Journal of Basic & Clinical Pharmacology
Arathy R, Jiyo Chacko, Santosh Pillai, Anish Bhanu, Ruby Raphael, Jalajakumari M.
Background: The World Health Organisation has defined drug utilization study as the marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences. The objective was to evaluate drug utilization pattern in medical intensive care unit (MICU) in a tertiary care teaching hospital. Methods: A retrospective observational study was conducted in MICU for adult patients admitted from October to December 2013. Data collected was analyzed for demographics, indication, duration of stay, World Health Organisation (WHO) prescribing indicators including anatomical therapeutic chemical classification and defined daily dose (DDD). Results: A six hundred encounters from 63 male and 44 female patients with a mean age of 60.88±16.87 were studied. Average duration of stay was 5.61±3.88 days. The common indications for admission were dyspnoea 20 (18.69%), upper gastrointestinal bleed 16 (14.95%), cerebrovascular accident 14 (13.08%) and sepsis 13 (12.15%). Total number of drugs prescribed was 246. Total drug encounters were 7695. Average number of drugs per encounter was 12.83. Percentage of drugs prescribed by generic name was 38.21%, 44.7% and 40.65% of the drugs were prescribed from National and WHO essential medicine list respectively. Among the drugs prescribed 65.44%, 32.93% and 17.48% were oral, injectable and fixed dose combination preparations respectively. Percentage of encounters resulting in prescription of an antibiotic and an injection were 59% and 85.83% respectively. The most commonly prescribed drugs were pantoprazole (100%), human regular insulin (52.83%), piperacillin+tazobactam (45%) and ceftriaxone (38%). Their DDD/100 bed days were found to be 83.79, 12.78, 12.50, and 17.81 respectively. Conclusions: Overall the prescribing pattern seems to be rational but may be further strengthened by increasing generic drug prescription, judicious use of pantoprazole and periodic longitudinal surveillance studies.


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Comparison of cardiovascular safety of escitalopram and sertraline based on electrocardiographic alterations: a pharmacovigilance study

2016-07-21T02-54-44Z
Source: International Journal of Basic & Clinical Pharmacology
Balwant K. Choure, Girish T. Raparti, Jayprakash B. Ramanand, Jyoti B. Tapase, Praveenkumar T. Patil, Nitin N. Puram, Rama R. Bhosale.
Background: Escitalopram and sertraline are the most commonly prescribed antidepressant drugs, belongs to SSRI class. Both the drugs are long been considered as free from cardiovascular adverse effects. Recently number of studies reported potential association between these drugs and pronounced cardiovascular adverse effects. ECG changes like prolongation of QT interval are frequently used as markers for the increased risk of a fatal cardiac arrhythmia. The potential cardiovascular adverse reaction profile of both these drugs is little studied in Indian rural population. Methods: This was a 6 weeks prospective open label observational study carried out in a drug naive 209 patients receiving either escitalopram (n=106) or sertraline (n=103). ECG parameters like heart rate, RR interval, PQ/PR interval, QRS duration and QTc interval, were obtained directly from the digital machine recordings, additionally the QT interval was measured manually with the help of caliper. Statistical analysis was done by using Statistical software SPSS 17.0. Results: Out of 209 drugs naive patients, 12 from escitalopram group and 10 patients from Sertraline were lost to follow-up. Hence ECG recordings of the remaining 94 patients under escitalopram group, 93 patients under sertraline group were used for study analysis. The ECG alterations caused by the escitalopram were compared with that caused by sertraline. It was observed that the differences between the ECG alterations caused by either of escitalopram or sertraline were statistically non-significant. Conclusions: It was concluded, at therapeutic doses neither of the drugs have the potential risk of drug induced arrhythmias, throughout the study.


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Prospective study of blood lipid parameters in patients with type-2 diabetes mellitus and its correlation with the glycated hemoglobin

2016-07-21T02-49-55Z
Source: International Journal of Advances in Medicine
Kumar Prafull Chandra, Dhirendra Kumar Shukla.
Background: Patients with type 2 diabetes mellitus (T2DM) are accompanied (many a time ignored) by dyslipidemia; such patients are the easy targets for the development of cardiovascular disease (CVD). An early treatment to normalize abnormal lipid levels can reduce the CVD and related mortality. The aim was to measure blood lipid parameters in patients with T2DM and their relation with the glycemic control. Methods: Prospective study including 124 T2DM patients in the Department of Medicine, Mayo Institute of Medical sciences, Barabanki, Uttar Pradesh, India between January 2016 to June 2016. Brief history, examination and investigations including fasting plasma glucose (FPG), post prandial blood glucose (PPG), glycated hemoglobin (HbA1c), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C) were done. Correlation was obtained for lipid parameters between patients having HbA1c


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Mysterious Myofibroblast: A Cell with Diverse Origin and Multiple Functions

2016-07-21T02-41-17Z
Source: Journal of Interdisciplinary Histopathology
Sowmya Rao, Jagadish Rao, Jyothi B.M, Varsha V.K.
Myofibroblasts are one of the most controversial cells in recent times. Ever since its first discovery, numerous discussions have been done on its illusive nature and functions. They are commonly considered as smooth muscle like fibroblasts. Their presence and distribution in normal and pathological conditions are still not clear since they are difficult to identify with the routine histological techniques. Recent studies have shown their ubiquitous presence in the body tissues hence suggesting their important role in both physiological functioning and pathological conditions. This review discusses briefly the cell in terms of its definition, possible precursors; mechanism involved in its modulation, most importantly how to differentiate it from its nearest counterparts such as fibroblasts and smooth muscle cells and finally its fundamental role in physiology and pathology.


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Effects of oral carbohydrate with amino acid solution on the metabolic status of patients in the preoperative period: a randomized, prospective clinical trial

Abstract

Objective

Enhanced recovery after surgery is increasingly desired nowadays, and preoperative nutrient intake may be beneficial for this purpose. In this study, we investigated whether the intake of preoperative carbohydrate with amino acid (ONS) solution can improve starvation status and lipid catabolism before the induction of anesthesia.

Methods

This randomized, prospective clinical trial included 24 patients who were divided into two groups before surgery under general anesthesia: a control group, comprising patients who fasted after their last meal the day before surgery (permitted to drink only water), and an ONS group, comprising patients who consumed ONS solution 2 h before surgery. Biochemical markers, the respiratory quotient, and psychosomatic scores were assessed at the initiation of anesthesia.

Results

Compared with the control group, the ONS group showed significantly lower serum free fatty acid levels [control group: 828 (729, 1004) µEq/L, ONS group: 479 (408, 610) µEq/L, P = 0.0002, median (25th, 75th percentile)] and total ketone bodies [control group: 119 (68, 440) µmol/L, ONS group: 40 [27, 64] µmol/L, P = 0.037]. In addition, analysis using the Visual Analog Scale showed higher preoperative scores for anxiety, hunger, and thirst for the control group, with no differences in any other measure of subjective well-being between groups.

Conclusions

The results of this study suggest that preoperative ONS intake improves lipid catabolism and starvation status before the induction of anesthesia. Furthermore, it can provide better preoperative mental health compared with complete fasting.

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The Roles of System and Organizational Leadership in System-Wide Evidence-Based Intervention Sustainment: A Mixed-Method Study

Abstract

If evidence-based interventions (EBIs) are not sustained, investments are wasted and public health impact is limited. Leadership has been suggested as a key determinant of implementation and sustainment; however, little empirical work has examined this factor. This mixed-methods study framed using the Exploration, Preparation, Implementation, Sustainment (EPIS) conceptual framework examines leadership in both the outer service system context and inner organizational context in eleven system-wide implementations of the same EBI across two U.S. states and 87 counties. Quantitative data at the outer context (i.e., system) and inner context (i.e., team) levels demonstrated that leadership predicted future sustainment and differentiated between sites with full, partial, or no sustainment. In the outer context positive sustainment leadership was characterized as establishing a project's mission and vision, early and continued planning for sustainment, realistic project plans, and having alternative strategies for project survival. Inner context frontline transformational leadership predicted sustainment while passive-avoidant leadership predicted non-sustainment. Qualitative results found that sustainment was associated with outer context leadership characterized by engagement in ongoing supportive EBI championing, marketing to stakeholders; persevering in these activities; taking action to institutionalize the EBI with funding, contracting, and system improvement plans; and fostering ongoing collaboration between stakeholders at state and county, and community stakeholder levels. For frontline leadership the most important activities included championing the EBI and providing practical support for service providers. There was both convergence and expansion that identified unique contributions of the quantitative and qualitative methods. Greater attention to leadership in both the outer system and inner organizational contexts is warranted to enhance EBI implementation and sustainment.

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Simple risk factors to predict urgent endoscopy in nonvariceal upper gastrointestinal bleeding pre-endoscopically

Medicine

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Efficacy and safety of endoscopic balloon dilation for upper gastrointestinal strictures of Crohn's disease

Digestive Diseases and Sciences

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Association of visceral fat area with abdominal skeletal muscle distribution in overweight Japanese adults

Obesity Research & Clinical Practice

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HCV eradication does not impact gut dysbiosis or systemic inflammation in cirrhotic patients

Alimentary Pharmacology and Therapeutics

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Sleeve gastrectomy and anti-reflux procedures

Surgical Endoscopy

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A phase II study of the HSP90 inhibitor AUY922 in chemotherapy refractory advanced pancreatic cancer

Cancer Chemotherapy and Pharmacology

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Association of model for end-stage liver disease score with mortality in emergency general surgery patients

JAMA Surgery

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Efficacy and safety of linagliptin in type 2 diabetes patients with self-reported hepatic disorders: A retrospective pooled analysis of 17 randomized, double-blind, placebo-controlled clinical trials

Journal of Diabetes and its Complications

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Laparoscopic paraesophageal hernia repair is safe in elderly patients

Surgical Endoscopy

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Pancreatitis and cholecystitis in primary acute symptomatic Epstein-Barr virus infection - Systematic review of the literature

Journal of Clinical Virology

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Body fat mass distribution and interrupter resistance, fractional exhaled nitric oxide and asthma at school-age

The Journal of Allergy and Clinical Immunology

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Hepatitis due to reactivation of HBV in endemic areas among patients with hepatitis C treated with direct-acting antivirals agents

Clinical Gastroenterology and Hepatology

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The risk of coronary artery disease and cerebrovascular disease in patients with hepatitis C: A systematic review and meta-analysis

International Journal of Cardiology

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Prevalence and clinical features of opioid-induced constipation in the general population: A French study of 15,000 individuals

United European Gastroenterology Journal

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Early neurodevelopmental outcomes of infants with intestinal failure

Early Human Development

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Humoral and cellular responses to casein in food protein-induced enterocolitis to cows milk

The Journal of Allergy and Clinical Immunology

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Critical role of fatty acid metabolism in ILC2-mediated barrier protection during malnutrition and helminth infection

Journal of Experimental Medicine

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Trajectories and predictors of state and trait anxiety in patients receiving chemotherapy for breast and colorectal cancer: Results from a longitudinal study

European Journal of Oncology Nursing

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Evaluating the surgeons perception of difficulties of two techniques to perform STARR for obstructed defecation syndrome: A multicenter randomized trial

Surgical Innovation

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Environmental factors in the etiology of type 1 diabetes, celiac disease, and narcolepsy

Pediatric Diabetes

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What is the BMI threshold for open ventral hernia repair?

Abstract

Background

Overweight and obese patients are often asked to lose weight prior to ventral hernia repair (VHR). Improved outcomes are the reasons behind this strategy. Data regarding weight loss targets are scant, and it is not known at what body mass index (BMI) threshold postoperative complications increase. This study aimed to determine the threshold to allow proper patient counseling.

Methods

All patients who underwent open VHR at our institution between 2002 and 2015 captured in the NSQIP database were included. The primary outcome was defined as any (≥1) of 18 captured postoperative complications. Patients were divided into five groups based on BMI: group 1 (<25 kg/m²); 2 (25–29.99 kg/m²); 3 (30–34.99 kg/m²); 4 (35–39.99 kg/m²); and 5 (≥40 kg/m²). Multivariable, adjusted logistic regression was performed to evaluate the association between BMI categories and postoperative complications.

Results

Sixty seven of 922 patients (7.3 %) had at least one postoperative complication following VHR. The adjusted odds of complications in group 5 was 2.89 times greater compared to group 1 (OR 2.89; 95 % CI = 1.22–6.84), while there was no significant differences in odds of postoperative complications for groups 2, 3, or 4 compared to group 1. BMI category was also significantly associated with undergoing recurrent VHR, with 28.7 % of patients in group 5 having a recurrent repair compared to 14 % in patients in group 1 (p = 0.03).

Conclusions

After VHR, complications are most likely to occur in patients with BMI ≥ 40 kg/m². This subset of patients also had a significantly higher risk of undergoing surgery for a recurrent hernia, suggesting that this group of patients is likely to experience adverse outcomes after VHR and should be counseled to consider bariatric surgery prior to attempts at VHR. VHR at lower BMIs appears appropriate, and delaying therapy to achieve preoperative weight loss will likely offer no advantage.

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Sleeve gastrectomy and anti-reflux procedures

Abstract

Background

Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem.

Methods

We performed an extensive literature review examining the different methods of anti-reflux procedures that are available both before and after a sleeve gastrectomy.

Results

We reviewed several different types of anti-reflux procedures, including those that supplement the lower esophageal sphincter anatomy, such as magnetic sphincter augmentation and radiofrequency ablation procedures. Re-operation was also discussed as a possible treatment of reflux in sleeve gastrectomy, especially if the original sleeve becomes dilated or if a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion is deemed necessary. Sleeve gastrectomy with concomitant anti-reflux procedure was also reviewed, including the anti-reflux gastroplasty, hiatal hernia repair, and limited fundoplication.

Conclusion

A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.

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Differences in Neuropeptide Y Secretion Between Intracerebral Hemorrhage and Aneurysmal Subarachnoid Hemorrhage.

Background: Neuropeptide Y (NPY) is one of the most potent endogenous vasoconstrictors, and its contribution to the multifactorial cascade of cerebral vasospasm due to nontraumatic subarachnoid hemorrhage (SAH) is not yet fully understood. This experimental study compared the hemorrhage-specific course of NPY secretion into cerebrospinal fluid (CSF) and into plasma between 2 groups: patients with SAH and patients with basal ganglia hemorrhage (BGH) or cerebellar hemorrhage (CH) over the first 10 days after hemorrhage. Materials and Methods: Seventy-nine patients were prospectively included: SAH patients (n=66) (historic population) and intracerebral hemorrhage patients (n=13). All patients received an external ventricular drain within 24 hours of the onset of bleeding. CSF and plasma were drawn daily from day 1 to day 10. The levels of NPY were determined by means of competitive enzyme immunoassay. The CSF samples of 29 patients (historic population) who had undergone spinal anesthesia due to orthopedic surgery served as the control group. Results: NPY levels in CSF were significantly higher in the 2 hemorrhage groups than in the control group. However, the 2 hemorrhage groups showed significant differences in NPY levels in CSF (SAH mean, 0.842 ng/mL vs. BGH/CH mean, 0.250 ng/mL; P

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Early Effects of Enteral Urea on Intracranial Pressure in Patients With Acute Brain Injury and Hyponatremia.

Background: Hyponatremia occurs commonly after acute brain injury and is often due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Urea administration is 1 therapeutic option. Methods: In our Department, enteral urea is routinely administered to patients with acute brain injury who develop hyponatremia consistent with SIADH and do not respond to an initial sodium load. We reviewed the records of all patients over a 2-year period, who had acute brain injury, received enteral urea because of hyponatremia, and had intracranial pressure (ICP) monitoring using an intraventricular catheter. We recorded demographic, biological, and clinical data; mean ICP values during the 6 hours before and after the first dose of urea were also recorded. Results: We included 40 patients (23 subarachnoid hemorrhage, 8 traumatic brain injury, 6 intracranial hemorrhage, 2 postbrain tumor surgery, and 1 ischemic stroke); median age was 54 years (IQRs, 44 to 63 y) and median admission APACHE II score was 19 (13 to 19); 6-month survival was 63%. Median baseline sodium was 133 mEq/L (131 to 135 mEq/L). No patients received additional therapy to decrease ICP during the 6 hours following urea initiation. After the first urea dose (15 g), ICP decreased from 14 (13 to 18 mm Hg) to 11 mm Hg (8 to 13 mm Hg) (P=15 mm Hg (n=22) than in the others (-8 mm Hg [-14 to -3 mm Hg] vs. -2 mm Hg [-3 to 0 mm Hg], P=0.001). Conclusions: Enteral urea administration in patients with acute brain injury and hyponatremia is associated with a significant reduction in ICP independent of changes in sodium levels. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

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Association Between Perioperative Hyperglycemia and Survival in Patients With Glioblastoma.

Background: Several studies have examined the association between hyperglycemia in the first 10 to 12 weeks following surgery and postoperative survival in glioblastoma multiforme (GBM) patients. We hypothesize that episodes of hyperglycemia before, during and/or following surgery for primary GBM are independent predictors of disease progression and mortality. Materials and Methods: A total of 162 adult patients were included in the analysis. All patients received adjuvant temozolamide. The progression free survival (PFS) and overall survival (OS) rates at 1 and 5 years were analyzed using different glycemic cutoff values. Multivariate analyses were conducted to test the association between preoperative, intraoperative and postoperative hyperglycemia with PFS and OS. Results: Kaplan-Meier curves revealed a trend toward increased PFS and OS with lower glucose concentrations with the exception of glucose concentrations >180 mg/dL in the intraoperative/postoperative day 0 time period. Univariate analysis of blood glucose levels did not demonstrate a statistically significant effect on PFS in any time period, however hyperglycemia was statistically significant for OS in the preoperative time period. Although, multivariate analysis showed no statistically significant association with hyperglycemia on PFS, a statistically significant decrease in OS was seen for plasma glucose concentrations >112 mg/dL (P=0.01) and >180 mg/dL (P=0.01) in the preoperative period. There was a decreasing effect on OS with blood glucose concentrations greater than the median in multiple time periods (P=0.02). Conclusions: Preoperative hyperglycemia is associated with poor OS after GBM surgery. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

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Elevated Intraoperative Serum Lactate During Craniotomy Is Associated With New Neurological Deficit and Longer Length of Stay.

Background: Hundreds of thousands of craniotomies are performed annually in the United States. During craniotomy, elevated serum lactate is a concerning and not infrequent occurrence. Elevated intraoperative serum lactate may occur as a result of global hypoperfusion or localized intracerebral ischemia from surgical retraction or inadequate blood supply. The distinction between systemic and hypoperfusion confined to the brain is important because the treatment differs. For example, fluid resuscitation may be indicated in the former but not the latter. Methods: To address whether elevated intraoperative serum lactate is associated with hypoperfusion confined to the brain or systemic hypoperfusion, we performed a retrospective cohort study of elective adult (age above 18) craniotomy cases. These included 436 surgeries which were performed at our institution under general anesthesia between May 2011 and August 2013. Results: Elevated intraoperative serum lactate in craniotomy patients is associated with new neurological deficits (odds ratio, 2.11) and longer length of stay (20% less likely to be discharged on a given day). Elevated lactate was not associated with systemic complications such as myocardial infarction or mortality. Conclusions: Our findings highlight the importance of conducting a definitive prospective study analyzing the clinical impact and mechanism behind hyperlactatemia in the craniotomy population. Knowledge of the serum lactate level may be of value in guiding intraoperative anesthetic and surgical decision-making. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

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Intraoperative Hyperthermia: A Harbinger of Hypothalamic Injury.

No abstract available

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Paediatric Patient With Acromegalic Features and Mallampati Class Zero Airway: A Rare Association.

No abstract available

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Progressive impairment of cerebellar mGluR signalling and its therapeutic potential for cerebellar ataxia in spinocerebellar ataxia type 1 model mice

Abstract

Spinocerebellar ataxia type 1 (SCA1) is a progressive neurodegenerative disease that presents with cerebellar ataxia and motor learning defects. Previous studies have indicated that the pathology of SCA1, as well as other ataxic diseases, is related to signalling pathways mediated by the metabotropic glutamate receptor type 1 (mGluR1), which is indispensable for proper motor coordination and learning. However, the functional contribution of mGluR signalling to SCA1 pathology is unclear. In the present study, we show that SCA1 model mice develop a functional impairment of mGluR signalling which mediates slow synaptic responses, dendritic Ca²⁺ signals and short- and long-term synaptic plasticity at parallel fibre (PF)-Purkinje cell (PC) synapses in a progressive manner from the early disease stage (5 postnatal weeks) prior to PC death. Notably, impairment of mGluR-mediated dendritic Ca²⁺ signals linearly correlated with reduction of PC capacitance (cell surface area) in the disease progression. Enhancement of mGluR signalling by baclofen, a clinically available GABA_B receptor agonist, led to an improvement of motor performance in SCA1 mice and the improvement lasted ∼1 week after a single application of baclofen. Moreover, the restoration of motor performance in baclofen-treated SCA1 mice matched the functional recovery of mGluR-mediated slow synaptic currents and mGluR-dependent short- and long-term synaptic plasticity. These results suggest that impairment of synaptic mGluR cascades is one of the important contributing factors to cerebellar ataxia in early and middle stages of SCA1 pathology, and that modulation of mGluR signalling by baclofen or other clinical interventions may be therapeutic targets to treat SCA1.

This article is protected by copyright. All rights reserved

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Biochemical and microbiological evaluation of neonatal seizures

2016-07-21T00-31-17Z
Source: International Journal of Contemporary Pediatrics
Bhaskar Reddy A., Ram Mohan G..
Background: Neonatal seizure is a common neurological problem in the neonatal period. Neonatal seizures have always been a topic of interest because of their universal occurrence. A varied number of conditions are capable of causing seizures in the neonatal period. The highest incidence of neonatal seizure occurs during first 24 hours of life. The aim was to study biochemical and microbiological factors related with neonatal seizures. Methods: The present study was conducted in the neonatology unit, department of pediatrics, SVS hospital and medical college. The study was done to assess the biochemical changes and microbilogical organisms implicated in neonatal seizures. Results: In the present study, out of 1080 babies admitted to neonatology unit during the study period 100 developed seizures giving a hospital incidence of 9.25%. Etilogy in majority of cases of neonatal seizures was hypoxic ischemic encephalopathy (43%). Biochemical changes accounted for 17% of neonatal seizures. Meningitis accounted for 11% of neonatal seizures. The most common organism implicated in neonatal seizures was Escherichia coli (35%). Conclusions: Biochemical abnormalities may significantly contribute to seizure activity and possibly correction of these abnormalities may play a significant role in seizure control. A biochemical work up is necessary for all cases of neonatal seizures. Appropriate treatment with antibiotics is essential. Examination of cerebrospinal fluid is essential work up in cases of neonatal seizures.


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Dilation of Pediatric Eosinophilic Esophagitis - Adverse Events and Short Term Outcomes.

Objectives: Although several studies report the experience with adult eosinophilic esophagitis (EoE) related stricture, outcomes for pediatric patients with EoE associated fibrostenosis and stricture is even more limited. To address this, we aim to identify the adverse event rate and short-term outcomes of the largest reported cohort of children with EoE to undergo esophageal dilation for management of symptomatic esophageal narrowing. Methods: A retrospective assessment of all children, 18 years and younger, who underwent esophageal dilation at an academic children's hospital over a 5-year period was conducted. Clinical, endoscopic, histologic and outcomes of dilation were extracted from the medical record. Adverse events (AE) were captured within a standardized endoscopic adverse event database. Grade 2 AE (requiring unanticipated medical intervention) were termed significant. Dilation related events were compared between patients with EoE, without EoE and those undergoing standard upper endoscopy. Results: Of 451 total dilations, 68 dilations were performed in 40 EoE patients (mean age 13.8 years, SD 3.3 yrs [4.6-18.9 yrs]). Forty-three percent (17/40) had repeat dilation during the study period. Dilation related grade 2 AE rates in EoE and in non-EoE patients were 2.9% and 3.1%, respectively (p > 0.5). Chest pain (any grade AE) was reported in 14.7% of EoE dilations. No significant associations were found between post procedural pain and dilation method, final dilator size, medical therapy or esophageal eosinophilia. No perforations or significant hemorrhage were reported. Conclusions: We conclude dilation can be performed safely in children with EoE. In the appropriate clinical setting, cautious dilation may be considered in the management of fibrostenotic EoE. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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